Science.gov

Sample records for review project patients

  1. Malignant melanoma slide review project: Patients from non-Kaiser hospitals in the San Francisco Bay Area. Final report

    SciTech Connect

    Reynolds, P.

    1993-01-05

    This project was initiated, in response to concerns that the observed excess of malignant melanoma among employees of Lawrence Livermore National Laboratory (LLNL) might reflect the incidence of disease diagnostically different than that observed in the general population. LLNL sponsored a slide review project, inviting leading dermatopathology experts to independently evaluate pathology slides from LLNL employees diagnosed with melanoma and those from a matched sample of Bay Area melanoma patients who did not work at the LLNL. The study objectives were to: Identify all 1969--1984 newly diagnosed cases of malignant melanoma among LLNL employees resident in the San Francisco-Oakland Metropolitan Statistical Area, and diagnosed at facilities other than Kaiser Permanente; identify a comparison series of melanoma cases also diagnosed between 1969--1984 in non-Kaiser facilities, and matched as closely as possible to the LLNL case series by gender, race, age at diagnosis, year of diagnosis, and hospital of diagnosis; obtain pathology slides for the identified (LLNL) case and (non-LLNL) comparison patients for review by the LLNL-invited panel of dermatopathology experts; and to compare the pathologic characteristics of the case and comparison melanoma patients, as recorded by the dermatopathology panel.

  2. Polypharmacy Reviews Among Elderly Populations Project: Assessing Needs in Patient-Provider Communication

    PubMed Central

    Balignasay, Mia-Danica; Nigg, Claudio R

    2013-01-01

    Adults sixty-five years of age and older are a growing population, and are the largest consumers of prescription and nonprescription medications in the United States with potentially increased medication interaction risks. Therefore, an investigation to determine if elderly populations at two minority serving, independent housing sites perceived any issues regarding their medication use, including any communication challenges with their providers. The data were collected using a survey in which participants had to recall information about their medication use and past provider interaction. Participants (N=21; 90.5% female; using 5.1 ± 2.6 medications) completed a needs assessment. Results indicated that patients felt comfortable talking to their doctors. However, the communication that occurs may not have included education on polypharmacy. Many participants did not believe that they could describe details about their medications, such as the purpose (47.6%), instructions (42.9%), side effects (66.7%), and the possible risk of addiction (42.9%). This assessment indicates a need for an intervention that is focused on communication about polypharmacy and medication review education. PMID:23386990

  3. Perinatal Patient Safety Project

    PubMed Central

    Nunes, Julie; McFerran, Sharon

    2005-01-01

    The Perinatal Patient Safety Project (PPSP) was created as a systemic strategy for creating high-reliability perinatal units by preventing identified causes of perinatal events in the clinical setting. With developmental funding from a Garfield grant, implementation of the PPSP has been completed at four pilot sites in the Kaiser Permanente Northern California (KPNC) Region. Its success has resulted in implementation at all perinatal units in the KPNC Region as well as being promoted by National Risk Management for nationwide implementation. PPSP emphasizes structured communication, multidisciplinary rounds, a definition of fetal well-being, and practicing for emergencies. Steps taken to create high reliability perinatal care include improved communication, patient safety focus, and satisfaction among perinatal patients, providers, and staff. PMID:21660157

  4. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Project review. 801.4... POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water... project review authority regarding proposed projects in the basin coming under the review of...

  5. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Project review. 801.4... POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water... project review authority regarding proposed projects in the basin coming under the review of...

  6. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Project review. 801.4... POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water... project review authority regarding proposed projects in the basin coming under the review of...

  7. Group Projects and Peer Review.

    ERIC Educational Resources Information Center

    Dyrud, Marilyn A.

    2001-01-01

    Describes problems the author experienced with disfunctionality in student group projects. Describes how she implemented informal and formal peer reviews throughout the term in these groups, which has helped short-circuit disfunctionality, improve student productivity, and help the instructor form a fairer overall assessment. (SR)

  8. Improving adequacy of hemodialysis in Northern California ESRD patients: a final project report. Provider Participants and Medical Review Board of the TransPacific Renal Network.

    PubMed

    Brown, J; Josephson, M

    2000-10-01

    The National Core Indicators Project, initiated in 1994, has brought progressive changes in adequacy of dialysis for end-stage renal disease (ESRD) patients in the TransPacific Renal Network and across the United States. The 1998 Core Indicator Project showed each Network's standing for percentage of patients with urea reduction ratio (URR) > or = 0.65 and average URR. The TransPacific Renal Network ranked 12(th) among the 18 Networks for this adequacy measure. The goals of this project were to improve the Network standing in the United States for the percent of patients with URR > or = 0.65, eliminate or reduce the barriers to achieving adequate dialysis, and evaluate URR versus KT/V data and the variances occurring with these measures. In January 1999, data were collected from all 113 Northern California hemodialysis facilities for quarter 4, 1998, to evaluate adequacy. Each facility provided patient population (N) for KT/V and URR samples, facility averages for KT/V and URR, number of patients with KT/V > or = 1.2 and URR > or = 0.65, and data on post-blood-urea-nitrogen (BUN) sampling methods. A random selection of 10% (12) providers with data below the US and Network standards was selected for an intensive assessment. Using baseline measurements, on-site data were collected from a random selection of the patient population. Chart data were reviewed, analyzed, and discussed in an exit interview with the facility management. On-site visits were performed in July/June 1999. The primary focus included adequacy data and process of care that affect adequacy outcomes, concurrent review of patients receiving treatment at the time of the site visit, and general medical record review. In Phase I, only 12 facilities showed an average URR below 0.65. All facilities reported an average KT/V greater than the DOQI target of 1.2. Forty-two facilities had their percentage of patients with a URR below the national benchmark; only 18 facilities had their percentage of patients

  9. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Section 801.4 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION GENERAL... resources of the basin shall be undertaken by any person, governmental authority, or other entity prior to... project review authority regarding proposed projects in the basin coming under the review of...

  10. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Section 801.4 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION GENERAL... resources of the basin shall be undertaken by any person, governmental authority, or other entity prior to... project review authority regarding proposed projects in the basin coming under the review of...

  11. FIP Interim Review Project. Final Report.

    ERIC Educational Resources Information Center

    Whitbeck, John K.

    The Family Independence Project (FIP) Interim Review Project in Washington was mounted in order to give preliminary information on the progress of the FIP program compared to Assistance for Families with Dependent Children (AFDC) site activity, for management planning, and to document short-term outcomes and trends for policy considerations. A…

  12. Review of Projective Personality Assessment Techniques.

    ERIC Educational Resources Information Center

    Obrzut, John E.

    This paper reviews the literatuare on projective techniques of personality assessment and their use by school psychologists. Following a brief survey of the development of projective techniques, several of the most widely used techniques are briefly discussed, i.e., the Thematic Apperception Test (TAT), the Childrens Apperception Test (CAT), the…

  13. Applied Economics. Curriculum Review Project.

    ERIC Educational Resources Information Center

    Butler, Judy D.

    This paper provides a review of "Applied Economics," a curriculum package developed by Junior Achievement, Inc. (Colorado Springs, Colorado). The materials are used in high schools across the nation and provide students an opportunity to study economics, learn about the U.S. free enterprise system, and explore their roles as citizens, producers,…

  14. The life project book review - A correction.

    PubMed

    Tallo, Donato

    2016-05-01

    I was pleased to see your review of The Life Project by Helen Pearson (reviews, April 16). However, it contained one serious error. The original cohort study started in 1946 - not 1958 as stated. I was present at the book launch and have met the author - my grandmother is one of the 1946 original cohort members. That error apart, a great review and a good book. PMID:27154115

  15. M-6 steam drive project review report

    SciTech Connect

    Cerrada, R.; Puig, F.

    1982-01-01

    A review of the status and experiences gained in the M-6 steam drive project after 3 yr of steam injection is presented. The M-6 project is being conducted in a fully depleted heavy oil reservoir of Venezuela Bolivar Coast field, and comprises 151 wells of which 19 are injectors. The review is based on the overall project performance and describes operational problems, steam plant performance, production forecast and special data acquisition. After a total of ca 7.8 x 106 metric tons of steam injected, steam breakthrough has been observed in some hexagons. Remedial shut off in oil production wells have performed successfully. The M-6 project continues to provide useful experience and information which will be used in planning future steam drive projects in the heavy oil reservoirs of the Bolivar Coast.

  16. Portable Common Execution Environment (PCEE) project review: Peer review

    NASA Technical Reports Server (NTRS)

    Locke, C. Douglass

    1991-01-01

    The purpose of the review was to conduct an independent, in-depth analysis of the PCEE project and to provide the results of said review. The review team was tasked with evaluating the potential contribution of the PCEE project to the improvement of the life cycle support of mission and safety critical (MASC) computing components for large, complex, non-stop, distributed systems similar to those planned for such NASA programs as the space station, lunar outpost, and manned missions to Mars. Some conclusions of the review team are as follow: The PCEE project was given high marks for its breath of vision on the overall problem with MASC software; Correlated with the sweeping vision, the Review Team is very skeptical that any research project can successfully attack such a broad range of problems; and several recommendations are made such as to identify the components of the broad solution envisioned, prioritizing them with respect to their impact and the likely ability of the PCEE or others to attack them successfully, and to rewrite its Concept Document differentiating the problem description, objectives, approach, and results so that the project vision becomes assessible to others.

  17. Methods for the drug effectiveness review project.

    PubMed

    McDonagh, Marian S; Jonas, Daniel E; Gartlehner, Gerald; Little, Alison; Peterson, Kim; Carson, Susan; Gibson, Mark; Helfand, Mark

    2012-01-01

    The Drug Effectiveness Review Project was initiated in 2003 in response to dramatic increases in the cost of pharmaceuticals, which lessened the purchasing power of state Medicaid budgets. A collaborative group of state Medicaid agencies and other organizations formed to commission high-quality comparative effectiveness reviews to inform evidence-based decisions about drugs that would be available to Medicaid recipients. The Project is coordinated by the Center for Evidence-based Policy (CEbP) at Oregon Health & Science University (OHSU), and the systematic reviews are undertaken by the Evidence-based Practice Centers (EPCs) at OHSU and at the University of North Carolina. The reviews adhere to high standards for comparative effectiveness reviews. Because the investigators have direct, regular communication with policy-makers, the reports have direct impact on policy and decision-making, unlike many systematic reviews. The Project was an innovator of methods to involve stakeholders and continues to develop its methods in conducting reviews that are highly relevant to policy-makers. The methods used for selecting topics, developing key questions, searching, determining eligibility of studies, assessing study quality, conducting qualitative and quantitative syntheses, rating the strength of evidence, and summarizing findings are described. In addition, our on-going interactions with the policy-makers that use the reports are described. PMID:22970848

  18. LLNL oil shale project review

    SciTech Connect

    Cena, R.J.

    1990-04-01

    Livermore's oil shale project is funded by two budget authorities, two thirds from base technology development and one third from environmental science. Our base technology development combines fundamental chemistry research with operation of pilot retorts and mathematical modeling. We've studied mechanisms for oil coking and cracking and have developed a detailed model of this chemistry. We combine the detailed chemistry and physics into oil shale process models (OSP) to study scale-up of generic second generation Hot-Recycled-Solid (HRS) retorting systems and compare with results from our 4 tonne-per-day continuous-loop HRS pilot retorting facility. Our environmental science program focuses on identification of gas, solid and liquid effluents from oil shale processes and development of abatement strategies where necessary. We've developed on-line instruments to quantitatively measure trace sulfur and nitrogen compounds released during shale pyrolysis and combustion. We've studied shale mineralogy, inorganic and organic reactions which generate and consume environmentally sensitive species. Figures, references, and tables are included with each discussion.

  19. Preliminary Design Reviews Project: SAPHIRE 8

    SciTech Connect

    Kurt G. Vedros; Curtis L. Smith

    2011-09-01

    The Preliminary Design Review (PDR) is intended to be performed at the conceptual phase of a design request. The design request is initiated with a Design Specification document which includes a problem statement, design details, a design checklist and supporting documentation and/or projected sample output. In addition to this, the design specification has a chapter devoted to the completion of the Preliminary Design Review. This document describes the process of documentation of the PDR in the Design Specification.

  20. Quality Assurance: Patient Chart Reviews

    SciTech Connect

    Oginni, B. M.; Odero, D. O.

    2009-07-06

    Recent developments in radiation therapy have immensely impacted the way the radiation dose is delivered to patients undergoing radiation treatments. However, the fundamental quality assurance (QA) issues underlying the radiation therapy still remain the accuracy of the radiation dose and the radiation safety. One of the major duties of clinical medical physicists in the radiation therapy departments still revolves around ensuring the accuracy of dose delivery to the planning target volume (PTV), the reduction of unintended radiation to normal organs and minimization of the radiation exposure to the medical personnel based on ALARA (as low as reasonably achievable) principle. Many of the errors in radiation therapy can be minimized through a comprehensive program of periodic checks. One of the QA procedures on the patient comes in the form of chart reviews which could be in either electronic or paper-based format. We present the quality assurance procedures that have to be performed on the patient records from the beginning and periodically to the end of the treatment, based on the guidelines from the American Association of Physicists in Medicine (AAPM) and American College of Physicians (ACP)

  1. Drawing on Experience. REPLAN Projects Review.

    ERIC Educational Resources Information Center

    Smith, Vernon; And Others

    This document reports good practice as learned in Britain's FEU (Further Education Unit) and NIACE (National Institute of Adult Continuing Education) programs aimed at providing educational opportunities for unemployed adults. Section 1 describes the review of projects that resulted in the document; mentions specific issues and problems relating…

  2. CADD/M project review: January 1981

    SciTech Connect

    Crowe, R.A.

    1981-01-30

    The Computer-aided Design, Drafting/Manufacturing (CADD/M) Project and its current status are reviewed. The Project's history is reviewed and its present programmatic impact is discussed. The investment to date (including FY 1981) is reported along with maintenance costs. Some user activities are also reviewed. The Programs receiving the majority of the benefits are Nuclear Design (ND), Military Applications (MA), and Nuclear Test Programs. In general the benefits include increased design/drafting personnel productivity, reductions in design turn-around time, and improved design quality and documentation. Each Division does, however, receive slightly different benefits because of different missions and operations. State-of-the-art technology that may impact planning is noted and the status of the research and development efforts is presented. The report concludes with the latest plan for further implementation of CAD/CAM technology.

  3. Dynamic infrared scene projection: a review

    NASA Astrophysics Data System (ADS)

    Williams, Owen M.

    1998-12-01

    Since the early 1990s, there has been major progress in the developing field of dynamic infrared scene projection, driven principally by the need for hardware-in-the-loop simulation of the oncoming generation of imaging infrared missile seekers and more recently by the needs for realistic simulation of the new generation of thermal imagers and forward-looking infrared systems. In this paper the current status of the dynamic infrared projection field is reviewed, commencing with an outline of its history. The requirements for dynamic infrared scene projection are examined, allowing a set of validity criteria to be developed. Each class of infrared projector that has been investigated—emissive, transmissive, reflective, laser scanner and phosphor—together with the specific technology initiatives within the class is described and examined against the validity criteria. In this way the leading dynamic infrared scene projection technologies are identified.

  4. NASA's Hypersonic Research Engine Project: A review

    NASA Technical Reports Server (NTRS)

    Andrews, Earl H.; Mackley, Ernest A.

    1994-01-01

    The goals of the NASA Hypersonic Research Engine (HRE) Project, which began in 1964, were to design, develop, and construct a high-performance hypersonic research ramjet/scramjet engine for flight tests of the developed concept over the speed range of Mach 4 to 8. The project was planned to be accomplished in three phases: project definition, research engine development, and flight test using the X-15A-2 research airplane, which was modified to carry hydrogen fuel for the research engine. The project goal of an engine flight test was eliminated when the X-15 program was canceled in 1968. Ground tests of full-scale engine models then became the focus of the project. Two axisymmetric full-scale engine models, having 18-inch-diameter cowls, were fabricated and tested: a structural model and combustion/propulsion model. A brief historical review of the project, with salient features, typical data results, and lessons learned, is presented. An extensive number of documents were generated during the HRE Project and are listed.

