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Sample records for european expert panel

  1. Principles of practice from the European expert panel on the contemporary treatment of schizophrenia.

    PubMed

    Altamura, A C; Bobes, J; Owens, D C; Gerlach, J; Hellewell, J S; Kasper, S; Naber, D; Tarrier, N; Os, J V

    2000-01-01

    Providing optimal treatment for people with schizophrenia is a difficult long-term problem for clinicians and healthcare providers. Over the years a variety of approaches to treatment have evolved and, until now, there have been no widely accepted standards for care. To determine the principles underpinning the best practice for schizophrenia treatment, an Expert Panel of European psychiatrists and psychologists has worked to distil current theory, collective practical experiences and published literature into 17 basic Principles of Practice . These are not intended to duplicate or replace local treatment policies or guidelines. Instead, they describe best practice in diagnosis, patient assessment and long-term treatment of schizophrenia as it exists at the beginning of the 21st century and is likely to exist in the near future. The Principles of Practice broadly fall into four main categories: (1) assessment, diagnosis and care provision; (2) treatment in day-to-day practice; (3) building a positive therapeutic alliance; and (4) a long-term clinical commitment. Running through all the Principles are several common threads - the fundamental importance of the therapeutic alliance between the clinician and the patient, the need to plan both for treatment efficacy and avoidance of side-effects and the importance of long-term treatment planning. It is intended that psychiatrists and other healthcare professionals can use the Principles as a benchmark for optimum patient management, and as a tool when negotiating the future of local and national schizophrenia management services. Furthermore, the Principles of Practice represent a first step in the development of a new patient-centred philosophy for the care of people with schizophrenia. PMID:24927301

  2. 21 CFR 516.141 - Qualified expert panels.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... of a qualified expert panel. Establishing a qualified expert panel is the first step in the process... expert panel member may not be an FDA employee. (4) A qualified expert panel must have at least three... panel meets the selection criteria listed in paragraphs (b)(1) through (b)(5) of this section. (3)...

  3. Boosted protease inhibitor monotherapy in HIV-infected adults: outputs from a pan-European expert panel meeting

    PubMed Central

    2013-01-01

    While the introduction of combination highly active antiretroviral therapy (HAART) regimens represents an important advance in the management of human immunodeficiency virus (HIV)-infected patients, tolerability can be an issue and the use of several different agents may produce problems. The switch of combination HAART to ritonavir-boosted protease inhibitor (PI) monotherapy may offer the opportunity to maintain antiviral efficacy while reducing treatment complexity and the risks of toxicity. Current European AIDS Clinical Society (EACS) guidelines recognise ritonavir-boosted PI monotherapy with twice-daily lopinavir/ritonavir or once-daily darunavir/ritonavir as a possible option in patients who have intolerance to nucleoside reverse transcriptase inhibitors, or for treatment simplification. Clinical trials data for PI boosted monotherapy are encouraging, showing substantial efficacy in the majority of patients; however, further data are required before this approach can be recommended as a routine treatment. Available data indicate that the most suitable candidates for the use of boosted PI monotherapy are long-term virologically suppressed patients who have demonstrated good adherence to antiretroviral therapy, who do not have chronic hepatitis B, have no history of treatment failure on PIs and are able to tolerate low-dose ritonavir. PMID:23347595

  4. A Virtual Panel of Expert Researchers.

    ERIC Educational Resources Information Center

    Hodges, Donald A.

    2000-01-01

    Presents the observations of a panel of research experts who have conducted research on music and the brain. States that the participants are Andrea Halpern, Larry Parsons, Ralph Spintge, and Sandra Trehub. After an introduction of each person, the participants characterized their principal findings. (CMK)

  5. Gender Equity Expert Panel: Exemplary & Promising Gender Equity Programs, 2000.

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    The U.S. Department of Education developed the Gender Equity Expert Panel to identify promising and exemplary programs that promote gender equity in and through education. This panel of experts reviewed self-nominated programs to determine whether they met four criteria: evidence of success/effectiveness in promoting gender equity; quality of the…

  6. Environmental factors and puberty timing: Expert panel research needs

    EPA Science Inventory

    An expert panel reviewed the literature on endocrine disrupting chemicals (EDCs), body size and puberty. The panel concluded that available experimental animal and human data support a possible role of EDCs and body size in relation to alterations in pubertal onset and progressio...

  7. A social choice approach to expert consensus panels.

    PubMed

    Gabel, Matthew J; Shipan, Charles R

    2004-05-01

    This study uses recent theoretical work about group decision-making to assess the quality of decision-making by expert consensus panels. We specifically examine (1) when individual members of panels will divulge their private judgments about the decision to the panel, and (2) when the group judgment is superior to the judgment of individual panelists and will lead to better treatment for patients. We conclude that to maximize the chance of an accurate decision, panels should be made as large as possible, adopt the smallest supermajority rule, and attract members with the highest individual competencies. Furthermore, interdependence among panelists and the goal of reaching consensus can reduce the efficacy of these panels. PMID:15120470

  8. TWRS vadose zone contamination issue expert panel report

    SciTech Connect

    Shafer, D.S.

    1997-05-01

    When members were first canvassed for participation in the Vadose Zone Expert Panel the stated purpose for convening the Panel was to review a controversial draft report, the SX Tank Farm Report. This report was produced by a DOE Grand Junction Project Office (GJPO) contractor, RUST Geotech, now MACTEC-ERS, for the DOE Richland Office (DOERL). Three meetings were planned for June, July and August, 1995 to review the draft report and to complete a Panel report by mid-September. The Expert Panel has found its efforts confounded by various non-technical issues. The Expert Panel has chosen to address some of the non-technical issues in this Preface rather than to dilute the technical discussion that follows in the body of this independent expert panel status report (Panel Report). Rather than performing a straightforward manuscript review, the Panel was asked to resolve conflicting interpretations of gamma-ray logging measurements performed in vadose zone boreholes (drywells) surrounding the high-level radioactive wastes of the SX tank farm. There are numerous and complex technical issues that must be evaluated before the vertical and radial extent of contaminant migration at the SX tank farm can be accurately assessed. When the Panel first met in early June, 1996, it quickly became apparent that the scientific and technical issues were obscured by policy and institutional affairs which have polarized discussion among various segments of the Hanford organization. This situation reflects the kinds of institutional problems described separately in reports by the National Research Council of the National Academy of Sciences (NAS/NRC), The Hanford Tanks Environmental Impacts and Policy Choices and BmTiers to Science: Technical Management of the Department of Energy Environmental Remediation Program. The Vadose Zone Characterization Program, appears to be caught between conflicting pressures and organizational mandates, some imposed from outside DOE-RL and some self

  9. Charge to the Tetrachloroethylene (Perchloroethylene) Neurotoxicity Expert Panel

    EPA Science Inventory

    Today NCEA is posting the charge which will be discussed at the expert panel meeting on neurotoxicity issues associated with exposure to tetrachlroroethylene. This charge is to be the main agenda topic for the meeting. The time and place of the meeting will be announced in a fu...

  10. 21 CFR 516.141 - Qualified expert panels.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS NEW ANIMAL DRUGS FOR MINOR USE AND MINOR SPECIES Index of Legally Marketed Unapproved New Animal Drugs for Minor Species § 516.141 Qualified expert panels. (a)...

  11. Cyanide poisoning by fire smoke inhalation: a European expert consensus.

    PubMed

    Anseeuw, Kurt; Delvau, Nicolas; Burillo-Putze, Guillermo; De Iaco, Fabio; Geldner, Götz; Holmström, Peter; Lambert, Yves; Sabbe, Marc

    2013-02-01

    Smoke inhalation is a common cause of cyanide poisoning during fires, resulting in injury and even death. In many cases of smoke inhalation, cyanide has increasingly been recognized as a significant toxicant. The diagnosis of cyanide poisoning remains very difficult, and failure to recognize it may result in inadequate or inappropriate treatment. Findings suggesting cyanide toxicity include the following: (a) a history of enclosed-space fire; (b) any alteration in the level of consciousness; (c) any cardiovascular changes (particularly inexplicable hypotension); and (d) elevated plasma lactate. The feasibility and safety of empiric treatment with hydroxocobalamin for fire smoke victims have been reported in the literature. On the basis of a literature review and a panel discussion, a group of European experts has proposed emergency management protocols for cyanide toxicity in fire smoke victims. PMID:22828651

  12. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts.

    PubMed

    Deprez, P H; Bergman, J J; Meisner, S; Ponchon, T; Repici, A; Dinis-Ribeiro, M; Haringsma, J

    2010-10-01

    Endoscopic submucosal dissection (ESD) is the gold standard technique for performing en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Experience in Europe, however, is still limited and ESD is only performed in a few selected centers, with low volumes of cases, no description of training programs, and few published reports. In 2008, a panel of experts gathered in Rotterdam to discuss indications, training, and the wider use of ESD. The panel of experts and participants reached a consensus on five general statements: 1) ESD aims at treating mucosal cancer; 2) treatment aims for R0 resection; 3) ESD should meet quality standards; 4) ESD should be performed following national or European Society of Gastrointestinal Endoscopy (ESGE) guidelines or under institutional review board approval; and 5) ESD cases should be registered. Due to the high level of expertise needed to perform the technique safely, ESD should be performed in a step-up approach, starting with lesions presenting in the rectum or in the distal stomach, then colon, proximal stomach, and finally in the esophagus. Registration is advised either at the local site or at a national or ESGE level, and should include information on indication (Paris classification of lesion, location, and histological results prior to treatment), technique used (e. g. type of knife), results (en bloc and R0 resection), complications, and follow-up. The panel also agreed on minimal institutional requirements: good quality imaging, experienced histopathologist following the Japanese criteria (2-mm sections, micrometric invasion, vessel and lymphatic infiltration, etc), and dedicated endoscopic follow-up. Moreover, minimum training requirements were also defined: knowledge in indications and instruments, exposure to experts (currently all in Japan), hands-on experience in a model of isolated pig stomach and in live pigs, and management of complications. The experts did not reach a

  13. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

    SciTech Connect

    Baldini, Elizabeth H.; Wang, Dian; Haas, Rick L.M.; Catton, Charles N.; Indelicato, Daniel J.; Kirsch, David G.; Roberge, David; Salerno, Kilian; Deville, Curtiland; Guadagnolo, B. Ashleigh; O'Sullivan, Brian; Petersen, Ivy A.; Le Pechoux, Cecile; Abrams, Ross A.; DeLaney, Thomas F.

    2015-07-01

    Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy

  14. NTP-CERHR EXPERT PANEL REPORT ON THE REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF ACRYLAMIDE

    EPA Science Inventory

    The National Toxicology Program Center for the Evaluation of Risks to Human Reproduction (NTP-CERHR) convened an expert panel in May 2004 to evaluate acrylamide. The report of the expert panel, prepared in accordance with CERHR Guidelines, provides a detailed summary of all publi...

  15. Expert Consensus Panel Guidelines on Geriatric Assessment in Oncology

    PubMed Central

    O'Donovan, A.; Mohile, S.G.; Leech, M.

    2015-01-01

    Introduction Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. Methods A four round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations in order to gain consensus on a given topic Results Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cutoff for assessment represented a higher degree of disagreement. Discussion The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients. PMID:25757457

  16. Content validation using an expert panel: assessment process for assistive technology adopted by farmers with disabilities.

    PubMed

    Mathew, S N; Field, W E; French, B F

    2011-07-01

    This article reports the use of an expert panel to perform content validation of an experimental assessment process for the safety of assistive technology (AT) adopted by farmers with disabilities. The validation process was conducted by a panel of six experts experienced in the subject matter, i.e., design, use, and assessment of AT for farmers with disabilities. The exercise included an evaluation session and two focus group sessions. The evaluation session consisted of using the assessment process under consideration by the panel to evaluate a set of nine ATs fabricated by a farmer on his farm site. The expert panel also participated in the focus group sessions conducted immediately before and after the evaluation session. The resulting data were analyzed using discursive analysis, and the results were incorporated into the final assessment process. The method and the results are presented with recommendations for the use of expert panels in research projects and validation of assessment tools. PMID:21919319

  17. Ranibizumab in retinal vein occlusion: treatment recommendations by an expert panel

    PubMed Central

    Gerding, Heinrich; Monés, Jordi; Tadayoni, Ramin; Boscia, Francesco; Pearce, Ian; Priglinger, Siegfried

    2015-01-01

    Retinal vein occlusion (RVO) is a common cause of retinal vascular disease, resulting in potentially irreversible loss of vision despite the existence of several therapeutic options. The humanised monoclonal antibody fragment ranibizumab binds to and inhibits vascular endothelial growth factor, a key driver of macular oedema in RVO. In 2010, ranibizumab was approved in the USA for the treatment of macular oedema in RVO and, in 2011, ranibizumab was approved in the European Union for the treatment of visual impairment caused by macular oedema secondary to RVO in branch and central RVO. Ranibizumab provides an additional therapeutic option for this complex disease: an option that was not fully considered during the preparation of current international guidelines. An expert panel was convened to critically evaluate the evidence for treatment with ranibizumab in patients with visual impairment caused by macular oedema secondary to RVO and to develop treatment recommendations, with the aim of assisting physicians to optimise patient treatment. PMID:25075121

  18. Fifth Single-Shell Tank Integrity Project Expert Panel Meeting August 28-29, 2014

    SciTech Connect

    Martin, Todd M.; Gunter, Jason R.; Boomer, Kayle D.

    2015-01-07

    On August 28th and 29th, 2014 the Single-Shell Tank Integrity Project (SSTIP) Expert Panel (Panel) convened in Richland, Washington. This was the Panel’s first meeting since 2011 and, as a result, was focused primarily on updating the Panel on progress in response to the past recommendations (Single-Shell Tank Integrity Expert Panel Report, RPP-RPT-45921, Rev 0, May 2010). This letter documents the Panel’s discussions and feedback on Phase I activities and results.

  19. Expert Panel Reaffirms Daily Aspirin's Use Against Heart Disease, Colon Cancer

    MedlinePlus

    ... news/fullstory_158240.html Expert Panel Reaffirms Daily Aspirin's Use Against Heart Disease, Colon Cancer Guideline applies ... of heart disease should take a low-dose aspirin each day to reduce their risk of both ...

  20. DELPHI expert panel evaluation of Hanford high level waste tank failure modes and release quantities

    SciTech Connect

    Dunford, G.L.; Han, F.C.

    1996-09-30

    The Failure Modes and Release Quantities of the Hanford High Level Waste Tanks due to postulated accident loads were established by a DELPHI Expert Panel consisting of both on-site and off-site experts in the field of Structure and Release. The Report presents the evaluation process, accident loads, tank structural failure conclusion reached by the panel during the two-day meeting.

  1. Tamarisk beetle (Diorhabda spp.) in the Colorado River basin: Synthesis of an expert panel forum

    USGS Publications Warehouse

    Bloodworth, Benjamin R.; Shafroth, Patrick B.; Sher, Anna A.; Manners, Rebecca B.; Bean, Daniel W.; Johnson, Matthew J.; Hinojosa-Huerta, Osvel

    2016-01-01

    In January 2015, the Tamarisk Coalition convened a panel of experts to discuss and present information on probable ecological trajectories in the face of widespread beetle presence and to consider opportunities for restoration and management of riparian systems in the Colorado River Basin (CRB). An in-depth description of the panel discussion follows. 

  2. EXPERT PANEL OVERSIGHT COMMITTEE ASSESSMENT OF FY2008 CORROSION AND STRESS CORROSION CRACKING SIMULANT TESTING PROGRAM

    SciTech Connect

    BOOMER KD

    2009-01-08

    The Expert Panel Oversight Committee (EPOC) has been overseeing the implementation of selected parts of Recommendation III of the final report, Expert Panel workshop for Hanford Site Double-Shell Tank Waste Chemistry Optimization, RPP-RPT-22126. Recommendation III provided four specific requirements necessary for Panel approval of a proposal to revise the chemistry control limits for the Double-Shell Tanks (DSTs). One of the more significant requirements was successful performance of an accelerated stress corrosion cracking (SCC) experimental program. This testing program has evaluated the optimization of the chemistry controls to prevent corrosion in the interstitial liquid and supernatant regions of the DSTs.

  3. Ethical evaluation of research proposals by ethics panels advising the European Commission.

    PubMed

    Kolar, Roman

    2004-06-01

    Ethical principles with regard to animal experimentation are referred to in European Union (EU) legislation and other official documents. Therefore, applications for funding of research under the EU's research programme may undergo an ethical review that is carried out by so-called ethics panels, consisting of experts chosen by the European Commission. The work of these panels differs substantially from that of other ethical committees, as they exist on the institutional, local, regional or national level. Their main purpose is not to decide whether a proposed research can be regarded legal, and therefore should be endorsed or licensed; instead, it is to help the Commission in prioritising its funding. The panels may examine other ethical aspects than those of animal experimentation or animal welfare alone, such as the use of human volunteers. This is reflected by the composition of the panels. Their decisions are normally based on consensus. Even though these decisions may refer to EU legislation, the criteria applied are not restricted to those provided by this legislation. Nevertheless, the various aspects of the Commission's ethical evaluation system (e.g. formal and practical basic conditions, information content of applications, type of decisions taken, lacking of any quality control) offers opportunities for improvement. PMID:23581113

  4. Treating Pain in Addicted Patients: Recommendations from an Expert Panel

    PubMed Central

    Cheatle, Martin; Wunsch, Martha; Skoufalos, Alexis; Reddy, Yeshwant

    2014-01-01

    Abstract Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches. (Population Health Management 2014;17:79–89) PMID:24138341

  5. NTP-CERHR EXPERT PANEL REPORT ON REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF METHYLPHENIDATE.

    EPA Science Inventory

    A manuscript describes the results of an expert panel meeting of the NTP Center for the Evaluation of Risks to Human Reproduction (CERHR). The purpose CERHR is to provide timely, unbiased, scientifically sound evaluations of human and experimental evidence for adverse effects on...

  6. NTP-CERHR EXPERT PANEL REPORT ON THE REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF AMPHETAMINE AND METHAMPHETAMINE.

    EPA Science Inventory

    A manuscript describes the results of an expert panel meeting of the NTP Center for the Evaluation of Risks to Human Reproduction (CERHR). The purpose CERHR is to provide timely, unbiased, scientifically sound evaluations of human and experimental evidence for adverse effects ...

  7. Curriculum Reform in 3D: A Panel of Experts Discuss the New HPE Curriculum in Australia

    ERIC Educational Resources Information Center

    Hickey, Chris; Kirk, David; Macdonald, Doune; Penney, Dawn

    2014-01-01

    This paper was developed at the request of the Organising Committee for the 27th Australian Council for Health, Physical Education and Recreation International Conference, in Melbourne, 2013. Its genesis was as a feature forum, wherein a panel of curriculum experts were bought together to discuss the emergence of the Australian Health and Physical…

  8. Drugs foresight 2020: a Delphi expert panel study

    PubMed Central

    2014-01-01

    Background Historically substance misuse has been relatively common in western countries, but comparatively few Finns report drug use. The Drugs 2020 study aimed at foreseeing changes in the drug situation in Finland by the year 2020. Methods The Delphi method was used, utilizing drug experts of the EU national network in Finland. Results Marked growth was foreseen in drug use, especially in synthetic designer drugs and misuse of medicinal drugs. Significant increase was also expected in growing cannabis at home. However, the control of drug market was expected to shift more into the hands of organized crime. No consensus was reached on how drug prices will develop in the time period. Drug use is likely to remain punishable although the use and possession of cannabis may be treated less severely. It seems likely that health and social services resources will be directed towards medicinal treatment. Conclusions Foresight can be utilized in preparing for the future; desirable developments can be fostered, and measures can be taken to curb probable but undesirable lines of development. Based on the results of this study, the experts’ view is that it is highly likely that the Finnish society will have to prepare for an increase in the demand for drug-related care, both in terms of content of the care and financing the services. Also, the forecasted increase in the role of legal prescription medicine used as intoxicants will call for efforts not only in changing prescription practices but in border and police control measures, as well. Parallel developments have been foreseen in the UK and Sweden, and it is likely that similar trends will actualize also in other western countries. PMID:24885142

  9. QT Interval Screening in Methadone Maintenance Treatment: Report of a SAMHSA Expert Panel

    PubMed Central

    Martin, Judith A.; Campbell, Anthony; Killip, Thomas; Kotz, Margaret; Krantz, Mori J.; Kreek, Mary Jeanne; McCarroll, Brian A.; Mehta, Davendra; Payte, J. Thomas; Stimmel, Barry; Taylor, Trusandra; Wilford, Bonnie B.

    2014-01-01

    In an effort to enhance patient safety in Opioid Treatment Programs (OTPs), the Substance Abuse and Mental Health Services Administration (SAMHSA) convened a multi-disciplinary Expert Panel on the Cardiac Effects of Methadone. Panel members reviewed the literature, regulatory actions, professional guidances, and OTPs’ experiences regarding adverse cardiac events associated with methadone. The Panel concluded that, to the extent possible, every OTP should have a universal Cardiac Risk Management Plan (incorporating clinical assessment, ECG assessment, risk stratification, and prevention of drug interactions) for all patients, and should strongly consider patient-specific risk minimization strategies (such as careful patient monitoring, obtaining ECGs as indicated by a particular patient’s risk profile, and adjusting the methadone dose as needed) for patients with identified risk factors for adverse cardiac events. The Panel also suggested specific modifications to informed consent documents, patient education, staff education, and methadone protocols. PMID:22026519

  10. An expert panel report of a proposed scientific model demonstrating the effectiveness of antibacterial handwash products.

    PubMed

    Boyce, John M; Dupont, Herbert L; Massaro, Joseph; Sack, David; Schaffner, Donald W

    2012-10-01

    In 2005, a US Food and Drug Administration Nonprescription Drug Advisory Committee (NDAC) review of consumer antiseptic handwash product studies concluded that the data regarding existing products failed to demonstrate any association between specific log reductions of bacteria achieved by antiseptic handwashing and reduction of infection. The NDAC recommended that consumer antibacterial handwashing products should demonstrate a reduction in infection compared with non-antibacterial handwash products. In response to the NDAC review, a consumer product industry-sponsored expert panel meeting was held in October 2007 to review new methods for assessing the efficacy of antibacterial handwashes. The expert panel reviewed a newly proposed model for linking the effectiveness of antibacterial handwashing to infection reduction and made recommendations for conducting future studies designed to demonstrate the efficacy of antibacterial handwash formulations. The panel concluded that using the surrogate infection model to demonstrate efficacy has a sound scientific basis, that the use of Shigella flexneri as a test organism coupled with a modified hand contamination procedure is supported by published data, and that the model represents a realistic test for the efficacy of consumer antibacterial handwash products. This article summarizes the expert panel's deliberations, conclusions, and recommendations. PMID:22300895

  11. Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results from expert panels

    PubMed Central

    Tran, Diem; Hall, Linda McGillis; Davis, Aileen; Landry, Michel D; Burnett, Dawn; Berg, Katherine; Jaglal, Susan

    2008-01-01

    Background Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However, health human resource (HHR) strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1) to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2) to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts. Methods A review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on Recruitment and Retention and the other on Education were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions. Results A total of 34 strategies were identified by the Recruitment and Retention and Education expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the Quality of Worklife and Work Environment theme, another seven in Financial Incentives and Marketing, two in Workload and Skill Mix, thirteen in Professional Development and five in Education and Training. Conclusion Based on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing Quality of Worklife and Work Environment, Financial Incentives and Marketing and Professional Development. PMID:19068134

  12. Expert Groups in the Building of European Public Policy

    ERIC Educational Resources Information Center

    Robert, Cecile

    2012-01-01

    When it comes to building European public action, expertise is ubiquitous and polymorphic. This article intends to study the ways expertise is being used in the European Commission and the logics underlying its use. The massive use of expertise also has consequences for the practices and identities of actors with whom European institutions…

  13. Training Future Physicians about Weapons of Mass Destruction: Report of the Expert Panel on Bioterrorism Education for Medical Students.

    ERIC Educational Resources Information Center

    Association of American Medical Colleges, Washington, DC.

    The Association of American Medical Colleges (AAMC) convened a multidisciplinary group of experts to share their insights about the learning objectives and educational experiences that they would recommend for the training of future physicians about bioterrorism. The expert panel broadened the scope of their discussion beyond bioterrorism to…

  14. The Expert System Programme of the European Space Agency

    NASA Astrophysics Data System (ADS)

    Lafay, J. F.; Allard, F.

    1992-08-01

    ESA's Expert System Demonstration (ESD) program is discussed in terms of its goals, structure, three-phase approach, and initial results. ESD is intended to demonstrate the benefits of AI and knowledge-based systems for in-orbit infrastructures by developing a strategic technology to contribute to ESA missions. Three phases were defined for: (1) program definition and review of existing work; (2) demonstration of applications prototypes; and (3) the development of operational systems from successful prototypes. Applications of 16 proposed expert-system candidates are grouped into payload-engineering and crew/operations categories. The candidates are to be evaluated in terms of their potential contribution to strategic goals such as improving scientific return and automating operator functions to eliminate human error.

  15. Invasive candidiasis in intensive care unit; consensus statement from an Iranian panel of experts, July 2013

    PubMed Central

    Ahmadi, Arezoo; Ardehali, Seyed Hossein; Beigmohammadi, Mohammad Taghi; Hajiabdolbaghi, Mahboubeh; Hashemian, Seyed Mohammad Reza; Kouchek, Mehran; Majidpour, Ali; Mokhtari, Majid; Moghaddam, Omid Moradi; Najafi, Atabak; Nejat, Reza; Niakan, Mohammad; Lotfi, Amir Hossein; Amirsavadkouhi, Ali; Shirazian, Farzad; Tabarsi, Payam; Taher, Mahshid Talebi; Torabi-Nami, Mohammad

    2014-01-01

    Invasive candidiasis (IC) is associated with high mortality in intensive care unit (ICU) patients. Timely diagnosis of this potentially fatal condition remains a challenge; on the other hand, the criteria for initiating empirical antifungal therapy in critically ill patients are not well defined in different patient population and ICU settings. Alongside the international guidelines, reaching regional and local consensus on diagnosis and management of IC in ICU setting is essential. This report summarizes our present status of IC management in ICU, considered by a group of Iranian experts in the fields of intensive care and infectious diseases. A round table of 17 experts was held to review the available data and discuss the optimal treatment strategies for IC in critical care setting. Comparative published data on the management of IC were analytically reviewed and the commonly asked questions about the management of IC in ICU were isolated. These questions were interactively discussed by the panel and audience responses were taken to consolidate point-to-point agreement with the panel arriving at consensus in many instances. The responses indicated that patients’ risk stratification, clinical discretion, fungal diagnostic techniques and the empirical therapy for IC are likely to save more patients. Treatment options were recommended to be based on the disease severity, prior azole exposure, and the presence of suspected azole-resistant Candida species. This report was reviewed, edited and discussed by all participants to include further evidence-based insights. The panel expects such endorsed recommendations to be soon formulated for implementation across the country. PMID:25057376

  16. Management of adverse events associated with idelalisib treatment: expert panel opinion

    PubMed Central

    Coutré, Steven E.; Barrientos, Jacqueline C.; Brown, Jennifer R.; de Vos, Sven; Furman, Richard R.; Keating, Michael J.; Li, Daniel; O’Brien, Susan M.; Pagel, John M.; Poleski, Martin H.; Sharman, Jeff P.; Yao, Nai-Shun; Zelenetz, Andrew D.

    2015-01-01

    Idelalisib is a first-in-class selective, oral, phosphatidylinositol 3-kinase delta (PI3Kδ) inhibitor approved for the treatment of several types of blood cancer. Idelalisib has demonstrated significant efficacy and a tolerable safety profile in clinical trials. However, the US prescribing information contains a black box warning for fatal and/or severe diarrhea or colitis, hepatotoxicity, pneumonitis and intestinal perforation. An expert panel was convened to review the pathology of these treatment-emergent adverse events (TEAEs) to propose key management tools for patients receiving idelalisib therapy. This article provides an overview of idelalisib TEAEs reported in clinical trials, and a summary of the panel's recommendations for identification and management of idelalisib treatment-emergent diarrhea or colitis as well as a discussion of transaminitis and pneumonitis. For idelalisib-related diarrhea or colitis (including unresolved grade 2 and grade ≥ 3), after exclusion of infectious causes, the panel recommends individualized treatment with budesonide or oral or intravenous steroid therapy. PMID:25726955

  17. Use of Expert Panels to Define the Reference Standard in Diagnostic Research: A Systematic Review of Published Methods and Reporting

    PubMed Central

    Bertens, Loes C. M.; Broekhuizen, Berna D. L.; Naaktgeboren, Christiana A.; Rutten, Frans H.; Hoes, Arno W.; van Mourik, Yvonne; Moons, Karel G. M.; Reitsma, Johannes B.

    2013-01-01

    Background In diagnostic studies, a single and error-free test that can be used as the reference (gold) standard often does not exist. One solution is the use of panel diagnosis, i.e., a group of experts who assess the results from multiple tests to reach a final diagnosis in each patient. Although panel diagnosis, also known as consensus or expert diagnosis, is frequently used as the reference standard, guidance on preferred methodology is lacking. The aim of this study is to provide an overview of methods used in panel diagnoses and to provide initial guidance on the use and reporting of panel diagnosis as reference standard. Methods and Findings PubMed was systematically searched for diagnostic studies applying a panel diagnosis as reference standard published up to May 31, 2012. We included diagnostic studies in which the final diagnosis was made by two or more persons based on results from multiple tests. General study characteristics and details of panel methodology were extracted. Eighty-one studies were included, of which most reported on psychiatry (37%) and cardiovascular (21%) diseases. Data extraction was hampered by incomplete reporting; one or more pieces of critical information about panel reference standard methodology was missing in 83% of studies. In most studies (75%), the panel consisted of three or fewer members. Panel members were blinded to the results of the index test results in 31% of studies. Reproducibility of the decision process was assessed in 17 (21%) studies. Reported details on panel constitution, information for diagnosis and methods of decision making varied considerably between studies. Conclusions Methods of panel diagnosis varied substantially across studies and many aspects of the procedure were either unclear or not reported. On the basis of our review, we identified areas for improvement and developed a checklist and flow chart for initial guidance for researchers conducting and reporting of studies involving panel

  18. Health Economics of Dengue: A Systematic Literature Review and Expert Panel's Assessment

    PubMed Central

    Beatty, Mark E.; Beutels, Philippe; Meltzer, Martin I.; Shepard, Donald S.; Hombach, Joachim; Hutubessy, Raymond; Dessis, Damien; Coudeville, Laurent; Dervaux, Benoit; Wichmann, Ole; Margolis, Harold S.; Kuritsky, Joel N.

    2011-01-01

    Dengue vaccines are currently in development and policymakers need appropriate economic studies to determine their potential financial and public health impact. We searched five databases (PubMed, EMBASE, LILAC, EconLit, and WHOLIS) to identify health economics studies of dengue. Forty-three manuscripts were identified that provided primary data: 32 report economic burden of dengue and nine are comparative economic analyses assessing various interventions. The remaining two were a willingness-to-pay study and a policymaker survey. An expert panel reviewed the existing dengue economic literature and recommended future research to fill information gaps. Although dengue is an important vector-borne disease, the economic literature is relatively sparse and results have often been conflicting because of use of inconsistent assumptions. Health economic research specific to dengue is urgently needed to ensure informed decision making on the various options for controlling and preventing this disease. PMID:21363989

  19. Health economics of dengue: a systematic literature review and expert panel's assessment.

    PubMed

    Beatty, Mark E; Beutels, Philippe; Meltzer, Martin I; Shepard, Donald S; Hombach, Joachim; Hutubessy, Raymond; Dessis, Damien; Coudeville, Laurent; Dervaux, Benoit; Wichmann, Ole; Margolis, Harold S; Kuritsky, Joel N

    2011-03-01

    Dengue vaccines are currently in development and policymakers need appropriate economic studies to determine their potential financial and public health impact. We searched five databases (PubMed, EMBASE, LILAC, EconLit, and WHOLIS) to identify health economics studies of dengue. Forty-three manuscripts were identified that provided primary data: 32 report economic burden of dengue and nine are comparative economic analyses assessing various interventions. The remaining two were a willingness-to-pay study and a policymaker survey. An expert panel reviewed the existing dengue economic literature and recommended future research to fill information gaps. Although dengue is an important vector-borne disease, the economic literature is relatively sparse and results have often been conflicting because of use of inconsistent assumptions. Health economic research specific to dengue is urgently needed to ensure informed decision making on the various options for controlling and preventing this disease. PMID:21363989

  20. Assuring the quality of health care for older persons. An expert panel's priorities.

    PubMed

    Fink, A; Siu, A L; Brook, R H; Park, R E; Solomon, D H

    1987-10-01

    To select topics for quality assurance activities focusing on older patients, we convened a 14-member panel of physicians and experts in quality assurance. In two rounds of ratings, panelists rated 42 medical conditions (eg, pneumonia) in terms of their effects on patient outcomes, the availability of beneficial interventions, and the health benefits from improving current quality. They rated 27 health services (eg, adult day-care) on similar dimensions. The feasibility of doing quality assurance work on each condition and service also was rated. Using the ratings, the conditions selected for quality assurance work were congestive heart failure, hypertension, pneumonia, breast cancer, adverse effects of drugs, incontinence, and depression. Health care services selected were hospital discharge planning, acute inpatient care for the frail elderly, long-term-care facilities (intermediate-care facilities and skilled nursing facilities), home health care services, and case management. PMID:3656600

  1. Advancing research on endocrine disrupting chemicals in breast cancer: Expert panel recommendations.

    PubMed

    Teitelbaum, Susan L; Belpoggi, Fiorella; Reinlib, Les

    2015-07-01

    Breast cancer incidence continues to increase in the US and Europe, a reflection of the growing influence of environment factors that interact with personal genetics. The US Environmental Protection Agency estimates that there are approximately 10,000 endocrine disrupting chemicals among the common daily exposures that could affect the risk of disease. The daunting tasks of identifying, characterizing, and elucidating the mechanisms of endocrine disrupting chemicals in breast cancer need to be addressed to produce a comprehensive model that will facilitate preventive strategies and public policy. An expert panel met to describe and bring attention to needs linking common environmental exposures, critical windows of exposure, and optimal times of assessment in investigating breast cancer risk. The group included investigators with extensive experience in the use of rodent models and in leading population studies and produced a set of recommendations for effective approaches to gaining insights into the environmental origins of breast cancer across the lifespan. PMID:25549947

  2. External Collection Devices as an Alternative to the Indwelling Urinary Catheter: Evidence-Based Review and Expert Clinical Panel Deliberations.

    PubMed

    Gray, Mikel; Skinner, Claudia; Kaler, Wendy

    2016-01-01

    Multiple evidence-based guidelines have suggested clinicians consider external collection devices (ECD) as alternatives to indwelling catheters. Nevertheless, there is a dearth of evidence-based resources concerning their use. An expert consensus panel was convened to review the current state of the evidence, indications for ECDs as an alternative to an indwelling urinary catheter, identify knowledge gaps, and areas for future research. This article presents the results of the expert consensus panel meeting and a systematic literature review regarding ECD use in the clinical setting. PMID:26974963

  3. Clinical practice guidelines for the treatment of invasive Aspergillus infections in adults in the Middle East region: Expert panel recommendations.

    PubMed

    Al-Abdely, Hail M; Alothman, Adel F; Salman, Jameela Al; Al-Musawi, Tariq; Almaslamani, Muna; Butt, Adeel A; Al Thaqafi, Abdulhakeem O; Raghubir, Nirvana; Morsi, Waleed El; Yared, Nadine A

    2014-02-01

    The incidence of invasive Aspergillus infections in the Middle East continues to rise with the increase in the number of immunocompromised patients, and carries significant morbidity and mortality. A panel of experts analysed the evidence from the most recent international guidelines and relevant published literature to reach consensus and develop clear clinical practice guidelines to aid diagnosis and treatment of invasive Aspergillus infections in the Middle East. Disease-specific recommendations were provided for the management of invasive aspergillosis. The expert panel acknowledged that these guidelines should be followed as closely as possible but used alongside clinical judgement. PMID:24029495

  4. Education policy implications from the Expert Panel on Electronic Media and Youth Violence.

    PubMed

    Worthen, Maria R

    2007-12-01

    The research from the Expert Panel on Electronic Media and Youth Violence makes a compelling case for why educators and education policymakers should care about the effects of media on youth behavior, and the growing phenomenon of Internet bullying and harassment. The ability of the U.S. education system to respond is limited not only by competing instructional priorities but also by the governance structure of the education system itself. The federal role is limited to a proportionally small amount of funding for states and schools, to raising public awareness, and to providing research and data. States can set priorities, make requirements, and direct funding. Districts and schools ultimately have the most control over prevention program selection and setting social and behavioral norms. Key implications of the panel's research for educators and education policymakers include: Internet bullying is correlated with school behavior problems; Internet bullying behavior may peak in middle school; Internet bullying shares common predictors with verbal and, to some extent, physical bullying; Media literacy programs may mitigate the negative effects of electronic media on youth. Specific recommendations based on these conclusions are discussed, and research priorities for the prevention and education fields are identified. PMID:18047948

  5. The healthy food environment policy index: findings of an expert panel in New Zealand

    PubMed Central

    Dominick, Clare; Devi, Anandita; Swinburn, Boyd

    2015-01-01

    Abstract Objective To assess government actions to improve the healthiness of food environments in New Zealand, based on the healthy food environment policy index. Methods A panel of 52 public health experts rated the extent of government implementation against international best practice for 42 indicators of food environment policy and infrastructure support. Their ratings were informed by documented evidence, validated by government officials and international benchmarks. Findings There was a high level of implementation for some indicators: providing ingredient lists and nutrient declarations and regulating health claims on packaged foods; transparency in policy development; monitoring prevalence of noncommunicable diseases and monitoring risk factors for noncommunicable diseases. There was very little, if any implementation of the following indicators: restrictions on unhealthy food marketing to children; fiscal and food retail policies and protection of national food environments within trade agreements. Interrater reliability was 0.78 (95% confidence interval, CI: 0.76–0.79). Based on the implementation gaps, the experts recommended 34 actions, and prioritized seven of these. Conclusion The healthy food environment policy index provides a useful set of indicators that can focus attention on where government action is needed. It is anticipated that this policy index will increase accountability of governments, stimulate government action and support civil society advocacy efforts. PMID:26229200

  6. Practice Guidance for Buprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process

    PubMed Central

    Farmer, Carrie M.; Lindsay, Dawn; Williams, Jessica; Ayers, Amanda; Schuster, James; Cilia, Alyssa; Flaherty, Michael T.; Mandell, Todd; Gordon, Adam J.; Stein, Bradley D.

    2015-01-01

    Background Although numbers of physicians credentialed to prescribe buprenorphine has increased over time, many credentialed physicians may be reluctant to treat individuals with opioid use disorders due to discomfort with prescribing buprenorphine. Though prescribing physicians are required to complete a training course, many have questions about buprenorphine and treatment guidelines have not been updated to reflect clinical experience in recent years. We report on an expert panel process to update and expand buprenorphine guidelines. Methods We identified candidate guidelines through expert opinion and a review of the literature and used a modified RAND/UCLA Appropriateness Method to assess the validity of the candidate guidelines. An expert panel completed two rounds of rating, with a meeting to discuss the guidelines between the first and second rating. Results Through the rating process, expert panel members rated 90 candidate guideline statements across eight domains, including candidacy for buprenorphine treatment, dosing of buprenorphine, psychosocial counseling, and treatment of co-occurring depression and anxiety. A total of 65 guideline statements (72%) were rated as valid. Expert panel members had agreement in some areas, such as the treatment of co-occurring mental health problems, but disagreement in others, including the appropriate dosing of buprenorphine given patient complexities. Conclusions Through an expert panel process, we developed an updated and expanded set of buprenorphine treatment guidelines; this additional guidance may increase credentialed physicians’ comfort with prescribing buprenorphine to patients with opioid use disorders. Future efforts should focus on appropriate dosing guidance and ensuring that guidelines can be adapted to a variety of practice settings. PMID:25844527

  7. Appropriateness of methadone maintenance treatment for opiate addiction: evaluation by an expert panel.

    PubMed

    Vader, John-Paul; Hämmig, Robert; Besson, Jacques; Eastus, Christopher; Eggenberger, Christina; Burnand, Bernard

    2003-01-01

    With some 30,000 dependent persons, opiate addiction constitutes a major public health problem in Switzerland. The Swiss Federal Office of Public Health (FOPH) has long played a leading role in the prevention and treatment of opiate addiction and in research on effective means of containing the epidemic of opiate addiction and its consequences. Major milestones on that path have been the successive "Methadone reports" published by that Office and providing guidance on the care of opiate addiction with substitution treatment. In view of updating the recommendations for the appropriateness of substitution treatment for opiate addiction, in particular for the prescription of methadone, the FOPH commissioned a multi-component project involving the following elements. A survey of current attitudes and practices in Switzerland related to opiate substitution treatment Review of Swiss literature on methadone substitution treatment Review of international literature on methadone substitution treatment National Methadone Substitution Conference Multidisciplinary expert panel to evaluate the appropriateness of substitution treatment. The present report documents the process and summarises the results of the latter element above. The RAND appropriateness method (RAM) was used to distil from literature-based evidence and systematically formulated expert opinion, areas where consensus exist on the appropriateness (or inappropriateness) of methadone maintenance treatment (MMT) and areas where disagreement or uncertainty persist and which should be further pursued. The major areas which were addressed by this report are Initial assessment of candidates for MMT Appropriate settings for initiation of MMT (general and special cases) Appropriateness of methadone supportive therapy Co-treatments and accompanying measures Dosage schedules and pharmacokinetic testing Withdrawal from MMT Miscellaneous questions Appropriateness of other (non-methadone) substitution treatment Summary

  8. Challenges in the implementation of trastuzumab biosimilars: an expert panel's recommendations.

    PubMed

    Pivot, Xavier; Aulagner, Gilles; Blay, Jean Yves; Fumoleau, Pierre; Kaliski, Alexandre; Sarkozy, François; Limat, Samuel

    2015-11-01

    Trastuzumab has transformed the treatment of HER2-positive breast cancer. Because of impending European patent expiry in 2017, numerous trastuzumab biosimilars are currently undergoing comparability exercises for marketing authorization. Although biosimilar products have been approved in Europe since 2006, many obstacles are expected for trastuzumab, resulting from its nature as a monoclonal antibody, its impact on overall survival, and its extensive biochemical complexities. Unsolved questions need to be addressed for the evaluation of biosimilars' activity in terms of appropriate clinical endpoint definitions for such anticancer drugs, specific assessment pathways and comparative testing of biosimilars, untested ensuing de facto combination of trastuzumab biosimilars with cytotoxics, and immunogenicity monitoring among immunocompromised patients. In such a context of uncertainties, the recent approval by the French parliament of biosimilar substitution, which would allow dispensing trastuzumab biosimilars in place of the originator, should interrogate the oncological community. A think tank of experts was created to delineate specificities and challenges stemming from trastuzumab biosimilars. PMID:26352219

  9. 78 FR 15012 - Request for Nominations of Experts for a Science Advisory Board Panel To Review EPA's Draft...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-08

    ... AGENCY Request for Nominations of Experts for a Science Advisory Board Panel To Review EPA's Draft Science Synthesis Report on the Connectivity of Streams and Wetlands to Downstream Waters AGENCY: Environmental Protection Agency (EPA). ACTION: Notice. SUMMARY: The EPA Science Advisory Board (SAB)...

  10. 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.'

  11. The Social Cognition Psychometric Evaluation Study: Results of the Expert Survey and RAND Panel

    PubMed Central

    Pinkham, Amy E.; Penn, David L.; Green, Michael F.; Buck, Benjamin; Healey, Kristin; Harvey, Philip D.

    2014-01-01

    Background: In schizophrenia, social cognition is strongly linked to functional outcome and is increasingly seen as a viable treatment target. The goal of the Social Cognition Psychometric Evaluation (SCOPE) study is to identify and improve the best existing measures of social cognition so they can be suitably applied in large-scale treatment studies. Initial phases of this project sought to (1) develop consensus on critical domains of social cognition and (2) identify the best existing measures of social cognition for use in treatment studies. Methods: Experts in social cognition were invited to nominate key domains of social cognition and the best measures of those domains. Nominations for measures were reduced according to set criteria, and all available psychometric information about these measures was summarized and provided to RAND panelists. Panelists rated the quality of each measure on multiple criteria, and diverging ratings were discussed at the in-person meeting to obtain consensus. Results: Expert surveys identified 4 core domains of social cognition—emotion processing, social perception, theory of mind/mental state attribution, and attributional style/bias. Using RAND panel consensus ratings, the following measures were selected for further evaluation: Ambiguous Intentions Hostility Questionnaire, Bell Lysaker Emotion Recognition Task, Penn Emotion Recognition Test, Relationships Across Domains, Reading the Mind in the Eyes Test, The Awareness of Social Inferences Test, Hinting Task, and Trustworthiness Task. Discussion: While it was possible to establish consensus, only a limited amount of psychometric information is currently available for the candidate measures, which underscores the need for well-validated and standardized measures in this area. PMID:23728248

  12. The Appropriateness of Renal Angioplasty. The ANPARIA Software: A Multidisciplinary Expert Panel Approach

    SciTech Connect

    Gerbaud, Laurent; Manhes, Geraud; Debourse, Juliette; Gouby, Gerald Glanddier, Phyllis-Yvonne; Vader, John-Paul; Boyer, Louis Deteix, Patrice

    2008-11-15

    Percutaneous transluminal renal angioplasty (PTRA) is an invasive technique that is costly and involves the risk of complications and renal failure. The ability of PTRA to reduce the administration of antihypertensive drugs has been demonstrated. A potentially greater benefit, which nevertheless remains to be proven, is the deferral of the need for chronic dialysis. The aim of the study (ANPARIA) was to assess the appropriateness of PTRA to impact on the evolution of renal function. A standardized expert panel method was used to assess the appropriateness of medical treatment alone or medical treatment with revascularization in various clinical situations. The choice of revascularization by either PTRA or surgery was examined for each clinical situation. Analysis was based on a detailed literature review and on systematically elicited expert opinion, which were obtained during a two-round modified Delphi process. The study provides detailed responses on the appropriateness of PTRA for 1848 distinct clinical scenarios. Depending on the major clinical presentation, appropriateness of revascularization varied from 32% to 75% for individual scenarios (overal 48%). Uncertainty as to revascularization was 41% overall. When revascularization was appropriate, PTRA was favored over surgery in 94% of the scenarios, except in certain cases of aortic atheroma where sugery was the preferred choice. Kidney size >7 cm, absence of coexisting disease, acute renal failure, a high degree of stenosis ({>=}70%), and absence of multiple arteries were identified as predictive variables of favorable appropriateness ratings. Situations such as cardiac failure with pulmonary edema or acute thrombosis of the renal artery were defined as indications for PTRA. This study identified clinical situations in which PTRA or surgery are appropriate for renal artery disease. We built a decision tree which can be used via Internet: the ANPARIA software (http://www

  13. NTP-CERHR expert panel report on the reproductive anddevelopmental toxicity of hydroxyurea

    SciTech Connect

    Liebelt, E.L.; Balk, S.J.; Faber, W.; Fisher, J.W.; Hughes, C.L.; Lanzkron, S.M.; Lewis, K.M.; Marchetti, F.; Mehendale, H.M.; Rogers,J.M.; Shad, A.T.; Skalko, R.G.; Stanek, E.J.

    2007-01-01

    The National Toxicology Program (NTP) and the National Institute of Environmental Health Sciences (NIEHS) established the NTP Center for the Evaluation of Risks to Human Reproduction (CERHR) in June 1998. The purpose of CERHR is to provide timely, unbiased, scientifically sound evaluations of human and experimental evidence for adverse effects on reproduction and development caused by agents to which humans may be exposed. Hydroxyurea was selected for evaluation by a CERHR expert panel because of (1) its increasing use in the treatment of sickle cell disease in children and adults, (2) knowledge that it inhibits DNA synthesis and is cytotoxic, and (3) published evidence of its reproductive and developmental toxicity in rodents. Hydroxyurea is FDA-approved for reducing the frequency of painful crises and the need for blood transfusions in adults with sickle cell anemia who experience recurrent moderate-to-severe crises. Hydroxyurea is used in the treatment of cancer, sickle cell disease, and thalassemia. It is the only treatment for sickle cell disease aside from blood transfusion used in children. Hydroxyurea may be used in the treatment of children and adults with sickle cell disease for an extended period of time or for repeated cycles of therapy. Treatment with hydroxyurea may be associated with cytotoxic and myelosuppressive effects, and hydroxyurea is mutagenic.

  14. Establishment of Reference Doses for residues of allergenic foods: report of the VITAL Expert Panel.

    PubMed

    Taylor, Steve L; Baumert, Joseph L; Kruizinga, Astrid G; Remington, Benjamin C; Crevel, Rene W R; Brooke-Taylor, Simon; Allen, Katrina J; Houben, Geert

    2014-01-01

    In 2011, an expert panel was assembled to establish appropriate Reference Doses for allergenic food residues as a part of the VITAL (Voluntary Incidental Trace Allergen Labeling) program of The Allergen Bureau of Australia & New Zealand (ABA). These Reference Doses would guide advisory labeling decisions for use on food labels. Individual NOAELs and LOAELs were obtained from clinical challenges of food-allergic subjects. Statistical dose-distribution models (log-normal, log-logistic, Weibull) were applied to the individual NOAELs and LOAELs for each allergenic food. The Reference Doses, in terms of mg of total protein from the allergenic food, were based upon either the ED01 (for peanut, cow's milk), the 95% lower confidence interval of the ED05 (for wheat, soybean, cashew, shrimp, sesame seed, mustard, and lupine), or both (egg, hazelnut) using all appropriate statistical dose-distribution models. Reference Doses were established for 11 allergenic foods ranging from 0.03 mg for egg protein to 10mg for shrimp protein. Reference Doses were not established for fish or celery due to poor model fits with existing data. Reference Doses were not established for other tree nuts beyond hazelnut and cashew because of the absence of data on NOAELs and LOAELs from individual subjects. PMID:24184597

  15. Future directions for postdoctoral training in cancer prevention: insights from a panel of experts.

    PubMed

    Nelson, David E; Faupel-Badger, Jessica; Phillips, Siobhan; Belcher, Britni; Chang, Shine; Abrams, David B; Kramer, Barnett S; White, Mary C; O'Malley, Michael; Varanasi, Arti P; Fabian, Carol J; Wiest, Jonathan S; Colditz, Graham A; Hall, Kara; Shields, Peter G; Weitzel, Jeffrey N

    2014-04-01

    Cancer prevention postdoctoral fellowships have existed since the 1970s. The National Cancer Institute facilitated a meeting by a panel of experts in April 2013 to consider four important topics for future directions for cancer prevention postdoctoral training programs: (i) future research needs; (ii) underrepresented disciplines; (iii) curriculum; and (iv) career preparation. Panelists proffered several areas needing more research or emphasis, ranging from computational science to culture. Health care providers, along with persons from nontraditional disciplines in scientific training programs such as engineers and lawyers, were among those recognized as being underrepresented in training programs. Curriculum suggestions were that fellows receive training in topics such as leadership and human relations, in addition to learning the principles of epidemiology, cancer biologic mechanisms, and behavioral science. For career preparation, there was a clear recognition of the diversity of employment options available besides academic positions, and that program leaders should do more to help fellows identify and prepare for different career paths. The major topics and strategies covered at this meeting can help form the basis for cancer prevention training program leaders to consider modifications or new directions, and keep them updated with the changing scientific and employment climate for doctoral degree recipients and postdoctoral fellows. PMID:24604827

  16. Italian Expert Panel on the management of patients with coexisting spondyloarthritis and inflammatory bowel disease.

    PubMed

    Olivieri, Ignazio; Cantini, Fabrizio; Castiglione, Fabiana; Felice, Carla; Gionchetti, Paolo; Orlando, Ambrogio; Salvarani, Carlo; Scarpa, Raffaele; Vecchi, Maurizio; Armuzzi, Alessandro

    2014-08-01

    Spondyloarthritis (SpA) is a group of diseases with similar clinical, radiologic and serologic features, including SpA associated with inflammatory bowel disease (IBD-associated SpA). Several studies have estimated the occurrence of SpA in IBD patients as ranging from 17% to 39%, confirming that SpA is the most frequent extra-intestinal manifestation in patients with IBD. In this paper, the expert panel presents some red flags to guide clinicians - both rheumatologists and gastroenterologists - to make a correct diagnosis of IBD-associated SpA in clinical practice. IBD-associated SpA classification, clinical presentation and diagnostic work-up are also presented. From the therapeutic point of view, only separate recommendations/guidelines are currently available for the treatment of Crohn's disease, ulcerative colitis and for both axial and peripheral SpA. However, when IBD and SpA coexist, the therapeutic strategy should be modulated to take into account the variable manifestations of IBD in terms of intestinal and extra-intestinal features, and the clinical manifestations of SpA, with particular attention to peripheral enthesitis, dactylitis and anterior uveitis. To our knowledge, this is the first attempt to define therapeutic algorithms for the integrated management of different IBD-associated SpA clinical scenarios. PMID:24726868

  17. Best Practices for Prescription Drug Monitoring Programs in the Emergency Department Setting: Results of an Expert Panel.

    PubMed

    Greenwood-Ericksen, Margaret B; Poon, Sabrina J; Nelson, Lewis S; Weiner, Scott G; Schuur, Jeremiah D

    2016-06-01

    Prescription drug monitoring programs are generally underused in emergency departments (ED) and nationwide enrollment is low among emergency physicians. We aimed to develop consensus recommendations for prescription drug monitoring program policy and design to optimize their functionality and use in the ED. We assembled a technical expert panel with key stakeholders in emergency medicine, public health, and public policy. The panel included academic and community-based emergency physicians, a pediatric fellowship-trained emergency physician, a medical toxicologist, a public health expert, a patient advocate, a legal expert, and two state prescription drug monitoring program administrators. We compiled prescription drug monitoring program policies and characteristics and organized them into domains based on user-prescription drug monitoring program interaction. The panel convened for 3 rounds in which the policies and characteristics were introduced, discussed, and modified in an iterative fashion to achieve consensus. The process yielded policy recommendations and design features, with majority agreement. The panel made 18 policy recommendations within these main themes: enrollment should be mandatory, with an automatic process to mitigate the workload; registration should be open to all prescribers; delegates should have access to prescription drug monitoring program to alleviate work flow burdens; prescription drug monitoring program data should be pushed into hospital electronic health records; prescription drug monitoring program review should be mandatory for patients receiving opioid prescriptions and based on objective criteria; the prescription drug monitoring program content should be standardized and updated in a timely manner; and states should encourage interstate data sharing. An expert panel identified 18 recommendations that can be used by states and policymakers to improve prescription drug monitoring program design to increase use in the ED

  18. Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults

    PubMed Central

    Hendricks, Katherine A.; Wright, Mary E.; Shadomy, Sean V.; Bradley, John S.; Morrow, Meredith G.; Pavia, Andy T.; Rubinstein, Ethan; Holty, Jon-Erik C.; Messonnier, Nancy E.; Smith, Theresa L.; Pesik, Nicki; Treadwell, Tracee A.

    2014-01-01

    The Centers for Disease Control and Prevention convened panels of anthrax experts to review and update guidelines for anthrax postexposure prophylaxis and treatment. The panels included civilian and military anthrax experts and clinicians with experience treating anthrax patients. Specialties represented included internal medicine, pediatrics, obstetrics, infectious disease, emergency medicine, critical care, pulmonology, hematology, and nephrology. Panelists discussed recent patients with systemic anthrax; reviews of published, unpublished, and proprietary data regarding antimicrobial drugs and anthrax antitoxins; and critical care measures of potential benefit to patients with anthrax. This article updates antimicrobial postexposure prophylaxis and antimicrobial and antitoxin treatment options and describes potentially beneficial critical care measures for persons with anthrax, including clinical procedures for infected nonpregnant adults. Changes from previous guidelines include an expanded discussion of critical care and clinical procedures and additional antimicrobial choices, including preferred antimicrobial drug treatment for possible anthrax meningitis. PMID:24447897

  19. Transcutaneous oximetry in clinical practice: consensus statements from an expert panel based on evidence.

    PubMed

    Fife, C E; Smart, D R; Sheffield, P J; Hopf, H W; Hawkins, G; Clarke, D

    2009-01-01

    Transcutaneous oximetry (PtcO2) is finding increasing application as a diagnostic tool to assess the peri-wound oxygen tension of wounds, ulcers, and skin flaps. It must be remembered that PtcO2 measures the oxygen partial pressure in adjacent areas of a wound and does not represent the actual partial pressure of oxygen within the wound, which is extremely difficult to perform. To provide clinical practice guidelines, an expert panel was convened with participants drawn from the transcutaneous oximetry workshop held on June 13, 2007, in Maui, Hawaii. Important consensus statements were (a) tissue hypoxia is defined as a PtcO2 <40 mm Hg; (b) in patients without vascular disease, PtcO2 values on the extremity increase to a value >100 mm Hg when breathing 100% oxygen under normobaric pressures; (c) patients with critical limb ischemia (ankle systolic pressure of < or =50 mm Hg or toe systolic pressure of < or =30 mm Hg) breathing air will usually have a PtcO2 <30 mm Hg; (d) low PtcO2 values obtained while breathing normobaric air can be caused by a diffusion barrier; (e) a PtcO2 <40 mm Hg obtained while breathing normobaric air is associated with a reduced likelihood of amputation healing; (f) if the baseline PtcO2 increases <10 mm Hg while breathing 100% normobaric oxygen, this is at least 68% accurate in predicting failure of healing post-amputation; (g) an increase in PtcO2 to >40 mm Hg during normobaric air breathing after revascularization is usually associated with subsequent healing, although the increase in PtcO2 may be delayed; (h) PtcO2 obtained while breathing normobaric air can assist in identifying which patients will not heal spontaneously. PMID:19341127

  20. Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings: Recommendations from a Multidisciplinary Expert Panel

    PubMed Central

    Kales, Helen C.; Gitlin, Laura N.; Lyketsos, Constantine G.

    2014-01-01

    Non-cognitive neuropsychiatric symptoms (NPS) of dementia include aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, and disinhibition. These affect dementia patients nearly universally across dementia stages and etiologies. NPS are associated with poor patient and caregiver outcomes including excess morbidity and mortality, increased health care utilization, and earlier nursing home placement, as well as caregiver stress, depression and reduced employment. While there is no FDA-approved pharmacotherapy for NPS, psychotropic medications are frequently used to manage these symptoms. However, in the few cases of proven pharmacologic efficacy, benefit may be off set by significant risk of adverse effects. Non-pharmacologic treatments, typically considered first-line, also show evidence for efficacy as well as a limited potential for adverse effects. However, their uptake as preferred treatments remains inadequate in real-world clinical settings. Thus, the field currently finds itself between a “rock and a hard place” in terms of management of these difficult symptoms. It was in this context that the University of Michigan Program for Positive Aging, working in collaboration with the Johns Hopkins Alzheimer’s Disease Research Center and Center for Innovative Care in Aging sponsored and convened a multidisciplinary expert panel in Detroit Michigan in Fall 2011 with three objectives, to: 1) define key elements of care for NPS in dementia; 2) construct an approach describing the sequential and iterative steps of managing NPS in real-world clinical settings that can be used as a basis for integrating non-pharmacologic and pharmacologic approaches; 3) discuss how the approach generated could be implemented in research and clinical care. PMID:24635665

  1. Pain Management in the Elderly: An FDA Safe Use Initiative Expert Panel's View on Preventable Harm Associated with NSAID Therapy

    PubMed Central

    Taylor, Robert; Lemtouni, Salma; Weiss, Karen; Pergolizzi, Joseph V.

    2012-01-01

    Optimization of current pain management strategies is necessary in order to reduce medication risks. Promoting patient and healthcare provider education on pain and pain medications is an essential step in reducing inadequate prescribing behaviors and adverse events. In an effort to raise awareness on medication safety, the FDA has launched the Safe Use Initiative program. The program seeks to identify areas with the greatest amount of preventable harm and help promote new methods and practices to reduce medication risks. Since the establishment of the program, FDA's Safe Use initiative staff convened a panel of key opinion leaders throughout the medical community to address pain management in older adults (≥65 years of age). The aim of the expert panel was to focus on areas where significant risk occurs and where potential interventions will be feasible, implementable, and lead to substantial impact. The panel suggested one focus could be the use of NSAIDs for pain management in the elderly. PMID:22400024

  2. Evaluating the clinical appropriateness of nurses' prescribing practice: method development and findings from an expert panel analysis

    PubMed Central

    Latter, Sue; Maben, Jill; Myall, Michelle; Young, Amanda

    2007-01-01

    Background The number of nurses independently prescribing medicines in England is rising steadily. There had been no attempt systematically to evaluate the clinical appropriateness of nurses' prescribing decisions. Aims (i) To establish a method of assessing the clinical appropriateness of nurses' prescribing decisions; (ii) to evaluate the prescribing decisions of a sample of nurses, using this method. Method A modified version of the Medication Appropriateness Index (MAI) was developed, piloted and subsequently used by seven medical prescribing experts to rate transcripts of 12 nurse prescriber consultations selected from a larger database of 118 audio‐recorded consultations collected as part of a national evaluation. Experts were also able to give written qualitative comments on each of the MAI dimensions applied to each of the consultations. Analysis Experts' ratings were analysed using descriptive statistics. Qualitative comments were subjected to a process of content analysis to identify themes within and across both MAI items and consultations. Results Experts' application of the modified MAI to transcripts of nurse prescriber consultations demonstrated validity and feasibility as a method of assessing the clinical appropriateness of nurses' prescribing decisions. In the majority of assessments made by the expert panel, nurses' prescribing decisions were rated as clinically appropriate on all nine items in the MAI. Conclusion A valid and feasible method of assessing the clinical appropriateness of nurses' prescribing practice has been developed using a modified MAI and transcripts of audio‐recorded consultations sent to a panel of prescribing experts. Prescribing nurses in this study were generally considered to be making clinically appropriate prescribing decisions. This approach to measuring prescribing appropriateness could be used as part of quality assurance in routine practice, as a method of identifying continuing professional development needs

  3. Expert perspectives on Western European prison health services: do ageing prisoners receive equivalent care?

    PubMed

    Bretschneider, Wiebke; Elger, Bernice Simone

    2014-09-01

    Health care in prison and particularly the health care of older prisoners are increasingly important topics due to the growth of the ageing prisoner population. The aim of this paper is to gain insight into the approaches used in the provision of equivalent health care to ageing prisoners and to confront the intuitive definition of equivalent care and the practical and ethical challenges that have been experienced by individuals working in this field. Forty interviews took place with experts working in the prison setting from three Western European countries to discover their views on prison health care. Experts indicated that the provision of equivalent care in prison is difficult mostly due to four factors: variability of care in different prisons, gatekeeper systems, lack of personnel, and delays in providing access. This lack of equivalence can be fixed by allocating adequate budgets and developing standards for health care in prison. PMID:24965437

  4. Risk Management Post-Marketing Surveillance for the Abuse of Medications Acting on the Central Nervous System: Expert Panel Report

    PubMed Central

    Johanson, Chris-Ellyn; Balster, Robert L.; Henningfield, Jack E.; Schuster, Charles R.; Anthony, James C.; Barthwell, Andrea G.; Coleman, John J.; Dart, Richard C.; Gorodetzky, Charles W.; O’Keeffe, Charles; Sellers, Edward M.; Vocci, Frank; Walsh, Sharon L.

    2010-01-01

    The abuse and diversion of medications is a significant public health problem. This paper is part of a supplemental issue of Drug and Alcohol Dependence focused on the development of risk management plans and post-marketing surveillance related to minimizing this problem. The issue is based on a conference that was held in October, 2008. An Expert Panel was formed to provide a summary of the conclusions and recommendations that emerged from the meeting involving drug abuse experts, regulators and other government agencies, pharmaceutical companies and professional and other non-governmental organizations. This paper provides a written report of this Expert Panel. Eleven conclusions and eleven recommendations emerged concerning the state of the art of this field of research, the regulatory and public health implications and recommendations for future directions. It is concluded that special surveillance tools are needed to detect the emergence of medication abuse in a timely manner and that risk management tools can be implemented to increase the benefit to risk ratio. The scientific basis for both the surveillance and risk management tools is in its infancy, yet progress needs to be made. It is also important that the unintended consequences of increased regulation and the imposition of risk management plans be minimized. PMID:19783383

  5. The Report of the Expert Panel on the Sustainable Management of Groundwater in Canada: The Council of Canadian Academies

    NASA Astrophysics Data System (ADS)

    Bruce, J. P.

    2009-05-01

    The Expert Panel on Groundwater was established in response to a request from the Minister of Natural Resources Canada, asking the Council of Canadian Academies to assess what is needed to achieve sustainable management of Canada's groundwater resources, from a science perspective. To this end, the Council of Canadian Academies assembled an interdisciplinary panel of experts who interpreted science, in the context of this assessment, to include natural and social sciences as well as local, provincial, and federal governance. The panel's report, released on May 11th 2009, noted that nearly 10 million Canadians rely on groundwater for household purposes, in addition to uses for agriculture and industry. Both media and public have expressed many recent concerns about water supplies and their quality. The concept of groundwater sustainability developed by the panel encompasses five interrelated goals: three that involve primarily the physical sciences and engineering, and two that are essentially socio-economic in nature. These goals are as follows: i. Protection of groundwater supplies from depletion ii. Protection of groundwater quality from contamination iii. Protection of ecosystem viability iv. Achievement of economic and social well-being v. Application of good governance The achievement of groundwater sustainability requires a careful analysis and balancing of the five goals; a comprehensive sustainability framework for groundwater has not yet been implemented in Canada. Adoption by federal, provincial and local jurisdictions of such a framework, based on the goals outlined above, would be invaluable in guiding efforts to improve the understanding and management of groundwater. To contextualize the components of the sustainability framework, the panel examined a series of case studies that typify examples along a spectrum, from near-sustainable, to situations that are fail to meet the outlined criteria. The panel identified the fragmentation of water management

  6. Expert Panel Reaffirms Need for Colon Cancer Screen Beginning At Age 50

    MedlinePlus

    ... key, because a positive stool test plus stool DNA test (such as Cologuard), or a positive imaging test ( ... blood in stool); and the recently approved Cologuard DNA-based stool test. The panel said there were no comparison studies ...