  5. Critical Design Reviews Project: SAPHIRE 8

    SciTech Connect

    Kurt G. Vedros; Curtis L. Smith

    2011-09-01

    The Critical Design Review (CDR) is intended to be performed at the phase of the design request immediately before proceeding to implementation of the design request. The design request is initiated with a Design Specification document which includes a problem statement, design details, a design checklist and supporting documentation and/or projected sample output. The document then records the process through the Preliminary Design Review (PDR) and on to the finalized design specification. In addition to this, the design specification has a chapter devoted to the completion of the CDR. This document describes the process of documentation of the CDR in the Design Specification.

  6. Peterborough projects put patients first.

    PubMed

    Baillie, Jonathan

    2009-09-01

    In one of the architectural practice's largest ever contracts of its kind, Nightingale Associates is playing a major part in a pound 335 million local health reconfiguration project (the Greater Peterborough Health Investment Plan) which should see primary and acute care provision transformed in Peterborough and its surrounds. Jonathan Baillie reports on the completion of two impressive new Nightingale-designed buildings constructed as key scheme elements. PMID:19795674

  7. 77 FR 75915 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-26

    ... COMMISSION 18 CFR Part 806 Review and Approval of Projects AGENCY: Susquehanna River Basin Commission. ACTION... would amend the project review regulations of the Susquehanna River Basin Commission (Commission) to... is to make further modifications to the Commission's project review regulations relating to...

  8. Review by a local medical research ethics committee of the conduct of approved research projects, by examination of patients' case notes, consent forms, and research records and by interview.

    PubMed Central

    Smith, T.; Moore, E. J.; Tunstall-Pedoe, H.

    1997-01-01

    OBJECTIVE: To monitor the conduct of medical research projects that have already been approved by the local medical research ethics committee. DESIGN: Follow up study of ethically approved studies (randomly selected from all the studies approved in the previous year) by examination of patients' case notes, consent forms, and research records and by interview of the researchers at their workplace. SETTING: Tayside, Scotland (mixed rural and urban population). SUBJECTS: 30 research projects approved by Tayside local medical research ethics committee. MAIN OUTCOME MEASURES: Adherence to the agreed protocol, particularly for recruitment (obtaining and recording informed consent) and for specific requirements of the ethics committee, including notification of changes to the protocol and of adverse events. RESULTS: In one project only oral consent had been obtained, and in a quarter of the studies one or more consent forms were incorrectly completed. Inadequate filing of case notes in five studies and of consent forms in six made them unavailable for scrutiny. Adverse events were reported, but there was a general failure to report the abandoning or non-starting of projects in two studies the investigators failed to notify a change in the responsible researcher. CONCLUSIONS: Monitoring of medical research by local medical research ethics committees promotes and preserves ethical standards, protects subjects and researchers, discourages fraud, and has the support of investigators. We recommend that 10% of projects should undergo on-site review, with all others monitored by questionnaire. This would require about six person hours of time and a salary bill of 120 pounds per study monitored. PMID:9169403

  9. 75 FR 60617 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-01

    ... COMMISSION 18 CFR Parts 806 and 808 Review and Approval of Projects AGENCY: Susquehanna River Basin Commission. ACTION: Final rule. SUMMARY: This document contains final rules that amend the project review... procedures for all project applications; clarify requirements for grandfathered projects increasing...

  10. Review of BODO Fireflood Pilot Project

    SciTech Connect

    Nazarko, T.W.

    1983-01-01

    This work reviews the past, present, and projected future operations of the Bodo Fireflood Pilot Project in the Provost Upper Mannville B Pool of E.-central Alberta. This single pattern project was initiated in 1975 to evaluate the potential of tar sand oil recovery by the in situ combustion process. The pool is comprised of a high porosity McLaren Waseca channel sand deposit that attains a maximum thickness of 30 m and contains heavy oil with a density of 979 kg/cu m and in situ viscosity of 2,300 mpa/sec. Primary oil recovery is expected to reach 5%. The project operated as a dry combustion scheme until early in 1982 when wet combustion was initiated. During the dry combustion phase operation, 38,300,000 cu m of air was injected while 97,500 cu m of oil was produced. This amounts to an air/oil ratio of 395 cu m/cu m and an estimated oil recovery of ca 18% of the pilot drainage area oil in place. This favorable performance led to a decision to expand the pilot operation to 7, 6-ha 7-spots to demonstrate the satisfactory performance of a multi-pattern scheme.

  11. 75 FR 36301 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-25

    ... final at 71 FR 78570, December 29, 2006, updating and expanding the range of projects subject to... COMMISSION 18 CFR Parts 806 and 808 Review and Approval of Projects AGENCY: Susquehanna River Basin... proposed rules that would amend the project review regulations of the Susquehanna River Basin...

  12. 76 FR 41154 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ... COMMISSION 18 CFR Part 806 Review and Approval of Projects AGENCY: Susquehanna River Basin Commission. ACTION... would amend the project review regulations of the Susquehanna River Basin Commission (Commission) to... flowback or produced fluids from a Commission approved hydrocarbon development project to an...

  13. Auditory hallucinations: A review of the ERC "VOICE" project.

    PubMed

    Hugdahl, Kenneth

    2015-06-22

    In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the "VOICE" ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the "voices" having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iPhone/iPod app. PMID:26110121

  14. A Compilation and Review of Alaska Energy Projects

    SciTech Connect

    Arlon Tussing; Steve Colt

    2008-12-31

    There have been many energy projects proposed in Alaska over the past several decades, from large scale hydro projects that have never been built to small scale village power projects to use local alternative energy sources, many of which have also not been built. This project was initially intended to review these rejected projects to evaluate the economic feasibility of these ideas in the light of current economics. This review included contacting the agencies responsible for reviewing and funding these projects in Alaska, including the Alaska Energy Authority, the Denali Commission, and the Arctic Energy Technology Development Laboratory, obtaining available information about these projects, and analyzing the economic data. Unfortunately, the most apparent result of this effort was that the data associated with these projects was not collected in a systematic way that allowed this information to be analyzed.

  15. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  16. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  17. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  18. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  19. Determinants of patient adherence: a review of systematic reviews

    PubMed Central

    Kardas, Przemyslaw; Lewek, Pawel; Matyjaszczyk, Michal

    2013-01-01

    Purpose: A number of potential determinants of medication non-adherence have been described so far. However, the heterogenic quality of existing publications poses the need for the use of a rigorous methodology in building a list of such determinants. The purpose of this study was a systematic review of current research on determinants of patient adherence on the basis of a recently agreed European consensus taxonomy and terminology. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Library, IPA, and PsycINFO were systematically searched for systematic reviews published between 2000/01/01 and 2009/12/31 that provided determinants on non-adherence to medication. The searches were limited to reviews having adherence to medication prescribed by health professionals for outpatient as a major topic. Results: Fifty-one reviews were included in this review, covering 19 different disease categories. In these reviews, exclusively assessing non-adherence to chronic therapies, 771 individual factor items were identified, of which most were determinants of implementation, and only 47—determinants of persistence with medication. Factors with an unambiguous effect on adherence were further grouped into 8 clusters of socio-economic-related factors, 6 of healthcare team- and system-related factors, 6 of condition-related factors, 6 of therapy-related factors, and 14 of patient-related factors. The lack of standardized definitions and use of poor measurement methods resulted in many inconsistencies. Conclusions: This study provides clear evidence that medication non-adherence is affected by multiple determinants. Therefore, the prediction of non-adherence of individual patients is difficult, and suitable measurement and multifaceted interventions may be the most effective answer toward unsatisfactory adherence. The limited number of publications assessing determinants of persistence with medication, and lack of those providing determinants of adherence to short-term treatment identify

  20. Field Review of Fish Habitat Improvement Projects in Central Idaho.

    SciTech Connect

    Beschta, Robert L.; Griffith, Jack; Wesche, Thomas A.

    1993-05-01

    The goal of this field review was to provide information to the Bonneville Power Administration (BPA) regarding previous and ongoing fish habitat improvement projects in central Idaho. On July 14, 1992, the review team met at the Sawtooth National Recreation Area office near Ketchum, Idaho, for a slide presentation illustrating several habitat projects during their construction phases. Following the slide presentation, the review team inspected fish habitat projects that have been implemented in the last several years in the Stanley Basin and adjacent valleys. At each site the habitat project was described to the field team and a brief period for project inspection followed. The review team visited approximately a dozen sites on the Challis, Sawtooth, and Boise National Forests over a period of approximately two and a half days. There are two objectives of this review namely to summarize observations for specific field sites and to provide overview commentary regarding the BPA habitat improvement program in central Idaho.

  1. Using clinical audit in practice: a pilot peer review project.

    PubMed

    Holt, V P; Earp, D P

    1996-09-01

    A well-established study group undertook a pilot peer review project testing the use of clinical audit in members' practices. Two peer review groups were formed involving a total of 16 practices. Practice visits were undertaken and a series of meetings were held to prepare and discuss the various projects. The progress of the groups was monitored by questionnaires. All practitioners reported benefits from the project (specifically, from the practice visits) and made changes in areas of their practice other than those specifically chosen for their project. The benefits of carrying out audit projects in a peer review setting are stressed as are the benefits of reciprocal practice visits. The importance of prior establishment of mutual trust and confidence in the peer review group is emphasised. PMID:10332335

  2. Renal failure in burn patients: a review

    PubMed Central

    Emara, S.S.; Alzaylai, A.A.

    2013-01-01

    Summary Burn care providers are usually challenged by multiple complications during the management of acute burns. One of the most common complications worldwide is renal failure. This article reviews the various aspects of renal failure management in burn patients. Two different types of renal failures develop in these patients. The different aetiological factors, incidence, suspected prognosis, ways of diagnosing, as well as prevention methods, and the most accepted treatment modalities are all discussed. A good understanding and an effective assessment of the problem help to reduce both morbidity and mortality in burn management. PMID:23966893

  3. Followup review of major system aquisitions and major projects

    SciTech Connect

    Not Available

    1990-11-21

    In 1985, we reviewed the Department's procedures and practices for managing and controlling its major acquisition program, both for major systems and major projects. The 1985 review resulted in the identification of significant deficiencies. We found, for example, deficiencies relating to documentation and reporting requirements for major acquisitions. The purpose of this review was to determine if this condition had been corrected. The review included an examination of applicable laws, Executive Orders, Office of Management and Budget (OMB) Circulars, and Department policies. We examined key documents prepared for major acquisitions and reviewed reports used by senior Departmental officials to monitor these projects. Our audit was based primarily on a limited review of documentation available at Department of Energy (DOE) Headquarters. We did not extend our review of the issues raised in this report because we concluded that the management of major acquisitions was of such importance to the Department at this time that expedited reporting was needed.

  4. Patient engagement in research: a systematic review

    PubMed Central

    2014-01-01

    Background A compelling ethical rationale supports patient engagement in healthcare research. It is also assumed that patient engagement will lead to research findings that are more pertinent to patients’ concerns and dilemmas. However; it is unclear how to best conduct this process. In this systematic review we aimed to answer 4 key questions: what are the best ways to identify patient representatives? How to engage them in designing and conducting research? What are the observed benefits of patient engagement? What are the harms and barriers of patient engagement? Methods We searched MEDLINE, EMBASE, PsycInfo, Cochrane, EBSCO, CINAHL, SCOPUS, Web of Science, Business Search Premier, Academic Search Premier and Google Scholar. Included studies were published in English, of any size or design that described engaging patients or their surrogates in research design. We conducted an environmental scan of the grey literature and consulted with experts and patients. Data were analyzed using a non-quantitative, meta-narrative approach. Results We included 142 studies that described a spectrum of engagement. In general, engagement was feasible in most settings and most commonly done in the beginning of research (agenda setting and protocol development) and less commonly during the execution and translation of research. We found no comparative analytic studies to recommend a particular method. Patient engagement increased study enrollment rates and aided researchers in securing funding, designing study protocols and choosing relevant outcomes. The most commonly cited challenges were related to logistics (extra time and funding needed for engagement) and to an overarching worry of a tokenistic engagement. Conclusions Patient engagement in healthcare research is likely feasible in many settings. However, this engagement comes at a cost and can become tokenistic. Research dedicated to identifying the best methods to achieve engagement is lacking and clearly needed. PMID

  5. Review of JPL Automotive Technology Status and Projections (ATSP) project

    NASA Technical Reports Server (NTRS)

    Dowdy, M. W.

    1978-01-01

    The general objective was to make a continuing assessment of current automotive technology development programs and of the prospects for new concepts. The study embraced alternative engines, advanced powertrain components, and related energy conserving vehicle modifications which could be implemented by the end of this century. Vehicle level projections of the fuel economy and emissions potential of alternative power systems were key elements of this assessment.

  6. Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs

    PubMed Central

    Cruz-Correia, Ricardo J; Vieira-Marques, Pedro M; Ferreira, Ana M; Almeida, Filipa C; Wyatt, Jeremy C; Costa-Pereira, Altamiro M

    2007-01-01

    Background The integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS. Methods The literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing. Results Of 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters. Conclusion It is clear that Information Systems are evolving to meet people's needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability. PMID:17565667

  7. SANTA MONICA BAY RESTORATION PROJECT IMPLEMENTATION REVIEW 2002

    EPA Science Inventory

    The Santa Monica Bay Restoration Project Implementation Review (IR) summarizes the progress and challenges ahead for the Project through examination of it activities in relation to the CCMP. Contents of the IR include: implementation progress with a financing for plan implementat...

  8. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... which the Administrator determines may contaminate the aquifer so as to create a significant hazard to... the Act, except the final determination that a project may contaminate the aquifer through its... review any project which he considers may potentially contaminate the aquifer through its recharge...

  9. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. (i) Any project... determined by the commissioners or Executive Director pursuant to § 806.5 or 18 CFR part 801. Such project...) Transfer of land used primarily for the raising of food, fiber or forage crops, trees, flowers,...

  10. Patient safety stories: a project utilizing narratives in resident training.

    PubMed

    Cox, LeeAnn M; Logio, Lia S

    2011-11-01

    Incident reports have traditionally been the vehicle for identifying, assessing, and responding to quality gaps in hospitals. Yet because of a variety of barriers, residents often fail to participate in this formal process. The authors created a project to engage residents in incident reporting through the use of an online, anonymous narrative format, faculty-facilitated discussion groups, and involvement of patient safety officers in the educational process. During three months, 36 residents submitted a total of 79 stories about patient care that did not "go as intended." The authors reviewed and scored each story for contributing factors and outcomes. The residents met monthly in small groups with trained faculty facilitators to analyze the stories, which were also shared with the patient safety officers. The stories, narratives of both personal involvement and observed events, ranged from near-misses to sentinel events. Key contributing factors included lapses of professionalism, decision errors, communication/information mishaps, transition mix-ups, and workload difficulties. The narrative format proved a feasible tool for collecting significant, previously unrecognized patient safety issues. Internal medicine residents were willing to discuss gaps in care when given the tools and opportunity for anonymous storytelling and blame-free dialogue. PMID:21952066

  11. BOOK REVIEW: Science Fair Projects: Physics

    NASA Astrophysics Data System (ADS)

    Reynolds, Helen

    2000-11-01

    I have often thought that the notion of a Science Fair is intrinsically a good one but have never set one up. With this book such an undertaking is possible, with 47 projects from which you can choose. Each project has a clearly stated purpose with an overview that contains the physics you need to get started. A hypothesis, or sometimes two, and a procedure detailing what the student should do follow this. The materials to be used are those you should be able to find at home, and safety guidelines as well as places the student needs adult help are clearly marked. Every project asks the student to write down the results of their experiment and decide whether or not their hypothesis was correct. There are also suggestions for taking each project further. Some of these projects are standard experiments that you may already do with students in class, for example, making plasticine boats, string telephones and levers. Most are interesting twists on standard experiments such as using a wedge as a simple machine, home-made spinning toys and the experiments with light bulbs. The latter are the only real cause for concern if students were to do these things at home as adult supervision would be essential. This is obviously an American book, though. Teachers in British classrooms would need to work out how to deal with the references to temperature in Fahrenheit and mass in ounces. Length is usually given in centimetres as well as inches. Translations of soda bottles and bobby pins would also be needed. This book is designed to be full of ideas and to give structure to projects students can do at home, not to provide ideas that you can transport into the classroom. It does this very well and I would recommend it to anyone thinking of starting up a Science Fair. Alternatively, this is an excellent resource for more interesting homework assignments that would put more responsibility on the student and give them something fun to do.