  7. An Experts Survey on Sustainability Across Twenty-Seven Extensive European Systems of Grassland Management

    NASA Astrophysics Data System (ADS)

    Caballero, Rafael; Gil, Ángel; Fernández-Santos, Xavier

    2008-08-01

    European Large Scale Grazing Systems (LSGS) are at a crossroad with environmental, agronomic, and social factors interacting on their future viability. This research assesses the current environmental and socio-economic status of a wide range of European LSGS according to an agreed subset of sustainability criteria and indicators, which have been recognized by corresponding experts and privileged observers on their respective case-study system. A survey questionnaire was drafted containing five main criteria (pastoral use, environmental, economic, social, and market and development), with four conceptual-scored variables (indicators) within each criterion. Descriptive, analytical and clustering statistical techniques helped to draw a synthesis of the main result and to standardize sustainability variables across different biogeographical regions and management situations. The results show large multicollinearity among the 20 variables proposed. This dependence was revealed by the reduction to six main factor-components, which accounted for about 73% of the total variance in responses. Aggregation of point-score indicators across criteria to obtain a sustainability index can be of less policy relevance than responses to specific criteria or indicators. Affinity between case-study systems, as judged by collaborative-expert responses, was not related to biogeographical location, operating livestock sector, or population density in their areas. The results show larger weaknesses and constraints in the economic and social criteria than in the pastoral and environmental criteria, and the large heterogeneity of responses appears in the social criterion.

  8. Defining the physician's duty to warn: consensus statement of Ontario's Medical Expert Panel on Duty to Inform

    PubMed Central

    Ferris, L E; Barkun, H; Carlisle, J; Hoffman, B; Katz, C; Silverman, M

    1998-01-01

    Ontario's Medical Expert Panel on Duty to Inform was formed to consider the duty of Ontario physicians in circumstances where a patient threatens to kill or cause serious bodily harm to a third party. The panel was concerned about the implications of any duty to inform on the integrity of the physician-patient relationship, particularly with respect to confidentiality. The panel agreed that regulations safeguarding the confidentiality of patient information ought to be changed only if there is a critical reason for doing so, but, after deliberation, the panel members concluded that the need to protect the public from serious risk of harm is a paramount concern that should supersede the duty of confidentiality. The recommendations reported here were endorsed in principle by the panelists and the groups they represented (the Royal College of Physicians and Surgeons of Canada, the Canadian Medical Protective Association, the College of Physicians and Surgeons of Ontario, the Ontario College of Family Physicians and the Ontario Medical Association) and are being implemented by the College of Physicians and Surgeons of Ontario. PMID:9629112

  9. Preoperative and perioperative use of levosimendan in cardiac surgery: European expert opinion.

    PubMed

    Toller, W; Heringlake, M; Guarracino, F; Algotsson, L; Alvarez, J; Argyriadou, H; Ben-Gal, T; Černý, V; Cholley, B; Eremenko, A; Guerrero-Orriach, J L; Järvelä, K; Karanovic, N; Kivikko, M; Lahtinen, P; Lomivorotov, V; Mehta, R H; Mušič, Š; Pollesello, P; Rex, S; Riha, H; Rudiger, A; Salmenperä, M; Szudi, L; Tritapepe, L; Wyncoll, D; Öwall, A

    2015-04-01

    In cardiac surgery, postoperative low cardiac output has been shown to correlate with increased rates of organ failure and mortality. Catecholamines have been the standard therapy for many years, although they carry substantial risk for adverse cardiac and systemic effects, and have been reported to be associated with increased mortality. On the other hand, the calcium sensitiser and potassium channel opener levosimendan has been shown to improve cardiac function with no imbalance in oxygen consumption, and to have protective effects in other organs. Numerous clinical trials have indicated favourable cardiac and non-cardiac effects of preoperative and perioperative administration of levosimendan. A panel of 27 experts from 18 countries has now reviewed the literature on the use of levosimendan in on-pump and off-pump coronary artery bypass grafting and in heart valve surgery. This panel discussed the published evidence in these various settings, and agreed to vote on a set of questions related to the cardioprotective effects of levosimendan when administered preoperatively, with the purpose of reaching a consensus on which patients could benefit from the preoperative use of levosimendan and in which kind of procedures, and at which doses and timing should levosimendan be administered. Here, we present a systematic review of the literature to report on the completed and ongoing studies on levosimendan, including the newly commenced LEVO-CTS phase III study (NCT02025621), and on the consensus reached on the recommendations proposed for the use of preoperative levosimendan. PMID:25734940

  10. The European Union Committee of Experts on Rare Diseases: three productive years at the service of the rare disease community

    PubMed Central

    2014-01-01

    The European Union Committee of Experts on Rare Diseases was entrusted with aiding the European Commission in a number of tasks, ranging from the monitoring of initiatives, to recommending improvements and actions to be pursued in the future, in addition to helping strengthen liaison at both European and International levels in the field of rare diseases. The three-year mandate of the EUCERD drew to a close in July 2013 with an impressive record. The EUCERD has laid down the foundations for future work so as to continue to advance in the key areas that have been identified as of interest for the rare disease community at large: centres of expertise, European Reference Networks, patient registries and databases, newborn screening, and indicators for national rare disease plans/strategies. The work of the Committee should now be continued by the newly formed European Commission Expert Group on Rare Diseases. PMID:24580800

  11. European Experimental Re-Entry Testbed EXPERT: Qualification of Payloads for Flight

    NASA Astrophysics Data System (ADS)

    Ratti, F.; Gavira, J.; Thirkettle, A. C.; Erba, F.; Muylaert, J.-M.; Walpot, L.; Rembiasz, J. M.

    2009-01-01

    The European Experimental Re-entry Test-bed EXPERT is developed by the European Space Agency (ESA) as part of its General Technological Research Program (GSTP). The aim of EXPERT is to improve the understanding of critical aero-thermodynamic phenomena associated with hypersonic re-entry flights. The EXPERT project provides an opportunity to the scientific community and industries throughout Europe to propose and perform experiments in order to obtain aero-thermodynamic data for the validation of numerical models and of ground to flight extrapolation methodologies. During the last years an intense activity has been performed at ESA in order to select the most suitable experiments, bring them to a mature design, manufacture the qualification model and qualify the experiments for flight. ESA staffs coordinated and supported the work of the principal investigators of the experiments from European institutions and industrial organizations in order to maximize the scientific output in compliance with the budget resources made available to the EXPERT project and the programmatic constraints. EXPERT is a re-entry capsule having the shape of a blunted cone. The front part consists of a nose made of ceramic material developed at DLR Stuttgart. No ablative material is implemented so as not to contaminate the specific measurements of Payloads on board. The ceramic nose hosts a set of experiments: the Flush Air Data System (FADS) developed by HTG aiming at collecting free flow data required for post flight analysis, the pyrometer PYREX developed at IRS in Stuttgart collecting data on the temperature and heat flux of the ceramic nose, and the IRS spectrometer RESPECT aiming at resolving the different species generated in the plasma region during re-entry. The sides of the blunted cone are protected by a metallic thermal protection system in which several experiments are located. Two Payloads developed by IRS and VKI are dedicated to the measurement of catalytic effects. One aims

  12. Expert Panel Recommendations for Hanford Double-Shell Tank Life Extension

    SciTech Connect

    Stewart, Charles W; Bush, Spencer H; Berman, Herbert Stanton; Czajkowski, Carl J; Divine, James R; Posakony, Gerald J; Johnson, A B; Elmore, Monte R; Reynolds, D A; Anantatmula, Ramamohan P; Sindelar, Robert L; Zapp, Philip E

    2001-06-29

    Expert workshops were held in Richland in May 2001 to review the Hanford Double-Shell Tank Integrity Project and make recommendations to extend the life of Hanford's double-shell waste tanks. The workshop scope was limited to corrosion of the primary tank liner, and the main areas for review were waste chemistry control, tank inspection, and corrosion monitoring. Participants were corrosion experts from Hanford, Savannah River Site, Brookhaven National Lab., Pacific Northwest National Lab., and several consultants. This report describes the current state of the three areas of the program, the final recommendations of the workshop, and the rationale for their selection.

  13. Expert Panel Recommendations for Hanford Double-Shell Tank Life Extension

    SciTech Connect

    Stewart, Charles W.; Bush, Spencer H.; Berman, Herbert S.; Czajkowski, Carl J.; Divine, James R.; Posakony, Gerald J.; Johnson, A. B.; Elmore, Monte R.; Reynolds, D. A.; Anantatmula, Ramamohan P.; Sindelar, Robert L.; Zapp, Philip E.

    2001-06-29

    Expert workshops were held in Richland in May 2001 to review the Hanford Double-Shell Tank Integrity Project and make recommendations to extend the life of Hanford's double-shell waste tanks. The workshop scope was limited to corrosion of the primary tank liner, and the main areas for review were waste chemistry control, tank inspection, and corrosion monitoring. Participants were corrosion experts from Hanford, Savannah River Site, Brookhaven National Laboratory, Pacific Northwest National Laboratory, and several consultants. This report describes the current state of the three areas of the program, the final recommendations of the workshop, and the rationale for their selection.

  14. Highlights of the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents.

    ERIC Educational Resources Information Center

    National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD.

    Studies have shown that high blood cholesterol levels play a role in the development of coronary heart disease in adults, and that the process leading to atherosclerosis begins in childhood. To address the problem of high cholesterol levels in children, the Panel on Blood Cholesterol Levels recommends complementary approaches for individuals and…

  15. The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper.

    PubMed

    Posthauer, Mary Ellen; Banks, Merrilyn; Dorner, Becky; Schols, Jos M G A

    2015-04-01

    Nutrition and hydration play an important role in preserving skin and tissue viability and in supporting tissue repair for pressure ulcer (PrU) healing. The majority of research investigating the relationship between nutrition and wounds focuses on PrUs. This white paper reviews the 2014 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Nutrition Guidelines and discusses nutrition strategies for PrU management. PMID:25775201

  16. Heart Rhythm Monitoring in the Constellation Lunar and Launch/Landing EVA Suit: Recommendations from an Expert Panel

    NASA Technical Reports Server (NTRS)

    Scheuring, Richard A.; Hamilton, D.; Jones, J. A.; Alexander, D.

    2008-01-01

    Currently there are several physiological monitoring requirements for Extravehicular Activity (EVA) in the Human-Systems Interface Requirements (HSIR) document, including continuous heart rhythm monitoring. However, it is not known whether heart rhythm monitoring in the lunar surface space suit is a necessary capability for lunar surface operations or in launch/landing suit the event of a cabin depressurization enroute to or from the moon. Methods: Current US astronaut corps demographic information was provided to an expert panel of cardiovascular medicine experts, including specialists in electrophysiology, exercise physiology, interventional cardiology and arrhythmia. This information included averages for male/female age, body mass index (BMI), blood pressure, cholesterol, inflammatory markers, echocardiogram, ranges for coronary artery calcium (CAC) scores for long duration astronauts, and ranges for heart rate (HR) and metabolic (MET) rates obtained during microgravity and lunar EVA. Results: The panel determined that no uncontrolled hazard was likely to occur in the suit during lunar surface or contingency microgravity ops that would require ECG monitoring in the highly screened US astronaut population. However having the capability for rhythm monitoring inside the vehicle (IVA) was considered critical to manage an astronaut in distress. Discussion: Heart rate (HR) monitoring alone allows effective monitoring of astronaut health and function. Consequently, electrocardiographic (ECG) monitoring capability as a clinical tool is not essential in the lunar or launch/landing space suit. However, the panel considered that rhythm monitoring could be useful in certain clinical situations, it was not considered required for safe operations. Also, lunar vehicles should be required to have ECG monitoring capability with a minimum of 5-lead ECG (derived 12- lead) for IVA medical assessments.

  17. Expert Panel Consensus for and Analysis of Key Attributes on Websites Devoted to Weight Control

    ERIC Educational Resources Information Center

    Brown, Stephen L.; Land, Diane; Johnson, Chandrika; Miller, Kim

    2014-01-01

    Background: Obesity presents major challenges to public health in the United States. Trials of web-based interventions for weight control suggest that the Internet is a promising option for program delivery. Purpose: This study sought consensus among experts regarding critical components of successful weight control and to systematically examine…

  18. Heart Rhythm Monitoring in the Constellation Lunar and Launch/Landing EVA Suit: Recommendations from an Expert Panel

    NASA Technical Reports Server (NTRS)

    Scheuring, Richard A.; Hamilton, Doug; Jones, Jeffrey A.; Alexander, David

    2009-01-01

    There are currently several physiological monitoring requirements for EVA in the Human-Systems Interface Requirements (HSIR) document. There are questions as to whether the capability to monitor heart rhythm in the lunar surface space suit is a necessary capability for lunar surface operations. Similarly, there are questions as to whether the capability to monitor heart rhythm during a cabin depressurization scenario in the launch/landing space suit is necessary. This presentation seeks to inform space medicine personnel of recommendations made by an expert panel of cardiovascular medicine specialists regarding in-suit ECG heart rhythm monitoring requirements during lunar surface operations. After a review of demographic information and clinical cases and panel discussion, the panel recommended that ECG monitoring capability as a clinical tool was not essential in the lunar space suit; ECG monitoring was not essential in the launch/landing space suit for contingency scenarios; the current hear rate monitoring capability requirement for both launch/landing and lunar space suits should be maintained; lunar vehicles should be required to have ECG monitoring capability with a minimum of 5-lead ECG for IVA medical assessments; and, exercise stress testing for astronaut selection and retention should be changed from the current 85% maximum heart rate limit to maximal, exhaustive 'symptom-limited' testing to maximize diagnostic utility as a screening tool for evaluating the functional capacity of astronauts and their cardiovascular health.

  19. The view of European experts regarding health economics for medical nutrition in disease-related malnutrition.

    PubMed

    Freijer, K; Lenoir-Wijnkoop, I; Russell, C A; Koopmanschap, M A; Kruizenga, H M; Lhachimi, S K; Norman, K; Nuijten, M J C; Schols, J M G A

    2015-05-01

    Health-care systems are currently facing tremendous budget constraints resulting in growing pressure on decision makers and health-care providers to obtain the maximum possible health benefits of the resources available. Choices have to be made, and health economics can help in allocating limited health-care resources among unlimited wants and needs. Attempts to achieve cost reductions often focus on severe pathologies and chronic diseases as they commonly represent high health-care expenditures. In this context, awareness of the considerable financial burden caused by disease-related malnutrition (DRM) is lacking. Possibilities of reducing costs by optimising the management of DRM through medical nutrition will mostly not even be taken into account. During a European expert meeting, the total evaluation of medical nutrition was viewed and discussed. The aim of this meeting was to gain an experts' outline of the key issues relating to the health economic assessment of the use of medical nutrition. This article provides a summary of the observations per discussed item and describes the next steps suggested. PMID:25604774

  20. Approach, methods and results of an individual elicitation for the volcanism expert judgment panel

    SciTech Connect

    Crowe, B.M.

    1996-06-01

    Probabilistic volcanic hazard assessment (PVHA) of future magnetic disruption of the Yucca Mountain site was completed as a participating member of the volcanism export judgment panel conducted by Geomatrix Consultants for the Department of Energy. The purpose of this summary is to describe the data assumptions, methods, and results of the elicitation and to contrast this assessment with past volcanism studies conducted for the Yucca Mountain Project.

  1. Expert panel answers questions for Super Safety and Health Day at KSC.

    NASA Technical Reports Server (NTRS)

    1999-01-01

    A panel of NASA and contractor senior staff, plus officers from the 45th Space Wing, discuss safety- and health-related concerns in front of an audience of KSC employees as part of Super Safety and Health Day. Moderating at the podium is Loren Shriver, deputy director for Launch & Payload Processing. Seated left to right are Burt Summerfield, associate director of the Biomedical Office; Colonel William S. Swindling, commander, 45th Medical Group, Patrick Air Force Base, Fla.; Ron Dittemore, manager, Space Shuttle Programs, Johnson Space Center; Roy Bridges, Center Director; Col. Tom Deppe, vice commander, 45th Space Wing, Patrick Air Force Base; Jim Schoefield, program manager, Payload Ground Operations, Boeing; Bill Hickman, program manager, Space Gateway Support; and Ed Adamek, vice president and associate program manager for Ground Operations, United Space Alliance. Answering a question at the microphone on the floor is Dave King, director, Shuttle Processing. The panel was one of the presentations during KSC's second annual day-long dedication to safety. Most normal work activities were suspended to allow personnel to attend related activities. The theme, 'Safety and Health Go Hand in Hand,' emphasized KSC's commitment to place the safety and health of the public, astronauts, employees and space- related resources first and foremost. Events also included a keynote address, vendor exhibits, and safety training in work groups. The keynote address and panel session were also broadcast internally over NASA television.

  2. Expert panel answers questions for Super Safety and Health Day at KSC.

    NASA Technical Reports Server (NTRS)

    1999-01-01

    A panel of NASA and contractor senior staff, plus officers from the 45th Space Wing, discuss safety- and health-related concerns in front of an audience of KSC employees, as part of Super Safety and Health Day. Moderating at the podium is Loren Shriver, deputy director for Launch & Payload Processing. Seated left to right are Burt Summerfield, associate director of the Biomedical Office; Colonel William S. Swindling, commander, 45th Medical Group, Patrick Air Force Base, Fla.; Ron Dittemore, manager, Space Shuttle Programs, Johnson Space Center; Roy Bridges, Center Director; Col. Tom Deppe, vice commander, 45th Space Wing, Patrick Air Force Base; Jim Schoefield, program manager, Payload Ground Operations, Boeing; Bill Hickman, program manager, Space Gateway Support; and Ed Adamek, vice president and associate program manager for Ground Operations, United Space Alliance. The panel was one of the presentations during KSC's second annual day-long dedication to safety. Most normal work activities were suspended to allow personnel to attend related activities. The theme, 'Safety and Health Go Hand in Hand,' emphasized KSC's commitment to place the safety and health of the public, astronauts, employees and space-related resources first and foremost. Events also included a keynote address, vendor exhibits, and safety training in work groups. The keynote address and panel session were also broadcast internally over NASA television.

  3. Cognitive and Physical Demands of Activities of Daily Living In Older Adults: Validation of Expert Panel Ratings

    PubMed Central

    Fong, Tamara G.; Gleason, Lauren J.; Wong, Bonnie; Habtemariam, Daniel; Jones, Richard N.; Schmitt, Eva M.; de Rooij, Sophia E.; Saczynski, Jane S.; Gross, Alden L.; Bean, Jonathan F.; Brown, Cynthia J.; Fick, Donna M.; Gruber-Baldini, Ann L.; O’Connor, Margaret; Tabloski, Patrica A.; Marcantonio, Edward R.; Inouye, Sharon K.

    2015-01-01

    Background Difficulties with performance of functional activities may result from cognitive and/or physical impairments. To date, there has not been a clear delineation of the physical and cognitive demands of activities of daily living. Objectives To quantify the relative physical and cognitive demands required to complete typical functional activities in older adults. Design Expert panel survey. Setting Web-based platform. Participants Eleven experts from eight academic medical centers and 300 community dwelling elderly adults age 70 and older scheduled for elective non-cardiac surgery from two academic medical centers. Methods Sum scores of expert ratings were calculated and then validated against objective data collected from a prospective longitudinal study. Main Outcome Measurements Correlation between expert ratings and objective neuropsychological tests (memory, language, complex attention) and physical measures (gait speed and grip strength) for performance-based tasks. Results Managing money, self-administering medications, using the telephone, and preparing meals were rated as requiring significantly more cognitive demand, while walking and transferring, moderately strenuous activities, and climbing stairs were assessed as more physically demanding. Largely cognitive activities correlated with objective neuropsychological performance (r=0.13–0.23, p<.05) and largely physical activities correlated with physical performance (r=0.15–0.46, p<.05). Conclusions Quantifying the degree of cognitive and/or physical demand for completing a specific task adds an additional dimension to standard measures of functional assessment. This additional information may significantly influence decisions about rehabilitation, post-acute care needs, treatment plans, and caregiver education. PMID:25661463

  4. Enlargement Futures Project: Expert Panel on Technology, Knowledge and Learning. Final Report.

    ERIC Educational Resources Information Center

    Gourova, Elissaveta; Ducatel, Ken; Gavigan, James; Scapolo, Fabiana; Di Pietrogiacomo, Paola

    The next 10 years provide an opportunity for the European Union (EU) to renew the science and technology (S&T) base and build necessary knowledge-society capacities and capabilities in Pre-Accession Countries (PACs). Applied research has faced a major downsize; redressing the balance in the research and development systems is urgently needed.…

  5. Embryos without secrets: an expert panel study on comprehensive embryo testing and the responsibility of the clinician.

    PubMed

    Hens, Kristien; Dondorp, Wybo; de Wert, Guido

    2013-02-01

    The introduction of comprehensive testing techniques, such as microarray technology or whole genome sequencing, in embryo testing has the potential to change the practice of Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS). However, the extra information these procedures yield may potentially generate dilemmas for couples and professionals regarding the scope of the tests and the selection of the right embryo. In order to understand this complexity and reflect on its consequences, we organized two expert panels consisting of professionals working in the field of assisted reproduction and/or genetics. We found that there is great uncertainty amongst professionals how to tackle questions related to comprehensive screening, such as which conditions to test for and who should have the final say on which embryo to select, and a lack of a framework from which such questions can be answered. Moreover, the complexity of genetic information comprehensive tests may yield may make it impossible to select the best embryo altogether. PMID:23131419

  6. Toward Earlier Inclusion of Pregnant and Postpartum Women in Tuberculosis Drug Trials: Consensus Statements From an International Expert Panel.

    PubMed

    Gupta, Amita; Mathad, Jyoti S; Abdel-Rahman, Susan M; Albano, Jessica D; Botgros, Radu; Brown, Vikki; Browning, Renee S; Dawson, Liza; Dooley, Kelly E; Gnanashanmugam, Devasena; Grinsztejn, Beatriz; Hernandez-Diaz, Sonia; Jean-Philippe, Patrick; Kim, Peter; Lyerly, Anne D; Mirochnick, Mark; Mofenson, Lynne M; Montepiedra, Grace; Piper, Jeanna; Sahin, Leyla; Savic, Radojka; Smith, Betsy; Spiegel, Hans; Swaminathan, Soumya; Watts, D Heather; White, Amina

    2016-03-15

    Tuberculosis is a major cause of morbidity and mortality in women of childbearing age (15-44 years). Despite increased tuberculosis risk during pregnancy, optimal clinical treatment remains unclear: safety, tolerability, and pharmacokinetic data for many tuberculosis drugs are lacking, and trials of promising new tuberculosis drugs exclude pregnant women. To advance inclusion of pregnant and postpartum women in tuberculosis drug trials, the US National Institutes of Health convened an international expert panel. Discussions generated consensus statements (>75% agreement among panelists) identifying high-priority research areas during pregnancy, including: (1) preventing progression of latent tuberculosis infection, especially in women coinfected with human immunodeficiency virus; (2) evaluating new agents/regimens for treatment of multidrug-resistant tuberculosis; and (3) evaluating safety, tolerability and pharmacokinetics of tuberculosis drugs already in use during pregnancy and postpartum. Incorporating pregnant women into clinical trials would extend evidence-based tuberculosis prevention and treatment standards to this special population. PMID:26658057

  7. Expert Panel Workshop Consensus Statement on the Role of the Environment in the Development of Autoimmune Disease

    PubMed Central

    Parks, Christine G.; Miller, Frederick W.; Pollard, Kenneth Michael; Selmi, Carlo; Germolec, Dori; Joyce, Kelly; Rose, Noel R.; Humble, Michael C.

    2014-01-01

    Autoimmune diseases include 80 or more complex disorders characterized by self-reactive, pathologic immune responses in which genetic susceptibility is largely insufficient to determine disease onset. In September 2010, the National Institute of Environmental Health Sciences (NIEHS) organized an expert panel workshop to evaluate the role of environmental factors in autoimmune diseases, and the state of the science regarding relevant mechanisms, animal models, and human studies. The objective of the workshop was to analyze the existing data to identify conclusions that could be drawn regarding environmental exposures and autoimmunity and to identify critical knowledge gaps and areas of uncertainty for future study. This consensus document summarizes key findings from published workshop monographs on areas in which “confident” and “likely” assessments were made, with recommendations for further research. Transcribed notes and slides were reviewed to synthesize an overview on exposure assessment and questions addressed by interdisciplinary panels. Critical advances in the field of autoimmune disease research have been made in the past decade. Collaborative translational and interdisciplinary research is needed to elucidate the role of environmental factors in autoimmune diseases. A focus on exposure assessment methodology is needed to improve the effectiveness of human studies, and more experimental studies are needed to focus on causal mechanisms underlying observed associations of environmental factors with autoimmune disease in humans. PMID:25196523

  8. Meeting the public health challenge of protecting private wells: Proceedings and recommendations from an expert panel workshop.

    PubMed

    Fox, Mary A; Nachman, Keeve E; Anderson, Breeana; Lam, Juleen; Resnick, Beth

    2016-06-01

    Private wells serving fewer than 25 people are federally unregulated, and their users may be exposed to naturally occurring agents of concern such as arsenic and radionuclides, as well as anthropogenic contaminants. The Centers for Disease Control and Prevention's Clean Water for Health Program works to protect private wells and prevent adverse health outcomes for the roughly 15% of Americans who rely on them. To understand current and emerging challenges to the private drinking water supply, an interdisciplinary expert panel workshop on "Future and Emerging Issues for Private Wells" was organized to inform strategic planning for the Clean Water for Health Program. The panel assessed current conditions of ground water as a source for private wells, identified emerging threats, critical gaps in knowledge, and public health needs, and recommended strategies to guide future activities to ensure the safety of private drinking water wells. These strategies addressed topics of broad interest to the environmental public health community including: development of new methods to support citizen science; addressing contaminant mixtures; expanding capacity for well testing; evaluating treatment technologies; building an evidence base on best practices on well owner outreach and stewardship; and research and data needs. PMID:26950625

  9. Optimal Stroke Prevention in the Geriatric Patient with Atrial Fibrillation: Position Paper of an Interdisciplinary Expert Panel.

    PubMed

    Bahrmann, P; Wehling, M; Ropers, D; Flohr, J; Leischker, A; Röther, J

    2015-10-01

    The present position paper summarises the outcomes of an expert panel discussion held by hospital-based and office-based physicians with ample experience in the treatment of geriatric patients. The optimal approach to stroke prevention in geriatric patients with atrial fibrillation (AF) has not been adequately clarified. Despite their high risk of stroke and clear indication for anticoagulation according to established risk scores, in practice geriatric AF patients often are withheld treatment because of comorbidities and comedications, concerns about low treatment adherence or fear of bleeding events, in particular due to falls. The panel agreed that geriatric patients should receive oral anticoagulation as a rule, unless a comprehensive neurological and geriatric assessment (including clinical examination, gait tests and validated instruments such as Modified Rankin Scale, Mini-mental state examination or Timed Test of Money Counting) provides sound reasons for refraining from treatment. All patients with a history of falls should be thoroughly evaluated for further evaluation of the causes. Patients with CHADS2 score ≥ 2 should receive anticoagulation even if at high risk for falls. The novel oral anticoagulants (NOAC) facilitate management in the geriatric population with AF (no INR monitoring needed, easier bridging during interventions) and have, based on available data, an improved benefit-risk ratio compared to vitamin K antagonists. Drugs with predominantly non-renal elimination are safer in geriatric patients and should be preferred. PMID:25285794

  10. Clinical practice guidelines for the management of invasive Candida infections in adults in the Middle East region: Expert panel recommendations.

    PubMed

    Alothman, Adel F; Al-Musawi, Tariq; Al-Abdely, Hail M; Salman, Jameela Al; Almaslamani, Muna; Yared, Nadine; Butt, Adeel A; Raghubir, Nirvana; Morsi, Waleed El; Al Thaqafi, Abdulhakeem O

    2014-02-01

    Invasive Candida infections contribute to significant morbidity and mortality in patients with healthcare-associated infections. They represent a major burden on the public health system, and are challenging to diagnose and treat. A multidisciplinary expert panel critically reviewed available evidence to provide consensus recommendations for the management of invasive Candida infections in the Middle East. Based on diagnosis, recommendations were provided for the management of Candida infections in non-neutropenic and neutropenic patients. Polyenes (amphotericin B-deoxycholate [AmB-d] and lipid formulations amphotericin B [LFAmB]), triazoles (fluconazole, itraconazole and voriconazole), echinocandins (caspofungin, anidulafungin, and micafungin) and flucytosine are the recommended categories of antifungal agents for treatment of Candida infections. Echinocandins are preferred for treatment of proven and suspected Candida infections, especially in critically ill patients or those with previous exposure to azoles. Recommendations were also provided for infections caused by specific Candida species as well as management of different disease conditions. The experts highlighted that the guidelines should be used along with clinical judgment. Given the paucity of published data from the region, research in the form of randomized clinical trials should be given priority. PMID:24035607

  11. Probability encoding of hydrologic parameters for basalt. Elicitation of expert opinions from a panel of five consulting hydrologists

    SciTech Connect

    Runchal, A.K.; Merkhofer, M.W.; Olmsted, E.; Davis, J.D.

    1984-11-01

    The Columbia River basalts underlying the Hanford Site in Washington State are being considered as a possible location for a geologic repository for high-level nuclear waste. To investigate the feasibility of a repository at this site, the hydrologic parameters of the site must be evaluated. Among hydrologic parameters of particular interest are the effective porosity of the Cohassett basalt flow top and flow interior and the vertical-to-horizontal hydraulic conductivity, or anisotropy ratio, of the Cohassett basalt flow interior. The Cohassett basalt flow is the prime candidate horizon for repository studies. Site-specific data for these hydrologic parameters are currently inadequate for the purpose of preliminary assessment of candidate repository performance. To obtain credible, auditable, and independently derived estimates of the specified hydrologic parameters, a panel of five nationally recognized hydrologists was assembled. Their expert judgments were quantified during two rounds of Delphi process by means of a probability encoding method developed to estimate the probability distributions of the selected hydrologic variables. The results indicate significant differences of expert opinion for cumulative probabilities of less than 10% and greater than 90%, but relatively close agreement in the middle ranges of values. The principal causes of the diversity of opinion are believed to be the lack of site-specific data and the absence of a single, widely accepted, conceptual or theoretical basis for analyzing these variables.

  12. Food, plant food, and vegetarian diets in the US dietary guidelines: conclusions of an expert panel.

    PubMed

    Jacobs, David R; Haddad, Ella H; Lanou, Amy Joy; Messina, Mark J

    2009-05-01

    We summarize conclusions drawn from a panel discussion at the "Fifth International Congress on Vegetarian Nutrition" about the roles of and emphasis on food, plant food, and vegetarianism in current and future US dietary guidelines. The most general recommendation of the panel was that future dietary guidelines, following the lead of the 2005 Dietary Guidelines Advisory Committee, should emphasize food-based recommendations and thinking to the full extent that evidence allows. Although nutrient-based thinking and Dietary Reference Intakes (DRIs) may help ensure an adequate diet in the sense that deficiency states are avoided, the emphasis on DRIs may not capture many important nutritional issues and may inhibit a focus on foods. More generally, in the context of the conference on vegetarian nutrition, this report focuses on the history and structure of the Dietary Guidelines Advisory Committee, on various plant food-oriented recommendations that are supported by literature evidence, and on mechanisms for participating in the process of forming dietary guidelines. Among recommendations that likely would improve health and the environment, some are oriented toward increased plant food consumption and some toward vegetarianism. The literature on health effects of individual foods and whole lifestyle diets is insufficient and justifies a call for future food-oriented research, including expanding the evidence base for plant-based and vegetarian diets. The Dietary Guidelines Advisory Committee's role should be carried forward to creation of a publicly accessible icon (eg, the current pyramid) and related materials to ensure that the science base is fully translated for the public. PMID:19297463

  13. Definitions and outcome measures for bullous pemphigoid: Recommendations by an international panel of experts

    PubMed Central

    Murrell, Dedee F.; Daniel, Benjamin S.; Joly, Pascal; Borradori, Luca; Amagai, Masayuki; Hashimoto, Takashi; Caux, Frédéric; Marinovic, Branka; Sinha, Animesh A.; Hertl, Michael; Bernard, Philippe; Sirois, David; Cianchini, Giuseppe; Fairley, Janet A.; Jonkman, Marcel F.; Pandya, Amit G.; Rubenstein, David; Zillikens, Detlef; Payne, Aimee S.; Woodley, David; Zambruno, Giovanna; Aoki, Valeria; Pincelli, Carlo; Diaz, Luis; Hall, Russell P.; Meurer, Michael; Mascaro, Jose M.; Schmidt, Enno; Shimizu, Hiroshi; Zone, John; Swerlick, Robert; Mimouni, Daniel; Culton, Donna; Lipozencic, Jasna; Bince, Benjamin; Grando, Sergei A.; Bystryn, Jean-Claude; Werth, Victoria P.