  12. Project Management of Randomized Clinical Trials: A Narrative Review

    PubMed Central

    Goodarzynejad, Hamidreza; Babamahmoodi, Abdolreza

    2015-01-01

    Context: A well-structured protocol for a clinical trial may be able to answer clinical questions, but it cannot be deemed enough to ensure success in the face of incompetent management of time as well as human and economic resources. To address this problem, in this article, we present our literature review on evidence as to how a good knowledge of proper management among researchers can enhance the likelihood of the success of clinical trial projects. Evidence Acquisition: Using multiple search strategies, we conducted a literature review on published studies in the English language from 2002 to 2012 by searching the Cochrane Database of Systematic Reviews, MEDLINE, Google Scholar, and EMBASE. Results: Our review suggests that a successful trial requires a work plan or work scope as well as a timeline. The trial manager should subsequently manage the study in accordance with the plan and the timeline. Many research units have called for a clinical project manager with scientific background and regulatory skills to effect coordination among various aspects of a clinical trial. Conclusions: Project management may benefit both the managerial and scientific aspects of medical projects and reduce fund waste. However, little has been written to date on project management in the context of clinical research. The suggestions represent the views of the individual authors. To provide a high level of evidence in this regard, we recommend that a randomized controlled trial be performed to compare trial projects progressed with and without the use of project management. PMID:26430517

  13. Emerging lessons from the drug effectiveness review project.

    PubMed

    Neumann, Peter J

    2006-01-01

    The Drug Effectiveness Review Project (DERP) is an alliance of fifteen states and two private organizations, which have pooled resources to synthesize and judge clinical evidence for drug-class reviews. The experience shines a bright light on challenges involved in implementing an evidence-based medicine process to inform drug formulary decisions: When should evidence reviewers accept surrogate markers and assume therapeutic class effects? How open and participatory should review procedures be? Should reviewers consider cost-effectiveness information? What is the appropriate role of the public sector in judging evidence? The DERP illustrates that attempts to undertake evidence-based reviews, apart from the methods themselves, which continue to evolve, involve questions of organization, process, and leadership. PMID:16757486

  14. Congressional hearing reviews NSF major research and facilities projects

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    2012-03-01

    An 8 March congressional hearing about the U.S. National Science Foundation's Major Research Equipment and Facilities Construction (NSF MREFC) account focused on fiscal management and accountability of projects in that account and reviewed concerns raised by NSF's Office of Inspector General (OIG). NSF established the MREFC account in 1995 to better plan and manage investments in major equipment and facilities projects, which can cost from tens of millions to hundreds of millions of dollars, and the foundation has funded 17 MREFC projects since then. The Obama administration's proposed fiscal year (FY) 2013 budget includes funding for four MREFC projects: Advanced Laser Gravitational-Wave Observatory (AdvLIGO), Advanced Technology Solar Telescope (ATST), National Ecological Observatory (NEON), and Ocean Observatories Initiative (OOI). The hearing, held by a subcommittee of the House of Representatives' Committee on Science, Space, and Technology, reviewed management oversight throughout the life cycles of MREFC projects and concerns raised in recent OIG reports about the use of budget contingency funds. NSF's February 2012 manual called "Risk management guide for large facilities" states that cost contingency is "that portion of the project budget required to cover `known unknowns,'" such as planning and estimating errors and omissions, minor labor or material price fluctuations, and design developments and changes within the project scope. Committee members acknowledged measures that NSF has made to improve the MREFC oversight process, but they also urged the agency to continue to take steps to ensure better project management.

  15. Telemedical Support in Patients with Chronic Heart Failure: Experience from Different Projects in Germany

    PubMed Central

    Müller, Axel; Schweizer, Johannes; Helms, Thomas M.; Oeff, Micheal; Sprenger, Claudia; Zugck, Christian

    2010-01-01

    The great epidemiological significance and costs associated with chronic heart failure pose a challenge to health systems in Western industrial countries. In the past few years, controlled randomised studies have shown that patients with chronic heart failure benefit from telemedical monitoring; specifically, telemonitoring of various vital parameters combined with a review of the symptoms, drug compliance and patient education. In Germany, various telemedical monitoring projects for patients with chronic heart failure have been initiated in the past few years; seven of them are presented here. Currently 7220 patients are being monitored in the seven selected projects. Most patients (51.1%) are in NYHA stage II, 26.3% in NYHA stage III, 14.5% in NYHA stage I and only 6.6% in NYHA stage IV respectively. Most projects are primarily regional. Their structure of telemedical monitoring tends to be modular and uses stratification according to the NYHA stages. All projects include medical or health economics assessments. The future of telemedical monitoring projects for patients with chronic heart failure will depend on the outcome of these assessments. Only of there is statistical evidence for medical benefit to the individual patient as well as cost savings will these projects continue. PMID:20814594

  16. The drug effectiveness review project: an important step forward.

    PubMed

    Gibson, Mark; Santa, John

    2006-01-01

    Peter Neumann's paper on the Drug Effectiveness Review Project (DERP) is a constructive if incomplete point of departure for discussing the work done by the project and the use of that work by decision-makers in states and elsewhere. This Perspective attempts to establish the proper context for judging the DERP by comparing its product and processes with those commonly produced and used by industry and other parties. It also provides a direct response to the criticisms of the project noted by Neumann. PMID:16757487

  17. The Virtual Factory Teaching System (VFTS): Project Review and Results.

    ERIC Educational Resources Information Center

    Kazlauskas, E. J.; Boyd, E. F., III; Dessouky, M. M.

    This paper presents a review of the Virtual Factory Teaching (VFTS) project, a Web-based, multimedia collaborative learning network. The system allows students, working alone or in teams, to build factories, forecast demand for products, plan production, establish release rules for new work into the factory, and set scheduling rules for…

  18. 77 FR 14272 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-09

    ... From the Federal Register Online via the Government Publishing Office SUSQUEHANNA RIVER BASIN COMMISSION 18 CFR Part 806 Review and Approval of Projects CFR Correction In Title 18 of the Code of Federal Regulations, Part 400 to End, revised as of April 1, 2011, on page 118, in Sec. 806.6, (b)(1)(i) and (ii)...

  19. 76 FR 60774 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ..., 2011 (76 FR 41154) may be submitted to the Commission on or before November 10, 2011. ADDRESSES... 10, 2011, the written comment deadline for proposed rules that appeared in 76 FR 41154-41157 July 13... COMMISSION 18 CFR Part 806 Review and Approval of Projects AGENCY: Susquehanna River Basin Commission....

  20. A Review of Research on Project STAR and Path Ahead

    ERIC Educational Resources Information Center

    Sohn, Kitae

    2016-01-01

    Understanding the effects of class size reduction (CSR) has been an enduring issue in education. For the past 3 decades, Project STAR has stimulated research and policy discussions regarding the effects of CSR on a variety of outcomes. Schanzenbach (2007) reviewed STAR studies and concluded that small classes improved student academic outcomes.…

  1. 78 FR 18481 - Project-Level Predecisional Administrative Review Process

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-27

    ... Forest Service 36 CFR Part 218 RIN 0596-AD07 Project-Level Predecisional Administrative Review Process... (the Department) is issuing this final rule to establish the ] sole process by which the public may... process. Section 428 further directs the Secretary to apply these procedures in lieu of the...

  2. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support such... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IDENTIFICATION AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an...

  3. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support such... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IDENTIFICATION AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an...

  4. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support such... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IDENTIFICATION AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an...

  5. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... § 806.5 or 18 CFR part 801. Such project sponsors shall be notified in writing by the Executive Director... forage crops, trees, flowers, shrubs, turf products, livestock, or poultry, or for aquaculture, to...

  6. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... § 806.5 or 18 CFR part 801. Such project sponsors shall be notified in writing by the Executive Director... forage crops, trees, flowers, shrubs, turf products, livestock, or poultry, or for aquaculture, to...

  7. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... determined by the commissioners or Executive Director pursuant to § 806.5 or 18 CFR part 801. Such project...) Transfer of land used primarily for the raising of food, fiber or forage crops, trees, flowers,...

  8. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... § 806.5 or 18 CFR part 801. Such project sponsors shall be notified in writing by the Executive Director... forage crops, trees, flowers, shrubs, turf products, livestock, or poultry, or for aquaculture, to...

  9. Videotex Project Reviews II. Research Report Prepared for OCLC.

    ERIC Educational Resources Information Center

    Widing, Robert E., II; Talarzyk, W. Wayne

    Designed to provide an overview of the nature and focus of activity in the fledgling videotex industry in the United States and Canada, this updated and extended report presents in-depth reviews of 26 projects which reflect the involvement of such industries as publishing, retailing, agriculture, banking, other financial intermediaries,…

  10. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.5 Projects that may require review and approval. (a) The following projects, if not otherwise requiring review and...

  11. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.5 Projects that may require review and approval. (a) The following projects, if not otherwise requiring review and...

  12. Patient Involvement in Health Care Decision Making: A Review

    PubMed Central

    Vahdat, Shaghayegh; Hamzehgardeshi, Leila; Hessam, Somayeh; Hamzehgardeshi, Zeinab

    2014-01-01

    Background: Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions. Objectives: Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making. Materials and Methods: To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article. Results: Based on the review of articles and books, topics were divided into six general categories: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making. Conclusions: In most studies, factors influencing patient participation consisted of: factors associated with health care professionals such as doctor-patient relationship, recognition of patient’s knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services. PMID:24719703

  13. 1990 DOE/SANDIA crystalline photovoltaic technology project review meeting

    SciTech Connect

    Ruby, D.S.

    1990-07-01

    This document serves as the proceedings for the annual project review meeting held by Sandia's Photovoltaic Cell Research Division and Photovoltaic Technology Division. It contains information supplied by each organization making a presentation at the meeting, which was held August 7 through 9, 1990 at the Sheraton Hotel in Albuquerque, New Mexico. Sessions were held to discuss national photovoltaic programs, one-sun crystalline silicon cell research, concentrator silicon cell research, concentrator 3-5 cell research, and concentrating collector development.

  14. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.5 Projects that may require review and approval. (a) The...

  15. Determinants of patient choice of healthcare providers: a scoping review

    PubMed Central

    2012-01-01

    Background In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice. Methods We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information. Results Our review shows that patients’ choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics. Conclusions There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several

  16. Preoperative patient assessment: a review of the literature and recommendations.

    PubMed Central

    Barnard, N. A.; Williams, R. W.; Spencer, E. M.

    1994-01-01

    The aims of preoperative assessment of patients are outlined, and the role of clinical and laboratory testing is defined. Following a review of the literature, guidelines for requesting such investigations are suggested. PMID:7979066

  17. [Nuclear energy and environment: review of the IAEA environmental projects].

    PubMed

    Fesenko, S; Fogt, G

    2012-01-01

    The review of the environmental projects of the International Atomic Energy Agency is presented. Basic IAEA documents intended to protect humans and the Environment are considered and their main features are discussed. Some challenging issues in the area of protection of the Environment and man, including the impact of nuclear facilities on the environment, radioactive waste management, and remediation of the areas affected by radiological accidents, nuclear testing and sites of nuclear facilities are also discussed. The need to maintain the existing knowledge in radioecology and protection of the environment is emphasised. PMID:23516895

  18. The Blue Button Project: Engaging Patients in Healthcare by a Click of a Button

    PubMed Central

    Mohsen, Mona Omar; Aziz, Hassan A.

    2015-01-01

    The Blue Button project has become a way for many Americans to download their health records by just a click in any way that suits them, such as in print, on a thumb drive, or on their mobile devices and smartphones. Several organizations have developed and applied Blue Buttons on their websites to allow beneficiaries to securely access and view personal medical information and claims. The purpose of this literature review is to highlight the significance of the Blue Button project in the field of health information management. Findings suggest that the project could empower and engage consumers and patients in a healthcare system by allowing access to medical records, thereby promoting better management and overall improvement of their healthcare. To date, the project has gained wide support from insurers, technology companies, and health providers despite the challenges of standardization and interoperability. PMID:26755898

  19. The Blue Button Project: Engaging Patients in Healthcare by a Click of a Button.

    PubMed

    Mohsen, Mona Omar; Aziz, Hassan A

    2015-01-01

    The Blue Button project has become a way for many Americans to download their health records by just a click in any way that suits them, such as in print, on a thumb drive, or on their mobile devices and smartphones. Several organizations have developed and applied Blue Buttons on their websites to allow beneficiaries to securely access and view personal medical information and claims. The purpose of this literature review is to highlight the significance of the Blue Button project in the field of health information management. Findings suggest that the project could empower and engage consumers and patients in a healthcare system by allowing access to medical records, thereby promoting better management and overall improvement of their healthcare. To date, the project has gained wide support from insurers, technology companies, and health providers despite the challenges of standardization and interoperability. PMID:26755898

  20. Estimating software development costs for a patient multimedia education project.

    PubMed

    Caban, A; Cimino, C; Swencionis, C; Ginsberg, M; Wylie-Rosett, J

    2001-01-01

    The authors compare alternative methods of cost estimation for a patient multimedia education (PME) program, using a computerized weight-reduction PME project as an example. Data from the project planning and budgeting process and actual costs of the completed project are analyzed retrospectively to calculate three different estimates-pre-work, post-work, and actual work. Three traditional methods of estimating the cost of computer programs (the lines-of-code, function point, and task ratio analyses) underestimate costs in this example. A commercial program (Cost Xpert) that calculates the cost of developing a graphical user interface provided a better estimate, as did a tally reflecting the complexity and quality of media material in the project. PMID:11230386

  1. Fertility Preservation for Cancer Patients: A Review

    PubMed Central

    Ajala, Tosin; Rafi, Junaid; Larsen-Disney, Peter; Howell, Richard

    2010-01-01

    Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the fore-front the potential for fertility preservation in patients being treated for cancer. Oncologists must be aware of situations where their treatment will affect fertility in patients who are being treated for cancer and they must also be aware of the pathways available for procedures such as cryopreservation of gametes and/or embryos. Improved cancer care associated with increased cure rates and long term survival, coupled with advances in fertility treatment means that it is now imperative that fertility preservation is considered as part of the care offered to these patients. This can only be approached within a multidisciplinary setting. There are obvious challenges that still remain to be resolved, especially in the area of fertility preservation in prepubertal patients. These include ethical issues, such as valid consent and research in the area of tissue retrieval, cryopreservation, and transplantation. PMID:20379357

  2. Scoping review of patient-centered care approaches in healthcare

    PubMed Central

    2014-01-01

    Background The purpose of this scoping review was to describe how three tenants of patient-centered care provision: communication, partnership, and health promotion are addressed in patient-centered care models/frameworks across the literature. Methods A scoping review of literature published in English since 1990 was conducted using Medline, CINAHL, and EMBASE. A key term search strategy was employed using “patient-centered care”, “client-centered care”, “framework” and “model” to identify relevant studies. Results Application of the search strategy resulted in a hit total of 101 articles. Nineteen articles met inclusion criteria, of which 12 were review articles; 5 were qualitative research papers; one was a randomized control trial; and one was a prospective study. From these articles, 25 different patient-centered care frameworks/models were identified. Conclusions The fact that all identified approaches to patient-centered care incorporated strategies to achieve effective communication, partnership, and health promotion indicates that clinicians can select a patient-centered approach from the literature that best suits their patient’s needs, and be confident that it will satisfy the three core elements of patient-centered care provision. While empirical literature on specific patient-centric frameworks and models was limited, much empiric evidence was sourced for the most consistently defined component of patient-centered care, communication. PMID:24947822

  3. Engaging patients and stakeholders in research proposal review: the patient-centered outcomes research institute.

    PubMed

    Fleurence, Rachael L; Forsythe, Laura P; Lauer, Michael; Rotter, Jason; Ioannidis, John P A; Beal, Anne; Frank, Lori; Selby, Joseph V

    2014-07-15

    The inaugural round of merit review for the Patient-Centered Outcomes Research Institute (PCORI) in November 2012 included patients and other stakeholders, as well as scientists. This article examines relationships among scores of the 3 reviewer types, changes in scoring after in-person discussion, and the effect of inclusion of patient and stakeholder reviewers on the review process. In the first phase, 363 scientists scored 480 applications. In the second phase, 59 scientists, 21 patients, and 31 stakeholders provided a "prediscussion" score and a final "postdiscussion" score after an in-person meeting for applications. Bland-Altman plots were used to characterize levels of agreement among and within reviewer types before and after discussion. Before discussion, there was little agreement among average scores given by the 4 lead scientific reviewers and patient and stakeholder reviewers. After discussion, the 4 primary reviewers showed mild convergence in their scores, and the 21-member panel came to a much stronger agreement. Of the 25 awards with the best (and lowest) scores after phase 2, only 13 had ranked in the top 25 after the phase 1 review by scientists. Five percent of the 480 proposals submitted were funded. The authors conclude that patient and stakeholder reviewers brought different perspectives to the review process but that in-person discussion led to closer agreement among reviewer types. It is not yet known whether these conclusions are generalizable to future rounds of peer review. Future work would benefit from additional data collection for evaluation purposes and from long-term evaluation of the effect on the funded research. PMID:25023251

  4. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  5. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  6. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  7. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  8. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  9. Treating Insomnia: A Review of Patient Perceptions Toward Treatment.

    PubMed

    Cheung, Janet M Y; Bartlett, Delwyn J; Armour, Carol L; Saini, Bandana

    2016-01-01

    Patient views about their treatment for insomnia often dictate outcome. This review explores the literature relating to the patients' global perceptions toward treatment for insomnia. A strategic literature search was conducted using five databases (PubMed, CINAHL, Medline, PsycINFO, and Embase). The 57 research articles included for this review were mapped out chronologically across three key stages of treatment-seeking (pretreatment appraisal, actual treatment experiences, and posttreatment evaluation). Patient perceptions played an important role across these three key stages and influenced subsequent health behaviors such as the initiation of help-seeking, treatment uptake, treatment adherence, and treatment adjustment. Patients' perceptions toward treatment were heavily grounded by their psychosocial contexts. Clinical implications and future directions for including patient-centered metrics in mainstream practice and research are discussed. PMID:26240937

  10. eHealth for Patient Engagement: A Systematic Review

    PubMed Central

    Barello, Serena; Triberti, Stefano; Graffigna, Guendalina; Libreri, Chiara; Serino, Silvia; Hibbard, Judith; Riva, Giuseppe

    2016-01-01

    eHealth interventions are recognized to have a tremendous potential to promote patient engagement. To date, the majority of studies examine the efficacy of eHealth in enhancing clinical outcomes without focusing on patient engagement in its specificity. This paper aimed at reviewing findings from the literature about the use of eHealth in engaging patients in their own care process. We undertook a comprehensive literature search within the peer-reviewed international literature. Eleven studies met the inclusion criteria. eHealth interventions reviewed were mainly devoted to foster only partial dimensions of patient engagement (i.e., alternatively cognitive, emotional or behavioral domains related to healthcare management), thus failing to consider the complexity of such an experience. This also led to a great heterogeneity of technologies, assessed variables and achieved outcomes. This systematic review underlines the need for a more holistic view of patient needs to actually engage them in eHealth interventions and obtaining positive outcomes. In this sense, patient engagement constitute a new frontiers for healthcare models where eHealth could maximize its potentialities. PMID:26779108

  11. 1992 DOE/Sandia crystalline photovoltaic technology project review meeting

    SciTech Connect

    Maish, A.

    1992-07-01

    This document serves as the proceedings for the annual project review meeting held by Sandia National Laboratories` Photovoltaic Technology and Photovoltaic Evaluation Departments. It contains information supplied by organizations making presentations at the meeting, which was held July 14--15, 1992 at the Sheraton Old Town Hotel in Albuquerque, New Mexico. Overview sessions covered the Department of Energy (DOE) program, including those at Sandia and the National Renewable Energy Laboratory (NREL), and non-DOE programs, including the EPRI concentrator collector program, The Japanese crystalline silicon program, and some concentrating photovoltaic activities in Europe. Additional sessions included papers on Sandia`s Photovoltaic Device Fabrication Laboratory`s collaborative research, cell processing research, the activities of the participants in the Concentrator Initiative Program, and photovoltaic technology evaluation at Sandia and NREL.

  12. An open library of CT patient projection data

    NASA Astrophysics Data System (ADS)

    Chen, Baiyu; Leng, Shuai; Yu, Lifeng; Holmes, David; Fletcher, Joel; McCollough, Cynthia

    2016-03-01

    Lack of access to projection data from patient CT scans is a major limitation for development and validation of new reconstruction algorithms. To meet this critical need, we are building a library of CT patient projection data in an open and vendor-neutral format, DICOM-CT-PD, which is an extended DICOM format that contains sinogram data, acquisition geometry, patient information, and pathology identification. The library consists of scans of various types, including head scans, chest scans, abdomen scans, electrocardiogram (ECG)-gated scans, and dual-energy scans. For each scan, three types of data are provided, including DICOM-CT-PD projection data at various dose levels, reconstructed CT images, and a free-form text file. Several instructional documents are provided to help the users extract information from DICOM-CT-PD files, including a dictionary file for the DICOM-CT-PD format, a DICOM-CT-PD reader, and a user manual. Radiologist detection performance based on the reconstructed CT images is also provided. So far 328 head cases, 228 chest cases, and 228 abdomen cases have been collected for potential inclusion. The final library will include a selection of 50 head, chest, and abdomen scans each from at least two different manufacturers, and a few ECG-gated scans and dual-source, dual-energy scans. It will be freely available to academic researchers, and is expected to greatly facilitate the development and validation of CT reconstruction algorithms.

  13. An Open Library of CT Patient Projection Data

    PubMed Central

    Chen, Baiyu; Leng, Shuai; Yu, Lifeng; Holmes, David; Fletcher, Joel; McCollough, Cynthia

    2016-01-01

    Lack of access to projection data from patient CT scans is a major limitation for development and validation of new reconstruction algorithms. To meet this critical need, we are building a library of CT patient projection data in an open and vendor-neutral format, DICOM-CT-PD, which is an extended DICOM format that contains sinogram data, acquisition geometry, patient information, and pathology identification. The library consists of scans of various types, including head scans, chest scans, abdomen scans, electrocardiogram (ECG)-gated scans, and dual-energy scans. For each scan, three types of data are provided, including DICOM-CT-PD projection data at various dose levels, reconstructed CT images, and a free-form text file. Several instructional documents are provided to help the users extract information from DICOM-CT-PD files, including a dictionary file for the DICOM-CT-PD format, a DICOM-CT-PD reader, and a user manual. Radiologist detection performance based on the reconstructed CT images is also provided. So far 328 head cases, 228 chest cases, and 228 abdomen cases have been collected for potential inclusion. The final library will include a selection of 50 head, chest, and abdomen scans each from at least two different manufacturers, and a few ECG-gated scans and dual-source, dual-energy scans. It will be freely available to academic researchers, and is expected to greatly facilitate the development and validation of CT reconstruction algorithms. PMID:27239087

  14. Implants in disabled patients: A review and update

    PubMed Central

    Romero-Pérez, María J.; Mang-de la Rosa, María R.; López-Jimenez, Julián; Fernández-Feijoo, Javier

    2014-01-01

    The range of indications for dental implants has broadened enormously owing to their predictability and the improvement of patient satisfaction in terms of stability, comfort, aesthetics and functionality. The aim of this article is to review those indications in patients with mental or physical disabilities as the difficulty to cope with oral hygiene often leads to teeth extraction, adding edentulousness to the impairments already present. Following that goal, available literature in Pubmed database, Scopus, Web of Knowledge and The Cochrane Library database about dental implants placement in these patients has been reviewed, assessing the variables of each study: number of patients, sex, average age, oral hygiene, parafunctional habits, impairment, bone quality, protocol of implant surgery, necessity of deep intravenous sedation or general anesthesia, follow-up period and number of failures. The comparison with studies involving other patient populations without mental or physical impediments did not show statistically significant differences in terms of the failure rate recorded. Although there is not much literature available, the results of this review seem to suggest that osseointegrated oral implants could be a therapeutic option in patients who suffer from any physical or psychological impairment. The success of an oral rehabilitation depends mainly on an adequate selection of the patients. Key words:Implants, disabled, sedation. PMID:24608221

  15. Implants in disabled patients: a review and update.

    PubMed

    Romero-Pérez, María-Jesús; Mang-de la Rosa, María del Rocio; López-Jimenez, Julián; Fernández-Feijoo, Javier; Cutando-Soriano, Antonio

    2014-09-01

    The range of indications for dental implants has broadened enormously owing to their predictability and the improvement of patient satisfaction in terms of stability, comfort, aesthetics and functionality. The aim of this article is to review those indications in patients with mental or physical disabilities as the difficulty to cope with oral hygiene often leads to teeth extraction, adding edentulousness to the impairments already present. Following that goal, available literature in Pubmed database, Scopus, Web of Knowledge and The Cochrane Library database about dental implants placement in these patients has been reviewed, assessing the variables of each study: number of patients, sex, average age, oral hygiene, parafunctional habits, impairment, bone quality, protocol of implant surgery, necessity of deep intravenous sedation or general anesthesia, follow-up period and number of failures. The comparison with studies involving other patient populations without mental or physical impediments did not show statistically significant differences in terms of the failure rate recorded. Although there is not much literature available, the results of this review seem to suggest that osseointegrated oral implants could be a therapeutic option in patients who suffer from any physical or psychological impairment. The success of an oral rehabilitation depends mainly on an adequate selection of the patients. PMID:24608221

  16. Review of PV Inverter Technology Cost and Performance Projections

    SciTech Connect

    Navigant Consulting Inc.

    2006-01-01

    The National Renewable Energy Laboratory (NREL) has a major responsibility in the implementation of the U.S. Department of Energy's (DOE's) Solar Energy Technologies Program. Sandia National Laboratories (SNL) has a major role in supporting inverter development, characterization, standards, certifications, and verifications. The Solar Energy Technologies Program recently published a Multiyear Technical Plan, which establishes a goal of reducing the Levelized Energy Cost (LEC) for photovoltaic (PV) systems to $0.06/kWh by 2020. The Multiyear Technical Plan estimates that, in order to meet the PV system goal, PV inverter prices will need to decline to $0.25-0.30 Wp by 2020. DOE determined the need to conduct a rigorous review of the PV Program's technical and economic targets, including the target set for PV inverters. NREL requested that Navigant Consulting Inc.(NCI) conduct a review of historical and projected cost and performance improvements for PV inverters, including identification of critical barriers identified and the approaches government might use to address them.

  17. Patient engagement in the inpatient setting: a systematic review

    PubMed Central

    Prey, Jennifer E; Woollen, Janet; Wilcox, Lauren; Sackeim, Alexander D; Hripcsak, George; Bakken, Suzanne; Restaino, Susan; Feiner, Steven; Vawdrey, David K

    2014-01-01

    Objective To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. Methods PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement (‘self-efficacy’, ‘patient empowerment’, ‘patient activation’, or ‘patient engagement’), (2) involved health information technology (‘technology’, ‘games’, ‘electronic health record’, ‘electronic medical record’, or ‘personal health record’), and (3) took place in the inpatient setting (‘inpatient’ or ‘hospital’). Only English language studies were reviewed. Results 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. Conclusions Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness. PMID:24272163

  18. How patients' review sites will change health care.

    PubMed

    Hotopf, Max

    2013-10-01

    TripAdvisor has changed how the travel industry treats customers. Is the same likely to happen to health services? Review sites are growing fast across Europe, propelled by expansions in patient choice. What impact will they have on the medical profession and on providers, both public and private? How will they change the nature of health care? To address these questions, those at the forefront of developing review sites in Europe were interviewed. PMID:23904237

  19. The Influence of Gatekeeping and Utilization Review on Patient Satisfaction

    PubMed Central

    Kerr, Eve A; Hays, Ron D; Mitchinson, Allison; Lee, Martin; Siu, Albert L

    1999-01-01

    OBJECTIVE To examine the influence of utilization review and denial of specialty referrals on patient satisfaction with overall medical care, willingness to recommend one’s physician group to a friend, and desire to disenroll from the health plan. DESIGN Two cross-sectional questionnaires: one of physician groups and one of patient satisfaction. SETTING Eighty-eight capitated physician groups in California. PARTICIPANTS Participants were 11,710 patients enrolled in a large California network-model HMO in 1993 who received care in one of the 88 physician groups. MEASUREMENTS AND MAIN RESULTS Our main measures were how groups conducted utilization review for specialty referrals and tests, patient-reported denial of specialty referrals, and patient satisfaction with overall medical care. Patients in groups that required preauthorization for access to many types of specialists were significantly (p≤ .001) less satisfied than patients in groups that had few preauthorization requirements, even after adjusting for patient and other group characteristics. Patients who had wanted to see a specialist in the previous year but did not see one were significantly less satisfied than those who had wanted to see a specialist and actually saw one (p < .001). In addition, patients who did not see a specialist when desired were more likely to want to disenroll from the health plan than patients who saw the specialist (40% vs 18%, p≤ .001) and more likely not to recommend their group to a friend (38% vs 13%, p≤ .001). CONCLUSIONS Policies that limited direct access to specialists, and especially denial of patient-desired referrals, were associated with significantly lower patient satisfaction, increased desire to disenroll, and lower likelihood of recommending the group to a friend. Health plans and physician groups need to take these factors into account when designing strategies to reduce specialty care use. PMID:10337038

  20. Auditory hallucinations: A review of the ERC “VOICE” project

    PubMed Central

    Hugdahl, Kenneth

    2015-01-01

    In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the “VOICE” ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the “voices” having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iPhone/iPod app. PMID:26110121

  1. Should we pay the patient? Review of financial incentives to enhance patient compliance.

    PubMed Central

    Giuffrida, A.; Torgerson, D. J.

    1997-01-01

    OBJECTIVE: To determine whether financial incentives increase patients' compliance with healthcare treatments. DATA SOURCES: Systematic literature review of computer databases--Medline, Embase, PsychLit, EconLit, and the Cochrane Database of Clinical Trials. In addition, the reference list of each retrieved article was reviewed and relevant citations retrieved. STUDY SELECTION: Only randomised trials with quantitative data concerning the effect, of financial incentives (cash, vouchers, lottery tickets, or gifts) on compliance with medication, medical advice, or medical appointments were included in the review. Eleven papers were identified as meeting the selection criteria. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted and analysed using odds ratios and the number of patients needed to be treated to improve compliance by one patient. RESULTS: 10 of the 11 studies showed improvements in patient compliance with the use of financial incentives. CONCLUSIONS: Financial incentives can improve patient compliance. PMID:9314754

  2. Status Review of Wildlife Mitigation, Columbia Basin Hydroelectric Projects, Washington Facilities (Intrastate) Final Report.

    SciTech Connect

    Howerton, Jack

    1984-11-01

    This report was prepared for BPA in fulfillment of section 1004 (b)(1) of the Pacific Northwest Electric Power Planning and Conservation Act of 1980, to review the status of past, present, and proposed future wildlife planning and mitigation program at existing hydroelectric projects in the Columbia River Basin. The project evaluations will form the basis for determining any needed remedial measures or additional project analysis. Projects addressed are: Merwin Dam; Swift Project; Yale Project; Cowlitz River; Boundary Dam; Box Canyon Dam; Lake Chelan; Condit Project; Enloe Project; Spokane River; Tumwater and Dryden Dam; Yakima; and Naches Project.