    2011-01-01

    Our scientific knowledge of bullous pemphigoid (BP) has dramatically progressed in recent years. However, despite the availability of various therapeutic options for the treatment of inflammatory diseases, only a few multicenter controlled trials have helped to define effective therapies in BP. A major obstacle in sharing multicenter-based evidences for therapeutic efforts is the lack of generally accepted definitions for the clinical evaluation of patients with BP. Common terms and end points of BP are needed so that experts in the field can accurately measure and assess disease extent, activity, severity, and therapeutic response, and thus facilitate and advance clinical trials. These recommendations from the International Pemphigoid Committee represent 2 years of collaborative efforts to attain mutually acceptable common definitions for BP and proposes a disease extent score, the BP Disease Area Index. These items should assist in the development of consistent reporting of outcomes in future BP reports and studies. PMID:22056920

  14. European expert recommendations on the use of injectable poly-L-lactic acid for facial rejuvenation.

    PubMed

    Alessio, Redaelli; Rzany, Berthold; Eve, Linda; Grangier, Yann; Herranz, Pedro; Olivier-Masveyraud, Frédérique; Vleggaar, Danny

    2014-09-01

    Over the last few years, there have been a number of important changes in how we appreciate and understand the aging face. Volume loss is now recognized as a major component of facial aging. Treatment options that replace lost volume are increasingly used for recontouring and rejuvenation of the aging face. In this review we present and discuss the European Expert Group recommendations on the ideal use of the unique collagen stimulator, poly-L-lactic acid (PLLA, Sculptra®, Sinclair Pharmaceuticals) for facial rejuvenation lasting up to 25 months. Optimal results are achieved based on a detailed knowledge of facial anatomy, correct treatment procedure, specifically the right dilution, the correct injection technique, as well as appropriate patient aftercare. PLLA is an effective and safe collagen stimulator that treats the whole face. PLLA is simple to use, provides the foundation for facial rejuvenation, is easy to combine with other treatments, and gives long-lasting effects with a high level of patient satisfaction. PMID:25226006

  15. Towards earlier inclusion of Children in Tuberculosis (TB) drugs trials: Consensus statements from an Expert Panel

    PubMed Central

    Nachman, Sharon; Ahmed, Amina; Amanullah, Farhana; Becerra, Mercedes C; Botgros, Radu; Brigden, Grania; Browning, Renee; Gardiner, Elizabeth; Hafner, Richard; Hesseling, Anneke; How, Cleotilde; Jean-Philippe, Patrick; Lessem, Erica; Makhene, Mamodikoe; Mbelle, Nontombi; Marais, Ben; McIlleron, Helen; Mc Neeley, David F; Mendel, Carl; Murray, Stephen; Navarro, Eileen; Oramasionwu, Gloria E; Porcalla, Ariel R; Powell, Clydette; Powell, Mair; Rigaud, Mona; Rouzier, Vanessa; Samson, Pearl; Schaaf, H. Simon; Shah, Seema; Starke, Jeff; Swaminathan, Soumya; Wobudeya, Eric; Worrell, Carol

    2015-01-01

    Children represent a significant proportion of the global tuberculosis (TB) burden, and may be disproportionately more affected by its most severe clinical manifestations. Currently available treatments for pediatric drug-susceptible (DS) and drug-resistant (DR) TB, albeit generally effective, are hampered by high pill burden, long duration of treatment, coexistent toxicities, and an overall lack of suitable, child-friendly formulations. The complex and burdensome nature of administering the existing regimens to treat DS TB also contributes to the rise of DR TB strains. Despite the availability and use of these therapies for decades, a dearth of dosing evidence in children underscores the importance of sustained efforts for TB drug development to better meet the treatment needs of children with TB. Several new TB drugs and regimens with promising activity against both DS and DR TB strains have recently entered clinical development and are in various phases of clinical evaluation in adults or have received marketing authorization for adults. However, initiation of clinical trials to evaluate these drugs in children is often deferred, pending the availability of complete safety and efficacy data in adults or after drug approval. This document summarizes consensus statements from an international panel of childhood TB opinion leaders which support the initiation of evaluation of new TB drugs and regimens in children at earlier phases of the TB Drug development cycle. PMID:25957923

  16. NTP CENTER FOR THE EVALUATION OF RISKS TO HUMAN REPRODUCTION: PHTHALATES EXPERT PANEL REPORT ON THE REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF DI-N-HEXYL PHTHALATE

    EPA Science Inventory

    The phthalates are a family of environmentally important compounds with diverse uses. Reproductive toxicity has been demonstrated for some members of this family. The NTP Center for the Evaluation of Risk to Human Reproduction (CERHR) convened an expert panel charged with examini...

  17. NTP CENTER FOR THE EVALUATION OF RISKS TO HUMAN REPRODUCTION: PHTHALATES EXPERT PANEL REPORT ON THE REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF BUTYL BENZYL PHTHALATE

    EPA Science Inventory

    The phthalates are a family of environmentally important compounds with diverse uses. Reproductive toxicity has been demonstrated for some members of this family. The NTP Center for the Evaluation of Risk to Human Reproduction (CERHR) convened an expert panel charged with examini...

  18. Executive summary and conclusions from the European Hydration Institute Expert Conference on human hydration, health, and performance.

    PubMed

    Benton, D; Braun, H; Cobo, J C; Edmonds, C; Elmadfa, I; El-Sharkawy, A; Feehally, J; Gellert, R; Holdsworth, J; Kapsokefalou, M; Kenney, W L; Leiper, J B; Macdonald, I A; Maffeis, C; Maughan, R J; Shirreffs, S M; Toth-Heyn, P; Watson, P

    2015-09-01

    On April 7-8, 2014, the European Hydration Institute hosted a small group of experts at Castle Combe Manor House, United Kingdom, to discuss a range of issues related to human hydration, health, and performance. The meeting included 18 recognized experts who brought a wealth of experience and knowledge to the topics under review. Eight selected topics were addressed, with the key issues being briefly presented before an in-depth discussion. Presented here is the executive summary and conclusions from this meeting. PMID:26290300

  19. Aflibercept in wet AMD beyond the first year of treatment: recommendations by an expert roundtable panel

    PubMed Central

    McKibbin, M; Devonport, H; Gale, R; Gavin, M; Lotery, A; Mahmood, S; Patel, P J; Ross, A; Sivaprasad, S; Talks, J; Walters, G

    2015-01-01

    This supplement has been sponsored by Bayer HealthCare. Please see acknowledgements for full disclaimer. Prescribing Information can be found in the appendices. L.GB.COM.05.2015.11280. Date of preparation: June 2015 This paper provides expert recommendations on administration of aflibercept in wet age-related macular degeneration (AMD) after Year 1 (Y1), based on a roundtable discussion held in London, UK in November 2014. The goals of treatment after Y1 are to maintain visual and anatomical gains whilst minimising treatment burden and using resources effectively. The treatment decision should be made at the seventh injection visit (assuming the label has been followed) in Y1, and three approaches are proposed: (a) eyes with active disease on imaging/examination but with stable visual acuity (VA) at the end of Y1 should continue with fixed 8-weekly dosing; (b) eyes with inactive disease on imaging/examination and stable VA should be managed using a ‘treat and extend' (T&E) regimen. T&E involves treating and then extending the interval until the next treatment, by 2-week intervals, to a maximum of 12 weeks, provided the disease remains inactive. If there is new evidence of disease activity, treatment is administered and the interval to the next treatment shortened; and (c) if there has been no disease activity for ≥3 consecutive visits, a trial of monitoring without treatment may be appropriate, initiated at the end of Y1 or at any time during Y2. Where possible, VA testing, OCT imaging and injection should be performed at the same visit. The second eye should be monitored to detect fellow eye involvement. In bilateral disease, the re-treatment interval should be driven by the better-seeing eye or, if the VA is similar, the eye with the more active disease. PMID:26156564

  20. From current status to optimization of HCV treatment: Recommendations from an expert panel.

    PubMed

    Craxì, Antonio; Perno, Carlo Federico; Viganò, Mauro; Ceccherini-Silberstein, Francesca; Petta, Salvatore

    2016-09-01

    Chronic hepatitis C virus (HCV) infection is a major public health problem at a global level, causing an enormous burden of hepatic and extra-hepatic morbidity and mortality. Treatment of chronic HCV (CHC) has been revolutionized in the last few years by the introduction of highly effective and well tolerated direct acting antiviral agents (DAAs) able to achieve >90% rates of sustained virological response (SVR) in many groups of patients, including those previously excluded from interferon-based regimens. For such reason interferon-free regimens are now the treatments of choice for all patients. Successful anti-HCV treatment can stop liver disease progression and can solve the HCV-related extra hepatic manifestations, eventually reducing both liver-related and overall mortality. Together with the rapidly accumulating data about the evolution of treatment landscape, different guidelines from national and international Liver Scientific Societies have been published until today. However, these recommendations may not be applied worldwide as, due to high treatment costs, most of them identify as priority groups only patients with advanced liver disease. Moreover some types of patients pose clinical management problems for which even the guidelines do not always provide useful answers. With the aim of treatment optimization by filling some of the gaps of the current guidelines and addressing the remaining unmet needs in practice, a group of Italian experts, experienced on treatment of HCV infection, met in Stresa in February 2016. The summary of all the considerations arising from this two-day meeting and the final statements are reported in this position paper. PMID:27388261

  1. New approaches for the treatment of diabetic macular oedema: recommendations by an expert panel

    PubMed Central

    Bandello, F; Cunha-Vaz, J; Chong, N V; Lang, G E; Massin, P; Mitchell, P; Porta, M; Prünte, C; Schlingemann, R; Schmidt-Erfurth, U

    2012-01-01

    The current standard therapy for patients with diabetic macular oedema (DME)—focal/grid laser photocoagulation—usually does not improve impaired vision, and many patients lose vision despite laser therapy. Recent approval of ranibizumab by the European Medicines Agency to treat visual impairment due to DME fulfils the previously unmet medical need for a treatment that can improve visual acuity (VA) in these patients. We reviewed 1- and 2-year clinical trial findings for ranibizumab used as treatment for DME to formulate evidence-based treatment recommendations in the context of this new therapy. DME with or without visual impairment should be considered for treatment when it fulfils the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria for clinically significant oedema. For DME with centre involvement and associated vision loss due to DME, monthly ranibizumab monotherapy with treatment interruption and re-initiation based on VA stability is recommended. Laser therapy based on ETDRS guidelines is recommended for other forms of clinically significant DME without centre involvement or when no vision loss has occurred, despite centre involvement. Because these recommendations are based on randomised controlled trials of 1–2 years duration, guidance may need updating as long-term ranibizumab data become available and as additional therapeutic agents are assessed in clinical trials. PMID:22241014

  2. Statin intolerance - an attempt at a unified definition. Position paper from an International Lipid Expert Panel.

    PubMed

    Banach, Maciej; Rizzo, Manfredi; Toth, Peter P; Farnier, Michel; Davidson, Michael H; Al-Rasadi, Khalid; Aronow, Wilbert S; Athyros, Vasilis; Djuric, Dragan M; Ezhov, Marat V; Greenfield, Robert S; Hovingh, G Kees; Kostner, Karam; Serban, Corina; Lighezan, Daniel; Fras, Zlatko; Moriarty, Patrick M; Muntner, Paul; Goudev, Assen; Ceska, Richard; Nicholls, Stephen J; Broncel, Marlena; Nikolic, Dragana; Pella, Daniel; Puri, Raman; Rysz, Jacek; Wong, Nathan D; Bajnok, Laszlo; Jones, Steven R; Ray, Kausik K; Mikhailidis, Dimitri P

    2015-03-16

    Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin associated muscle symptoms (SAMS), and avoided the use of the term 'statin intolerance'. Although muscle syndromes are the most common adverse effects observed after statin therapy, excluding other side effects might underestimate the number of patients with statin intolerance, which might be observed in 10-15% of patients. In clinical practice, statin intolerance limits effective treatment of patients at risk of, or with, cardiovascular disease. Knowledge of the most common adverse effects of statin therapy that might cause statin intolerance and the clear definition of this phenomenon is crucial to effectively treat patients with lipid disorders. Therefore, the aim of this position paper was to suggest a unified definition of statin intolerance, and to complement the recent EAS statement on SAMS, where the pathophysiology, diagnosis and the management were comprehensively presented. PMID:25861286

  3. Ethical acceptability of research on human-animal chimeric embryos: summary of opinions by the Japanese Expert Panel on Bioethics.

    PubMed

    Mizuno, Hiroshi; Akutsu, Hidenori; Kato, Kazuto

    2015-01-01

    Human-animal chimeric embryos are embryos obtained by introducing human cells into a non-human animal embryo. It is envisaged that the application of human-animal chimeric embryos may make possible many useful research projects including producing three-dimensional human organs in animals and verification of the pluripotency of human ES cells or iPS cells in vivo. The use of human-animal chimeric embryos, however, raises several ethical and moral concerns. The most fundamental one is that human-animal chimeric embryos possess the potential to develop into organisms containing human-derived tissue, which may lead to infringing upon the identity of the human species, and thus impairing human dignity. The Japanese Expert Panel on Bioethics in the Cabinet Office carefully considered the scientific significance and ethical acceptability of the issue and released its "Opinions regarding the handling of research using human-animal chimeric embryos". The Panel proposed a framework of case-by-case review, and suggested that the following points must be carefully reviewed from the perspective of ethical acceptability: (a) Types of animal embryos and types of animals receiving embryo transfers, particularly in dealing with non-human primates; (b) Types of human cells and organs intended for production, particularly in dealing with human nerve or germ cells; and (c) Extent of the period required for post-transfer studies. The scientific knowledge that can be gained from transfer into an animal uterus and from the production of an individual must be clarified to avoid unnecessary generation of chimeric animals. The time is ripe for the scientific community and governments to start discussing the ethical issues for establishing a global consensus. PMID:26694481

  4. Interventions to Mitigate Emergency Department and Hospital Crowding During an Infectious Respiratory Disease Outbreak: Results from an Expert Panel

    PubMed Central

    Dugas, Andrea Freyer; Morton, Melinda; Beard, Raphaelle; Pines, Jesse M.; Bayram, Jamil D.; Hsieh, Yu-Hsiang; Kelen, Gabor; Uscher-Pines, Lori; Jeng, Kevin; Cole, Gai; Rothman, Richard

    2013-01-01

    Objective: To identify and prioritize potential Emergency Department (ED) and hospital-based interventions which could mitigate the impact of crowding during patient surge from a widespread infectious respiratory disease outbreak and determine potential data sources that may be useful for triggering decisions to implement these high priority interventions. Design: Expert panel utilizing Nominal Group Technique to identify and prioritize interventions, and in addition, determine appropriate “triggers” for implementation of the high priority interventions in the context of four different infectious respiratory disease scenarios that vary by patient volumes (high versus low) and illness severity (high versus low). Setting: One day in-person conference held November, 2011. Participants: Regional and national experts representing the fields of public health, disease surveillance, clinical medicine, ED operations, and hospital operations. Main Outcome Measure: Prioritized list of potential interventions to reduce ED and hospital crowding, respectively. In addition, we created a prioritized list of potential data sources which could be useful to trigger interventions. Results: High priority interventions to mitigate ED surge included standardizing admission and discharge criteria and instituting infection control measures. To mitigate hospital crowding, panelists prioritized mandatory vaccination and an algorithm for antiviral use. Data sources identified for triggering implementation of these interventions were most commonly ED and hospital utilization metrics. Conclusions: We developed a prioritized list of potentially useful interventions to mitigate ED and hospital crowding in various outbreak scenarios. The data sources identified to “trigger” the implementation of these high priority interventions consist mainly of sources available at the local, institutional level. PMID:23856917

  5. Topical antifungal-corticosteroid combination therapy for the treatment of superficial mycoses: conclusions of an expert panel meeting.

    PubMed

    Schaller, Martin; Friedrich, Markus; Papini, Manuela; Pujol, Ramon M; Veraldi, Stefano

    2016-06-01

    Superficial fungal infections affect 20-25% of people worldwide and can cause considerable morbidity, particularly if an inflammatory component is present. As superficial fungal infections can be diverse, the treatment should be tailored to the individual needs of the patient and several factors should be taken into account when deciding on the most appropriate treatment option. These include the type, location and surface area of the infection, patient age, degree of inflammation and underlying comorbidities. Although several meta-analyses have shown that there are no significant differences between the numerous available topical antifungal agents with regard to mycological cure, agents differ in their specific intrinsic properties, which can affect their clinical use. The addition of a corticosteroid to an antifungal agent at the initiation of treatment can attenuate the inflammatory symptoms of the infection and is thought to increase patient compliance, reduce the risk of bacterial superinfection and enhance the efficacy of the antifungal agent. However, incorrect use of antifungal-corticosteroid therapy may be associated with treatment failure and adverse effects. This review summarises available treatment options for superficial fungal infections and provides general treatment recommendations based on the consensus outcomes of an Expert Panel meeting on the topical treatment of superficial mycoses. PMID:26916648

  6. [The frequency of medical malpractice: the results of the German Expert Panels and Arbitration Boards for Medical Liability].

    PubMed

    Schaffartzik, Walter; Neu, Johann

    2008-01-01

    The Gutachterkommissionen and Schlichtungsstellen in Germany (Expert Panels and Arbitration Boards for Medical Liability) were founded in the 1970s in order to serve as an institution other than the courts where suspected incidents of malpractice can be evaluated. The "Medical Error Reporting System" (MERS) was developed by the North German Schlichtungsstelle. The data it provides serve as the basis for the national statistics published by the Bundesärztekammer (German Medical Association). 7201 factual decisions were made. In 5074 proceedings no malpractice cases or risk disclosure problems were discovered, while in 2127 proceedings either of the two problems was noticed, and in 1,683 proceedings these problems were rated as being causative in the claimed harm and led to the recommendation to grant financial compensation to the patient. The MERS data reveal that most of the diagnoses which led patients to file a claim with the Gutachterkommissionen and Schlichtungsstellen referred to orthopaedics and traumatology and in the majority of cases reproaches were directed at surgical therapy. Doctors must strive to minimise malpractice and harm caused by medical treatment. With the help of the national statistics of the Bundesärztekammer derived from MERS the doctor can easily access information on cases of medical malpractice and harm in his or her discipline. This knowledge helps to foresee risks in a patient's treatment and to avoid errors. PMID:19213444

  7. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007.

    PubMed

    2007-11-01

    Highlights of the National Asthma Education and Prevention Program's Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Full Report 2007 are presented in this EPR-3 summary report. The updated guidelines emphasize the importance of asthma control. Asthma control is the degree to which the manifestations of asthma are minimized by therapeutic intervention and the goals of therapy are met. Because asthma is highly variable, the level of control must be monitored on a periodic basis to determine whether therapy should be maintained or adjusted (stepped up if necessary, stepped down if possible). On the other hand, asthma severity is the intrinsic intensity of the disease process, most easily and directly measured in a patient not receiving long-term control therapy. For managing asthma, the recommendation is to assess severity to initiate therapy and assess control to adjust therapy. Recommendations for managing asthma include an expanded section on childhood asthma with addition of an age group 5 to 11 years old (earlier guidelines combined this group with adults). The guidelines provide new recommendations on patient education in settings beyond the physician's office, and new advice for controlling environmental factors that can cause asthma symptoms. The concepts of current impairment (frequency and intensity of symptoms, low lung function, and limitations of daily activities) and future risk (likelihood of exacerbations, progressive loss of lung function, or adverse side effects from medications) support a new approach to assessing and monitoring the patient's level of asthma control through use of multiple measures. The guidelines stress that some patients can still be at high risk for frequent exacerbations even if they have few day-to-day effects of asthma.Moreover, EPR-3 confirms the importance of teaching patients skills to self-monitor and manage asthma and to use a written asthma action plan, which should include

  8. Regulatory considerations surrounding the deployment of Bt-expressing cowpea in Africa: report of the deliberations of an expert panel.

    PubMed

    Huesing, Joseph; Romeis, Jörg; Ellstrand, Norman; Raybould, Alan; Hellmich, Richard; Wolt, Jeff; Ehlers, Jeff; Dabiré, Clémentine; Fatokun, Christian; Hokanson, Karen; Ishiyaku, Mohammad F; Margam, Venu; Obokoh, Nompumelelo; Mignouna, Jacob; Nangayo, Francis; Ouedraogo, Jeremy; Pasquet, Rémy; Pittendrigh, Barry; Schaal, Barbara; Stein, Jeff; Tamò, Manuele; Murdock, Larry

    2011-01-01

    Cowpea (Vigna unguiculata spp unguiculata) is adapted to the drier agro-ecological zones of West Africa where it is a major source of dietary protein and widely used as a fodder crop. Improving the productivity of cowpea can enhance food availability and security in West Africa. Insect predation--predominately from the legume pod borer (Maruca vitrata), flower thrips (Megalurothrips sjostedti) and a complex of pod-sucking bugs (e.g., Clavigralla spp)--is a major yield-limiting factor in West African cowpea production. Dramatic increases in yield are shown when M. vitrata is controlled with insecticides. However, availability, costs, and safety considerations limit pesticides as a viable option for boosting cowpea production. Development of Bt-cowpea through genetic modification (GM) to control the legume pod borer is a promising approach to cowpea improvement. Cowpea expressing the lepidopteran-active Cry1Ab protein from Bacillus thuringiensis is being developed as a first generation Bt-cowpea crop for West Africa. Appropriate stewardship of Bt-cowpea to assure its sustainability under West African conditions is critical to its successful development. A first step in this process is an environmental risk assessment to determine the likelihood and magnitude of adverse effects of the Cry1Ab protein on key environmental protection goals in West Africa. Here we describe the results of an expert panel convened in 2009 to develop the problem formulation phase for Bt-cowpea and to address specific issues around gene flow, non-target arthropods, and insect resistance management. PMID:22179194

  9. Prioritisation of wildlife pathogens to be targeted in European surveillance programmes: Expert-based risk analysis focus on ruminants.

    PubMed

    Ciliberti, Alexandre; Gavier-Widén, Dolores; Yon, Lisa; Hutchings, Mike R; Artois, Marc

    2015-03-01

    This study attempted to develop a list of priority pathogens. It is part of a European Union (EU) project dedicated to the surveillance of emerging or re-emerging pathogens of wildlife. Partners of the consortium established an initial list of 138 pathogens of concern, which was reduced to a smaller list of 65 pathogens likely to affect ruminants (i.e., the most costly animal group in the EU over the last 15 years). These 65 pathogens underwent a two-step, expert-based risk analysis: 92 experts graded them with respect to their global importance for animal welfare, species conservation, trade/economic impacts and public health. In step 2, the top 15 pathogens from step 1 were assessed by 69 experts considering seven weighted epidemiological criteria (pathogen variability, host specificity, potential for contagion, speed of spread, presence in Europe, difficulty of surveillance in wildlife and persistence in the environment) for which four options were possible. The responses concerned a wide geographic coverage. The resulting top-list pathogens were ranked as follows: 1. Salmonella enterica, 2. Coxiella burnetii, 3. foot-and-mouth disease virus, 4. Mycobacterium bovis, 5. bluetongue virus, and 6. European tick-borne encephalitis virus. The influence of the characteristics of the respondents, the importance of the levels of uncertainty/variability and the implication of the results are discussed. This work highlights the relevance of developing such lists for preparedness. PMID:25496774

  10. Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus.

    PubMed

    Cairo, Mitchell S; Coiffier, Bertrand; Reiter, Alfred; Younes, Anas

    2010-05-01

    Tumour lysis syndrome (TLS) is a life-threatening oncological emergency characterized by metabolic abnormalities including hyperuricaemia, hyperphosphataemia, hyperkalaemia and hypocalcaemia. These metabolic complications predispose the cancer patient to clinical toxicities including renal insufficiency, cardiac arrhythmias, seizures, neurological complications and potentially sudden death. With the increased availability of newer therapeutic targeted agents, such as rasburicase (recombinant urate oxidase), there are no published guidelines on the risk classification of TLS for individual patients at risk of developing this syndrome. We convened an international TLS expert consensus panel to develop guidelines for a medical decision tree to assign low, intermediate and high risk to patients with cancer at risk for TLS. Risk factors included biological evidence of laboratory TLS (LTLS), proliferation, bulk and stage of malignant tumour and renal impairment and/or involvement at the time of TLS diagnosis. An international TLS consensus expert panel of paediatric and adult oncologists, experts in TLS pathophysiology and experts in TLS prophylaxis and management, developed a final model of low, intermediate and high risk TLS classification and associated TLS prophylaxis recommendations. PMID:20331465

  11. Health Experts’ Opinions about Tobacco Control Activities in Iran: Results from a Delphi Panel of National Experts

    PubMed Central

    Sharifi, Hooman; Masjedi, Mohammad Reza

    2012-01-01

    Background Iran signed the Framework Convention on Tobacco Control on June 16, 2003 and it was ratified by the parliament and the House of Representatives on November 6, 2005. Finally, it came into force on February 4, 2006. In this study, we aimed to evaluate health experts’ opinion about tobacco control activities in Iran. Materials and Methods This was a qualitative case study. We used a series of open-ended questionnaires to assess important information regarding Iranian National Tobacco Control law and FCTC implementation. The study population comprised of health experts. Use of this method ensured the validity of questionnaires’ contents. The first round of the questionnaire had been pre-tested in a pilot study. The final structure and lay out of questionnaires consisted of three main parts. The first part was designed with 7 multiple choice questions. Participants were able to rank answers from five (the most important) to one (the least important). The second part comprised four questions mainly on National Tobacco Control Program (NTCP) and the final part was about FCTC. Data collection was carried out between May 2010 and May 2011. In the analysis process each interview was considered as a separate case and then compared to other cases to ascertain variations in answers. Results All 40 members (100%) of the panel completed the entire process. All the participants had a consensus on tobacco control program in Iran. They believed the prevention programs to be important priorities in this regard. Tobacco Company as a governmental organization is believed to be the main barrier against tobacco control activities in Iran, and banning sales of tobacco to minors and controlling its smuggling are important factors for decreasing the supply of tobacco products. It is essential to implement comprehensive tobacco control law in Iran. Conclusion It is essential to implement comprehensive tobacco control law in Iran that covers all the priorities mentioned above

  12. Biofuels and Food Security. A report by the High Level Panel of Experts on Food Security and Nutrition

    SciTech Connect

    2013-06-15

    In October 2011, the UN Committee on World Food Security (CFS) recommended a ''review of biofuels policies -- where applicable and if necessary -- according to balanced science-based assessments of the opportunities and challenges that they may represent for food security so that biofuels can be produced where it is socially, economically and environmentally feasible to do so''. In line with this, the CFS requested the HLPE (High Level Panel of Experts) to ''conduct a science-based comparative literature analysis taking into consideration the work produced by the FAO and Global Bioenergy Partnership (GBEP) of the positive and negative effects of biofuels on food security''. Recommendations from the report include the following. Food security policies and biofuel policies cannot be separated because they mutually interact. Food security and the right to food should be priority concerns in the design of any biofuel policy. Governments should adopt the principle: biofuels shall not compromise food security and therefore should be managed so that food access or the resources necessary for the production of food, principally land, biodiversity, water and labour are not put at risk. The CFS should undertake action to ensure that this principle is operable in the very varied contexts in which all countries find themselves. Given the trend to the emergence of a global biofuels market, and a context moving from policy-driven to market-driven biofuels, there is an urgent need for close and pro-active coordination of food security, biofuel/bioenergy policies and energy policies, at national and international levels, as well as rapid response mechanisms in case of crisis. There is also an urgent need to create an enabling, responsible climate for food and non-food investments compatible with food security. The HLPE recommends that governments adopt a coordinated food security and energy security strategy, which would require articulation around the following five axes

  13. Sequencing an Ashkenazi reference panel supports population-targeted personal genomics and illuminates Jewish and European origins.

    PubMed

    Carmi, Shai; Hui, Ken Y; Kochav, Ethan; Liu, Xinmin; Xue, James; Grady, Fillan; Guha, Saurav; Upadhyay, Kinnari; Ben-Avraham, Dan; Mukherjee, Semanti; Bowen, B Monica; Thomas, Tinu; Vijai, Joseph; Cruts, Marc; Froyen, Guy; Lambrechts, Diether; Plaisance, Stéphane; Van Broeckhoven, Christine; Van Damme, Philip; Van Marck, Herwig; Barzilai, Nir; Darvasi, Ariel; Offit, Kenneth; Bressman, Susan; Ozelius, Laurie J; Peter, Inga; Cho, Judy H; Ostrer, Harry; Atzmon, Gil; Clark, Lorraine N; Lencz, Todd; Pe'er, Itsik

    2014-01-01

    The Ashkenazi Jewish (AJ) population is a genetic isolate close to European and Middle Eastern groups, with genetic diversity patterns conducive to disease mapping. Here we report high-depth sequencing of 128 complete genomes of AJ controls. Compared with European samples, our AJ panel has 47% more novel variants per genome and is eightfold more effective at filtering benign variants out of AJ clinical genomes. Our panel improves imputation accuracy for AJ SNP arrays by 28%, and covers at least one haplotype in ≈ 67% of any AJ genome with long, identical-by-descent segments. Reconstruction of recent AJ history from such segments confirms a recent bottleneck of merely ≈ 350 individuals. Modelling of ancient histories for AJ and European populations using their joint allele frequency spectrum determines AJ to be an even admixture of European and likely Middle Eastern origins. We date the split between the two ancestral populations to ≈ 12-25 Kyr, suggesting a predominantly Near Eastern source for the repopulation of Europe after the Last Glacial Maximum. PMID:25203624

  14. Sequencing an Ashkenazi reference panel supports population-targeted personal genomics and illuminates Jewish and European origins

    PubMed Central

    Carmi, Shai; Hui, Ken Y.; Kochav, Ethan; Liu, Xinmin; Xue, James; Grady, Fillan; Guha, Saurav; Upadhyay, Kinnari; Ben-Avraham, Dan; Mukherjee, Semanti; Bowen, B. Monica; Thomas, Tinu; Vijai, Joseph; Cruts, Marc; Froyen, Guy; Lambrechts, Diether; Plaisance, Stéphane; Van Broeckhoven, Christine; Van Damme, Philip; Van Marck, Herwig; Barzilai, Nir; Darvasi, Ariel; Offit, Kenneth; Bressman, Susan; Ozelius, Laurie J.; Peter, Inga; Cho, Judy H.; Ostrer, Harry; Atzmon, Gil; Clark, Lorraine N.; Lencz, Todd; Pe’er, Itsik

    2014-01-01

    The Ashkenazi Jewish (AJ) population is a genetic isolate close to European and Middle Eastern groups, with genetic diversity patterns conducive to disease mapping. Here we report high-depth sequencing of 128 complete genomes of AJ controls. Compared with European samples, our AJ panel has 47% more novel variants per genome and is eightfold more effective at filtering benign variants out of AJ clinical genomes. Our panel improves imputation accuracy for AJ SNP arrays by 28%, and covers at least one haplotype in ≈67% of any AJ genome with long, identical-by-descent segments. Reconstruction of recent AJ history from such segments confirms a recent bottleneck of merely ≈350 individuals. Modelling of ancient histories for AJ and European populations using their joint allele frequency spectrum determines AJ to be an even admixture of European and likely Middle Eastern origins. We date the split between the two ancestral populations to ≈12–25 Kyr, suggesting a predominantly Near Eastern source for the repopulation of Europe after the Last Glacial Maximum. PMID:25203624

  15. Expert Views on the Implementation of Teacher Professional Development in European Countries

    ERIC Educational Resources Information Center

    Lipowski, Katrin; Jorde, Doris; Prenzel, Manfred; Seidel, Tina

    2011-01-01

    International comparisons in science (and mathematics) education show the relevance of teaching quality for learning outcomes. Teacher professional development (TPD) is hence considered particularly relevant for improving teaching and learning in science. The study at hand is part of a European network initiative named Mind the Gap that explores…

  16. SUMMARY AND RECOMMENDATIONS OF THE EXPERT PANEL OVERSIGHT COMMITTEE MEETING ON DOUBLE-SHELL TANK CORROSION MONITORING AND TESTING HELD AUGUST 4-5 2008

    SciTech Connect

    BOOMER KD

    2009-01-08

    The Expert Panel Oversight Committee (EPOC) on Double-Shell Tank Corrosion Monitoring and Testing has been overseeing the Fiscal Year FY 2008 experimental program being performed at CC Technologies (CCT) to optimize the chemistry control for corrosion limits in Double-Shell Tanks (DSTs). The EPOC met at the M & D Professional Services Conference Facility on August 4 and 5, 2008 to discuss various aspects of that responsibility including FY 2009 planning. Formal presentations were made to update the EPOC on the these subjects.