  3. Patient Perceptions of Participating in the RSNA Image Share Project: a Preliminary Study.

    PubMed

    Hiremath, Atheeth; Awan, Omer; Mendelson, David; Siegel, Eliot L

    2016-04-01

    The purpose of this study was to gauge patient perceptions of the RSNA Image Share Project (ISP), a pilot program that provides patients access to their imaging studies online via secure Personal Health Record (PHR) accounts. Two separate Institutional Review Board exempted surveys were distributed to patients depending on whether they decided to enroll or opt out of enrollment in the ISP. For patients that enrolled, a survey gauged baseline computer usage, perceptions of online access to images through the ISP, effect of patient access to images on patient-physician relationships, and interest in alternative use of images. The other survey documented the age and reasons for declining participation for those that opted out of enrolling in the ISP. Out of 564 patients, 470 enrolled in the ISP (83 % participation rate) and 456 of these 470 individuals completed the survey for a survey participation rate of 97 %. Patients who enrolled overwhelmingly perceived access to online images as beneficial and felt it bolstered their patient-physician relationship. Out of 564 patients, 94 declined enrollment in the ISP and all 94 individuals completed the survey for a survey participation rate of 100 %. Patients who declined to participate in the ISP cited unreliable access to Internet and existing availability of non-web-based intra-network images to their physicians. Patients who participated in the ISP found having a measure of control over their images to be beneficial and felt that patient-physician relationships could be negatively affected by challenges related to image accessibility. PMID:26452494

  4. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review

    PubMed Central

    Ghimire, Saurav; Castelino, Ronald L.; Lioufas, Nicole M.; Peterson, Gregory M.; Zaidi, Syed Tabish R.

    2015-01-01

    Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that

  5. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review

    PubMed Central

    Hall, Louise H.; Johnson, Judith; Watt, Ian; Tsipa, Anastasia; O’Connor, Daryl B.

    2016-01-01

    Objective To determine whether there is an association between healthcare professionals’ wellbeing and burnout, with patient safety. Design Systematic research review. Data Sources PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles. Eligibility Criteria for Selecting Studies Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations. Results Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety. Conclusions Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed. Implications This review illustrates the need for healthcare organisations to consider improving employees’ mental health as well as creating safer work environments when planning interventions to improve patient safety. Systematic Review Registration PROSPERO registration number: CRD42015023340. PMID:27391946

  6. A review of health outcomes in patients with psoriasis.

    PubMed

    Li, Kai; Armstrong, April W

    2012-01-01

    Psoriasis, a chronic inflammatory skin condition, is a complex disease in terms of its significant comorbidities and impact on patients' quality of life. The objective of this article is to elucidate the health outcomes of the disease, including its economic and psychosocial burden on the patient. Current treatments options and the economic considerations of treatment costs are reviewed. Psoriasis is a multidimensional disease, so patients benefit from having a multidisciplinary team of dermatologists and other physicians for management of it and of associated comorbid conditions. PMID:22117868

  7. Support for patients with celiac disease: A literature review

    PubMed Central

    Card, Tim; Ciclitira, Paul J; Swift, Gillian L; Nasr, Ikram; Sanders, David S; Ciacci, Carolina

    2015-01-01

    Background Celiac disease (CD) is a lifelong disorder. Patients are at increased risk of complications and comorbidity. Objectives We conducted a review of the literature on patient support and information in CD and aim to issue recommendations about patient information with regards to CD. Methods Data source: We searched PubMed for English-language articles published between 1900 and June 2014, containing terms related to costs, economics of CD, or education and CD. Study selection: Papers deemed relevant by any of the participating authors were included in the study. Data synthesis: No quantitative synthesis of data was performed. Instead we formulated a consensus view of the information that should be offered to all patients with CD. Results There are few randomized clinical trials examining the effect of patient support in CD. Patients and their families receive information from many sources. It is important that health care personnel guide the patient through the plethora of facts and comments on the Internet. An understanding of CD is likely to improve dietary adherence. Patients should be educated about current knowledge about risk factors for CD, as well as the increased risk of complications. Patients should also be advised to avoid other health hazards, such as smoking. Many patients are eager to learn about future non-dietary treatments of CD. This review also comments on novel therapies but it is important to stress that no such treatment is available at present. Conclusion Based on mostly observational data, we suggest that patient support and information should be an integral part of the management of CD, and is likely to affect the outcome of CD. PMID:25922674

  8. The Recovery of Walking in Stroke Patients: A Review

    ERIC Educational Resources Information Center

    Jang, Sung Ho

    2010-01-01

    We reviewed the literature on walking recovery of stroke patients as it relates to the following subjects: epidemiology of walking dysfunction, recovery course of walking, and recovery mechanism of walking (neural control of normal walking, the evaluation methods for leg motor function, and motor recovery mechanism of leg). The recovery of walking…

  9. Treatment considerations for patient with Amelogenesis Imperfecta: a review

    PubMed Central

    Chen, Chiung-Fen; Hu, Jan CC; Bresciani, Eduardo; Peters, Mathilde C; Estrella, Maria Regina

    2016-01-01

    Objectives Amelogenesis imperfecta (AI) is a group of inherited disorders primary affecting the structural of enamel. Patients with AI experience poor esthetic, excessive tooth sensitivity and compromised chewing function that dental treatments are frequently required at early age. This review describes the non-enamel implications, stage-specific management strategies and outcomes of selected restorative materials based on literature evidence.

  10. Learning from open source software projects to improve scientific review

    PubMed Central

    Ghosh, Satrajit S.; Klein, Arno; Avants, Brian; Millman, K. Jarrod

    2012-01-01

    Peer-reviewed publications are the primary mechanism for sharing scientific results. The current peer-review process is, however, fraught with many problems that undermine the pace, validity, and credibility of science. We highlight five salient problems: (1) reviewers are expected to have comprehensive expertise; (2) reviewers do not have sufficient access to methods and materials to evaluate a study; (3) reviewers are neither identified nor acknowledged; (4) there is no measure of the quality of a review; and (5) reviews take a lot of time, and once submitted cannot evolve. We propose that these problems can be resolved by making the following changes to the review process. Distributing reviews to many reviewers would allow each reviewer to focus on portions of the article that reflect the reviewer's specialty or area of interest and place less of a burden on any one reviewer. Providing reviewers materials and methods to perform comprehensive evaluation would facilitate transparency, greater scrutiny, and replication of results. Acknowledging reviewers makes it possible to quantitatively assess reviewer contributions, which could be used to establish the impact of the reviewer in the scientific community. Quantifying review quality could help establish the importance of individual reviews and reviewers as well as the submitted article. Finally, we recommend expediting post-publication reviews and allowing for the dialog to continue and flourish in a dynamic and interactive manner. We argue that these solutions can be implemented by adapting existing features from open-source software management and social networking technologies. We propose a model of an open, interactive review system that quantifies the significance of articles, the quality of reviews, and the reputation of reviewers. PMID:22529798

  11. Learning from open source software projects to improve scientific review.

    PubMed

    Ghosh, Satrajit S; Klein, Arno; Avants, Brian; Millman, K Jarrod

    2012-01-01

    Peer-reviewed publications are the primary mechanism for sharing scientific results. The current peer-review process is, however, fraught with many problems that undermine the pace, validity, and credibility of science. We highlight five salient problems: (1) reviewers are expected to have comprehensive expertise; (2) reviewers do not have sufficient access to methods and materials to evaluate a study; (3) reviewers are neither identified nor acknowledged; (4) there is no measure of the quality of a review; and (5) reviews take a lot of time, and once submitted cannot evolve. We propose that these problems can be resolved by making the following changes to the review process. Distributing reviews to many reviewers would allow each reviewer to focus on portions of the article that reflect the reviewer's specialty or area of interest and place less of a burden on any one reviewer. Providing reviewers materials and methods to perform comprehensive evaluation would facilitate transparency, greater scrutiny, and replication of results. Acknowledging reviewers makes it possible to quantitatively assess reviewer contributions, which could be used to establish the impact of the reviewer in the scientific community. Quantifying review quality could help establish the importance of individual reviews and reviewers as well as the submitted article. Finally, we recommend expediting post-publication reviews and allowing for the dialog to continue and flourish in a dynamic and interactive manner. We argue that these solutions can be implemented by adapting existing features from open-source software management and social networking technologies. We propose a model of an open, interactive review system that quantifies the significance of articles, the quality of reviews, and the reputation of reviewers. PMID:22529798

  12. Practical review of immunizations in adult patients with cancer

    PubMed Central

    Ariza-Heredia, Ella J; Chemaly, Roy F

    2015-01-01

    Compared with the general population, patients with cancer in general are more susceptible to vaccine-preventable infections, either by an increased risk due to the malignancy itself or immunosuppressive treatment. The goal of immunizations in these patients is therefore to provide protection against these infections, and to decrease the number of vulnerable patients who can disseminate these organisms. The proper timing of immunization with cancer treatment is key to achieving better vaccine protection. As the oncology field continues to advance, leading to better quality of life and longer survival, immunization and other aspects of preventive medicine ought to move to the frontline in the care of these patients. Herein, we review the vaccines most clinically relevant to patients with cancer, as well as special cases including vaccines after splenectomy, travel immunization and recommendations for family members. PMID:26110220

  13. Design review plan for Multi-Function Waste Tank Facility (Project W-236A)

    SciTech Connect

    Renfro, G.G.

    1994-12-20

    This plan describes how the Multi-Function Waste Tank Facility (MWTF) Project conducts reviews of design media; describes actions required by Project participants; and provides the methodology to ensure that the design is complete, meets the technical baseline of the Project, is operable and maintainable, and is constructable. Project W-236A is an integrated project wherein the relationship between the operating contractor and architect-engineer is somewhat different than that of a conventional project. Working together, Westinghouse Hanford Company (WHC) and ICF Karser Hanford (ICF KH) have developed a relationship whereby ICF KH performs extensive design reviews and design verification. WHC actively participates in over-the-shoulder reviews during design development, performs a final review of the completed design, and conducts a formal design review of the Safety Class I, ASME boiler and Pressure Vessel Code items in accordance with WHC-CM-6-1, Standard Engineering Practices.

  14. [Exercise in haemodyalisis patients: a literature systematic review].

    PubMed

    Segura-Ortí, Eva

    2010-01-01

    Exercise as a therapeutic tool used in End-stage renal disease patients (ESRD) in hemodialysis (HD) is not routinately applied, as it occurs with cardiac or respiratory patients. Lack of awareness of research in this field may contribute to the current situation. Thus, the aims of this review are: 1) to systematically review the literature of exercise training on adult HD patients or patients at a pre-HD stage; 2) to show the evidence on the benefits of exercise for counteracting physiological, functional and psychological impairments found even in older ESRD patients; 3) to recommend requirements of future research in order to include exercise prescription in the HD patients treatment. The Data bases reviewed from 2005 to 2009 were: MEDLINE (Ovid), CINAHL (EBSCOHost), SportDicus (EBSCOHost), Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), MedicLatina (EBSCOHost), PEDro y PubMed. Additionally, references from identified articles, several reviews on ESRD and abstracts to Nephrology Congresses were also reviewed. Randomized Controlled Trials on aerobic, strength and combined programs for HD patients were selected. Data from the studies was compiled and Van Tulder criteria were used for methodological quality assessment. Metanalysis included 6 studies on aerobic exercise, 2 on strength exercise and 5 on combined exercise programs. 640 patients were included in 16 included studies. Effects on physical function, health related quality of life and other secondary measurements were summarized by the Standardized Mean Difference (SMD) Moderate evidence exists on positive effects of aerobic training on peak oxygen consumption at the graded exercise test (SMD 6.55; CI 95%: 4.31-8.78). There is high evidence on positive effects of strength training on health related quality of life (SMD 11.03; CI 95%: 5.63-16.43). Finally, moderate evidence exists on positive effects of combined exercise on peak oxygen consumption at the graded exercise test (SMD 5.57; CI

  15. Economic evaluation in patient safety: a literature review of methods.

    PubMed

    de Rezende, Bruna Alves; Or, Zeynep; Com-Ruelle, Laure; Michel, Philippe

    2012-06-01

    Patient safety practices, targeting organisational changes for improving patient safety, are implemented worldwide but their costs are rarely evaluated. This paper provides a review of the methods used in economic evaluation of such practices. International medical and economics databases were searched for peer-reviewed publications on economic evaluations of patient safety between 2000 and 2010 in English and French. This was complemented by a manual search of the reference lists of relevant papers. Grey literature was excluded. Studies were described using a standardised template and assessed independently by two researchers according to six quality criteria. 33 articles were reviewed that were representative of different patient safety domains, data types and evaluation methods. 18 estimated the economic burden of adverse events, 3 measured the costs of patient safety practices and 12 provided complete economic evaluations. Healthcare-associated infections were the most common subject of evaluation, followed by medication-related errors and all types of adverse events. Of these, 10 were selected that had adequately fulfilled one or several key quality criteria for illustration. This review shows that full cost-benefit/utility evaluations are rarely completed as they are resource intensive and often require unavailable data; some overcome these difficulties by performing stochastic modelling and by using secondary sources. Low methodological transparency can be a problem for building evidence from available economic evaluations. Investing in the economic design and reporting of studies with more emphasis on defining study perspectives, data collection and methodological choices could be helpful for strengthening our knowledge base on practices for improving patient safety. PMID:22396602

  16. Literature Review on Decentralization: Strengthening Local Educational Capacity. Educational Policy and Planning Project. A Government of Indonesia-USAID Project.

    ERIC Educational Resources Information Center

    Chieuw, Juliet SF.; Mandolang, Nadine H.

    This literature review, while not comprehensive, is aimed at informing the Strengthening Local Education Capacity project under way in Indonesia. Strategies that strengthen educational capacities at the school and local levels were reviewed, followed by strategies for local governance. Two school governance models, public choice and public…

  17. Patient safety through intelligent procedures in medication: the PSIP project.

    PubMed

    Beuscart, Régis; McNair, Peter; Brender, Jytte

    2009-01-01

    The European project Patient Safety through Intelligent Procedures in medication (PSIP) aims at preventing medical errors. The objective are: (1) to facilitate the systematic production of epidemiological knowledge on Adverse Drug Events (ADE) and (2) to improve the entire medication cycle in a hospital environment. The first sub-objective is to produce knowledge on ADE: to know, as exactly as possible, per hospital, per medical department, their number, type, consequences and causes, including human factors. Data Mining of structured hospital data bases, and semantic mining of free-texts will provide a list of observed ADE, with frequencies and probabilities, thus giving a better understanding of potential risks. The second sub-objective is to develop innovative knowledge based on the mining results and to deliver professionals and patients contextualized alerts and recommendations fitting the local risk parameters. This knowledge will be implemented in a PSIP-Platform independent of existing ICT applications. PMID:19745230

  18. Patient exposure tracking: the IAEA smart card project.

    PubMed

    Rehani, Madan M; Frush, Donald P

    2011-09-01

    The existing approach of radiation protection is largely based on the collective dose to the population with provisions for protection at an individual level through justification and optimisation. With the individual patient dose now exceeding the life-long occupational dose to a worker in a typical radiology practice, there is a need to establish approaches based on the protection of an individual patient. Radiation exposure tracking seems a way forward in this respect. Technological advances in recent years have provided opportunities for tracking to becoming a reality. The IAEA project on Smart Card/SmartRadTrack is described in this paper. The tracking is now a reality in a few dozen centres in many countries connected by picture archiving and communication systems, and there is hope that this will extend to cover other countries and continents. PMID:21778155

  19. Sleep disorders in patients with myasthenia gravis: a systematic review.

    PubMed

    Fernandes Oliveira, Ezequiel; Nacif, Sergio R; Alves Pereira, Nixon; Fonseca, Nina Teixeira; Urbano, Jéssica Julioti; Perez, Eduardo Araújo; Cavalcante, Valéria; Santos Oliveira, Claudia; Insalaco, Giuseppe; Oliveira, Acary Sousa Bulle; Oliveira, Luis Vicente Franco

    2015-06-01

    [Purpose] This systematic review evaluated the presence of sleep-disordered breathing in patients with myasthenia gravis and clarified the role of physiotherapy. [Subjects and Methods] We followed the PRISMA declaration criteria. The evaluation was performed in accordance with the STROBE statement for observational and cross-sectional studies and the CONSORT checklist for clinical trials. Searches were followed by hand on MEDLINE, EMBASE, SciELO, PubMed Central, and the Cochrane Central Register of Controlled Trials. [Results] Our searches yielded a total of 36 studies published between 1970 and 2014. The number of patients involved ranged from 9-490. Of the 36 studies, 19 articles were excluded because they did not meet the inclusion criteria. Therefore, 17 observational, cross-sectional, or clinical studies assessing the quality of sleep and prevalence of sleep disorders in patients with myasthenia gravis were eligible for our review. [Conclusion] Some studies of patients with MG show that patients with MG are associated with poor sleep quality, excessive daytime sleepiness, presence of restless syndrome, and a higher incidence of SDB, while other studies do not report such associations. Therefore, given the current inconclusive evidence and limited literature, further study of sleep disturbances in patients with MG is needed. PMID:26180370

  20. Sleep disorders in patients with myasthenia gravis: a systematic review

    PubMed Central

    Fernandes Oliveira, Ezequiel; Nacif, Sergio R.; Alves Pereira, Nixon; Fonseca, Nina Teixeira; Urbano, Jéssica Julioti; Perez, Eduardo Araújo; Cavalcante, Valéria; Santos Oliveira, Claudia; Insalaco, Giuseppe; Oliveira, Acary Sousa Bulle; Oliveira, Luis Vicente Franco

    2015-01-01

    [Purpose] This systematic review evaluated the presence of sleep-disordered breathing in patients with myasthenia gravis and clarified the role of physiotherapy. [Subjects and Methods] We followed the PRISMA declaration criteria. The evaluation was performed in accordance with the STROBE statement for observational and cross-sectional studies and the CONSORT checklist for clinical trials. Searches were followed by hand on MEDLINE, EMBASE, SciELO, PubMed Central, and the Cochrane Central Register of Controlled Trials. [Results] Our searches yielded a total of 36 studies published between 1970 and 2014. The number of patients involved ranged from 9–490. Of the 36 studies, 19 articles were excluded because they did not meet the inclusion criteria. Therefore, 17 observational, cross-sectional, or clinical studies assessing the quality of sleep and prevalence of sleep disorders in patients with myasthenia gravis were eligible for our review. [Conclusion] Some studies of patients with MG show that patients with MG are associated with poor sleep quality, excessive daytime sleepiness, presence of restless syndrome, and a higher incidence of SDB, while other studies do not report such associations. Therefore, given the current inconclusive evidence and limited literature, further study of sleep disturbances in patients with MG is needed. PMID:26180370

  1. Nocardia infections among immunomodulated inflammatory bowel disease patients: A review.

    PubMed

    Abreu, Cândida; Rocha-Pereira, Nuno; Sarmento, António; Magro, Fernando

    2015-06-01

    Human nocardiosis, caused by Nocardia spp., an ubiquitous soil-borne bacteria, is a rare granulomatous disease close related to immune dysfunctions. Clinically can occur as an acute life-threatening disease, with lung, brain and skin being commonly affected. The infection was classically diagnosed in HIV infected persons, organ transplanted recipients and long term corticosteroid treated patients. Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario. Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings. We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals. Eleven cases of nocardiosis associated with anti-tumor necrosis factor (TNF) prescription (9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease (IBD), 4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients, lung disease in 4 patients, hepatic in one and disseminated disease in 3 patients. From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine. In conclusion, nocardiosis requires high levels of clinical suspicion and experience of laboratory staff, in order to establish a timely diagnosis and by doing so avoid worst outcomes. Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential. The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated. PMID:26074688

  2. Assessment of Patient Empowerment - A Systematic Review of Measures

    PubMed Central

    Barr, Paul J.; Scholl, Isabelle; Bravo, Paulina; Faber, Marjan J.; Elwyn, Glyn; McAllister, Marion

    2015-01-01

    Background Patient empowerment has gained considerable importance but uncertainty remains about the best way to define and measure it. The validity of empirical findings depends on the quality of measures used. This systematic review aims to provide an overview of studies assessing psychometric properties of questionnaires purporting to capture patient empowerment, evaluate the methodological quality of these studies and assess the psychometric properties of measures identified. Methods Electronic searches in five databases were combined with reference tracking of included articles. Peer-reviewed articles reporting psychometric testing of empowerment measures for adult patients in French, German, English, Portuguese and Spanish were included. Study characteristics, constructs operationalised and psychometric properties were extracted. The quality of study design, methods and reporting was assessed using the COSMIN checklist. The quality of psychometric properties was assessed using Terwee’s 2007 criteria. Findings 30 studies on 19 measures were included. Six measures are generic, while 13 were developed for a specific condition (N=4) or specialty (N=9). Most studies tested measures in English (N=17) or Swedish (N=6). Sample sizes of included studies varied from N=35 to N=8261. A range of patient empowerment constructs was operationalised in included measures. These were classified into four domains: patient states, experiences and capacities; patient actions and behaviours; patient self-determination within the healthcare relationship and patient skills development. Quality assessment revealed several flaws in methodological study quality with COSMIN scores mainly fair or poor. The overall quality of psychometric properties of included measures was intermediate to positive. Certain psychometric properties were not tested for most measures. Discussion Findings provide a basis from which to develop consensus on a core set of patient empowerment constructs and for

  3. A Review of Recent Advances in Perioperative Patient Safety

    PubMed Central

    Fowler, Alexander J.

    2013-01-01

    Major complications in surgery affect up to 16% of surgical procedures. Over the past 50 years, many patient safety initiatives have attempted to reduce such complications. Since the formation of the National Patient Safety Agency in 2001, there have been major advances in patient safety. Most recently, the production and implementation of the Surgical Safety Checklist by the World Health Organisation (WHO), a checklist ensuring that certain ‘never events’ (wrong-site surgery, wrong operation etc.) do not occur, irrespective of healthcare allowance. In this review, a summary of recent advances in patient safety are considered – including improvements in communication, understanding of human factors that cause mistakes, and strategies developed to minimise these. Additionally, the synthesis of best medical practice and harm minimisation is examined, with particular emphasis on communication and appreciation of human factors in the operating theatre. This is based on the resource management systems developed in other high risk industries (e.g. nuclear), and has also been adopted for other high risk medical areas. The WHO global movement to reduce surgical mortality has been highly successful, especially in the healthcare systems of developing nations where mortality reductions of up to 50% have been observed, and reductions in patient complications of 4%. Incident reporting has long been a key component of patient safety and continues to be so; allowing reflection and improved guideline formation. All patients are placed at risk in the surgical environment. It is crucial that this risk is minimised, whilst optimising the patient's outcome. In this review, recent advances in perioperative patient safety are examined and placed in context. PMID:26977290

  4. 18 CFR 806.7 - Concurrent project review by member jurisdictions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Concurrent project review by member jurisdictions. 806.7 Section 806.7 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.7 Concurrent...

  5. 18 CFR 806.7 - Concurrent project review by member jurisdictions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Concurrent project review by member jurisdictions. 806.7 Section 806.7 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.7 Concurrent...

  6. 77 FR 18885 - Improving Performance of Federal Permitting and Review of Infrastructure Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ..., employees, or agents, or any other person. (Presidential Sig.) THE WHITE HOUSE, March 22, 2012. [FR Doc... and Review of Infrastructure Projects Memorandum of March 22, 2012--Expediting Review of Pipeline Projects From Cushing, Oklahoma, to Port Arthur, Texas, and Other Domestic Pipeline Infrastructure...

  7. Clinical review: The critical care management of the burn patient

    PubMed Central

    2013-01-01

    Between 4 and 22% of burn patients presenting to the emergency department are admitted to critical care. Burn injury is characterised by a hypermetabolic response with physiologic, catabolic and immune effects. Burn care has seen renewed interest in colloid resuscitation, a change in transfusion practice and the development of anti-catabolic therapies. A literature search was conducted with priority given to review articles, meta-analyses and well-designed large trials; paediatric studies were included where adult studies were lacking with the aim to review the advances in adult intensive care burn management and place them in the general context of day-to-day practical burn management. PMID:24093225

  8. Patient participation in public elections: a literature review.

    PubMed

    Regan, Paul; Hudson, Neal; McRory, Barry

    2011-03-01

    Healthcare organisations and nurse leaders have an important role in promoting patients' right to vote, through the development of policy guidelines, integrated networking and innovative practice. Patients' mental capacity to vote is usually assessed by nurses, who must therefore be aware of clients' voting rights and if the right resources are in place to help them do so. Patients' rights, as citizens, are recognised in law and in professional guidelines, but more needs to be done to protect their voting rights. There should also be better access to transport and family support, and more flexible electoral procedures. This article reviews the literature on promoting patients' participation in local and general elections and suggests that their voting rights should be endorsed by organisations and nurse leaders through policy guidelines and a flexible and proactive nursing approach to participation. PMID:21485910

  9. Topical review: skin infections in the foot and ankle patient.

    PubMed

    Hsu, Andrew R; Hsu, Jessica W

    2012-07-01

    There are numerous cutaneous disorders that affect the foot, but of these conditions skin infections have the most significant impact on overall patient morbidity and clinical outcome. Skin infections in foot and ankle patients are common, with often devastating consequences if left unrecognized and untreated in both surgical and nonsurgical cases. There is a diverse array of infectious dermatoses that afflict the foot and ankle patient including tinea pedis, onychomycosis, paronychia, pitted keratolysis, verruca, folliculitis, and erysipelas. Prompt diagnosis, treatment, and surveillance of these common infectious conditions are critical in managing these dermatoses that can potentially progress to form deep abscesses and osteomyelitis. Infections can be managed with a combination of ventilated shoewear and synthetic substances to keep the feet dry, topical and oral antimicrobial agents, and patient education regarding preventative hygiene measures. The purpose of this review is to aid foot and ankle surgeons and other physicians in the diagnosis and treatment of infectious dermatoses affecting the foot. PMID:22835400

  10. Patient-Centered Endodontic Outcomes: A Narrative Review

    PubMed Central

    Hamedy, Reza; Shakiba, Bita; Fayazi, Sara; Pak, Jacklyn G; White, Shane N

    2013-01-01

    Introduction Root canal treatment (RCT) success criteria inform us of the path to bony healing and of prognostic factors, but tell little about how the patient perceives, feels, or values RCT. Patients choose, undergo, and pay for RCT, they live with the result, and inform their community. The purpose of this narrative review was to appraise patient-centered outcomes of initial non-surgical RCT and nonsurgical retreatment, in adults. Materials and Methods Patient-centered RCT outcome themes were identified in the extant literature: quality of life, satisfaction, anxiety, fear, pain, tooth survival and cost. Narrative review was applied because the disparate themes and data were unsuited to systematic review or meta-analysis. Results Application of the Oral Health Impact Profile (OHIP) demonstrated that disease of pulpal origin affects quality of life with moderate severity, primarily through physical pain and psychological discomfort, and that RCT results in broad improvement of quality of life. Satisfaction with RCT is extremely high, but cost is the primary reason for dissatisfaction. Anxiety and fear affect RCT patients, profoundly influencing their behaviors, including treatment avoidance, and their pain experience. Fear of pain is “fair” to “very much” prior to RCT. Pain is widely feared, disliked, and remembered; however, disease of pulpal origin generally produces moderate, but not severe pain. RCT causes a dramatic decrease in pain prevalence and severity over the week following treatment. Survival rates of teeth after RCT are very high; complication rates are low. Cost is a barrier to RCT, but initial costs, lifetime costs, cost effectiveness, cost utility, and cost benefit all compare extremely well to the alternatives involving replacement using implants or fixed prostheses. Conclusion Dentists must strive to reduce anxiety, fear, experienced and remembered pain, and to accurately inform and educate their patients with respect to technical

  11. Cognitive functioning in meningioma patients: a systematic review.

    PubMed

    Meskal, Ikram; Gehring, Karin; Rutten, Geert-Jan M; Sitskoorn, Margriet M

    2016-06-01

    This systematic review evaluates relevant findings and methodologic aspects of studies on cognitive functioning in meningioma patients prior to and/or following surgery with or without adjuvant radiotherapy. PubMed and Web of Science electronic databases were searched until December 2015. From 1012 initially identified articles, 11 met the inclusion criteria for this review. Multiple methodological limitations were identified which include the lack of pre-treatment assessments, variations in the number and types of neuropsychological tests used, the normative data used to identify patients with cognitive deficits, and the variety of definitions for cognitive impairment. Study results suggest that most of meningioma patients are faced with cognitive deficits in several cognitive domains prior to surgery. Following surgery, most of these patients seem to improve in cognitive functioning. However, they still have impairments in a wide range of cognitive functions compared to healthy controls. Suggestions are given for future research. Adequate diagnosis and treatment of cognitive deficits may ultimately lead to improved outcome and quality of life in meningioma patients. PMID:27048208

  12. Review of Evaluation Procedures Used in Project POWER.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    Project POWER is a workplace literacy program conducted by Triton College. The project offers courses in English as a Second Language (ESL) and Adult Basic Education (ABE) to employers who are willing to pay their employees for half their class time and for 15 percent of the instructional costs. By the end of January 1990, the project had…

  13. Trust in nurse-patient relationships: a literature review.

    PubMed

    Dinç, Leyla; Gastmans, Chris

    2013-08-01

    The aim of this study was to report the results of a literature review of empirical studies on trust within the nurse-patient relationship. A search of electronic databases yielded 34 articles published between 1980 and 2011. Twenty-two studies used a qualitative design, and 12 studies used quantitative research methods. The context of most quantitative studies was nurse caring behaviours, whereas most qualitative studies focused on trust in the nurse-patient relationship. Most of the quantitative studies used a descriptive design, while qualitative methods included the phenomenological approach, grounded theory, ethnography and interpretive interactionism. Data collection was mainly by questionnaires or interviews. Evidence from this review suggests that the development of trust is a relational phenomenon, and a process, during which trust could be broken and re-established. Nurses' professional competencies and interpersonal caring attributes were important in developing trust; however, various factors may hinder the trusting relationship. PMID:23426234

  14. Bariatric surgery in elderly patients: a systematic review

    PubMed Central

    Giordano, Salvatore; Victorzon, Mikael

    2015-01-01

    Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (%) with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I2 test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone. PMID:26508845

  15. Sarcoidosis in Melanoma Patients: Case Report and Literature Review

    PubMed Central

    Beutler, Bryce D.; Cohen, Philip R.

    2015-01-01

    Sarcoidosis is a systemic inflammatory disease characterized by the development of noncaseating granulomas in multiple organ systems. Many hematologic malignancies and solid tumors, including melanoma, have been associated with sarcoidosis. We describe the clinical and pathologic findings of a 54-year-old man with melanoma-associated sarcoidosis. In addition, we not only review the literature describing characteristics of other melanoma patients with sarcoidosis, but also the features of melanoma patients with antineoplastic therapy-associated sarcoidosis. Sarcoidosis has been described in 80 melanoma patients; sufficient information for analysis was provided in 39 of these individuals. In 43.6% of individuals (17 out of 39), sarcoidosis was directly associated with melanoma; in 56.4% of oncologic patients (22 out of 39), sarcoidosis was induced by antineoplastic therapy that had been administered for the treatment of their metastatic melanoma. The discovery of melanoma preceded the development of sarcoidosis in 12 of the 17 (70.5%) individuals who did not receive systemic treatment. Pulmonary and/or cutaneous manifestations of sarcoidosis were common among both groups of patients. Most patients did not require treatment for sarcoidosis. Melanoma patients—either following antineoplastic therapy or without systemic treatment—may be at an increased risk to develop sarcoidosis. In antineoplastic therapy naive melanoma patients, a common etiologic factor—such as exposure to ultraviolet light—may play a role in their developing melanoma and sarcoidosis. PMID:26083934

  16. Status Review of Wildlife Mitigation, Columbia Basin Hydroelectric Projects, Columbia River Mainstem Facilities, 1984 Final Report.

    SciTech Connect

    Howerton, Jack; Hwang, Diana

    1984-11-01

    This report reviews the status of past, present, and proposed future wildlife planning and mitigation programs at existing hydroelectric projects in the Columbia River Basin. The project evaluations will form the basis for determining any needed remedial measures or additional project analysis. Each hydropower facility report is abstracted separately for inclusion in the Energy Data Base.