  17. Diagnostic procedures for non-small-cell lung cancer (NSCLC): recommendations of the European Expert Group

    PubMed Central

    Dietel, Manfred; Bubendorf, Lukas; Dingemans, Anne-Marie C; Dooms, Christophe; Elmberger, Göran; García, Rosa Calero; Kerr, Keith M; Lim, Eric; López-Ríos, Fernando; Thunnissen, Erik; Van Schil, Paul E; von Laffert, Maximilian

    2016-01-01

    Background There is currently no Europe-wide consensus on the appropriate preanalytical measures and workflow to optimise procedures for tissue-based molecular testing of non-small-cell lung cancer (NSCLC). To address this, a group of lung cancer experts (see list of authors) convened to discuss and propose standard operating procedures (SOPs) for NSCLC. Methods Based on earlier meetings and scientific expertise on lung cancer, a multidisciplinary group meeting was aligned. The aim was to include all relevant aspects concerning NSCLC diagnosis. After careful consideration, the following topics were selected and each was reviewed by the experts: surgical resection and sampling; biopsy procedures for analysis; preanalytical and other variables affecting quality of tissue; tissue conservation; testing procedures for epidermal growth factor receptor, anaplastic lymphoma kinase and ROS proto-oncogene 1, receptor tyrosine kinase (ROS1) in lung tissue and cytological specimens; as well as standardised reporting and quality control (QC). Finally, an optimal workflow was described. Results Suggested optimal procedures and workflows are discussed in detail. The broad consensus was that the complex workflow presented can only be executed effectively by an interdisciplinary approach using a well-trained team. Conclusions To optimise diagnosis and treatment of patients with NSCLC, it is essential to establish SOPs that are adaptable to the local situation. In addition, a continuous QC system and a local multidisciplinary tumour-type-oriented board are essential. PMID:26530085

  18. The effect of income growth and inequality on health inequality: Theory and empirical evidence from the European Panel.

    PubMed

    Van Ourti, Tom; van Doorslaer, Eddy; Koolman, Xander

    2009-05-01

    Governments of EU countries have declared that they would like to couple income growth with reductions in social inequalities in income and health. We show that, theoretically, both aims can be reconciled only under very specific conditions concerning the type of growth and the income responsiveness of health. We investigate whether these conditions were met in Europe in the 1990s using panel data from the European Community Household Panel. We demonstrate that (i) in most countries, the income elasticity of health was positive and increases with income, and (ii) that income growth was not pro-rich in most EU countries, resulting in small or negligible reductions in income inequality. The combination of both findings explains the modest increases we observe in income-related health inequality in the majority of countries. PMID:19185942

  19. 77 FR 15753 - Request for Nominations of Experts for a Science Advisory Board Panel To Review EPA's Web-Based...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-16

    ... Report on the Environment AGENCY: Environmental Protection Agency (EPA). ACTION: Notice. SUMMARY: The EPA... panel to review the Agency's Web-based Report on the Environment. DATES: Nominations should be submitted... Web-based Report on the Environment (ROE) has been developed to provide a comprehensive online...

  20. Impella ventricular support in clinical practice: Collaborative viewpoint from a European expert user group.

    PubMed

    Burzotta, Francesco; Trani, Carlo; Doshi, Sagar N; Townend, Jonathan; van Geuns, Robert Jan; Hunziker, Patrick; Schieffer, Bernhard; Karatolios, Konstantinos; Møller, Jacob Eifer; Ribichini, Flavio L; Schäfer, Andreas; Henriques, José P S

    2015-12-15

    Mechanical circulatory support represents an evolving field of clinical research and practice. Currently, several cardiac assist devices have been developed but, among different institutions and countries, a large variation in indications for use and device selection exists. The Impella platform is an easy to use percutaneous circulatory support device which is increasingly used worldwide. During 2014, we established a working group of European physicians who have collected considerable experience with the Impella device in recent years. By critically comparing the individual experiences and the operative protocols, this working group attempted to establish the best clinical practice with the technology. The present paper reviews the main theoretical principles of Impella and provides an up-to-date summary of the best practical aspects of device use which may help others gain the maximal advantage with Impella technology in a variety of clinical settings. PMID:26363632

  1. Summary of conclusions from a consensus panel of experts on health attributes of lactic cultures: significance to fluid milk products containing cultures.

    PubMed

    Sanders, M E

    1993-07-01

    A panel of experts sponsored by the California Dairy Research Foundation was convened on January 31, 1992 to discuss the effect of the consumption of lactic cultures on human health. The panel was composed of 10 scientists with diverse applicable specialties. Topics discussed included lactose digestion, diarrheal diseases, chronic kidney disease, cancer, adherence, immune system stimulation, cholesterol reduction, constipation, and safety. Legitimacy of health claims and research needs for these areas were determined. The panel noted the promising results in the areas of positive effects of ingestion of lactic cultures on lactose digestion, some diarrheal illnesses, small bowel overgrowth associated with chronic kidney disease, and reduction of fecal enzymes that may play a role in colon cancer. However, additional research is necessary to confirm the effects in all of these areas. A coordinated research effort between microbiologists and clinicians is essential for the most effective research to ensure the choice of best available strains, the best conditions of analysis, and the best clinical models. PMID:8345120

  2. Epidemic threats to the European Union: expert views on six virus groups.

    PubMed

    Kelly, L; Brouwer, A; Wilson, A; Gale, P; Snary, E; Ross, David; de Vos, C J

    2013-08-01

    In recent years, several animal disease epidemics have occurred within the European Union (EU). At the 4th Annual Meeting of the EPIZONE network (7-10 June 2010, St. Malo, France), an interactive session was run to elicit the opinions of delegates on a pre-defined list of epidemic threats to the EU. Responses from over 190 delegates, to questions relating to impact and likelihood, were used to rank six virus groups with respect to their perceived threat now (2010) and in 2020. The combined opinions of all delegates suggested that, from the pre-selected list of virus groups, foot-and-mouth disease and influenza are currently of most concern. Delegates thought that influenza would be less of a threat and zoonotic arboviruses would be more of a threat in 2020. Although the virus group rankings should not be taken as definitive, the results could be used in conjunction with experimental and field data, by scientists, policy-makers and stakeholders when assessing and managing risks associated with these virus groups. PMID:22762483

  3. End-of-Life Decision-Making in Canada: The Report by the Royal Society of Canada Expert Panel on End-of-Life Decision-Making

    PubMed Central

    Schüklenk, Udo; Van Delden, Johannes J M; Downie, Jocelyn; Mclean, Sheila A M; Upshur, Ross; Weinstock, Daniel

    2011-01-01

    This report on end-of-life decision-making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters. Chapter 1 reviews what is known about end-of-life care and opinions about assisted dying in Canada. Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death. Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order. Chapter 4 reviews the experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form. Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. PMID:22085416

  4. Using the dynamic indicators of basic early literacy skills with students who are deaf or hard of hearing: perspectives of a panel of experts.

    PubMed

    Luckner, John L

    2013-01-01

    Early literacy skills serve as the foundation for the development of subsequent reading skills and strategies. Increasingly, educators are administering early literacy assessments to identify young students who are at risk for reading failure and providing them with additional evidence based interventions. The most widely used assessments for reading in preschools and elementary schools for typical hearing students are the Dynamic Indicators of Basic Early Literacy Skills (DIBELS). The purpose of this study was to gather the perceptions of a panel of experts in the area of reading and individuals who are deaf or hard of hearing regarding the potential appropriateness of using the subtests of the DIBELS with students who are deaf or hard of hearing. Results, as well as practical and research implications, are provided. PMID:23858700

  5. Management of adult patients with Langerhans cell histiocytosis: recommendations from an expert panel on behalf of Euro-Histio-Net

    PubMed Central

    2013-01-01

    Langerhans Cell Histiocytosis (LCH) is an orphan disease of clonal dendritic cells which may affect any organ of the body. Most of the knowledge about the diagnosis and therapy is based on pedriatic studies. Adult LCH patients are often evaluated by physicians who focus on only the most obviously affected organ without sufficient evaluation of other systems, resulting in patients being underdiagnosed and/or incompletely staged. Furthermore they may be treated with pediatric-based therapies which are less effective and sometimes more toxic for adults. The published literature on adult LCH cases lacks a comprehensive discussion on the differences between pediatric and adult patients and there are no recommendations for evaluation and comparative therapies. In order to fill this void, a number of experts in this field cooperated to develop the first recommendations for management of adult patients with LCH. Key questions were selected according to the clinical relevance focusing on diagnostic work up, therapy, and follow up. Based on the available literature up to December 2012, recommendations were established, drafts were commented by the entire group, and redrafted by the executive editor. The quality of evidence of the recommendations is predominantly attributed to the level of expert opinion. Final agreement was by consensus. PMID:23672541

  6. WTEC panel report on European nuclear instrumentation and controls. Final report

    SciTech Connect

    White, J.D.; Lanning, D.D.; Beltracchi, L.; Best, F.R.; Easter, J.R.

    1991-12-01

    A study of instrumentation and controls (I and C) technology used in nuclear power plants in Europe was conducted by a panel of American specialists. The study included a review of the literature on the subject, followed by a visit to some of the leading organizations in Europe in the field of nuclear I and C. The findings of the study are presented in the report. The scope is limited to pressurized water reactors in Czechoslovakia, France, Germany, Norway and Russia. Specific topics include: The role of the operator and control room design; the transition from analog to digital technology; computerized operator support systems for fault management; control strategies and techniques; an investigation of nuclear power plant I and C architecture; instrumentation; computer standards and tools. A companion study is JTEC Panel Report on Nuclear Power in Japan (PB90-215724).

  7. WTEC panel report on European nuclear instrumentation and controls. Final report

    SciTech Connect

    White, J.D.; Lanning, D.D.; Johnson, P.M.H.; Shelton, R.D.

    1991-12-01

    A study of instrumentation and controls (I and C) technology used in nuclear power plants in Europe was conducted by a panel of US specialists. This study plants in Europe was conducted by a panel of US specialists. This study included a review of the literature on the subject, followed by a visit to some of the leading organizations in Europe in the field nuclear I and C. Areas covered are: (1) role of the operator and control room design; (2) transition from analog to digital technology; (3) computerized operator support systems for fault management; (4) control strategies and techniques; (5) Nuclear power plant I and C architecture; (6) instrumentation and (7) computer standards and tools. The finding relate to poor reactions.

  8. Estimates of the solubilities of waste element radionuclides in waste isolation pilot plant brines: A report by the expert panel on the source term

    SciTech Connect

    Hobart, D.E. |; Bruton, C.J. |; Millero, F.J. |; Chou, I.M. |; Trauth, K.M.; Anderson, D.R.

    1996-05-01

    Evaluation of the long-term performance of the WIPP includes estimation of the cumulative releases of radionuclide elements to the accessible environment. Nonradioactive lead is added because of the large quantity expected in WIPP wastes. To estimate the solubilities of these elements in WIPP brines, the Panel used the following approach. Existing thermodynamic data were used to identify the most likely aqueous species in solution through the construction of aqueous speciation diagrams. Existing thermodynamic data and expert judgment were used to identify potential solubility-limiting solid phases. Thermodynamic data were used to calculate the activities of the radionuclide aqueous species in equilibrium with each solid. Activity coefficients of the radionuclide-bearing aqueous species were estimated using Pitzer`s equations. These activity coefficients were then used to calculate the concentration of each radionuclide at the 0.1 and 0.9 fractiles. The 0.5 fractile was chosen to represent experimental data with activity coefficient corrections as described above. Expert judgment was used to develop the 0.0, 0.25, 0.75, and 1.0 fractiles by considering the sensitivity of solubility to the potential variability in the composition of brine and gas, and the extent of waste contaminants, and extending the probability distributions accordingly. The results were used in the 1991 and 1992 performance assessment calculations. 68 refs.

  9. An exploration of the barriers to the confident diagnosis of irritable bowel syndrome: A survey among general practitioners, gastroenterologists and experts in five European countries

    PubMed Central

    Whorwell, Peter; Fortea, Josep; Auzière, Sébastien

    2015-01-01

    Background The diagnostic processes for chronic abdominal conditions are challenging. Despite their tendency for diagnostic tests in patients with irritable bowel syndrome (IBS) symptoms, clinicians are encouraged to make a positive diagnosis based on symptom criteria without alarm signs. We explored how European physicians diagnose and manage patients suffering from IBS. Methods We conducted a vignette-based survey to evaluate the diagnostic approaches in four standardized patients with IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), inflammatory bowel disease (IBD) and chronic constipation (CC). General practitioners (GP, n = 104), gastroenterologists (GE, n = 100) and IBS experts (n = 25) from five European countries participated. Results Experts showed the highest rates of correct diagnoses (88%–92%) for all cases except CC (only 60%) and were more prone to a positive diagnosis (64%/68% in IBS-C/CC), whereas GEs and GPs tended toward a diagnosis by exclusion (63%/63% and 62%/60% in IBS-C/CC). In the CC vignette, conducting tests was more frequent than prescribing treatment among 44% experts, 63% GEs and 36% GPs. The diagnosis of IBD presented little difficulty for any of the participants. Conclusions This study highlights the difficulties in confidently diagnosing chronic functional bowel conditions, especially for non-experts, whereas IBD caused little difficulty. Differentiating between IBS-C and CC seemed particularly challenging, even for experts. PMID:25653858

  10. Phenotypic variability in a panel of strawberry cultivars from North America and the European Union

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The phenotypic diversity in 96 antique and modern cultivars from the European Union and North America was evaluated in Michigan and Oregon, in 2011 and 2012. A total of thirty-five fruit and developmental characteristics were measured. Significant differences (p < 0.05) were observed among cultivars...

  11. Risk assessment of gene flow from genetically engineered virus resistant cassava to wild relatives in Africa: an expert panel report.

    PubMed

    Hokanson, Karen E; Ellstrand, Norman C; Dixon, Alfred G O; Kulembeka, Heneriko P; Olsen, Kenneth M; Raybould, Alan

    2016-02-01

    The probability and consequences of gene flow to wild relatives is typically considered in the environmental risk assessment of genetically engineered crops. This is a report from a discussion by a group of experts who used a problem formulation approach to consider existing information for risk assessment of gene flow from cassava (Manihot esculenta) genetically engineered for virus resistance to the 'wild' (naturalized) relative M. glaziovii in East Africa. Two environmental harms were considered in this case: (1) loss of genetic diversity in the germplasm pool, and (2) loss of valued species, ecosystem resources, or crop yield and quality due to weediness or invasiveness of wild relatives. Based on existing information, it was concluded that gene flow will occur, but it is not likely that this will reduce the genetic diversity in the germplasm pool. There is little existing information about the impact of the virus in natural populations that could be used to inform a prediction about whether virus resistance would lead to an increase in reproduction or survival, hence abundance of M. glaziovii. However, an increase in the abundance of M. glaziovii should be manageable, and would not necessarily lead to the identified environmental harms. PMID:26667472

  12. Adult Education and Development with Special Reference to the Arab States. Final Report. Proceedings of the International Expert Panel (Sirs-El-Layyan, Menoufia - A.R.E., November 29-December 9, 1975).

    ERIC Educational Resources Information Center

    Muller, Josef, Ed.

    This report on adult education and development in the Arab States was prepared by a panel of experts who convened to examine the adult education situation in Arab countries and exchange experiences regarding the operation of comprehensive adult education programs and services. Section 1, a summary report, overviews the adult education situation in…

  13. Learning from Consumer-Oriented Review Efforts To Guide the Development of a System of Expert Panels To Identify and Share Promising and Exemplary Products and Programs. Working Papers. Volumes One and Two.

    ERIC Educational Resources Information Center

    Office of Educational Research and Improvement (ED), Washington, DC. Office of Reform Assistance and Dissemination.

    These volumes contain working papers related to the development of the Office of Educational Research and Improvement (OERI) Facilitated System of Expert Panels. Introductory papers by Susan Klein, Michael Scriven, Sharon Bobbitt and Susan Klein, and Michael Scriven and Lois-ellin Datta (printed in both volumes) set the stage for the discussions…

  14. Health Promotion for Older Children and Adolescents. National Nursing Research Agenda--Developing Knowledge for Practice: Challenges and Opportunities. A Report of the NINR Priority Expert Panel on Health Promotion, 5.

    ERIC Educational Resources Information Center

    National Inst. of Nursing Research (NIH), Bethesda, MD.

    This publication reports the findings of an expert panel convened by the National Center for Nursing Research to address health promotion for older children and adolescents (ages 8 through 18), the role of nurses, and the contributions of nursing science. Three chapters focus on basic science, intervention, and application. Each chapter includes…

  15. Defining European preparedness and research needs regarding emerging infectious animal diseases: results from a Delphi expert consultation.

    PubMed

    Wentholt, M T A; Cardoen, S; Imberechts, H; Van Huffel, X; Ooms, B W; Frewer, L J

    2012-02-01

    Emerging and major infectious animal diseases can have significant international impact on social, economic and environmental level, and are being driven by various factors. Prevention and control measures should be prepared at both national and international level to mitigate these disease risks. Research to support such policy development is mostly carried out at national level and dedicated transnational research programmes are still in its infancy. This research reports on part of a process to develop a common strategic research agenda on emerging and major infectious diseases of livestock in Europe, covering a 5-15-year time span. A two round online Delphi study was conducted to explore the views of experts on issues relating to research needs on emerging infectious diseases of livestock in Europe. Drivers that may influence the incidence of emerging infectious animal diseases in both the short (next 5 years) and medium term (10-15 years) were identified. Drivers related to regulatory measures and biological science developments were thought to decrease the incidence, and socio-economic factors to increase the incidence of emerging infectious animal diseases. From the first round a list of threats to animal health was compiled and participants combined these threats with relevant drivers in the second round. Next to identifying threats to animal health, also possible mitigatory actions to reduce the negative impact of these threats were identified. Participants emphasised that interdisciplinary research is needed to understand drivers of emerging infectious animal diseases, as well as to develop prevention and control measures which are both socio-economic and technical. From this it can be concluded that interdisciplinary research combining both natural and social research themes is required. Some of the European member states research budget needs to be allocated so that effective prevention and mitigation strategies can be developed. PMID:22000288

  16. Daily baseline skin care in the prevention, treatment, and supportive care of skin toxicity in oncology patients: recommendations from a multinational expert panel.

    PubMed

    Bensadoun, René-Jean; Humbert, Phillipe; Krutman, Jean; Luger, Thomas; Triller, Raoul; Rougier, André; Seite, Sophie; Dreno, Brigitte

    2013-01-01

    Skin reactions due to radiotherapy and chemotherapy are a significant problem for an important number of cancer patients. While effective for treating cancer, they disturb cutaneous barrier function, causing a reaction soon after initiation of treatment that impacts patient quality of life. Managing these symptoms with cosmetics and nonpharmaceutical skin care products for camouflage or personal hygiene may be important for increasing patient self-esteem. However, inappropriate product choice or use could worsen side effects. Although recommendations exist for the pharmaceutical treatment of skin reactions, there are no recommendations for the choice or use of dermatologic skin care products for oncology patients. The present guidelines were developed by a board of European experts in dermatology and oncology to provide cancer care professionals with guidance for the appropriate use of non-pharmaceutical, dermocosmetic skin care management of cutaneous toxicities associated with radiotherapy and systemic chemotherapy, including epidermal growth factor inhibitors and monoclonal antibodies. The experts hope that these recommendations will improve the management of cutaneous side effects and hence quality of life for oncology patients. PMID:24353440

  17. Daily baseline skin care in the prevention, treatment, and supportive care of skin toxicity in oncology patients: recommendations from a multinational expert panel

    PubMed Central

    Bensadoun, René-Jean; Humbert, Phillipe; Krutman, Jean; Luger, Thomas; Triller, Raoul; Rougier, André; Seite, Sophie; Dreno, Brigitte

    2013-01-01

    Skin reactions due to radiotherapy and chemotherapy are a significant problem for an important number of cancer patients. While effective for treating cancer, they disturb cutaneous barrier function, causing a reaction soon after initiation of treatment that impacts patient quality of life. Managing these symptoms with cosmetics and nonpharmaceutical skin care products for camouflage or personal hygiene may be important for increasing patient self-esteem. However, inappropriate product choice or use could worsen side effects. Although recommendations exist for the pharmaceutical treatment of skin reactions, there are no recommendations for the choice or use of dermatologic skin care products for oncology patients. The present guidelines were developed by a board of European experts in dermatology and oncology to provide cancer care professionals with guidance for the appropriate use of non-pharmaceutical, dermocosmetic skin care management of cutaneous toxicities associated with radiotherapy and systemic chemotherapy, including epidermal growth factor inhibitors and monoclonal antibodies. The experts hope that these recommendations will improve the management of cutaneous side effects and hence quality of life for oncology patients. PMID:24353440

  18. Hematopoietic stem cell transplantation in thalassemia major and sickle cell disease: indications and management recommendations from an international expert panel

    PubMed Central

    Angelucci, Emanuele; Matthes-Martin, Susanne; Baronciani, Donatella; Bernaudin, Françoise; Bonanomi, Sonia; Cappellini, Maria Domenica; Dalle, Jean-Hugues; Di Bartolomeo, Paolo; de Heredia, Cristina Díaz; Dickerhoff, Roswitha; Giardini, Claudio; Gluckman, Eliane; Hussein, Ayad Achmed; Kamani, Naynesh; Minkov, Milen; Locatelli, Franco; Rocha, Vanderson; Sedlacek, Petr; Smiers, Frans; Thuret, Isabelle; Yaniv, Isaac; Cavazzana, Marina; Peters, Christina

    2014-01-01

    Thalassemia major and sickle cell disease are the two most widely disseminated hereditary hemoglobinopathies in the world. The outlook for affected individuals has improved in recent years due to advances in medical management in the prevention and treatment of complications. However, hematopoietic stem cell transplantation is still the only available curative option. The use of hematopoietic stem cell transplantation has been increasing, and outcomes today have substantially improved compared with the past three decades. Current experience world-wide is that more than 90% of patients now survive hematopoietic stem cell transplantation and disease-free survival is around 80%. However, only a few controlled trials have been reported, and decisions on patient selection for hematopoietic stem cell transplantation and transplant management remain principally dependent on data from retrospective analyses and on the clinical experience of the transplant centers. This consensus document from the European Blood and Marrow Transplantation Inborn Error Working Party and the Paediatric Diseases Working Party aims to report new data and provide consensus-based recommendations on indications for hematopoietic stem cell transplantation and transplant management. PMID:24790059

  19. Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

    PubMed Central

    Rizzo, Manfredi; Toth, Peter P.; Farnier, Michel; Davidson, Michael H.; Al-Rasadi, Khalid; Aronow, Wilbert S.; Athyros, Vasilis; Djuric, Dragan M.; Ezhov, Marat V.; Greenfield, Robert S.; Hovingh, G. Kees; Kostner, Karam; Serban, Corina; Lighezan, Daniel; Fras, Zlatko; Moriarty, Patrick M.; Muntner, Paul; Goudev, Assen; Ceska, Richard; Nicholls, Stephen J.; Broncel, Marlena; Nikolic, Dragana; Pella, Daniel; Puri, Raman; Rysz, Jacek; Wong, Nathan D.; Bajnok, Laszlo; Jones, Steven R.; Ray, Kausik K.; Mikhailidis, Dimitri P.

    2015-01-01

    Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin associated muscle symptoms (SAMS), and avoided the use of the term ‘statin intolerance’. Although muscle syndromes are the most common adverse effects observed after statin therapy, excluding other side effects might underestimate the number of patients with statin intolerance, which might be observed in 10–15% of patients. In clinical practice, statin intolerance limits effective treatment of patients at risk of, or with, cardiovascular disease. Knowledge of the most common adverse effects of statin therapy that might cause statin intolerance and the clear definition of this phenomenon is crucial to effectively treat patients with lipid disorders. Therefore, the aim of this position paper was to suggest a unified definition of statin intolerance, and to complement the recent EAS statement on SAMS, where the pathophysiology, diagnosis and the management were comprehensively presented. PMID:25861286

  20. Adjuvant bisphosphonates in early breast cancer: consensus guidance for clinical practice from a European Panel.

    PubMed

    Hadji, P; Coleman, R E; Wilson, C; Powles, T J; Clézardin, P; Aapro, M; Costa, L; Body, J-J; Markopoulos, C; Santini, D; Diel, I; Di Leo, A; Cameron, D; Dodwell, D; Smith, I; Gnant, M; Gray, R; Harbeck, N; Thurlimann, B; Untch, M; Cortes, J; Martin, M; Albert, U-S; Conte, P-F; Ejlertsen, B; Bergh, J; Kaufmann, M; Holen, I

    2016-03-01

    Bisphosphonates have been studied in randomised trials in early breast cancer to investigate their ability to prevent cancer treatment-induced bone loss (CTIBL) and reduce the risk of disease recurrence and metastasis. Treatment benefits have been reported but bisphosphonates do not currently have regulatory approval for either of these potential indications. This consensus paper provides a review of the evidence and offers guidance to breast cancer clinicians on the use of bisphosphonates in early breast cancer. Using the nominal group methodology for consensus, a systematic review of the literature was augmented by a workshop held in October 2014 for breast cancer and bone specialists to present and debate the available pre-clinical and clinical evidence for the use of adjuvant bisphosphonates. This was followed by a questionnaire to all members of the writing committee to identify areas of consensus. The panel recommended that bisphosphonates should be considered as part of routine clinical practice for the prevention of CTIBL in all patients with a T score of <-2.0 or ≥2 clinical risk factors for fracture. Compelling evidence from a meta-analysis of trial data of >18,000 patients supports clinically significant benefits of bisphosphonates on the development of bone metastases and breast cancer mortality in post-menopausal women or those receiving ovarian suppression therapy. Therefore, the panel recommends that bisphosphonates (either intravenous zoledronic acid or oral clodronate) are considered as part of the adjuvant breast cancer treatment in this population and the potential benefits and risks discussed with relevant patients. PMID:26681681

  1. von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA).

    PubMed

    Nichols, W L; Hultin, M B; James, A H; Manco-Johnson, M J; Montgomery, R R; Ortel, T L; Rick, M E; Sadler, J E; Weinstein, M; Yawn, B P

    2008-03-01

    von Willebrand disease (VWD) is a commonly encountered inherited bleeding disorder affecting both males and females, causing mucous membrane and skin bleeding symptoms, and bleeding with surgical or other haemostatic challenges. VWD may be disproportionately symptomatic in women of child-bearing age. It may also occur less frequently as an acquired disorder (acquired von Willebrand syndrome). VWD is caused by deficiency or dysfunction of von Willebrand factor (VWF), a plasma protein that mediates platelet haemostatic function and stabilizes blood coagulation factor VIII. The pathophysiology, classification, diagnosis and management of VWD are relatively complex, but understanding them is important for proper diagnosis and management of patients with VWD. These evidence-based guidelines for diagnosis and management of VWD from the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel (USA) review relevant publications, summarize current understanding of VWD pathophysiology and classification, and present consensus diagnostic and management recommendations based on analysis of the literature and expert opinion. They also suggest an approach for clinical and laboratory evaluation of individuals with bleeding symptoms, history of bleeding or conditions associated with increased bleeding risk. This document summarizes needs for further research in VWF, VWD and bleeding disorders, including clinical research to obtain more objective information about bleeding symptoms, advancements in diagnostic and therapeutic tools, and enhancement in the education and training of clinicians and scientists in bleeding and thrombotic disorders. The NHLBI Web site (http://www.nhlbi.nih.gov/guidelines/vwd) has a more detailed document, a synopsis of these recommendations, and patient education information. PMID:18315614

  2. Derived Reference Doses (RfDs) for the environmental degradates of the herbicides alachlor and acetochlor: results of an independent expert panel deliberation.

    PubMed

    Gadagbui, Bernard; Maier, Andrew; Dourson, Michael; Parker, Ann; Willis, Alison; Christopher, John P; Hicks, Lebelle; Ramasamy, Santhini; Roberts, Stephen M

    2010-01-01

    An independent peer expert panel was convened under the auspices of the Alliance for Risk Assessment (ARA) to review toxicology data and derive oral Reference Doses (RfDs) for four environmental degradates of the acetanilide herbicides, alachlor and acetochlor. The degradates included in this evaluation were (1) alachlor tertiary-ethanesulfonic acid (ESA), (2) alachlor tertiary-oxanilic acid (OXA), (3) acetochlor ESA, and (4) acetochlor OXA. Each degradate was judged to have sufficient data for developing low to medium confidence RfD, with use of an additional uncertainty factor (UF) to cover data gaps. Body weight decreases were identified as the most sensitive treatment-related adverse effect for RfD development. A composite UF of 1000 (10 for human variability in sensitivity, 10 for interspecies differences in sensitivity, and 10 for subchronic to chronic and database deficiency combined; i.e., 10(A)x10(H)x10(S&D)) for each degradate was considered reasonable, while noting that an argument could be made for an UF of 3000 (10(A)x10(H)x30(S&D)). Based on the available data, an oral RfD of 0.2 mg/kg-day is recommended for both acetochlor ESA and acetochlor OXA and an oral RfD of 0.8 mg/kg-day is recommended for both alachlor ESA and alachlor OXA. PMID:20206657

  3. Treatment of Elderly Patients With Non-Small-Cell Lung Cancer: Results of an International Expert Panel Meeting of the Italian Association of Thoracic Oncology.

    PubMed

    Gridelli, Cesare; Balducci, Lodovico; Ciardiello, Fortunato; Di Maio, Massimo; Felip, Enriqueta; Langer, Corey; Lilenbaum, Rogerio C; Perrone, Francesco; Senan, Suresh; de Marinis, Filippo

    2015-09-01

    Most patients with non-small-cell lung cancer (NSCLC) are elderly, and age has important implications for their management and treatment. In May 2014, the Italian Association of Thoracic Oncology organized an International Experts Panel Meeting with the intent to review the available evidence regarding the treatment of elderly patients with NSCLC and to discuss the implications for clinical practice and future research in this field; this article summarizes the panelists' conclusions. All patients aged more than 70 years should receive an assessment of physiologic age, including mortality and toxicity prediction. Age itself does not contraindicate adjuvant chemotherapy after resection. Elderly patients with locally advanced NSCLC should be considered for combined chemo-radiotherapy. In the advanced setting, the combination of carboplatin/paclitaxel results in prolonged survival compared with single-agent gemcitabine or vinorelbine, albeit with increased toxicity. In fit selected patients, other carboplatin-based or cisplatin-based regimens are feasible, but randomized trials specifically showing survival prolongation in elderly patients are lacking. The survival benefit for bevacizumab added to chemotherapy seems limited to patients aged less than 75 years. In unfit elderly patients, single agents are recommended. Regardless of age, patients with advanced nonsquamous NSCLC, and those who have never smoked independently of their histologic subtype, should be tested for epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement. In patients with NSCLC harboring EGFR mutation or ALK rearrangement, targeted drugs are feasible and well tolerated. PMID:25862554

  4. Role of biomarkers in the management of antibiotic therapy: an expert panel review: I – currently available biomarkers for clinical use in acute infections

    PubMed Central

    2013-01-01

    In the context of worldwide increasing antimicrobial resistance, good antimicrobial prescribing in more needed than ever; unfortunately, information available to clinicians often are insufficient to rely on. Biomarkers might provide help for decision-making and improve antibiotic management. The purpose of this expert panel review was to examine currently available literature on the potential role of biomarkers to improve antimicrobial prescribing, by answering three questions: 1) Which are the biomarkers available for this purpose?; 2) What is their potential role in the initiation of antibiotic therapy?; and 3) What is their role in the decision to stop antibiotic therapy? To answer these questions, studies reviewed were limited to recent clinical studies (<15 years), involving a substantial number of patients (>50) and restricted to controlled trials and meta-analyses for answering questions 2 and 3. With regard to the first question concerning routinely available biomarkers, which might be useful for antibiotic management of acute infections, these are currently limited to C-reactive protein (CRP) and procalcitonin (PCT). Other promising biomarkers that may prove useful in the near future but need to undergo more extensive clinical testing include sTREM-1, suPAR, ProADM, and Presepsin. New approaches to biomarkers of infections include point-of-care testing and genomics. PMID:23837559

  5. PRIORITY EXPERT PANEL (PEP) REPORTS

    EPA Science Inventory

    The National Institute of Nursing Research supports clinical and basic research to establish a scientific basis for the care of individuals across the life span-from management of patients during illness and recovery to the reduction of risks for disease and disability, the promo...

  6. A Review of Traditional and Novel Treatments for Seizures in Autism Spectrum Disorder: Findings from a Systematic Review and Expert Panel

    PubMed Central

    Frye, Richard E.; Rossignol, Daniel; Casanova, Manuel F.; Brown, Gregory L.; Martin, Victoria; Edelson, Stephen; Coben, Robert; Lewine, Jeffrey; Slattery, John C.; Lau, Chrystal; Hardy, Paul; Fatemi, S. Hossein; Folsom, Timothy D.; MacFabe, Derrick; Adams, James B.

    2013-01-01

    Despite the fact that seizures are commonly associated with autism spectrum disorder (ASD), the effectiveness of treatments for seizures has not been well studied in individuals with ASD. This manuscript reviews both traditional and novel treatments for seizures associated with ASD. Studies were selected by systematically searching major electronic databases and by a panel of experts that treat ASD individuals. Only a few anti-epileptic drugs (AEDs) have undergone carefully controlled trials in ASD, but these trials examined outcomes other than seizures. Several lines of evidence point to valproate, lamotrigine, and levetiracetam as the most effective and tolerable AEDs for individuals with ASD. Limited evidence supports the use of traditional non-AED treatments, such as the ketogenic and modified Atkins diet, multiple subpial transections, immunomodulation, and neurofeedback treatments. Although specific treatments may be more appropriate for specific genetic and metabolic syndromes associated with ASD and seizures, there are few studies which have documented the effectiveness of treatments for seizures for specific syndromes. Limited evidence supports l-carnitine, multivitamins, and N-acetyl-l-cysteine in mitochondrial disease and dysfunction, folinic acid in cerebral folate abnormalities and early treatment with vigabatrin in tuberous sclerosis complex. Finally, there is limited evidence for a number of novel treatments, particularly magnesium with pyridoxine, omega-3 fatty acids, the gluten-free casein-free diet, and low-frequency repetitive transcranial magnetic simulation. Zinc and l-carnosine are potential novel treatments supported by basic research but not clinical studies. This review demonstrates the wide variety of treatments used to treat seizures in individuals with ASD as well as the striking lack of clinical trials performed to support the use of these treatments. Additional studies concerning these treatments for controlling seizures in individuals

  7. International Experts Panel Meeting of the Italian Association of Thoracic Oncology on Antiangiogenetic Drugs for Non-Small Cell Lung Cancer: Realities and Hopes.

    PubMed

    de Marinis, Filippo; Bria, Emilio; Ciardiello, Fortunato; Crinò, Lucio; Douillard, Jean Yves; Griesinger, Frank; Lambrechts, Diether; Perol, Maurice; Ramalingam, Suresh S; Smit, Egbert F; Gridelli, Cesare

    2016-07-01

    Angiogenesis, one of the hallmarks of cancer, occurs when new blood vessels feed malignant cells, providing oxygen and nutrients, promoting tumor growth, and allowing tumor cells to escape into the circulation, thus leading to metastases. To date, a series of antiangiogenic drugs (either monoclonal antibodies or small molecules) have been approved by regulatory agencies for the treatment of advanced non-small cell lung cancer, and they are currently available for both first- and second-line therapy. The overall benefit of these drugs seems modest (although clearly significant), especially when administered as a single agent, and there is no clear consensus with regard to which patients should be candidates to receive these drugs across the different disease settings. From the biological perspective, angiogenesis represents a difficult and complex process to explore, given the interference with other key pathways and the dynamic evolution during the disease's history. Indeed, this process is complicated by the presence of multiple targets to hit, polymorphisms, hypoxia-dependent modifications, and epigenetics. These difficulties do not allow capture of which specific key pathways can be identified as biomarkers of efficacy so as to maximize to overall benefit of such drugs. An International Experts Panel Meeting was inspired by the absence of clear recommendations to address which patients should receive antiangiogenic drugs in the context of advanced non-small cell lung cancer so as to support decisions for clinical practice on a daily basis and determine priorities for future research. After a literature review and panelists consensus, a series of recommendations were defined to support decisions for the daily clinical practice and to indicate a potential road map for translational research. PMID:27063293

  8. A review of traditional and novel treatments for seizures in autism spectrum disorder: findings from a systematic review and expert panel.

    PubMed

    Frye, Richard E; Rossignol, Daniel; Casanova, Manuel F; Brown, Gregory L; Martin, Victoria; Edelson, Stephen; Coben, Robert; Lewine, Jeffrey; Slattery, John C; Lau, Chrystal; Hardy, Paul; Fatemi, S Hossein; Folsom, Timothy D; Macfabe, Derrick; Adams, James B

    2013-01-01

    Despite the fact that seizures are commonly associated with autism spectrum disorder (ASD), the effectiveness of treatments for seizures has not been well studied in individuals with ASD. This manuscript reviews both traditional and novel treatments for seizures associated with ASD. Studies were selected by systematically searching major electronic databases and by a panel of experts that treat ASD individuals. Only a few anti-epileptic drugs (AEDs) have undergone carefully controlled trials in ASD, but these trials examined outcomes other than seizures. Several lines of evidence point to valproate, lamotrigine, and levetiracetam as the most effective and tolerable AEDs for individuals with ASD. Limited evidence supports the use of traditional non-AED treatments, such as the ketogenic and modified Atkins diet, multiple subpial transections, immunomodulation, and neurofeedback treatments. Although specific treatments may be more appropriate for specific genetic and metabolic syndromes associated with ASD and seizures, there are few studies which have documented the effectiveness of treatments for seizures for specific syndromes. Limited evidence supports l-carnitine, multivitamins, and N-acetyl-l-cysteine in mitochondrial disease and dysfunction, folinic acid in cerebral folate abnormalities and early treatment with vigabatrin in tuberous sclerosis complex. Finally, there is limited evidence for a number of novel treatments, particularly magnesium with pyridoxine, omega-3 fatty acids, the gluten-free casein-free diet, and low-frequency repetitive transcranial magnetic simulation. Zinc and l-carnosine are potential novel treatments supported by basic research but not clinical studies. This review demonstrates the wide variety of treatments used to treat seizures in individuals with ASD as well as the striking lack of clinical trials performed to support the use of these treatments. Additional studies concerning these treatments for controlling seizures in individuals

  9. Early diagnosis of peripheral nervous system involvement in Fabry disease and treatment of neuropathic pain: the report of an expert panel

    PubMed Central

    2011-01-01

    Background Fabry disease is an inherited metabolic disorder characterized by progressive lysosomal accumulation of lipids in a variety of cell types, including neural cells. Small, unmyelinated nerve fibers are particularly affected and small fiber peripheral neuropathy often clinically manifests at young age. Peripheral pain can be chronic and/or occur as provoked attacks of excruciating pain. Manifestations of dysfunction of small autonomic fibers may include, among others, impaired sweating, gastrointestinal dysmotility, and abnormal pain perception. Patients with Fabry disease often remain undiagnosed until severe complications involving the kidney, heart, peripheral nerves and/or brain have arisen. Methods An international expert panel convened with the goal to provide guidance to clinicians who may encounter unrecognized patients with Fabry disease on how to diagnose these patients early using simple diagnostic tests. A further aim was to offer recommendations to control neuropathic pain. Results We describe the neuropathy in Fabry disease, focusing on peripheral small fiber dysfunction - the hallmark of early neurologic involvement in this disorder. The clinical course of peripheral pain is summarized, and the importance of medical history-taking, including family history, is highlighted. A thorough physical examination (e.g., angiokeratoma, corneal opacities) and simple non-invasive sensory perception tests could provide clues to the diagnosis of Fabry disease. Reported early clinical benefits of enzyme replacement therapy include reduction of neuropathic pain, and adequate management of residual pain to a tolerable and functional level can substantially improve the quality of life for patients. Conclusions Our recommendations can assist in diagnosing Fabry small fiber neuropathy early, and offer clinicians guidance in controlling peripheral pain. This is particularly important since management of pain in young patients with Fabry disease appears to be

  10. Guidelines for locoregional therapy in primary breast cancer in developing countries: The results of an expert panel at the 8th Annual Women's Cancer Initiative – Tata Memorial Hospital (WCI-TMH) Conference

    PubMed Central

    Munshi, Anusheel; Gupta, Sudeep; Anderson, Benjamin; Yarnold, John; Parmar, Vani; Jalali, Rakesh; Sharma, Suresh Chander; Desai, Sangeeta; Thakur, Meenakshi; Baijal, Gunjan; Sarin, Rajiv; Mittra, Indraneel; Ghosh, Jaya; Badwe, Rajendra

    2012-01-01

    Background: Limited guidelines exist for breast cancer management in developing countries. In this context, the Women's Cancer Initiative - Tata Memorial Hospital (WCI-TMH) organised its 8th Annual Conference to update guidelines in breast cancer. Materials and Methods: Appropriately formulated guideline questions on each topic and subtopic in the surgical, radiation and systemic management of primary breast cancer were developed by the scientific committee and shared with the guest faculty of the Conference. Majority of the questions had multiple choice answers. The opinion of the audience, comprising academic and community oncologists, was electronically cumulated, followed by focussed presentations by eminent national and international experts on each topic. The guidelines were finally developed through an expert panel that voted on each guideline question after all talks had been delivered and audience opinion elicited. Separate panels were constituted for locoregional and systemic therapy in primary breast cancer. Results: Based on the voting results of the expert panel, guidelines for locoregional therapy of breast cancer have been formulated. Voting patterns for each question are reported. Conclusions: The updated guidelines on locoregional management of primary breast cancer in the context of developing countries are presented in this article. These recommendations have been designed to allow centers in the developing world to improve the quality of care for breast cancer patients. PMID:22988354

  11. Guidance for contact tracing of cases of Lassa fever, Ebola or Marburg haemorrhagic fever on an airplane: results of a European expert consultation

    PubMed Central

    2012-01-01

    Background Travel from countries where viral haemorrhagic fevers (VHF) are endemic has increased significantly over the past decades. In several reported VHF events on airplanes, passenger trace back was initiated but the scale of the trace back differed considerably. The absence of guidance documents to help the decision on necessity and scale of the trace back contributed to this variation. This article outlines the recommendations of an expert panel on Lassa fever, Ebola and Marburg haemorrhagic fever to the wider scientific community in order to advise the relevant stakeholders in the decision and scale of a possible passenger trace back. Method The evidence was collected through review of published literature and through the views of an expert panel. The guidance was agreed by consensus. Results Only a few events of VHF cases during air travel are reported in literature, with no documented infection in followed up contacts, so that no evidence of transmission of VHF during air travel exists to date. Based on this and the expert opinion, it was recommended that passenger trace back was undertaken only if: the index case had symptoms during the flight; the flight was within 21 days after detection of the event; and for Lassa fever if exposure of body fluid has been reported. The trace back should only be done after confirmation of the index case. Passengers and crew with direct contact, seat neighbours (+/− 1 seat), crew and cleaning personal of the section of the index case should be included in the trace back. Conclusion No evidence has been found for the transmission of VHF in airplanes. This information should be taken into account, when a trace back decision has to be taken, because such a measure produces an enormous work load. The procedure suggested by the expert group can guide decisions made in future events, where a patient with suspected VHF infection travelled on a plane. However, the actual decision on start and scale of a trace back always lies

  12. ESCAP Expert Paper: New developments in the diagnosis and treatment of adolescent anorexia nervosa--a European perspective.

    PubMed

    Herpertz-Dahlmann, Beate; van Elburg, Annemarie; Castro-Fornieles, Josefina; Schmidt, Ulrike

    2015-10-01

    Anorexia nervosa is a potentially life-threatening disorder with a typical onset in adolescence and high rates of medical complications and psychiatric comorbidity. This article summarizes issues relating to classification in DSM-5 and presents a narrative review of key evidence-based medical and behavioral interventions for adolescent AN and subthreshold restricting eating disorders, mainly, but not exclusively published between 2012 and 2014. In addition, it systematically compares the clinical guidelines of four European countries (Germany, Spain, The Netherlands, and United Kingdom) and outlines common clinical practice, in relation to treatment settings, nutritional rehabilitation, family-oriented and individual psychotherapy, and psychopharmacological treatment. With the exception of family-based treatment, which is mainly evaluated and practiced in Anglo-American countries, the evidence base is weak, especially for medical interventions such as refeeding and pharmacological intervention. There is a need for common European research efforts, to improve the available evidence base and resulting clinical guidance. PMID:26226918

  13. Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions

    PubMed Central

    Ray-Coquard, I.; Montesco, M. C.; Coindre, J. M.; Dei Tos, A. P.; Lurkin, A.; Ranchère-Vince, D.; Vecchiato, A.; Decouvelaere, A. V.; Mathoulin-Pélissier, S.; Albert, S.; Cousin, P.; Cellier, D.; Toffolatti, L.; Rossi, C. R.; Blay, J. Y.

    2012-01-01

    Background Sarcomas represent a heterogeneous group of tumors. Accurate determination of histological diagnosis and prognostic factors is critical for the delineation of treatment strategies. The contribution of second opinion (SO) to improve diagnostic accuracy has been suggested for sarcoma but has never been established in population-based studies. Methods Histological data of patients diagnosed with sarcoma in Rhone-Alpes (France), Veneto (Italy) and Aquitaine (France) over a 2-year period were collected. Initial diagnoses were systematically compared with SO from regional and national experts. Results Of 2016 selected patients, 1463 (73%) matched the inclusion criteria and were analyzed. Full concordance between primary diagnosis and SO (the first pathologist and the expert reached identical conclusions) was observed in 824 (56%) cases, partial concordance (identical diagnosis of connective tumor but different grade or histological subtype) in 518 (35%) cases and complete discordance (benign versus malignant, different histological type or invalidation of the diagnosis of sarcoma) in 121 (8%) cases. The major discrepancies were related to histological grade (n = 274, 43%), histological type (n = 144, 24%), subtype (n = 18, 3%) and grade plus subtype or grade plus histological type (n = 178, 29%). Conclusion More than 40% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions. PMID:22331640

  14. The role of self-monitoring of blood glucose in patients treated with SGLT-2 inhibitors: a European expert recommendation.

    PubMed

    Schnell, Oliver; Alawi, Hasan; Battelino, Tadej; Ceriello, Antonio; Diem, Peter; Felton, Anne-Marie; Harno, Kari; Satman, Ilhan; Vergès, Bruno

    2014-07-01

    The role for the novel treatment approach of sodium-glucose cotransporter-2 (SGLT-2) in type 2 diabetes is increasing. Structured self-monitoring of blood glucose (SMBG), based on a less intensive and a more intensive scheme, may contribute to an optimization of SGLT-2 inhibitor based treatment. The current expert recommendation suggests individualized approaches of SMBG, using simple and clinically applicable schemes. Potential benefits of SMBG in SGLT-2 inhibitor based treatment approaches are early assessment of treatment success or failure, timely modification of treatment, detection of hypoglycemic episodes, assessment of glucose excursions, and support of diabetes management and education. The length and frequency of SMBG should depend on the clinical setting and the quality of metabolic control. PMID:24876442

  15. Expert Cold Structure Development

    NASA Astrophysics Data System (ADS)

    Atkins, T.; Demuysere, P.

    2011-05-01

    The EXPERT Program is funded by ESA. The objective of the EXPERT mission is to perform a sub-orbital flight during which measurements of critical aero- thermodynamic phenomena will be obtained by using state-of-the-art instrumentation. As part of the EXPERT Flight Segment, the responsibility of the Cold Structure Development Design, Manufacturing and Validation was committed to the Belgian industrial team SONACA/SABCA. The EXPERT Cold Structure includes the Launcher Adapter, the Bottom Panel, the Upper Panel, two Cross Panels and the Parachute Bay. An additional Launcher Adapter was manufactured for the separation tests. The selected assembly definition and manufacturing technologies ( machined parts and sandwich panels) were dictated classically by the mass and stiffness, but also by the CoG location and the sensitive separation interface. Used as support for the various on-board equipment, the Cold Structure is fixed to but thermally uncoupled from the PM 1000 thermal shield. It is protect on its bottom panel by a thermal blanket. As it is a protoflight, analysis was the main tool for the verification. Low level stiffness and modal analysis tests have also been performed on the Cold Structure equipped with its ballast. It allowed to complete its qualification and to prepare SONACA/SABCA support for the system dynamic tests foreseen in 2011. The structure was finally coated with a thermal control black painting and delivered on time to Thales Alenia Space-Italy end of March 201.

  16. Probability encoding of hydrologic parameters for basalt. Elicitation of expert opinions from a panel of three basalt waste isolation project staff hydrologists

    SciTech Connect

    Runchal, A.K.; Merkhofer, M.W.; Olmsted, E.; Davis, J.D.

    1984-11-01

    The present study implemented a probability encoding method to estimate the probability distributions of selected hydrologic variables for the Cohassett basalt flow top and flow interior, and the anisotropy ratio of the interior of the Cohassett basalt flow beneath the Hanford Site. Site-speciic data for these hydrologic parameters are currently inadequate for the purpose of preliminary assessment of candidate repository performance. However, this information is required to complete preliminary performance assessment studies. Rockwell chose a probability encoding method developed by SRI International to generate credible and auditable estimates of the probability distributions of effective porosity and hydraulic conductivity anisotropy. The results indicate significant differences of opinion among the experts. This was especially true of the values of the effective porosity of the Cohassett basalt flow interior for which estimates differ by more than five orders of magnitude. The experts are in greater agreement about the values of effective porosity of the Cohassett basalt flow top; their estimates for this variable are generally within one to two orders of magnitiude of each other. For anisotropy ratio, the expert estimates are generally within two or three orders of magnitude of each other. Based on this study, the Rockwell hydrologists estimate the effective porosity of the Cohassett basalt flow top to be generally higher than do the independent experts. For the effective porosity of the Cohassett basalt flow top, the estimates of the Rockwell hydrologists indicate a smaller uncertainty than do the estimates of the independent experts. On the other hand, for the effective porosity and anisotropy ratio of the Cohassett basalt flow interior, the estimates of the Rockwell hydrologists indicate a larger uncertainty than do the estimates of the independent experts.

  17. Statin-associated muscle symptoms: impact on statin therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management

    PubMed Central

    Stroes, Erik S.; Thompson, Paul D.; Corsini, Alberto; Vladutiu, Georgirene D.; Raal, Frederick J.; Ray, Kausik K.; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G.; Bruckert, Eric; De Backer, Guy; Krauss, Ronald M.; Laufs, Ulrich; Santos, Raul D.; Hegele, Robert A.; Hovingh, G. Kees; Leiter, Lawrence A.; Mach, Francois; März, Winfried; Newman, Connie B.; Wiklund, Olov; Jacobson, Terry A.; Catapano, Alberico L.; Chapman, M. John; Ginsberg, Henry N.; Stroes, Erik; Thompson, Paul D.; Corsini, Alberto; Vladutiu, Georgirene D.; Raal, Frederick J.; Ray, Kausik K.; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G.; Bruckert, Eric; Krauss, Ronald M.; Laufs, Ulrich; Santos, Raul D.; März, Winfried; Newman, Connie B.; John Chapman, M.; Ginsberg, Henry N.; John Chapman, M.; Ginsberg, Henry N.; de Backer, Guy; Catapano, Alberico L.; Hegele, Robert A.; Kees Hovingh, G.; Jacobson, Terry A.; Leiter, Lawrence; Mach, Francois; Wiklund, Olov

    2015-01-01

    Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin-associated myopathy, and provides guidance for diagnosis and management of SAMS. Statin-associated myopathy, with significant elevation of serum creatine kinase (CK), is a rare but serious side effect of statins, affecting 1 per 1000 to 1 per 10 000 people on standard statin doses. Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7–29% in registries and observational studies. Preclinical studies show that statins decrease mitochondrial function, attenuate energy production, and alter muscle protein degradation, thereby providing a potential link between statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify SAMS by symptoms typical of statin myalgia (i.e. muscle pain or aching) and their temporal association with discontinuation and response to repetitive statin re-challenge. In people with SAMS, the Panel recommends the use of a maximally tolerated statin dose combined with non-statin lipid-lowering therapies to attain recommended low-density lipoprotein cholesterol targets. The Panel recommends a structured work-up to identify individuals with clinically relevant SAMS generally to at least three different statins, so that they can be offered therapeutic regimens to satisfactorily address their cardiovascular risk. Further research into the underlying pathophysiological mechanisms may offer future therapeutic potential. PMID:25694464

  18. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management.

    PubMed

    Stroes, Erik S; Thompson, Paul D; Corsini, Alberto; Vladutiu, Georgirene D; Raal, Frederick J; Ray, Kausik K; Roden, Michael; Stein, Evan; Tokgözoğlu, Lale; Nordestgaard, Børge G; Bruckert, Eric; De Backer, Guy; Krauss, Ronald M; Laufs, Ulrich; Santos, Raul D; Hegele, Robert A; Hovingh, G Kees; Leiter, Lawrence A; Mach, Francois; März, Winfried; Newman, Connie B; Wiklund, Olov; Jacobson, Terry A; Catapano, Alberico L; Chapman, M John; Ginsberg, Henry N

    2015-05-01

    Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin-associated myopathy, and provides guidance for diagnosis and management of SAMS. Statin-associated myopathy, with significant elevation of serum creatine kinase (CK), is a rare but serious side effect of statins, affecting 1 per 1000 to 1 per 10 000 people on standard statin doses. Statin-associated muscle symptoms cover a broader range of clinical presentations, usually with normal or minimally elevated CK levels, with a prevalence of 7-29% in registries and observational studies. Preclinical studies show that statins decrease mitochondrial function, attenuate energy production, and alter muscle protein degradation, thereby providing a potential link between statins and muscle symptoms; controlled mechanistic and genetic studies in humans are necessary to further understanding. The Panel proposes to identify SAMS by symptoms typical of statin myalgia (i.e. muscle pain or aching) and their temporal association with discontinuation and response to repetitive statin re-challenge. In people with SAMS, the Panel recommends the use of a maximally tolerated statin dose combined with non-statin lipid-lowering therapies to attain recommended low-density lipoprotein cholesterol targets. The Panel recommends a structured work-up to identify individuals with clinically relevant SAMS generally to at least three different statins, so that they can be offered therapeutic regimens to satisfactorily address their cardiovascular risk. Further research into the underlying pathophysiological mechanisms may offer future therapeutic potential. PMID:25694464

  19. MASSACHUSETTS DIVISION OF FISHERIES AND WILDLIFE ADAPTATION PLANNING USING AN EXPERT PANEL BASED HABITAT VULNERABLITY ASSESSMENT John O'Leary, MA Div. of Fisheries and Wildlife and Hector Galbraith, Ph d. Climate Change Initiative, Manomet Center for Conservation Sciences

    NASA Astrophysics Data System (ADS)

    O'Leary, J. A.; Galbraith, H.

    2010-12-01

    We are using the results from a recently completed Habitat Vulnerability Assessment (HVA) for adaptation planning within the Massachusetts Division of Fisheries and Wildlife. We used Regional Downscale Climate Projections to provide exposure information for the assessment and an Expert Panel of biologists to provide information on the sensitivity and adaptive capacity of the habitat types we assessed. We estimated the vulnerability of 22 key habitat types which were identified in the State Wildlife Action Plan (SWAP). Results of the expert panel based HVA include a relative ranking of vulnerability to climate change for these habitats within Massachusetts, a confidence score for the estimated vulnerability for each habitat type evaluated and a narrative identifying the factors which influence the vulnerability of the habitat. We also evaluated the vulnerability of the Species in Greatest Conservation Need (SGCN) from the SWAP to climate change conditions. The SGCN are linked to their primary habitat types. The HVA results along with recommendations from the National Academies Report: Adapting to the Impacts of Climate Change America’s Climate Choices: Panel on Adapting to the Impacts of Climate Change will inform “climate smart” adaptation strategies for agency management, acquisition, and research and monitoring programs that build on and do not replace existing implementation strategies. We believe that the adaptation planning process that we outline in this presentation could serve as a model for resource agencies and others who are in the process of developing their response to anticipated impacts from climate change conditions. We are also engaged in a collaborative effort to conduct a Regional Habitat Vulnerability Assessment (RHVA). Results form the RHVA will provide the MDFW with the ability to assess adaptation strategies based on regional need.

  20. Breast cancer screening in the era of density notification legislation: summary of 2014 Massachusetts experience and suggestion of an evidence-based management algorithm by multi-disciplinary expert panel.

    PubMed

    Freer, Phoebe E; Slanetz, Priscilla J; Haas, Jennifer S; Tung, Nadine M; Hughes, Kevin S; Armstrong, Katrina; Semine, A Alan; Troyan, Susan L; Birdwell, Robyn L

    2015-09-01

    Stemming from breast density notification legislation in Massachusetts effective 2015, we sought to develop a collaborative evidence-based approach to density notification that could be used by practitioners across the state. Our goal was to develop an evidence-based consensus management algorithm to help patients and health care providers follow best practices to implement a coordinated, evidence-based, cost-effective, sustainable practice and to standardize care in recommendations for supplemental screening. We formed the Massachusetts Breast Risk Education and Assessment Task Force (MA-BREAST) a multi-institutional, multi-disciplinary panel of expert radiologists, surgeons, primary care physicians, and oncologists to develop a collaborative approach to density notification legislation. Using evidence-based data from the Institute for Clinical and Economic Review, the Cochrane review, National Comprehensive Cancer Network guidelines, American Cancer Society recommendations, and American College of Radiology appropriateness criteria, the group collaboratively developed an evidence-based best-practices algorithm. The expert consensus algorithm uses breast density as one element in the risk stratification to determine the need for supplemental screening. Women with dense breasts and otherwise low risk (<15% lifetime risk), do not routinely require supplemental screening per the expert consensus. Women of high risk (>20% lifetime) should consider supplemental screening MRI in addition to routine mammography regardless of breast density. We report the development of the multi-disciplinary collaborative approach to density notification. We propose a risk stratification algorithm to assess personal level of risk to determine the need for supplemental screening for an individual woman. PMID:26290416

  1. Regulatory Considerations for the Clinical and Research Use of Transcranial Direct Current Stimulation (tDCS): review and recommendations from an expert panel

    PubMed Central

    Fregni, F; Nitsche, MA; Loo, C.K.; Brunoni, AR; Marangolo, P; Leite, J; Carvalho, S; Bolognini, N; Caumo, W; Paik, NJ; Simis, M; Ueda, K; Ekhitari, H; Luu, P; Tucker, DM; Tyler, WJ; Brunelin, J; Datta, A; Juan, CH; Venkatasubramanian, G; Boggio, PS; Bikson, M

    2014-01-01

    The field of transcranial electrical stimulation (tES) has experienced significant growth in the past 15 years. One of the tES techniques leading this increased interest is transcranial direct current stimulation (tDCS). Significant research efforts have been devoted to determining the clinical potential of tDCS in humans. Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity on international regulatory pathways. We therefore convened a group of research and clinician experts on tDCS to review the research and clinical use of tDCS. In this report, we review the regulatory status of tDCS, and we summarize the results according to research, off-label and compassionate use of tDCS in the following countries: Australia, Brazil, France, Germany, India, Iran, Italy, Portugal, South Korea, Taiwan and United States. Research use, off label treatment and compassionate use of tDCS are employed in most of the countries reviewed in this study. It is critical that a global or local effort is organized to pursue definite evidence to either approve and regulate or restrict the use of tDCS in clinical practice on the basis of adequate randomized controlled treatment trials. PMID:25983531

  2. Neuropathic pain phenotyping by international consensus (NeuroPPIC) for genetic studies: a NeuPSIG systematic review, Delphi survey, and expert panel recommendations

    PubMed Central

    van Hecke, Oliver; Kamerman, Peter R.; Attal, Nadine; Baron, Ralf; Bjornsdottir, Gyda; Bennett, David L.H.; Bennett, Michael I.; Bouhassira, Didier; Diatchenko, Luda; Freeman, Roy; Freynhagen, Rainer; Haanpää, Maija; Jensen, Troels S.; Raja, Srinivasa N.; Rice, Andrew S.C.; Seltzer, Ze'ev; Thorgeirsson, Thorgeir E.; Yarnitsky, David; Smith, Blair H.

    2015-01-01

    Abstract For genetic research to contribute more fully to furthering our knowledge of neuropathic pain, we require an agreed, valid, and feasible approach to phenotyping, to allow collaboration and replication in samples of sufficient size. Results from genetic studies on neuropathic pain have been inconsistent and have met with replication difficulties, in part because of differences in phenotypes used for case ascertainment. Because there is no consensus on the nature of these phenotypes, nor on the methods of collecting them, this study aimed to provide guidelines on collecting and reporting phenotypes in cases and controls for genetic studies. Consensus was achieved through a staged approach: (1) systematic literature review to identify all neuropathic pain phenotypes used in previous genetic studies; (2) Delphi survey to identify the most useful neuropathic pain phenotypes and their validity and feasibility; and (3) meeting of experts to reach consensus on the optimal phenotype(s) to be collected from patients with neuropathic pain for genetic studies. A basic “entry level” set of phenotypes was identified for any genetic study of neuropathic pain. This set identifies cases of “possible” neuropathic pain, and controls, and includes: (1) a validated symptom-based questionnaire to determine whether any pain is likely to be neuropathic; (2) body chart or checklist to identify whether the area of pain distribution is neuroanatomically logical; and (3) details of pain history (intensity, duration, any formal diagnosis). This NeuroPPIC “entry level” set of phenotypes can be expanded by more extensive and specific measures, as determined by scientific requirements and resource availability. PMID:26469320

  3. Neuropathic pain phenotyping by international consensus (NeuroPPIC) for genetic studies: a NeuPSIG systematic review, Delphi survey, and expert panel recommendations.

    PubMed

    van Hecke, Oliver; Kamerman, Peter R; Attal, Nadine; Baron, Ralf; Bjornsdottir, Gyda; Bennett, David L H; Bennett, Michael I; Bouhassira, Didier; Diatchenko, Luda; Freeman, Roy; Freynhagen, Rainer; Haanpää, Maija; Jensen, Troels S; Raja, Srinivasa N; Rice, Andrew S C; Seltzer, Zeʼev; Thorgeirsson, Thorgeir E; Yarnitsky, David; Smith, Blair H

    2015-11-01

    For genetic research to contribute more fully to furthering our knowledge of neuropathic pain, we require an agreed, valid, and feasible approach to phenotyping, to allow collaboration and replication in samples of sufficient size. Results from genetic studies on neuropathic pain have been inconsistent and have met with replication difficulties, in part because of differences in phenotypes used for case ascertainment. Because there is no consensus on the nature of these phenotypes, nor on the methods of collecting them, this study aimed to provide guidelines on collecting and reporting phenotypes in cases and controls for genetic studies. Consensus was achieved through a staged approach: (1) systematic literature review to identify all neuropathic pain phenotypes used in previous genetic studies; (2) Delphi survey to identify the most useful neuropathic pain phenotypes and their validity and feasibility; and (3) meeting of experts to reach consensus on the optimal phenotype(s) to be collected from patients with neuropathic pain for genetic studies. A basic "entry level" set of phenotypes was identified for any genetic study of neuropathic pain. This set identifies cases of "possible" neuropathic pain, and controls, and includes: (1) a validated symptom-based questionnaire to determine whether any pain is likely to be neuropathic; (2) body chart or checklist to identify whether the area of pain distribution is neuroanatomically logical; and (3) details of pain history (intensity, duration, any formal diagnosis). This NeuroPPIC "entry level" set of phenotypes can be expanded by more extensive and specific measures, as determined by scientific requirements and resource availability. PMID:26469320

  4. [Advanced Prostate Cancer Consensus Conference (APCCC) 2015 in St. Gallen : Critical review of the recommendations on diagnosis and therapy of metastatic prostate cancer by a German expert panel].

    PubMed

    Thomas, C; Bögemann, M; König, F; Machtens, S; Schostak, M; Steuber, T; Heidenreich, A

    2016-06-01

    In March 2015, the first Advanced Prostate Cancer Consensus Conference (APCC) took place in St. Gallen. 41 experts from 17 countries reviewed important areas of controversy in advanced hormone-naive and castration-resistant prostate cancer and gave therapy recommendations. These results have been recently published in "Annals of Oncology". While most of the recommendations from St. Gallen are comprehensible, some of them need to be further discussed. Therefore, we as a German expert panel will critically debate the St. Gallen recommendations. For metastatic hormone-naive prostate cancer, continuous androgen deprivation remains the standard. There is no evidence for superiority of primary maximal androgen deprivation. Patients suitable for chemotherapy, especially in the presence of high tumour burden, should receive androgen deprivation plus taxanes upfront. In metastatic castration resistant prostate cancer, novel hormonal agents like abiraterone or enzalutamid should be the treatment of choice in the majority of patients. Taxanes should be used first-line in patients with unfavourable prognostic markers. Radium-223 is an option in symptomatic patients with bone metastases. There is first evidence that second-line hormonal treatment after first-line failure of a novel endocrine agent has a high failure rate. Cabazitaxel should be part of the treatment sequence in patients with a good performance status. Baseline staging for castration-resistant prostate cancer should include CT-abdomen/-chest and bone scan. Radiographic monitoring should be performed 2 to 3 times a year. Determination of PSA and ALP is to take place every 2 to 4 months. PMID:26820660

  5. The Evolving Role of Nivolumab in Non-Small-Cell Lung Cancer for Second-Line Treatment: A New Cornerstone for Our Treatment Algorithms. Results From an International Experts Panel Meeting of the Italian Association of Thoracic Oncology.