  17. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT... SELF-GOVERNANCE Construction Nepa Process § 137.294 What is the typical IHS environmental review process for construction projects? (a) Most IHS construction projects normally do not have a...

  18. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT... SELF-GOVERNANCE Construction Nepa Process § 137.294 What is the typical IHS environmental review process for construction projects? (a) Most IHS construction projects normally do not have a...

  19. 42 CFR 137.301 - How are project and program environmental review costs identified?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Construction Nepa Process § 137.301 How are project and program environmental review costs identified? (a) The... identified during the performance of the construction project, the Self-Governance Tribe or, at the request... 42 Public Health 1 2010-10-01 2010-10-01 false How are project and program environmental...

  20. Worker Relocation: A Review of U.S. Department of Labor Mobility Demonstration Projects. Final Report.

    ERIC Educational Resources Information Center

    Fairchild, Charles K.

    This report reviews the knowledge gained in 4 years of operation of labor mobility demonstration projects and provides guidelines on the design and operation of a permanent worker relocation program. Data were gathered both from written material covering the experience of each project and from field trips to some of the projects when additional…

  1. Opioid Drugs in Patients With Liver Disease: A Systematic Review

    PubMed Central

    Soleimanpour, Hassan; Safari, Saeid; Shahsavari Nia, Kavous; Sanaie, Sarvin; Alavian, Seyed Moayed

    2016-01-01

    Context The liver, one of the most important organs of the body, is known to be responsible for several functions. The functional contribution of the liver to the metabolism of carbohydrates, protein, drugs and toxins, fats and cholesterol and many other biological processes are still unknown. Liver disorders are classified into two types: acute and chronic. Different drugs are used in liver diseases to treat and control pain. Most pain relief medications such as opioids are metabolized via the liver; therefore, the adverse reactions of drugs are probably higher for patients with liver disease. The current study aimed to evaluate the effects of opioid drugs on patients with liver disease; therefore, it is necessary to select suitable opioids for such patients. Evidence Acquisition This review was written by referring to research literature including 70 articles and four textbooks published from 1958 to 2015 on various reputable sites. Searches were carried out on the key phrases of narcotic pain relievers (opioids), acute and chronic hepatic failure, opioid adverse drug reactions, drug-induced liver injury (DILI) and other similar keywords. References included a variety of research papers (descriptive and analytical), intervention and review articles. Results In patients with liver disease, administration of opioid analgesics should be observed, accurately. As a general rule, lower doses of drugs should be administered at regular intervals based on the signs of drug accumulation. Secondly, the interactions of opioid drugs with different levels of substrates of the P450 cytochrome enzyme should be considered. Conclusions Pain management in patients with liver dysfunction is always challenging to physicians because of the adverse reactions of drugs, especially opioids. Opioids should be used cautiously since they can cause sedation, constipation and sudden encephalopathy effects. Since the clearance of these drugs in patients with hepatic insufficiency is decreased

  2. Neurosurgical procedures in patients with liver cirrhosis: A review

    PubMed Central

    Chen, Ching-Chang; Huang, Yin-Cheng; Yeh, Chun-Nan

    2015-01-01

    Liver cirrhosis, a devastating liver fibrosis caused by hepatitis/inflammation or tumors, is a major comorbid factor in known surgery fields, such as cardiovascular and abdominal surgeries. It is important to review possible comorbid results in neurosurgical procedures in cirrhotic patients. In the reviewed literature, Child-Pugh and model for end-stage liver disease scores are commonly used in the assessment of surgical risks for cirrhotic patients undergoing abdominal, cardiovascular or neurosurgical procedures. The major categories of neurosurgery are traumatic brain injury (TBI), spontaneous intracranial hemorrhage (SICH), brain tumors, and spinal instrumentation procedures. TBI was reported with surgical mortality as high as 34.5% and a complication rate of 87.2%. For SICH, mortality ranged from 22.7% to 47.0%, while complications were reported to be 43.2%. Less is discussed in brain tumor patients; still the postoperative hemorrhage rate approached 26.7%. In spinal fusion instrumentation procedures, the complication rate was as high as 41.0%. Preoperative assessment and correction could possibly decrease complications such as hemorrhage, wound infection and other cirrhosis-related complications (renal, pulmonary, ascites and encephalopathy). In this study, we reviewed the neurosurgical-related literature with regard to liver cirrhosis as a prognostic factor influencing neurosurgical outcomes. PMID:26413225

  3. Review: engaging patients as vigilant partners in safety: a systematic review.

    PubMed

    Schwappach, David L B

    2010-04-01

    Several initiatives promote patient involvement in error prevention, but little is known about its feasibility and effectiveness. A systematic review was conducted on the evidence of patients' attitudes toward engagement in error prevention and the effectiveness of efforts to increase patient participation. Database searches yielded 3,840 candidate articles, of which 21 studies fulfilled the inclusion criteria. Patients share a positive attitude about engaging in their safety at a general level, but their intentions and actual behaviors vary considerably. Studies applied theories of planned behavior and indicate that self-efficacy, preventability of incidents, and effectiveness of actions seem to be central to patients' intention to engage in error prevention. Rigorous evaluations of major educational campaigns are lacking. Interventions embedded within clinical settings have been effective to some extent. Evidence suggests that involvement in safety may be successful if interventions promote complex behavioral change and are sensitively implemented in health care settings. PMID:19671916

  4. Status of India's population education programme--the subject of tripartite projects review and annual country review.

    PubMed

    1981-12-01

    A 3-step monitoring of India's population education program was undertaken in 1981 in order to determine the level of implementation and progress of the program. This monitoring program, conducted by the Unesco Mobile Team in collaboration with other institutions, followed 3 procedures: Project Progress Report (PPR); Tripartite Project Review (TPR); and Annual Country Review (ACR). The review meetings of the 10 state population education projects were organized at Chandigarh and Madras during August. The states covered in the review were Bihar, Haryana, Madhaya Pradesh, Punjab, Rajasthan, Chandigarh, Gujarat, Karnataka, Maharashtra, and Tamil Nadu. The Tripartite Review identified the following as problems which were hindering the smooth implementation of the population education program: 1) difficulty in spending funds unless certain formalities were completed by the governments of the states; 2) administrative problems such as getting printing paper for instructional materials, waiving the sales tax for equipment to be purchased under the project, and uncertainty regarding the admissible rates of per diem to be paid to the participants in various training programs; 3) the lack of experience of project staff; 4) problems created by having more than 1 cell in a state such as Rajasthan; and 5) an inadequate time frame within which the project should complete all its activities and make population education an integral part of the school system. The following were among the recommendations made: 1) the Project should be made coterminous with the 6th Five-Year Plan up to March 31, 1985; and 2) there should be only 1 Population Education Cell in every state. Among the points discussed at the annual country review, held during October, were the following: rephasing of the program from a 3 to 5 year project to synchronize it with the 6th plan; and the need for additional funds in view of inflation. PMID:12264113

  5. Patient Portals and Patient Engagement: A State of the Science Review

    PubMed Central

    DeVito Dabbs, Annette; Curran, Christine R

    2015-01-01

    Background Patient portals (ie, electronic personal health records tethered to institutional electronic health records) are recognized as a promising mechanism to support greater patient engagement, yet questions remain about how health care leaders, policy makers, and designers can encourage adoption of patient portals and what factors might contribute to sustained utilization. Objective The purposes of this state of the science review are to (1) present the definition, background, and how current literature addresses the encouragement and support of patient engagement through the patient portal, and (2) provide a summary of future directions for patient portal research and development to meaningfully impact patient engagement. Methods We reviewed literature from 2006 through 2014 in PubMed, Ovid Medline, and PsycInfo using the search terms “patient portal” OR “personal health record” OR “electronic personal health record”. Final inclusion criterion dictated that studies report on the patient experience and/or ways that patients may be supported to make competent health care decisions and act on those decisions using patient portal functionality. Results We found 120 studies that met the inclusion criteria. Based on the research questions, explicit and implicit aims of the studies, and related measures addressed, the studies were grouped into five major topics (patient adoption, provider endorsement, health literacy, usability, and utility). We discuss the findings and conclusions of studies that address the five topical areas. Conclusions Current research has demonstrated that patients’ interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Health care delivery factors, mainly provider endorsement and patient portal usability also contribute to patient’s ability to engage through and with the patient portal. Future

  6. Sleep attacks in patients taking dopamine agonists: review

    PubMed Central

    Homann, Carl Nikolaus; Wenzel, Karoline; Suppan, Klaudia; Ivanic, Gerd; Kriechbaum, Norbert; Crevenna, Richard; Ott, Erwin

    2002-01-01

    Objectives To assess the evidence for the existence and prevalence of sleep attacks in patients taking dopamine agonists for Parkinson's disease, the type of drugs implicated, and strategies for prevention and treatment. Design Review of publications between July 1999 and May 2001 in which sleep attacks or narcoleptic-like attacks were discussed in patients with Parkinson's disease. Results 124 patients with sleep events were found in 20 publications. Overall, 6.6% of patients taking dopamine agonists who attended movement disorder centres had sleep events. Men were over-represented. Sleep events occurred at both high and low doses of the drugs, with different durations of treatment (0-20 years), and with or without preceding signs of tiredness. Sleep attacks are a class effect, having been found in patients taking the following dopamine agonists: levodopa (monotherapy in 8 patients), ergot agonists (apomorphine in 2 patients, bromocriptine in 13, cabergoline in 1, lisuride or piribedil in 23, pergolide in 5,) and non-ergot agonists (pramipexole in 32, ropinirole in 38). Reports suggest two distinct types of events: those of sudden onset without warning and those of slow onset with prodrome drowsiness. Conclusion Insufficient data are available to provide effective guidelines for prevention and treatment of sleep events in patients taking dopamine agonists for Parkinson's disease. Prospective population based studies are needed to provide this information. What is already known on this topicCar crashes in patients with Parkinson's disease have been associated with sleep attacks caused by the dopamine agonists pramipexole and ropiniroleWhether sleep attacks exist, their connection with certain agonists, prevention or treatment, and the justification of legal actions are controversialWhat this study addsSleep attacks as a phenomenon distinct from normal somnolence really do existThey are a class effect of all dopamine drugsEffective prevention and treatment

  7. [Patients with gastric cancer submitted to gastrectomy: an integrative review].

    PubMed

    Mello, Bruna Schroeder; Lucena, Amália de Fátima; Echer, Isabel Cristina; Luzia, Melissa de Freitas

    2010-12-01

    This study aims to analyze the scientific production about patients with gastric cancer submitted to gastrectomy and describe important aspects of nursing guidelines for these patients. An integrative review was carried out using Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases; twenty two articles were analyzed. Retrospective cross-sectional studies were the most frequent. The scientific production of nursing is numerically small in relation to the medical area. The results show that approaches related to pre and post-operative in gastrectomy for gastric cancer resection subsidize the knowledge of issues essential for nurses to promote efficient intervention for the recovery of such patients. There is still the need for further research on the practice of nursing in the guidelines of this kind of surgery. PMID:21805893

  8. Recommended frequency of ABPI review for patients wearing compression hosiery.

    PubMed

    Furlong, Winnie

    2015-11-11

    This paper is a sequel to the article 'How often should patients in compression have ABPI recorded?' ( Furlong, 2013 ). Monitoring ankle brachial pressure index (ABPI) is essential, especially in those patients wearing compression hosiery, as it can change over time ( Simon et al, 1994 ; Pankhurst, 2004 ), particularly in the presence of peripheral arterial disease (PAD). Leg ulceration caused by venous disease requires graduated compression ( Wounds UK, 2002 ; Anderson, 2008). Once healed, compression hosiery is required to help prevent ulcer recurrence ( Vandongen and Stacey, 2000 ). The Royal College of Nursing ( RCN, 2006 ) guidelines suggest 3-monthly reviews, including ABPI, with no further guidance. Wounds UK (2002) suggests that patients who have ABPI<0.9, diabetes, reduced mobility or symptoms of claudication should have at least 3/12 Doppler, and that those in compression hosiery without complications who are able to report should have vascular assessment yearly. PMID:26559232

  9. Pancreatic injury in patients with septic shock: A literature review

    PubMed Central

    Chaari, Anis; Abdel Hakim, Karim; Bousselmi, Kamel; Etman, Mahmoud; El Bahr, Mohamed; El Saka, Ahmed; Hamza, Eman; Ismail, Mohamed; Khalil, Elsayed Mahmoud; Kauts, Vipin; Casey, William Francis

    2016-01-01

    Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention. PMID:27559431

  10. Comorbidities in idiopathic pulmonary fibrosis patients: a systematic literature review.

    PubMed

    Raghu, Ganesh; Amatto, Valeria C; Behr, Jürgen; Stowasser, Susanne

    2015-10-01

    Idiopathic pulmonary fibrosis (IPF) is associated with a fatal prognosis and manifests in patients over 60 years old who may have comorbidities. The prevalence and impact of comorbidities on the clinical course of IPF is unclear.This systematic literature review examined the prevalence of comorbidities and mortality associated with comorbidities in IPF patients. Relevant observational studies published in English from January 1990 to January 2015 identified via MEDLINE and EMBASE were included; bibliographies of articles were also searched.Among the 126 studies included, prevalence of pulmonary hypertension (PH) was 3-86%, 6-91% for obstructive sleep apnoea, 3-48% for lung cancer and 6-67% for chronic obstructive pulmonary disease (COPD). Nonrespiratory comorbidities included ischaemic heart disease (IHD) (3-68%) and gastro-oesophageal reflux (GER) (0-94%). Mortality was highest among patients with IPF and lung cancer. Most studies assessed relatively small samples of patients with IPF.PH, COPD, lung cancer, GER and IHD are significant comorbidities; differences in IPF severity, case definitions and patient characteristics limited the comparability of findings. The identification and prompt treatment of comorbidities may have a clinically significant impact on overall outcome that is meaningful for patients with IPF. PMID:26424523

  11. Pancreatic injury in patients with septic shock: A literature review.

    PubMed

    Chaari, Anis; Abdel Hakim, Karim; Bousselmi, Kamel; Etman, Mahmoud; El Bahr, Mohamed; El Saka, Ahmed; Hamza, Eman; Ismail, Mohamed; Khalil, Elsayed Mahmoud; Kauts, Vipin; Casey, William Francis

    2016-07-15

    Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention. PMID:27559431

  12. Measurement of Physician-Patient Communication—A Systematic Review

    PubMed Central

    Zill, Jördis M.; Christalle, Eva; Müller, Evamaria; Härter, Martin; Dirmaier, Jörg; Scholl, Isabelle

    2014-01-01

    Background Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures. Methods A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed), reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments) checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues. Results Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.'s criteria was rated mainly intermediate or positive. Discussion This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the methodological quality of

  13. 78 FR 18348 - Submission for OMB Review; Use of Project Labor Agreements for Federal Construction Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... estimate. As stated in the final rule in the Federal Register at 75 FR 19169 on April 10, 2010, Project...; Use of Project Labor Agreements for Federal Construction Projects AGENCY: Department of Defense (DOD... identified by Information Collection 9000- 0175, Use of Project Labor Agreements for Federal...

  14. 75 FR 13765 - Submission for OMB Review; Use of Project Labor Agreements for Federal Construction Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-23

    ...; Use of Project Labor Agreements for Federal Construction Projects AGENCY: Department of Defense (DOD... collection requirement regarding Use of Project Labor Agreements for Federal Construction Projects. A request for public comments was published in the Federal Register at 74 FR 33953, on July 14, 2009....

  15. A Review of Wind Project Financing Structures in the USA

    SciTech Connect

    Bolinger, Mark A; Harper, John; Karcher, Matthew

    2008-09-24

    The rapid pace of wind power development in the U.S. over the last decade has outstripped the ability of most project developers to provide adequate equity capital and make efficient use of project-related tax benefits. In response, the sector has created novel project financing structures that feature varying combinations of equity capital from project developers and third-party tax-oriented investors, and in some cases commercial debt. While their origins stem from variations in the financial capacity and business objectives of wind project developers, as well as the risk tolerances and objectives of equity and debt providers, each structure is, at its core, designed to manage project risk and allocate federal tax incentives to those entities that can use them most efficiently. This article surveys the six principal financing structures through which most new utility-scale wind projects (excluding utility-owned projects) in the U.S. have been financed from 1999 to the present. These structures include simple balance-sheet finance, several varieties of all-equity special allocation partnership 'flip' structures, and two leveraged structures. In addition to describing each structure's mechanics, the article also discusses its rationale for use, the types of investors that find it appealing and why, and its relative frequency of use in the market. The article concludes with a generalized summary of how a developer might choose one structure over another.