    PubMed

    Gridelli, Cesare; Besse, Benjamin; Brahmer, Julie Renee; Crinò, Lucio; Felip, Enriqueta; de Marinis, Filippo

    2016-05-01

    Lung cancer is the leading cause of death from cancer worldwide that currently has only a few available treatment options in patients with no driver mutations. The therapeutic options for patients with non-small-cell lung cancer (NSCLC) who progress after first-line chemotherapy have been limited from a long time. Docetaxel has remained a cornerstone of second-line treatment for more than 20 years, but it is associated with an unfavorable safety profile. Recently, the results from immunotherapy treatment with anti-PD1 and PD-L1 inhibitors has changed our current knowledge base and increased therapeutic options for patients with NSCLC in the second-line setting. The results of 2 randomized phase III trials assessing nivolumab in lung cancer, Check-Mate-017 and Check-Mate-057, have deeply changed our current clinical practice and raised several discussion points. This paper explores the recent findings about nivolumab for the treatment of NSCLC in the second-line setting by analyzing recent trial findings and discussing their implications in clinical practice and future directions. The paper also summarizes the conclusions from an International Experts Panel Meeting of the Italian Association of Thoracic Oncology. PMID:26908078

  6. Expert Biogeographers

    ERIC Educational Resources Information Center

    Bednarski, Marsha

    2006-01-01

    This article describes an alternative way of teaching about biomes by having students become expert biogeographers. In order to become experts students need to first find out what a biogeographer does. Doing an online search lets students find out for themselves what the responsibilities are of people who work in this field. A good place to visit…

  7. Assessment of avionics technology in European aerospace organizations

    NASA Technical Reports Server (NTRS)

    Martinec, D. A.; Baumbick, Robert; Hitt, Ellis; Leondes, Cornelius; Mayton, Monica; Schwind, Joseph; Traybar, Joseph

    1992-01-01

    This report provides a summary of the observations and recommendations made by a technical panel formed by the National Aeronautics and Space Administration (NASA). The panel, comprising prominent experts in the avionics field, was tasked to visit various organizations in Europe to assess the level of technology planned for use in manufactured civil avionics in the future. The primary purpose of the study was to assess avionics systems planned for implementation or already employed on civil aircraft and to evaluate future research, development, and engineering (RD&E) programs, address avionic systems and aircraft programs. The ultimate goal is to ensure that the technology addressed by NASa programs is commensurate with the needs of the aerospace industry at an international level. The panel focused on specific technologies, including guidance and control systems, advanced cockpit displays, sensors and data networks, and fly-by-wire/fly-by-light systems. However, discussions the panel had with the European organizations were not limited to these topics.

  8. Expert Seeker

    NASA Technical Reports Server (NTRS)

    Fernandez, Becerra

    2003-01-01

    Expert Seeker is a computer program of the knowledge-management-system (KMS) type that falls within the category of expertise-locator systems. The main goal of the KMS system implemented by Expert Seeker is to organize and distribute knowledge of who are the domain experts within and without a given institution, company, or other organization. The intent in developing this KMS was to enable the re-use of organizational knowledge and provide a methodology for querying existing information (including structured, semistructured, and unstructured information) in a way that could help identify organizational experts. More specifically, Expert Seeker was developed to make it possible, by use of an intranet, to do any or all of the following: Assist an employee in identifying who has the skills needed for specific projects and to determine whether the experts so identified are available. Assist managers in identifying employees who may need training opportunities. Assist managers in determining what expertise is lost when employees retire or otherwise leave. Facilitate the development of new ways of identifying opportunities for innovation and minimization of duplicated efforts. Assist employees in achieving competitive advantages through the application of knowledge-management concepts and related systems. Assist external organizations in requesting speakers for specific engagements or determining from whom they might be able to request help via electronic mail. Help foster an environment of collaboration for rapid development in today's environment, in which it is increasingly necessary to assemble teams of experts from government, universities, research laboratories, and industries, to quickly solve problems anytime, anywhere. Make experts more visible. Provide a central repository of information about employees, including information that, heretofore, has typically not been captured by the human-resources systems (e.g., information about past projects, patents, or

  9. Weekly working hours for Norwegian hospital doctors since 1994 with special attention to postgraduate training, work–home balance and the European Working Time Directive: a panel study

    PubMed Central

    Rosta, Judith; Aasland, Olaf G

    2014-01-01

    Objectives To examine the weekly working hours of Norwegian hospital doctors from 1994 to 2012 with special emphasis on the quality of postgraduate training and work–home balance, and in relation to the requirements of the European Working Time Directive (EWTD). Design Panel study based on postal questionnaires. Setting Norway. Participants Unbalanced cohort of 1300–1600 doctors in 1994, 1995, 1996, 1997, 2000, 2002, 2004, 2006, 2008, 2010 and 2012. Outcome measures Self-reported total weekly working hours and whether 45 weekly working hours are too short, sufficient, or too long to meet the quality requirements of obligatory postgraduate training for junior doctors. Results From 1994 to 2012, the number of weekly working hours was stable for senior (46–47 h) and junior (45–46 h) hospital doctors. In 2012, significantly more senior (27–35%) than junior (11–20%) doctors reported suboptimal work–home balance, defined as working more than 48 h a week. The majority perceived the present situation with an average of 45 h per week for juniors as sufficient for obligatory postgraduate specialist training, but doctors of higher age (OR 1.04, 95% CI 1.01 to 1.08), senior doctors (1.07, 1.04 to 1.11) and doctors working in surgical specialties (OR 1 vs laboratory medicine 0.03, 0.01 to 0.25, internal medicine 0.31, 0.17 to 0.58, psychiatry 0.12, 0.04 to 0.36, paediatrics 0.36, 0.12 to 1.07, anaesthesiology 0.08, 0.02 to 0.39, gynaecology 0.07, 0.01 to 0.56 and others 0.39, 0.04 to 3.56) were more likely to want the work-week to be longer. Conclusions The weekly working hours of Norwegian hospital doctors were always below the EWTD requirements. A significant growth of hospital doctor density over the past two decades, national regulations and cultural values might be important factors. Specialty differences in perception of sufficient training time may call for more flexibility in working time regulations. PMID:25311038

  10. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

    PubMed Central

    Visser, K; Katchamart, W; Loza, E; Martinez-Lopez, J A; Salliot, C; Trudeau, J; Bombardier, C; Carmona, L; van der Heijde, D; Bijlsma, J W J; Boumpas, D T; Canhao, H; Edwards, C J; Hamuryudan, V; Kvien, T K; Leeb, B F; Martín-Mola, E M; Mielants, H; Müller-Ladner, U; Murphy, G; Østergaard, M; Pereira, I A; Ramos-Remus, C; Valentini, G; Zochling, J; Dougados, M

    2009-01-01

    Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007–8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005–7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroid-sparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use. PMID:19033291

  11. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

    PubMed Central

    Colebatch, Alexandra N.; Buchbinder, Rachelle; Edwards, Christopher J.; Adams, Karen; Englbrecht, Matthias; Hazlewood, Glen; Marks, Jonathan L.; Radner, Helga; Ramiro, Sofia; Richards, Bethan L.; Tarner, Ingo H.; Aletaha, Daniel; Bombardier, Claire; Landewé, Robert B.; Müller-Ladner, Ulf; Bijlsma, Johannes W. J.; Branco, Jaime C.; Bykerk, Vivian P.; da Rocha Castelar Pinheiro, Geraldo; Catrina, Anca I.; Hannonen, Pekka; Kiely, Patrick; Leeb, Burkhard; Lie, Elisabeth; Martinez-Osuna, Píndaro; Montecucco, Carlomaurizio; Østergaard, Mikkel; Westhovens, Rene; Zochling, Jane; van der Heijde, Désirée

    2012-01-01

    Objective. To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). Methods. A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008–09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. Results. A total of 49 242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice. Conclusions. Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice. PMID:22447886

  12. Influenza vaccination: key facts for general practitioners in Europe-a synthesis by European experts based on national guidelines and best practices in the United Kingdom and the Netherlands.

    PubMed

    Kassianos, George; Blank, Patricia; Falup-Pecurariu, Oana; Kuchar, Ernest; Kyncl, Jan; De Lejarazu, Raul Ortiz; Nitsch-Osuch, Aneta; van Essen, Gerrit A

    2016-01-01

    Currently there is no influenza vaccination guidance for European general practitioners. Furthermore, although the European Council recommends a target seasonal influenza vaccination rate of 75% in the elderly (65 years and above) and in anyone aged >6 months with a chronic medical condition, there remain wide discrepancies throughout Europe. A harmonised guideline regarding not only vaccination strategy but also for the consistent diagnosis of influenza across Europe is essential to support a common approach for the implementation of seasonal influenza vaccination across Europe. This document is based on pre-existing guidelines available in the UK and Netherlands and has been approved by a group of European experts for use throughout Europe. As well as providing a standardised influenza diagnosis, it also reviews the current recommendations for influenza vaccination, the types of vaccine available, the contraindications, vaccine use in special populations (in pregnancy, children, and in those with egg allergy), and concomitant administration with other vaccines. The effectiveness, safety, and timing of the seasonal influenza vaccine are also reviewed. A second section provides practical guidance for general practitioners for the implementation of a seasonal influenza vaccination program, including the selection and notification of those eligible for vaccination, as well as suggestions for the organisation of a vaccination programme. Finally, suggested responses to common patient misconceptions and frequently asked questions are included. The aim of this article is to harmonise the diagnosis of seasonal influenza and the approach of European general practitioners to seasonal influenza vaccination in order to better identify influenza outbreaks and to move towards reaching the target vaccination rate of 75% throughout Europe. PMID:27540408

  13. Influenza vaccination: key facts for general practitioners in Europe—a synthesis by European experts based on national guidelines and best practices in the United Kingdom and the Netherlands

    PubMed Central

    Kassianos, George; Blank, Patricia; Falup-Pecurariu, Oana; Kuchar, Ernest; Kyncl, Jan; De Lejarazu, Raul Ortiz; Nitsch-Osuch, Aneta; van Essen, Gerrit A

    2016-01-01

    Currently there is no influenza vaccination guidance for European general practitioners. Furthermore, although the European Council recommends a target seasonal influenza vaccination rate of 75% in the elderly (65 years and above) and in anyone aged >6 months with a chronic medical condition, there remain wide discrepancies throughout Europe. A harmonised guideline regarding not only vaccination strategy but also for the consistent diagnosis of influenza across Europe is essential to support a common approach for the implementation of seasonal influenza vaccination across Europe. This document is based on pre-existing guidelines available in the UK and Netherlands and has been approved by a group of European experts for use throughout Europe. As well as providing a standardised influenza diagnosis, it also reviews the current recommendations for influenza vaccination, the types of vaccine available, the contraindications, vaccine use in special populations (in pregnancy, children, and in those with egg allergy), and concomitant administration with other vaccines. The effectiveness, safety, and timing of the seasonal influenza vaccine are also reviewed. A second section provides practical guidance for general practitioners for the implementation of a seasonal influenza vaccination program, including the selection and notification of those eligible for vaccination, as well as suggestions for the organisation of a vaccination programme. Finally, suggested responses to common patient misconceptions and frequently asked questions are included. The aim of this article is to harmonise the diagnosis of seasonal influenza and the approach of European general practitioners to seasonal influenza vaccination in order to better identify influenza outbreaks and to move towards reaching the target vaccination rate of 75% throughout Europe. PMID:27540408

  14. CDC Panel Says FluMist Nasal Flu Vaccine Ineffective

    MedlinePlus

    ... fullstory_159535.html CDC Panel Says FluMist Nasal Flu Vaccine Ineffective Agency advisors say the product has ... do without the easier, nasal spray form of flu vaccine next flu season, a panel of experts ...

  15. CDC Panel Says FluMist Nasal Flu Vaccine Ineffective

    MedlinePlus

    ... 159535.html CDC Panel Says FluMist Nasal Flu Vaccine Ineffective Agency advisors say the product has lost ... without the easier, nasal spray form of flu vaccine next flu season, a panel of experts decided ...

  16. [Homozygous familial hypercholesterolaemia: Spanish adaptation of the position paper from the Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society. Consensus document of the Spanish Society of Arteriosclerosis (SEA) and Familial Hypercholesterolaemia Foundation (FHF)].

    PubMed

    Ascaso, Juan F; Mata, Pedro; Arbona, Cristina; Civeira, Fernando; Valdivielso, Pedro; Masana, Luis

    2015-01-01

    Homozygous familial hypercholesterolaemia (HoFH) is a rare life-threatening disease characterized by markedly elevated circulating levels of low-density lipoprotein cholesterol (LDL-C) and accelerated, premature atherosclerotic cardiovascular disease (ACVD). The Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society (EAS) has recently published a clinical guide to diagnose and manage HoFH (Eur Heart J. 2014;35:2146-57). Both the Spanish Society of Atherosclerosis (SEA) and Familial Hypercholesterolaemia Foundation (FHF) consider this European Consensus document of great value and utility. However, there are particularities in our country which advise to have a Spanish adaptation of the European HoFH document in order to approximate this clinical guide to our environment. In Spain, chronic treatment with statins, ezetimibe and resins (colesevelam) has a reduced contribution in the National Health System (NHS) and is one of the few European countries where LDL apheresis is included in the Basic Service Portfolio coverage. This Spanish document also includes clinical experience in the management of these patients in our country. The Drafting Committee emphasizes the need for early identification of HoFH patients, prompt referral to specialized units, and an early and appropriate treatment. These recommendations will provide a guidance for HoFH patient management in Spain. PMID:25757840

  17. Interactive Panel Discussion

    NASA Astrophysics Data System (ADS)

    Bernius, Mark

    2014-03-01

    Quo Vadis? Here is the opportunity to ask panel members your questions: seek a forecast of current trends, where are we going as a collection of physicists in a wide variety of employment settings? What is the likelihood of remaining cohesive as those schooled in the fundamentals of physics? How might we better foster collaboration, with the disparate agendas of academia, government and commerce? Come with your questions, and share in this unique opportunity to quiz the experts.

  18. Expert consensus document: Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA).

    PubMed

    Banales, Jesus M; Cardinale, Vincenzo; Carpino, Guido; Marzioni, Marco; Andersen, Jesper B; Invernizzi, Pietro; Lind, Guro E; Folseraas, Trine; Forbes, Stuart J; Fouassier, Laura; Geier, Andreas; Calvisi, Diego F; Mertens, Joachim C; Trauner, Michael; Benedetti, Antonio; Maroni, Luca; Vaquero, Javier; Macias, Rocio I R; Raggi, Chiara; Perugorria, Maria J; Gaudio, Eugenio; Boberg, Kirsten M; Marin, Jose J G; Alvaro, Domenico

    2016-05-01

    Cholangiocarcinoma (CCA) is a heterogeneous group of malignancies with features of biliary tract differentiation. CCA is the second most common primary liver tumour and the incidence is increasing worldwide. CCA has high mortality owing to its aggressiveness, late diagnosis and refractory nature. In May 2015, the "European Network for the Study of Cholangiocarcinoma" (ENS-CCA: www.enscca.org or www.cholangiocarcinoma.eu) was created to promote and boost international research collaboration on the study of CCA at basic, translational and clinical level. In this Consensus Statement, we aim to provide valuable information on classifications, pathological features, risk factors, cells of origin, genetic and epigenetic modifications and current therapies available for this cancer. Moreover, future directions on basic and clinical investigations and plans for the ENS-CCA are highlighted. PMID:27095655

  19. Panel 5: Microbiology and Immunology Panel

    PubMed Central

    Murphy, Timothy F.; Chonmaitree, Tasnee; Barenkamp, Stephen; Kyd, Jennelle; Nokso-Koivisto, Johanna; Patel, Janak A.; Heikkinen, Terho; Yamanaka, Noboru; Ogra, Pearay; Swords, W. Edward; Sih, Tania; Pettigrew, Melinda M.

    2014-01-01

    Objective The objective is to perform a comprehensive review of the literature from January 2007 through June 2011 on the virology, bacteriology, and immunology related to otitis media. Data Sources PubMed database of the National Library of Medicine. Review Methods Three subpanels with co-chairs comprising experts in the virology, bacteriology, and immunology of otitis media were formed. Each of the panels reviewed the literature in their respective fields and wrote draft reviews. The reviews were shared with all panel members, and a second draft was created. The entire panel met at the 10th International Symposium on Recent Advances in Otitis Media in June 2011 and discussed the review and refined the content further. A final draft was created, circulated, and approved by the panel. Conclusion Excellent progress has been made in the past 4 years in advancing an understanding of the microbiology and immunology of otitis media. Advances include laboratory-based basic studies, cell-based assays, work in animal models, and clinical studies. Implications for Practice The advances of the past 4 years formed the basis of a series of short-term and long-term research goals in an effort to guide the field. Accomplishing these goals will provide opportunities for the development of novel interventions, including new ways to better treat and prevent otitis media. PMID:23536533

  20. Expert reports.

    PubMed

    Thornton, R G

    2000-10-01

    In 1996, article 4590i of the Texas Revised Civil Statutes Annotated, the statutory provision that governs health care liability claims in Texas, was amended to require claimants to file expert reports within 180 days as part of the prosecution of their claims. Sufficient expert reports include explanations of the standard of care, the deviation from that standard, and how the deviation caused the claimant's damages. Two provisions allow courts to grant a 30-day extension for filing expert reports. A good cause extension can be used to extend the filing deadline to 210 days; however, case law has not clearly defined what constitutes good cause. An accident or mistake grace period can be used to justify reports filed >210 days after the suit has been filed; judges determine whether the failure is due to a mistake or intentional indifference. As with any statute, the language is not as important as how the courts (judges) interpret that language. The statute may appear strict but room for interpretation exists. PMID:16389359

  1. Panel flutter

    NASA Technical Reports Server (NTRS)

    Dowell, E. H.

    1972-01-01

    Criteria are presented for the prediction of panel flutter, determination of its occurrence, design for its prevention, and evaluation of its severity. Theoretical analyses recommended for the prediction of flutter stability boundaries, vibration amplitudes, and frequencies for several types of panels are described. Vibration tests and wind tunnel tests are recommended for certain panels and environmental flow conditions to provide information for design of verification analysis. Appropriate design margins on flutter stability boundaries are given and general criteria are presented for evaluating the severity of possible short-duration, limited-amplitude panel flutter on nonreusable vehicles.

  2. Geothermal Technologies Program Blue Ribbon Panel Recommendations

    SciTech Connect

    none,

    2011-06-17

    The Geothermal Technologies Program assembled a geothermal Blue Ribbon Panel on March 22-23, 2011 in Albuquerque, New Mexico for a guided discussion on the future of geothermal energy in the United States and the role of the DOE Program. The Geothermal Blue Ribbon Panel Report captures the discussions and recommendations of the experts. An addendum is available here: http://www.eere.energy.gov/geothermal/pdfs/gtp_blue_ribbon_panel_report_addendum10-2011.pdf

  3. Joint USNRC/EC consequence uncertainty study: The ingestion pathway, dosimetry and health effects expert judgment elicitations and results

    SciTech Connect

    Harper, F.; Goossens, L.; Abbott, M.

    1996-08-01

    The US Nuclear Regulatory Commission (USNRC) and the European Commission (EC) have conducted a formal expert judgment elicitation jointly to systematically collect the quantitative information needed to perform consequence uncertainty analyses on a broad set of commercial nuclear power plants. Information from three sets of joint US/European expert panels was collected and processed. Information from the three sets of panels was collected in the following areas: in the phenomenological areas of atmospheric dispersion and deposition, in the areas of ingestion pathways and external dosimetry, and in the areas of health effects and internal dosimetry. This exercise has demonstrated that the uncertainty for particular issues as measured by the ratio of the 95th percentile to the 5th percentile can be extremely large (orders of magnitude), or rather small (factor of two). This information has already been used by many of the experts that were involved in this process in areas other than the consequence uncertainty field. The benefit to the field of radiological consequences is just beginning as the results of this study are published and made available to the consequence community.

  4. Role of risk stratification by SPECT, PET, and hybrid imaging in guiding management of stable patients with ischaemic heart disease: expert panel of the EANM cardiovascular committee and EACVI.

    PubMed

    Acampa, Wanda; Gaemperli, Oliver; Gimelli, Alessia; Knaapen, Paul; Schindler, Thomas H; Verberne, Hein J; Zellweger, Michael J

    2015-12-01

    Risk stratification has become increasingly important in the management of patients with suspected or known ischaemic heart disease (IHD). Recent guidelines recommend that these patients have their care driven by risk assessment. The purpose of this position statement is to summarize current evidence on the value of cardiac single-photon emission computed tomography, positron emission tomography, and hybrid imaging in risk stratifying asymptomatic or symptomatic patients with suspected IHD, patients with stable disease, patients after coronary revascularization, heart failure patients, and specific patient population. In addition, this position statement evaluates the impact of imaging results on clinical decision-making and thereby its role in patient management. The document represents the opinion of the European Association of Nuclear Medicine (EANM) Cardiovascular Committee and of the European Association of Cardiovascular Imaging (EACVI) and intends to stimulate future research in this field. PMID:25902767

  5. 40 CFR 766.28 - Expert review of protocols.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Expert review of protocols. EPA will gather a panel of experts in analysis of chemical matrices for HDDs... and/or of other U.S. Government agencies who have had experience in analysis of chemical matrices and... Prevention and Toxics, whether the protocol submitted is likely to allow analysis down to the target LOQs,...

  6. 40 CFR 766.28 - Expert review of protocols.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Expert review of protocols. EPA will gather a panel of experts in analysis of chemical matrices for HDDs... and/or of other U.S. Government agencies who have had experience in analysis of chemical matrices and... Prevention and Toxics, whether the protocol submitted is likely to allow analysis down to the target LOQs,...

  7. 40 CFR 766.28 - Expert review of protocols.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Expert review of protocols. EPA will gather a panel of experts in analysis of chemical matrices for HDDs... and/or of other U.S. Government agencies who have had experience in analysis of chemical matrices and... Prevention and Toxics, whether the protocol submitted is likely to allow analysis down to the target LOQs,...

  8. 40 CFR 766.28 - Expert review of protocols.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Expert review of protocols. EPA will gather a panel of experts in analysis of chemical matrices for HDDs... and/or of other U.S. Government agencies who have had experience in analysis of chemical matrices and... Prevention and Toxics, whether the protocol submitted is likely to allow analysis down to the target LOQs,...

  9. 40 CFR 766.28 - Expert review of protocols.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Expert review of protocols. EPA will gather a panel of experts in analysis of chemical matrices for HDDs... and/or of other U.S. Government agencies who have had experience in analysis of chemical matrices and... Prevention and Toxics, whether the protocol submitted is likely to allow analysis down to the target LOQs,...

  10. Media Panel.

    ERIC Educational Resources Information Center

    Marklund, Inger, Ed.; Hanse, Mona-Britt, Ed.

    1984-01-01

    The Swedish Media Panel is a research program about children and young persons and their use of mass media. The aim of the ten-year (1975-1985) project is to explain how media habits originate, how they change as children grow older, what factors on the part of children themselves and in their surroundings may be connected with a certain use of…

  11. Panel Sessions.

    ERIC Educational Resources Information Center

    Proceedings of the ASIS Mid-Year Meeting, 1992

    1992-01-01

    Lists the speakers and summarizes the issues addressed for 12 panel sessions on topics related to networking, including libraries and national networks, federal national resources and energy programs, multimedia issues, telecommuting, remote image serving, accessing the Internet, library automation, scientific information, applications of Z39.50,…

  12. Speech spectrogram expert

    SciTech Connect

    Johannsen, J.; Macallister, J.; Michalek, T.; Ross, S.

    1983-01-01

    Various authors have pointed out that humans can become quite adept at deriving phonetic transcriptions from speech spectrograms (as good as 90percent accuracy at the phoneme level). The authors describe an expert system which attempts to simulate this performance. The speech spectrogram expert (spex) is actually a society made up of three experts: a 2-dimensional vision expert, an acoustic-phonetic expert, and a phonetics expert. The visual reasoning expert finds important visual features of the spectrogram. The acoustic-phonetic expert reasons about how visual features relates to phonemes, and about how phonemes change visually in different contexts. The phonetics expert reasons about allowable phoneme sequences and transformations, and deduces an english spelling for phoneme strings. The speech spectrogram expert is highly interactive, allowing users to investigate hypotheses and edit rules. 10 references.

  13. 61. Upper panel in cornerpower panel lcpa lower panel in ...

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

    61. Upper panel in corner-power panel lcpa lower panel in corner-oxygen regeneration unit, at right-air conditioner control panel, on floor-bio-pack 45 for emergency breathing, looking northwest - Ellsworth Air Force Base, Delta Flight, Launch Control Facility, County Road CS23A, North of Exit 127, Interior, Jackson County, SD

  14. Architectural Panels

    NASA Technical Reports Server (NTRS)

    1985-01-01

    Alliance Wall Corporation's Whyteboard, a porcelain enamel on steel panels wall board, owes its color stability to a KIAC engineering background study to identify potential technologies and manufacturers of equipment which could be used to detect surface flaws. One result of the data base search was the purchase of a spectrocolorimeter which enables the company to control some 250 standard colors, and match special colors.

  15. Multinational evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

    PubMed Central

    Machado, P; Castrejon, I; Katchamart, W; Koevoets, R; Kuriya, B; Schoels, M; Silva-Fernández, L; Thevissen, K; Vercoutere, W; Villeneuve, E; Aletaha, D; Carmona, L; Landewé, R; van der Heijde, D; Bijlsma, J W J; Bykerk, V; Canhão, H; Catrina, A I; Durez, P; Edwards, C J; Mjaavatten, M D; Leeb, B F; Losada, B; Martín-Mola, E M; Martinez-Osuna, P; Montecucco, C; Müller-Ladner, U; Østergaard, M; Sheane, B; Xavier, R M; Zochling, J; Bombardier, C

    2011-01-01

    Objective To develop evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis (UPIA). Methods 697 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2008–9 consisting of three separate rounds of discussions and modified Delphi votes. In the first round 10 clinical questions were selected. A bibliographic team systematically searched Medline, Embase, the Cochrane Library and ACR/EULAR 2007–2008 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In the second round each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results A total of 39 756 references were identified, of which 250 were systematically reviewed. Ten multinational key recommendations about the investigation and follow-up of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to establishing the operational diagnosis of UPIA, seven recommendations related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, autoantibodies, radiographs, MRI and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity) and the final recommendation addressed monitoring of clinical disease activity in UPIA. Conclusions Ten recommendations on how to investigate and follow-up UPIA in the clinical setting were developed. They are evidence-based and supported by a large panel of rheumatologists, thus enhancing their validity and practical use. PMID:20724311

  16. Expert system prototype of food aid distribution.

    PubMed

    Singh, Neeta

    2007-01-01

    The aim of this study was to improve efficiency of the food aid distribution process of international food relief organizations. An overall objective of this study was to develop a prototype expert system for monitoring and evaluating food aid by international disaster relief organizations. The research identifies data related to monitoring and evaluation processes of various international food-aid organizations. It then applies an artificial intelligence-based expert system to develop a prototype for those processes. Existing data related to monitoring and evaluation program cycles were obtained. An expert system shell called CLIPS(c) (National Aeronautics Space Administration) was used to develop a prototype system named Food Aid Monitor, a rule-based expert system, which uses facts and heuristic rules to provide an adaptive feedback regarding monitoring and evaluating processes at various stages of food aid operation. The Food Aid Monitor was evaluated and validated by three expert panels checking the prototype system for completeness, relevancy, consistency, correctness, precision, and use-ability. Finally, the panels indicated a belief that the system could have an overall positive impact on the stages of monitoring and evaluating food aid processes of the food relief organizations. PMID:17392088

  17. Approaches to the verification of rule-based expert systems

    NASA Technical Reports Server (NTRS)

    Culbert, Chris; Riley, Gary; Savely, Robert T.

    1987-01-01

    Expert systems are a highly useful spinoff of artificial intelligence research. One major stumbling block to extended use of expert systems is the lack of well-defined verification and validation (V and V) methodologies. Since expert systems are computer programs, the definitions of verification and validation from conventional software are applicable. The primary difficulty with expert systems is the use of development methodologies which do not support effective V and V. If proper techniques are used to document requirements, V and V of rule-based expert systems is possible, and may be easier than with conventional code. For NASA applications, the flight technique panels used in previous programs should provide an excellent way to verify the rules used in expert systems. There are, however, some inherent differences in expert systems that will affect V and V considerations.

  18. The Expert Witness

    ERIC Educational Resources Information Center

    Environmental Science and Technology, 1975

    1975-01-01

    As consumers organize and industry begins to feel the economic pinch of pollution control laws, litigation may increase as will the need for the expert witness. Discussed are the functions and preparations of expert witnesses, their role and conduct in judicial proceedings, and the techniques of being an expert witness. (BT)

  19. An expert system development methodology which supports verification and validation

    NASA Technical Reports Server (NTRS)

    Culbert, Chris; Riley, Gary; Savely, Robert T.

    1987-01-01

    Expert systems have demonstrated commercial viability in a wide range of applications, but still face some obstacles to widespread use. A major stumbling block is the lack of well defined verification and validation (V and V) techniques. The primary difficulty with expert system V and V is the use of development methodologies which do not support V and V. As with conventional code, the key to effective V and V is the development methodology. An expert system development methodology is described which is based upon a panel review approach, that allows input from all parties concerned with the expert system.

  20. Towards Horizon 2020: challenges and advances for clinical mental health research – outcome of an expert survey

    PubMed Central

    van der Feltz-Cornelis, Christina M; van Os, Jim; Knappe, Susanne; Schumann, Gunter; Vieta, Eduard; Wittchen, Hans-Ulrich; Lewis, Shôn W; Elfeddali, Iman; Wahlbeck, Kristian; Linszen, Donald; Obradors-Tarragó, Carla; Haro, Josep Maria

    2014-01-01

    Background The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders. Methods The research was conducted as an expert survey and expert panel discussion during a scientific workshop. Results Eighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The “subjectivity gap” between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required. Conclusion Innovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs. PMID:25061300

  1. Expert witness reform.

    PubMed

    Horton, J Bauer; Reece, Edward; Janis, Jeffrey E; Broughton, George; Hollier, Larry; Thornton, James F; Kenkel, Jeffrey M; Rohrich, Rod J

    2007-12-01

    The legal system depends on the medical expert for evidence. Doctors readily complain about frivolous cases that go to trial, yet a lawyer cannot bring a frivolous claim to trial without a physician expert witness stating that the claim is not frivolous. An insurance company cannot raise premiums without medical expert witnesses servicing the increasing litigation against the insured. Physicians must look to themselves as a major contributor to rising malpractice insurance costs. For without the physician expert witness, no medical malpractice lawsuit can take place. It is the expert physician, not the attorneys or insurance companies, who defines "meritless" and "frivolous" and who ultimately controls the courts' medical malpractice caseload. PMID:18090781

  2. Expert status and performance.

    PubMed

    Burgman, Mark A; McBride, Marissa; Ashton, Raquel; Speirs-Bridge, Andrew; Flander, Louisa; Wintle, Bonnie; Fidler, Fiona; Rumpff, Libby; Twardy, Charles

    2011-01-01

    Expert judgements are essential when time and resources are stretched or we face novel dilemmas requiring fast solutions. Good advice can save lives and large sums of money. Typically, experts are defined by their qualifications, track record and experience. The social expectation hypothesis argues that more highly regarded and more experienced experts will give better advice. We asked experts to predict how they will perform, and how their peers will perform, on sets of questions. The results indicate that the way experts regard each other is consistent, but unfortunately, ranks are a poor guide to actual performance. Expert advice will be more accurate if technical decisions routinely use broadly-defined expert groups, structured question protocols and feedback. PMID:21829574

  3. Expert Status and Performance

    PubMed Central

    Burgman, Mark A.; McBride, Marissa; Ashton, Raquel; Speirs-Bridge, Andrew; Flander, Louisa; Wintle, Bonnie; Fidler, Fiona; Rumpff, Libby; Twardy, Charles

    2011-01-01

    Expert judgements are essential when time and resources are stretched or we face novel dilemmas requiring fast solutions. Good advice can save lives and large sums of money. Typically, experts are defined by their qualifications, track record and experience [1], [2]. The social expectation hypothesis argues that more highly regarded and more experienced experts will give better advice. We asked experts to predict how they will perform, and how their peers will perform, on sets of questions. The results indicate that the way experts regard each other is consistent, but unfortunately, ranks are a poor guide to actual performance. Expert advice will be more accurate if technical decisions routinely use broadly-defined expert groups, structured question protocols and feedback. PMID:21829574

  4. Panel Moves toward "Next Generation" Science Standards

    ERIC Educational Resources Information Center

    Robelen, Erik W.

    2010-01-01

    As part of a national effort to produce "next generation" science standards for K-12 education, a panel of experts convened by the National Research Council (NRC) has issued a draft of a conceptual framework designed to guide the standards and "move science education toward a more coherent vision." One key goal of the effort is to focus science…

  5. Heat exchanger panel

    NASA Technical Reports Server (NTRS)

    Warburton, Robert E. (Inventor); Cuva, William J. (Inventor)

    2005-01-01

    The present invention relates to a heat exchanger panel which has broad utility in high temperature environments. The heat exchanger panel has a first panel, a second panel, and at least one fluid containment device positioned intermediate the first and second panels. At least one of the first panel and the second panel have at least one feature on an interior surface to accommodate the at least one fluid containment device. In a preferred embodiment, each of the first and second panels is formed from a high conductivity, high temperature composite material. Also, in a preferred embodiment, the first and second panels are joined together by one or more composite fasteners.

  6. Genotoxicity of radiofrequency radiation. DNA/Genetox Expert Panel.

    PubMed

    Brusick, D; Albertini, R; McRee, D; Peterson, D; Williams, G; Hanawalt, P; Preston, J

    1998-01-01

    During the past several years, concerns have been raised regarding the potential adverse effects of exposures to nonionizing radiation, particularly in the extremely low frequency (ELF) range (50 to 60 MHz) and radiofrequency radiation (RFR) with frequencies ranging from 30 KHz to 30,000 MHz. One focus of concern has been potential DNA interactions. Publications reviewing the genotoxicity of ELF radiation [McCann et al. (1993): Mutat Res 297(1):61-95; Murphy et al. (1993): Mutat Res 296:221-240; NAS (1997)], have been uniform in concluding that the weight of evidence does not indicate any genotoxic risk from exposure to this type of radiation. Concern that RFR may be associated with adverse biological effects [WHO, 1993], including recent allegations that they may be involved in the production of brain tumors in humans [Elmer-Dewit (1993): Time, February 8:42], has resulted in the production of a large number of publications describing the effects of RFR on the integrity of nucleic acids. Data from studies conducted in a frequency range from 800 to 3,000 MHz were reviewed and subjected to a weight-of-evidence evaluation. The evaluation focused on direct toxicological effects of RFR as well as on studies addressing basic biological responses to RFR at the cellular and molecular level. The data from over 100 studies suggest that RFR is not directly mutagenic and that adverse effects from exposure of organisms to high frequencies and high power intensities of RFR are predominantly the result of hyperthermia; however, there may be some subtle indirect effects on the replication and/or transcription of genes under relatively restricted exposure conditions. PMID:9707093

  7. 21 CFR 516.141 - Qualified expert panels.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL..., their spouse, their minor children, their general partners, or any organizations in which they serve as an officer, director, trustee, general partner or employee: (i) Is currently receiving or...

  8. 21 CFR 516.141 - Qualified expert panels.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... funding from the requestor through a contract or research grant (either directly or indirectly through...), including for each the following: Name of the firm, topic/issue, amount received, date initiated. (iv) Contracts, grants, Cooperation Research and Development Agreement (CRADAs) (current or under...

  9. 21 CFR 516.141 - Qualified expert panels.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... funding from the requestor through a contract or research grant (either directly or indirectly through...), including for each the following: Name of the firm, topic/issue, amount received, date initiated. (iv) Contracts, grants, Cooperation Research and Development Agreement (CRADAs) (current or under...

  10. Identifying Characteristics of Dissemination Success Using an Expert Panel

    ERIC Educational Resources Information Center

    Bourrie, David M.; Cegielski, Casey G.; Jones-Farmer, L. Allison; Sankar, Chetan S.

    2014-01-01

    Although considerable work has been done to develop new educational innovations, few have found widespread acceptance in the classroom. To improve the likelihood of adoption of educational innovations, researchers need to understand why some innovations are adopted and routinely used, while others are not. An initial aspect of the diffusion of…

  11. Evaluation of a Performance-Based Expert Elicitation: WHO Global Attribution of Foodborne Diseases.

    PubMed

    Aspinall, W P; Cooke, R M; Havelaar, A H; Hoffmann, S; Hald, T

    2016-01-01

    For many societally important science-based decisions, data are inadequate, unreliable or non-existent, and expert advice is sought. In such cases, procedures for eliciting structured expert judgments (SEJ) are increasingly used. This raises questions regarding validity and reproducibility. This paper presents new findings from a large-scale international SEJ study intended to estimate the global burden of foodborne disease on behalf of WHO. The study involved 72 experts distributed over 134 expert panels, with panels comprising thirteen experts on average. Elicitations were conducted in five languages. Performance-based weighted solutions for target questions of interest were formed for each panel. These weights were based on individual expert's statistical accuracy and informativeness, determined using between ten and fifteen calibration variables from the experts' field with known values. Equal weights combinations were also calculated. The main conclusions on expert performance are: (1) SEJ does provide a science-based method for attribution of the global burden of foodborne diseases; (2) equal weighting of experts per panel increased statistical accuracy to acceptable levels, but at the cost of informativeness; (3) performance-based weighting increased informativeness, while retaining accuracy; (4) due to study constraints individual experts' accuracies were generally lower than in other SEJ studies, and (5) there was a negative correlation between experts' informativeness and statistical accuracy which attenuated as accuracy improved, revealing that the least accurate experts drive the negative correlation. It is shown, however, that performance-based weighting has the ability to yield statistically accurate and informative combinations of experts' judgments, thereby offsetting this contrary influence. The present findings suggest that application of SEJ on a large scale is feasible, and motivate the development of enhanced training and tools for remote

  12. Expert system technology

    NASA Technical Reports Server (NTRS)

    Prince, Mary Ellen

    1987-01-01

    The expert system is a computer program which attempts to reproduce the problem-solving behavior of an expert, who is able to view problems from a broad perspective and arrive at conclusions rapidly, using intuition, shortcuts, and analogies to previous situations. Expert systems are a departure from the usual artificial intelligence approach to problem solving. Researchers have traditionally tried to develop general modes of human intelligence that could be applied to many different situations. Expert systems, on the other hand, tend to rely on large quantities of domain specific knowledge, much of it heuristic. The reasoning component of the system is relatively simple and straightforward. For this reason, expert systems are often called knowledge based systems. The report expands on the foregoing. Section 1 discusses the architecture of a typical expert system. Section 2 deals with the characteristics that make a problem a suitable candidate for expert system solution. Section 3 surveys current technology, describing some of the software aids available for expert system development. Section 4 discusses the limitations of the latter. The concluding section makes predictions of future trends.

  13. Expert networks in CLIPS

    NASA Technical Reports Server (NTRS)

    Hruska, S. I.; Dalke, A.; Ferguson, J. J.; Lacher, R. C.

    1991-01-01

    Rule-based expert systems may be structurally and functionally mapped onto a special class of neural networks called expert networks. This mapping lends itself to adaptation of connectionist learning strategies for the expert networks. A parsing algorithm to translate C Language Integrated Production System (CLIPS) rules into a network of interconnected assertion and operation nodes has been developed. The translation of CLIPS rules to an expert network and back again is illustrated. Measures of uncertainty similar to those rules in MYCIN-like systems are introduced into the CLIPS system and techniques for combining and hiring nodes in the network based on rule-firing with these certainty factors in the expert system are presented. Several learning algorithms are under study which automate the process of attaching certainty factors to rules.

  14. Ethical Expert Systems

    PubMed Central

    Victoroff, Michael S.

    1985-01-01

    The title is a double entendre. The discussion approaches expert systems from two directions: “What ethical hazards are created by expert systems in medicine?” and “Would it be ethical to design an expert system for solving problems in bioethics?” Computers present new ethical problems to society, some of which are unprecedented. These can be categorized under several rubrics. The paper describes a rudimentary scheme for understanding ethical issues raised by computers, in general, and medical expert systems, in particular. It focuses on bioethical implications of AI in medicine; explores norms, assumptions and taboos; and highlights certain ethical pitfalls. Principles are elucidated, for building ethically sound systems. Finally, a proposal is discussed, for the design of an expert system for moral problem solving, and the ethical implications of this notion are analyzed.

  15. Adaptive feature extraction expert

    SciTech Connect

    Yuschik, M.

    1983-01-01

    The identification of discriminatory features places an upper bound on the recognition rate of any automatic speech recognition (ASR) system. One way to structure the extraction of features is to construct an expert system which applies a set of rules to identify particular properties of the speech patterns. However, these patterns vary for an individual speaker and from speaker to speaker so that another expert is actually needed to learn the new variations. The author investigates the problem by using sets of discriminatory features that are suggested by a feature generation expert, improves the selectivity of these features with a training expert, and finally develops a minimally spanning feature set with a statistical selection expert. 12 references.

  16. World Health Organization Estimates of the Relative Contributions of Food to the Burden of Disease Due to Selected Foodborne Hazards: A Structured Expert Elicitation

    PubMed Central

    Hald, Tine; Aspinall, Willy; Devleesschauwer, Brecht; Cooke, Roger; Corrigan, Tim; Havelaar, Arie H.; Gibb, Herman J.; Torgerson, Paul R.; Kirk, Martyn D.; Angulo, Fred J.; Lake, Robin J.; Speybroeck, Niko; Hoffmann, Sandra

    2016-01-01

    providing estimates for one or more subregions, depending on their experience in the region. The size of the 19 hazard-specific panels ranged from 6 to 15 persons with several experts serving on more than one panel. Pathogens with animal reservoirs (e.g. non-typhoidal Salmonella spp. and Toxoplasma gondii) were in general assessed by the experts to have a higher proportion of illnesses attributable to food than pathogens with mainly a human reservoir, where human-to-human transmission (e.g. Shigella spp. and Norovirus) or waterborne transmission (e.g. Salmonella Typhi and Vibrio cholerae) were judged to dominate. For many pathogens, the foodborne route was assessed relatively more important in developed subregions than in developing subregions. The main exposure routes for lead varied across subregions, with the foodborne route being assessed most important only in two subregions of the European region. Conclusions For the first time, we present worldwide estimates of the proportion of specific diseases attributable to food and other major transmission routes. These findings are essential for global burden of FBD estimates. While gaps exist, we believe the estimates presented here are the best current source of guidance to support decision makers when allocating resources for control and intervention, and for future research initiatives. PMID:26784029

  17. Brazil to Join the European Southern Observatory

    NASA Astrophysics Data System (ADS)

    2010-12-01

    conducted where every aspect of this large project was scrutinised by an international panel of independent experts. The panel found that the E-ELT project is technically ready to enter the construction phase. The go-ahead for E-ELT construction is planned for 2011 and when operations start early in the next decade, European, Brazilian and Chilean astronomers will have access to this giant telescope. The president of ESO's governing body, the Council, Laurent Vigroux, concludes: "Astronomers in Brazil will benefit from collaborating with European colleagues, and naturally from having observing time at ESO's world-class observatories at La Silla and Paranal, as well as on ALMA, which ESO is constructing with its international partners." Notes [1] After ratification of Brazil's membership, the ESO Member States will be Austria, Belgium, Brazil, the Czech Republic, Denmark, France, Finland, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, Switzerland and the United Kingdom. More information ESO, the European Southern Observatory, is the foremost intergovernmental astronomy organisation in Europe and the world's most productive astronomical observatory. It is supported by 14 countries: Austria, Belgium, the Czech Republic, Denmark, France, Finland, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, Switzerland and the United Kingdom. ESO carries out an ambitious programme focused on the design, construction and operation of powerful ground-based observing facilities enabling astronomers to make important scientific discoveries. ESO also plays a leading role in promoting and organising cooperation in astronomical research. ESO operates three unique world-class observing sites in Chile: La Silla, Paranal and Chajnantor. At Paranal, ESO operates the Very Large Telescope, the world's most advanced visible-light astronomical observatory and VISTA, the world's largest survey telescope. ESO is the European partner of a revolutionary astronomical telescope ALMA, the

  18. Future Challenges in Higher Education--Bologna Experts' Community Case Study

    ERIC Educational Resources Information Center

    Yemini, Miri

    2012-01-01

    This work presents results from systematic analysis of the challenges for the future of higher education in European and neighboring countries as it was extracted from the Bologna experts and Higher Education Reform experts' opinions. Opinions of more than 100 experts from 35 countries were documented and analyzed. Significant differences in the…

  19. A European Sustainable Tourism Labels proposal using a composite indicator

    SciTech Connect

    Blancas, Francisco Javier; Lozano-Oyola, Macarena; González, Mercedes

    2015-09-15

    The tourism sector in Europe faces important challenges which it must deal with to promote its future development. In this context, the European Commission considers that two key issues must be addressed. On the one hand, a better base of socio-economic knowledge about tourism and its relationship with the environment is needed, and, on the other hand, it is necessary to improve the image of European areas as quality sustainable tourism destinations. In this paper we present analytical tools that cover these needs. Specifically, we define a system of sustainable tourism indicators and we obtain a composite indicator incorporating weights quantified using a panel of experts. Employing the values of this global indicator as a basis, we define a Sustainable Tourism Country-Brand Ranking which assesses the perception of each country-brand depending on its degree of sustainability, and a system of sustainable tourism labels which reward the management carried out. - Highlights: • We define a system of indicators to improve the knowledge about sustainable tourism. • We obtain composite indicators based on expert knowledge. • The Sustainable Tourism Country-Brand Ranking would improve the image of destinations. • We define a Sustainable Tourism Labels System to assess country-brands. • The conclusions of the empirical analysis can be extrapolated to other tourist areas.

  20. Verification issues for rule-based expert systems

    NASA Technical Reports Server (NTRS)

    Culbert, Chris; Riley, Gary; Savely, Robert T.

    1987-01-01

    Verification and validation of expert systems is very important for the future success of this technology. Software will never be used in non-trivial applications unless the program developers can assure both users and managers that the software is reliable and generally free from error. Therefore, verification and validation of expert systems must be done. The primary hindrance to effective verification and validation is the use of methodologies which do not produce testable requirements. An extension of the flight technique panels used in previous NASA programs should provide both documented requirements and very high levels of verification for expert systems.

  1. The Remarkable Staying Power of "Death Panels".

    PubMed

    Frankford, David M

    2015-10-01

    Sarah Palin's phrase "death panels" derailed proposed provisions of the Affordable Care Act (ACA) to pay physicians for end-of-life discussions with patients, a policy designed to make dying more humane, something all Americans desire. Even now, "death panels" has truth-value for approximately half of Americans and is used to paint ACA components as threatening to "pull the plug on Grandma." How can this be? To some, the death panels claim is simply a lie, an improvised explosive device hurled against any ACA provision. To others, the phrase's power stems from the public's lack of a common vocabulary to discuss end-of-life care. "Death panels," however, taps into many Americans' fear of government involvement, that government's purchasing end-of-life discussions as commodities necessitates accountability and cost control. Standardization and reduction of humanity follows, something Americans already experience routinely in their health care system. Expert jargon, compelling among experts themselves, doesn't evoke people's images of chats with Marcus Welby. The jargon is unintelligible, off-putting. When that jargon enters the nonjargonized world, it mixes with common fears, extant experience of dehumanization and reduction, and awareness that someone's plug is getting pulled all the time. "Death panels" cannot be dismissed as delusional, but neither can it help fulfill Americans' aspirations for a humane last voyage. PMID:26195604

  2. Benchmarking expert system tools

    NASA Technical Reports Server (NTRS)

    Riley, Gary

    1988-01-01

    As part of its evaluation of new technologies, the Artificial Intelligence Section of the Mission Planning and Analysis Div. at NASA-Johnson has made timing tests of several expert system building tools. Among the production systems tested were Automated Reasoning Tool, several versions of OPS5, and CLIPS (C Language Integrated Production System), an expert system builder developed by the AI section. Also included in the test were a Zetalisp version of the benchmark along with four versions of the benchmark written in Knowledge Engineering Environment, an object oriented, frame based expert system tool. The benchmarks used for testing are studied.

  3. Pantex Falling Man - Independent Review Panel Report.

    SciTech Connect

    Bertolini, Louis; Brannon, Nathan; Olson, Jared; Price, Bernard; Wardle, Robert; Steinzig, Mike; Winfield, Michael

    2014-11-01

    Consolidated Nuclear Security (CNS) Pantex took the initiative to organize a Review Panel of subject matter experts to independently assess the adequacy of the Pantex Tripping Man Analysis methodology. The purpose of this report is to capture the details of the assessment including the scope, approach, results, and detailed Appendices. Along with the assessment of the analysis methodology, the panel evaluated the adequacy with which the methodology was applied as well as congruence with Department of Energy (DOE) standards 3009 and 3016. The approach included the review of relevant documentation, interactive discussion with Pantex staff, and the iterative process of evaluating critical lines of inquiry.

  4. Expert model process control of composite materials in a press

    NASA Astrophysics Data System (ADS)

    Saliba, Tony E.; Quinter, Suzanne R.; Abrams, Frances L.

    An expert model for the control of the press processing of thermoset composite materials has been developed. The knowledge base written using the PC PLUS expert system shell was interfaced with models written in FORTRAN. The expert model, which is running on a single computer with a single processor, takes advantage of the symbol-crunching capability of LISP and the number crunching capability of FORTRAN. The Expert Model control system is a qualitative-quantitative process automation (QQPA) system since it includes both quantitative model-based and qualitative rule-based expert system operations. Various physical and mechanical properties were measured from panels processed using the two cycles. Using QQPA, processing time has been reduced significantly without altering product quality.

  5. Safety organizations and experts

    NASA Technical Reports Server (NTRS)

    Mandel, G.; Rubinstein, R. I.; Pinto, J. J.; Meschkow, S. Z.

    1977-01-01

    Handbook lists organizations and experts in specific, well defined areas of safety technology. Special emphasis is given to relevant safety information sources on aircraft fire hazards and aircraft interior flammability.

  6. Expert Consensus on Characteristics of Wisdom: A Delphi Method Study

    ERIC Educational Resources Information Center

    Jeste, Dilip V.; Ardelt, Monika; Blazer, Dan; Kraemer, Helena C.; Vaillant, George; Meeks, Thomas W.

    2010-01-01

    Purpose: Wisdom has received increasing attention in empirical research in recent years, especially in gerontology and psychology, but consistent definitions of wisdom remain elusive. We sought to better characterize this concept via an expert consensus panel using a 2-phase Delphi method. Design and Methods: A survey questionnaire comprised 53…

  7. A European Humus Forms Reference Base

    NASA Astrophysics Data System (ADS)

    Zanella, A.; Englisch, M.; Ponge, J.-F.; Jabiol, B.; Sartori, G.; Gardi, C.

    2012-04-01

    From 2003 on, a panel of experts in humus and humus dynamics (Humus group) has been working about a standardisation and improvement of existing national humus classifications. Some important goals have been reached, in order to share data and experiences: a) definition of specific terms; b) description of 15 types of diagnostic horizons; c) of 10 basic humus forms references; d) subdivision of each main reference in 2-4 sub-unities; e) elaboration of a general European Humus Form Reference Base (http://hal-agroparistech.archives-ouvertes.fr/docs/00/56/17/95/PDF/Humus_Forms_ERB_31_01_2011.pdf); f) publication of the scientific significance of this base of classification as an article [A European morpho-functional classification of humus forms. Geoderma, 164 (3-4), 138-145]. The classification will be updated every 2 years and presently the Humus group is assessing biological (general: soil, vegetation, biome; specific: fungi, bacteria, pedofauna), physical (air temperature, rainfall) and chemical (pH, mineral elements, organic matter, quality and quantity of humic components…) factors which characterize basic humus forms and their varieties. The content of the new version of the classification is planned to be more "practical", like an ecological manual which lists associated humus forms and environmental data in the aim to contribute to a more precise environmental diagnosis of every analysed terrestrial and semiterrestrial European ecosystem. The Humus group is also involved in an endeavour to include humus forms in the World Reference Base for Soils (WRB-FAO) according to nomenclatural principles erected for soil profiles. Thirty basic references have been defined, complemented by a set of qualifiers (prefixes and suffixes), allowing to classify European humus forms and probably a large majority of humus forms known worldwide. The principles of the classification, the diagnostic horizons and humus forms main references are presented at the General Assembly of

  8. Experts Examine Ukraine Energy Security Needs

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    2014-07-01

    Russia's recent annexation of Crimea and the ongoing tensions between Russia and Ukraine have heightened concerns about how Ukraine will meet its continuing energy needs. Despite the current situation, Ukraine's long-term energy future looks promising if tensions diminish and other measures are taken, experts said during a 1 July panel on Russia, Ukraine, and energy held at the Woodrow Wilson International Center for Scholars in Washington, D. C. However, they said, a serious short-term concern is whether the country will make it through this coming winter with sufficient energy supplies.

  9. Evaluation of a Performance-Based Expert Elicitation: WHO Global Attribution of Foodborne Diseases

    PubMed Central

    Aspinall, W. P.; Cooke, R. M.; Havelaar, A. H.; Hoffmann, S.; Hald, T.

    2016-01-01

    For many societally important science-based decisions, data are inadequate, unreliable or non-existent, and expert advice is sought. In such cases, procedures for eliciting structured expert judgments (SEJ) are increasingly used. This raises questions regarding validity and reproducibility. This paper presents new findings from a large-scale international SEJ study intended to estimate the global burden of foodborne disease on behalf of WHO. The study involved 72 experts distributed over 134 expert panels, with panels comprising thirteen experts on average. Elicitations were conducted in five languages. Performance-based weighted solutions for target questions of interest were formed for each panel. These weights were based on individual expert’s statistical accuracy and informativeness, determined using between ten and fifteen calibration variables from the experts' field with known values. Equal weights combinations were also calculated. The main conclusions on expert performance are: (1) SEJ does provide a science-based method for attribution of the global burden of foodborne diseases; (2) equal weighting of experts per panel increased statistical accuracy to acceptable levels, but at the cost of informativeness; (3) performance-based weighting increased informativeness, while retaining accuracy; (4) due to study constraints individual experts’ accuracies were generally lower than in other SEJ studies, and (5) there was a negative correlation between experts' informativeness and statistical accuracy which attenuated as accuracy improved, revealing that the least accurate experts drive the negative correlation. It is shown, however, that performance-based weighting has the ability to yield statistically accurate and informative combinations of experts' judgments, thereby offsetting this contrary influence. The present findings suggest that application of SEJ on a large scale is feasible, and motivate the development of enhanced training and tools for remote

  10. 76 FR 33765 - CHIPRA Pediatric Quality Measures Program: Request for Nominations for Expert Panelists

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-09

    ... enhanced children's health care quality measures will be evaluated. The expected time commitment for expert panelists is up to 3 days. This includes travel to and from the expert panel meeting to be held on September... children, particularly children with special physical, mental, and developmental health care needs;...

  11. 76 FR 54466 - Request for Nominations of Experts for the Science Advisory Board's Animal Feeding Operation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-01

    ...The EPA Science Advisory Board (SAB) Staff Office is requesting public nominations of technical experts to serve on an expert panel under the auspices of the SAB to conduct a peer review of EPA's development of air emission estimating methodologies for animal feeding...

  12. Current and Emerging Ethical Issues in Counseling: A Delphi Study of Expert Opinions

    ERIC Educational Resources Information Center

    Herlihy, Barbara; Dufrene, Roxane L.

    2011-01-01

    A Delphi study was conducted to ascertain the opinions of panel experts regarding the most important current and emerging ethical issues facing the counseling profession. Expert opinions on ethical issues in counselor preparation also were sought. Eighteen panelists responded to 3 rounds of data collection interspersed with feedback. Themes that…

  13. Seismic hazard analysis. Volume 5. Review panel, Ground Motion Panel, and feedback results

    SciTech Connect

    Bernreuter, D. L.

    1981-08-01

    The Site Specific Spectra Project (SSSP) was a multi-year study funded by the US Nuclear Regulatory Commission to provide estimates of the seismic hazards at a number of nuclear power plant sites in the Eastern US. A key element of our approach was the Peer Review Panel, which we formed in order to ensure that our use of expert opinion was reasonable. We discuss the Peer Review Panel results and provide the complete text of each member's report. In order to improve the ground motion model, an Eastern US Ground Motion Model Panel was formed. In Section 4 we tabulate the responses from the panel members to our feedback questionnaire and discuss the implications of changes introduced by them. We conclude that the net difference in seismic hazard values from those presented in Volume 4 is small and does not warrant a reanalysis. 22 figs.

  14. Self-Monitoring of Blood Glucose in Diabetes: From Evidence to Clinical Reality in Central and Eastern Europe—Recommendations from the International Central-Eastern European Expert Group

    PubMed Central

    Barkai, László; Bolgarska, Svetlana; Bronisz, Agata; Broz, Jan; Cypryk, Katarzyna; Honka, Marek; Janez, Andrej; Krnic, Mladen; Lalic, Nebojsa; Martinka, Emil; Rahelic, Dario; Roman, Gabriela; Tankova, Tsvetalina; Várkonyi, Tamás; Wolnik, Bogumił; Zherdova, Nadia

    2014-01-01

    Abstract Self-monitoring of blood glucose (SMBG) is universally considered to be an integral part of type 1 diabetes management and crucial for optimizing the safety and efficacy of complex insulin regimens. This extends to type 2 diabetes patients on intensive insulin therapy, and there is also a growing body of evidence suggesting that structured SMBG is beneficial for all type 2 diabetes patients, regardless of therapy. However, access to SMBG can be limited in many countries in Central and Eastern Europe. A consensus group of diabetes experts from 10 countries in this region (with overlapping historical, political, and social environments)—Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, Slovenia, and Ukraine—was formed to discuss the role of SMBG across the spectrum of patients with diabetes. The group considered SMBG to be an essential tool that should be accessible to all patients with diabetes, including those with non–insulin-treated type 2 diabetes. The current article summarizes the evidence put forward by the consensus group and provides their recommendations for the appropriate use of SMBG as part of individualized patient management. The ultimate goal of these evidence-based recommendations is to help patients and providers in Central and Eastern Europe to make optimal use of SMBG in order to maximize the efficacy and safety of glucose-lowering therapies, to prevent complications, and to empower the patient to play a more active role in the management of their diabetes. PMID:24716890

  15. Avionic expert systems

    NASA Technical Reports Server (NTRS)

    Golshani, Forouzan

    1988-01-01

    At the heart of any intelligent flight control system, there is a knowledge based expert system. The efficiency of these knowledge bases is one of the major factors in the success of aviation and space control systems. In the future, the speed and the capabilities of the expert system and their underlying data base(s) will be the limiting factors in the ability to build more accurate real time space controllers. A methodology is proposed for design and construction of such expert systems. It is noted that existing expert systems are inefficient (slow) in dealing with nontrivial real world situations that involve a vast collection of data. However, current data bases, which are fast in handling large amounts of data, cannot carry out intelligent tasks normally expected from an expert system. The system presented provides the power of deduction (reasoning) along with the efficient mechanisms for management of large data bases. In the system, both straight forward evaluation procedures and sophisticated inference mechanisms coexist. The design methodology is based on mathematics and logic, which ensures the correctness of the final product.

  16. Comprehensive metabolic panel

    MedlinePlus

    ... panel - comprehensive; Chem-20; SMA20; Sequential multi-channel analysis with computer-20; SMAC20; Metabolic panel 20 ... How your kidneys and liver are working Blood sugar, cholesterol, and calcium levels Sodium, potassium, and chloride ...

  17. CF Mutation Panel

    MedlinePlus

    ... page: Was this page helpful? Also known as: Cystic Fibrosis Genotyping; CF DNA Analysis; CF Gene Mutation Panel; CF Molecular Genetic Testing Formal name: Cystic Fibrosis Gene Mutation Panel Related tests: Sweat Test ; Trypsinogen ; ...

  18. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

    PubMed Central

    2011-01-01

    Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care. PMID:21996444

  19. Advanced concentrator panels

    NASA Technical Reports Server (NTRS)

    Bell, D. M.; Bedard, R. J., Jr.

    1981-01-01

    The prototype fabrication of a lightweight, high-quality cellular glass substrate reflective panel for use in an advanced point-focusing solar concentrator was completed. The reflective panel is a gore shaped segment of an 11-m paraboloidal dish. The overall concentrator design and the design of the reflective panels are described. prototype-specific panel design modifications are discussed and the fabrication approach and procedure outlined.

  20. Autonomous power expert system

    NASA Technical Reports Server (NTRS)

    Walters, Jerry L.; Petrik, Edward J.; Roth, Mary Ellen; Truong, Long Van; Quinn, Todd; Krawczonek, Walter M.

    1990-01-01

    The Autonomous Power Expert (APEX) system was designed to monitor and diagnose fault conditions that occur within the Space Station Freedom Electrical Power System (SSF/EPS) Testbed. APEX is designed to interface with SSF/EPS testbed power management controllers to provide enhanced autonomous operation and control capability. The APEX architecture consists of three components: (1) a rule-based expert system, (2) a testbed data acquisition interface, and (3) a power scheduler interface. Fault detection, fault isolation, justification of probable causes, recommended actions, and incipient fault analysis are the main functions of the expert system component. The data acquisition component requests and receives pertinent parametric values from the EPS testbed and asserts the values into a knowledge base. Power load profile information is obtained from a remote scheduler through the power scheduler interface component. The current APEX design and development work is discussed. Operation and use of APEX by way of the user interface screens is also covered.

  1. TRMM Solar Array Panels

    NASA Technical Reports Server (NTRS)

    1998-01-01

    This final report presents conclusions/recommendations concerning the TRMM Solar Array; deliverable list and schedule summary; waivers and deviations; as-shipped performance data, including flight panel verification matrix, panel output detail, shadow test summary, humidity test summary, reverse bias test panel; and finally, quality assurance summary.

  2. A new way to ask the experts: Rating radioactive waste risks

    SciTech Connect

    Kerr, R.A.

    1996-11-08

    The possible risks of a proposed nuclear waste repository at Yucca Mountain include the dozen or more young volcanos near by. Now some earth scientists have a new approach to evaluating hazards accounting for uncertainty at every step - `expert elicitation.` This pulls together a panel of experts, carefully assesses the uncertainties of each of their views then mathematically combines their risk estimates along with the accompanying uncertainties. The article goes on to describe just such a panel which considered seismic hazards to Yucca Mountain, how they came to their conclusions, the arguments about the conclusions, and the future of expert elicitation in evaluating the risks of nuclear waste disposal.

  3. Expert systems: a classical introduction.

    PubMed

    Semmel, R D

    1988-01-01

    Expert systems are providing a means of solving complex problems that previously defied automation efforts. This paper explains what an expert system is and how one operates. Following a brief description of expert systems, the nature of computer problem-solving and the role of knowledge in that activity are discussed. A typical expert system architecture and common knowledge representation schemes are then described. Finally, the operation of a simple, rule-based expert system is illustrated. PMID:10288417

  4. Expert Systems Application In Manufacturing

    NASA Astrophysics Data System (ADS)

    Som, Pradip; Chitturi, Ramesh; Babu, A. J. G.

    1987-05-01

    Expert system, a special branch of Artificial Intelligence finds its way in the domain of manufacturing. This paper presents the basic ideas and features of the expert systems, problems in manufacturing and application of expert systems in manufacturing. As the process planning is an important phase in manufacturing, the suitability of expert systems for process planning area has been highlighted. Several expert systems, developed to solve manufacturing problems are also discussed in the paper.

  5. Safety Panel Resources

    NASA Technical Reports Server (NTRS)

    Stewart, Christine E.

    2008-01-01

    The goal of this paper is to explore what resources are potentially available to safety panels and to provide some guidance on how to utilize those resources. While the examples used in this paper will concentrate on the Flight Equipment and Reliability Review Panel (FESRRP) and Extravehicular Activity (EVA) hardware that have come through that panel, as well as resources at Johnson Space Center, the paper will address how this applies to safety panels in general, and where possible cite examples for other safety panels.

  6. Where Experts Come From.

    ERIC Educational Resources Information Center

    Horgan, Dianne D.

    Studies of over 100 chess players at varying skill levels and ages show the ways in which experts and nonexperts differ in problem-solving strategies. Important differences are found at all stages of problem solving. The most significant differences appear to be before and after the evaluation of alternatives ("sizing up" the problem, generating…

  7. Expert Systems Research.

    ERIC Educational Resources Information Center

    Duda, Richard O.; Shortliffe, Edward H.

    1983-01-01

    Discusses a class of artificial intelligence computer programs (often called "expert systems" because they address problems normally thought to require human specialists for their solution) intended to serve as consultants for decision making. Also discusses accomplishments (including information systematization in medical diagnosis and geology)…

  8. Experts, Dialects, and Discourse.

    ERIC Educational Resources Information Center

    Bhatt, Rakesh Mohan

    2002-01-01

    Examines "expert" discourse--complexes of signs and practices that organize and legitimize social existence and social reproduction--to demonstrate the ideological process involved in the manufacture of Standard English ideology and its continual duplication as necessitated by the three axiomatic conceptions of the English-sacred imagined…

  9. ICFA neutrino panel report

    NASA Astrophysics Data System (ADS)

    Long, K.

    2015-07-01

    In the summer of 2013 the International Committee on Future Accelerators (ICFA) established a Neutrino Panel with the mandate: "To promote international cooperation in the development of the accelerator-based neutrino-oscillation program and to promote international collaboration in the development of a neutrino factory as a future intense source of neutrinos for particle physics experiments." In its first year the Panel organised a series of regional Town Meetings to collect input from the community and to receive reports from the regional planning exercises. The Panel distilled its findings and presented them in a report to ICFA [1]. In this contribution the formation and composition of the Panel are presented together with a summary of the Panel's findings from the three Regional Town Meetings. The Panel's initial conclusions are then articulated and the steps that the Panel seeks to take are outlined.

  10. Quiet Honeycomb Panels

    NASA Technical Reports Server (NTRS)

    Palumbo, Daniel L.; Klos, Jacob

    2010-01-01

    Sandwich honeycomb composite panels are lightweight and strong, and, therefore, provide a reasonable alternative to the aluminum ring frame/stringer architecture currently used for most aircraft airframes. The drawback to honeycomb panels is that they radiate noise into the aircraft cabin veil- efficiently provoking the need for additional sound treatment which adds weight and reduces the material's cost advantage. A series of honeycomb panels was made -hick incorporated different design strategies aimed at reducing the honeycomb panels' radiation efficiency while at the same time maintaining their strength. The majority of the designs were centered around the concept of creating areas of reduced stiffness in the panel by adding voids and recesses to the core. The effort culminated with a reinforced/recessed panel which had 6 dB higher transmission loss than the baseline solid core panel while maintaining comparable strength.