  16. Review of the Regional Biomass Energy Program: Technical projects

    SciTech Connect

    Lusk, P.

    1994-12-31

    This article summarizes technical projects of the regional Biomass Energy Program. Projects included are as follows: economic impact studies for renewable energy resources; alternative liquid fuels; Wood pellets fuels forum; residential fuel wood consumption; waste to energy decision-makers guide; fuel assessment for cogeneration facilities; municipal solid waste combustion characteristics.

  17. REVIEW OF NEW ENGLAND COMPARATIVE RISK PROJECTS AND RANKINGS

    EPA Science Inventory

    Ten years ago, EPA New England (EPA NE) conducted a pilot comparative risk project:"Unfinished Business in New England: A Comparative Assessment of Environmental Problems" (December 1988). This regional effort was modeled after the national EPA comparative risk project: "Unfinis...

  18. Formal design review report project W-151 mixer pump procurement

    SciTech Connect

    Crass, D.W.

    1997-01-21

    A formal design review for WHC-S-0040 was held on January 21, 1993. The review was completed January 29, 1993. No outstanding action items existed. Comments were recorded on Record Comment Record (RCR) forms and incorporated into the specification. The specification was considered acceptable, approved and issued as WHC-S-0040, Rev. 0 on March 4, 1993.

  19. Fluid management of the neurological patient: a concise review.

    PubMed

    van der Jagt, Mathieu

    2016-01-01

    Maintenance fluids in critically ill brain-injured patients are part of routine critical care. Both the amounts of fluid volumes infused and the type and tonicity of maintenance fluids are relevant in understanding the impact of fluids on the pathophysiology of secondary brain injuries in these patients. In this narrative review, current evidence on routine fluid management of critically ill brain-injured patients and use of haemodynamic monitoring is summarized. Pertinent guidelines and consensus statements on fluid management for brain-injured patients are highlighted. In general, existing guidelines indicate that fluid management in these neurocritical care patients should be targeted at euvolemia using isotonic fluids. A critical appraisal is made of the available literature regarding the appropriate amount of fluids, haemodynamic monitoring and which types of fluids should be administered or avoided and a practical approach to fluid management is elaborated. Although hypovolemia is bound to contribute to secondary brain injury, some more recent data have emerged indicating the potential risks of fluid overload. However, it is acknowledged that many factors govern the relationship between fluid management and cerebral blood flow and oxygenation and more research seems warranted to optimise fluid management and improve outcomes. PMID:27240859

  20. New perspectives of volemic resuscitation in polytrauma patients: a review.

    PubMed

    Bedreag, Ovidiu Horea; Papurica, Marius; Rogobete, Alexandru Florin; Sarandan, Mirela; Cradigati, Carmen Alina; Vernic, Corina; Dumbuleu, Corina Maria; Nartita, Radu; Sandesc, Dorel

    2016-01-01

    Nowadays, fluid resuscitation of multiple trauma patients is still a challenging therapy. Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the patient. Patients presenting with multiple trauma often develop hemorrhagic shock, which triggers a series of metabolic, physiological and cellular dysfunction. These disorders combined, lead to complications that significantly decrease survival rate in this subset of patients. Volume and electrolyte resuscitation is challenging due to many factors that overlap. Poor management can lead to post-resuscitation systemic inflammation causing multiple organ failure and ultimately death. In literature, there is no exact formula for this purpose, and opinions are divided. This paper presents a review of modern techniques and current studies regarding the management of fluid resuscitation in trauma patients with hemorrhagic shock. According to the literature and from clinical experience, all aspects regarding post-resuscitation period need to be considered. Also, for every case in particular, emergency therapy management needs to be rigorously respected considering all physiological, biochemical and biological parameters. PMID:27574675

  1. Characteristics of patients with pseudochylothorax—a systematic review

    PubMed Central

    Lama, Adriana; Toubes, María E.; Golpe, Antonio; Gude, Francisco; Álvarez-Dobaño, José M.; González-Barcala, Francisco J.; San José, Esther; Rodríguez-Núñez, Nuria; Rábade, Carlos; Rodríguez-García, Carlota; Valdés, Luis

    2016-01-01

    Background Pseudochylothorax (PCT) (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion (PE) that is commonly associated with chronic inflammatory disorders. Nevertheless, the characteristics of patients with PCT are poorly defined. Methods A systematic review was performed across two electronic databases searching for studies reporting clinical findings, PE characteristics, and the most effective treatment of PCT. Case descriptions and retrospective studies were included. Results The review consisted of 62 studies with a total of 104 patients. Median age was 58 years, the male/female ratio was 2.6/1, and in the 88.5% of cases the etiology was tuberculosis (TB) or rheumatoid arthritis (RA). PE was usually unilateral (88%) and occupied greater than one-third of the hemithorax (96.3%). There was no evidence of pleural thickening in 20.6% of patients, and 14 patients had a previous PE. The pleural fluid (PF) was an exudate, usually milky (94%) and with a predominance of lymphocytes (61.1%). The most sensitive tests to establish the diagnosis were the cholesterol/triglycerides ratio (CHOL/TG ratio) >1, and the presence of cholesterol crystals (97.4% and 89.7%, respectively). PF culture for TB was positive in the 34.1% of patients. Favorable outcomes with medical treatment, therapeutic thoracentesis, decortication/pleurectomy, pleurodesis, thoracic drainage and thoracoscopic drainage were achieved in 78.9%, 47.8%, 86.7%, 66.6%, 37.5% and 42.9%, respectively. Conclusions PCT is usually tuberculous or rheumatoid, unilateral and the PF is a milky exudate. The presence of cholesterol crystals and a CHOL/TG ratio >1 are the most sensitive test for the diagnosis. The lack of pleural thickening does not rule out PCT. Treatment should be sequential, treating the underlying causes, and assessing the need for interventional techniques. PMID:27621864

  2. The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review

    PubMed Central

    Kirkman, Matthew A; Sevdalis, Nick; Arora, Sonal; Baker, Paul; Vincent, Charles; Ahmed, Maria

    2015-01-01

    Objective To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic. Design A systematic review. Data sources Embase, Ovid Medline and PsycINFO databases. Study selection Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014. Data extraction The review was performed using a structured data capture tool. Thematic analysis also identified factors influencing successful implementation of interventions. Results We identified 26 studies reporting patient safety interventions: 11 involving students and 15 involving trainees/residents. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. No studies demonstrated patient benefit. Availability of expert faculty, competing curricular/service demands and institutional culture were important factors affecting implementation. Conclusions There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread. PMID:25995240

  3. Preliminary design review report for K Basin Dose Reduction Project

    SciTech Connect

    Blackburn, L.D.

    1996-01-01

    The strategy for reducing radiation dose, originating from radionuclides absorbed in the K East Basin concrete, is to raise the pool water level to provide additional shielding. This report documents a preliminary design review conducted to ensure that design approaches for cleaning/coating basin walls and modifying other basin components were appropriate. The conclusion of this review was that design documents presently conclusion of this review was that design documents presently completed or in process of modification are and acceptable basis for proceeding to complete the design.

  4. Reviewing 741 patients records in two hours with FASTVISU

    PubMed Central

    Escudié, Jean-Baptiste; Jannot, Anne-Sophie; Zapletal, Eric; Cohen, Sarah; Malamut, Georgia; Burgun, Anita; Rance, Bastien

    2015-01-01

    The secondary use of electronic health records opens up new perspectives. They provide researchers with structured data and unstructured data, including free text reports. Many applications been developed to leverage knowledge from free-text reports, but manual review of documents is still a complex process. We developed FASTVISU a web-based application to assist clinicians in reviewing documents. We used FASTVISU to review a set of 6340 documents from 741 patients suffering from the celiac disease. A first automated selection pruned the original set to 847 documents from 276 patients’ records. The records were reviewed by two trained physicians to identify the presence of 15 auto-immune diseases. It took respectively two hours and two hours and a half to evaluate the entire corpus. Inter-annotator agreement was high (Cohen’s kappa at 0.89). FASTVISU is a user-friendly modular solution to validate entities extracted by NLP methods from free-text documents stored in clinical data warehouses. PMID:26958189

  5. CASCO BAY ESTUARY PROJECT TRIENNIAL IMPLEMENTATION REVIEW MARCH, 2004

    EPA Science Inventory

    The Casco Bay Estuary Project has seven primary goals/priorities which include: minimize pollutant loading from stormwater; open and protect shellfish beds; protect and restore habitat; reduce toxic pollution; promote responsible stewardship; sustain and promote the continued eff...

  6. Review of geography internship of convective wave project

    NASA Technical Reports Server (NTRS)

    Rademacher, Kurt R.; Collins, Charles

    1990-01-01

    The internship of the author is examined in detail. The acquisition of the internship, the personnel of the project, the project itself, and the goals associated with it are described. The authors orientation to the internship, the project's operations, and the conclusion of the findings are also described. The overall goal of the project was to determine the effect of convective waves on wind speeds in the middle and upper troposphere, and how these waves affect the general circulation on a global scale. A more specific goal of the author was the satellite analysis of cloud street formations. This was done to determine frequency and areas in which cloud streets occur off the East Asian and North American coastlines.

  7. UAS Integration in the NAS Project - FY 14 Annual Review

    NASA Technical Reports Server (NTRS)

    Grindle, Laurie; Randall, Debra; Hackenberg, Davis

    2014-01-01

    This briefing gives insight into the research activities and efforts being executed in order to integrate unmanned aircraft systems into the national airspace system. This briefing is to inform others of the UAS-NAS Projects progress and future directions.

  8. AgRISTARS. Project management report: Program review presentation to level 1, interagency coordination committee

    NASA Technical Reports Server (NTRS)

    1981-01-01

    The AgRISTARS supporting research projects in the areas of data systems, scene radiation, and pattern recognition are reviewed. The objectives, activities, and accomplishments of FY-80 and the objectives and status of FY-81 programs are described.

  9. Reviewing the Unmet Needs of Patients with Multiple Sclerosis

    PubMed Central

    Mehr, Stanton R.; Zimmerman, Marj P.

    2015-01-01

    Significant innovations in the treatment of patients with multiple sclerosis (MS) have primarily addressed the frequency of flare-ups in relapsing-remitting MS (RRMS). Many advances have been made in this area, and the medical community may be on the verge of a serious discussion of what constitutes a truly effective MS treatment. Certainly, it is important to further delay MS flare-ups and more effectively treat RRMS symptoms. However, great strides in reducing or preventing MS-related disability and providing neuroprotection have been elusive. Many unmet needs are still voiced by patients with MS, clinicians, and caregivers. Current information on the need for progress in various areas is reviewed in this article, including psychosocial care, treatments for progressive MS, biomarker identification, functional outcome measures, individualization of treatment, reducing side effects of medications, and improving medication adherence. PMID:26702334

  10. General management of nonagenarian patients: a review of the literature.

    PubMed

    Rivoirard, Romain; Chargari, Cyrus; Trone, Jane-Chloé; Falk, Alexander Tuan; Guy, Jean-Baptiste; Eddekaoui, Houda; Lahmar, Rima; Pacaut, Cécile; Mery, Benoite; Assouline, Avi; Auberdiac, Pierre; Moriceau, Guillaume; Gonthier, Regis; Guillot, Aline; Merrouche, Yacine; Magné, Nicolas

    2014-01-01

    The number of nonagenarian people in the world is steadily growing. This phenomenon will increase in future years: in 2050, world population prospects estimate 71.16 million people aged 90 years or older. The two main causes of death among people aged 85 years or more in Europe in 2003 were cardiovascular and cerebrovascular diseases and cancers. However, the elderly are often excluded from clinical trials; they are underrepresented in clinical registries and especially nonagenarians. Care (medical, surgical, oncology) of these very elderly is currently insufficiently based on scientific recommendations. For the physician, the choice to treat or not to treat very elderly patients (for fear of side effects) is difficult. Oncology is particularly affected by this problem. Here we review these different fields of internal medicine management of nonagenarian patients with a special focus on oncology and on comprehensive geriatric assessment as a base for all care decision taking. PMID:25536522

  11. Reviewing the Unmet Needs of Patients with Multiple Sclerosis.

    PubMed

    Mehr, Stanton R; Zimmerman, Marj P

    2015-11-01

    Significant innovations in the treatment of patients with multiple sclerosis (MS) have primarily addressed the frequency of flare-ups in relapsing-remitting MS (RRMS). Many advances have been made in this area, and the medical community may be on the verge of a serious discussion of what constitutes a truly effective MS treatment. Certainly, it is important to further delay MS flare-ups and more effectively treat RRMS symptoms. However, great strides in reducing or preventing MS-related disability and providing neuroprotection have been elusive. Many unmet needs are still voiced by patients with MS, clinicians, and caregivers. Current information on the need for progress in various areas is reviewed in this article, including psychosocial care, treatments for progressive MS, biomarker identification, functional outcome measures, individualization of treatment, reducing side effects of medications, and improving medication adherence. PMID:26702334

  12. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery.

    PubMed

    Rizk, Paul; Morris, William; Oladeji, Philip; Huo, Michael

    2016-06-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms. PMID:27239384

  13. Patient-based radiographic exposure factor selection: a systematic review

    SciTech Connect

    Ching, William; Robinson, John; McEntee, Mark

    2014-09-15

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system.

  14. Clinical review: early patient mobilization in the ICU.

    PubMed

    Hodgson, Carol L; Berney, Sue; Harrold, Megan; Saxena, Manoj; Bellomo, Rinaldo

    2013-01-01

    Early mobilization (EM) of ICU patients is a physiologically logical intervention to attenuate critical illness-associated muscle weakness. However, its long-term value remains controversial. We performed a detailed analytical review of the literature using multiple relevant key terms in order to provide a comprehensive assessment of current knowledge on EM in critically ill patients. We found that the term EM remains undefined and encompasses a range of heterogeneous interventions that have been used alone or in combination. Nonetheless, several studies suggest that different forms of EM may be both safe and feasible in ICU patients, including those receiving mechanical ventilation. Unfortunately, these studies of EM are mostly single center in design, have limited external validity and have highly variable control treatments. In addition, new technology to facilitate EM such as cycle ergometry, transcutaneous electrical muscle stimulation and video therapy are increasingly being used to achieve such EM despite limited evidence of efficacy. We conclude that although preliminary low-level evidence suggests that EM in the ICU is safe, feasible and may yield clinical benefits, EM is also labor-intensive and requires appropriate staffing models and equipment. More research is thus required to identify current standard practice, optimal EM techniques and appropriate outcome measures before EM can be introduced into the routine care of critically ill patients. PMID:23672747

  15. Limb pterygium syndromes: a review and report of eleven patients.

    PubMed

    Hall, J G; Reed, S D; Rosenbaum, K N; Gershanik, J; Chen, H; Wilson, K M

    1982-08-01

    Conditions with limb pterygia and congenital contractures were reviewed as part of a study of over 350 infants with arthrogryposis. Emphasis was placed on inheritance and variability of distinct pterygium conditions. Eleven patients with limb pterygia were recognized in our study and are described here. Seven of the 350 patients with congenital contractures had the autosomal recessively inherited multiple pterygium syndrome (Patients 1-7). Three of the seven are sibs, a fourth was born to consanguineous parents, and three were chance isolated cases. These seven had multiple joint webs, unusual finger contractures, syndactyly, rocker bottom feet, ptosis, antimongoloid slant of palpebral fissures, epicanthal folds, highly arched palate, scoliosis, and short stature. There is intrafamilial variability. Three patients from one family had a lethal multiple pterygium syndrome. Two were monozygotic twins. They had webbing and contractures of the elbows, knees, neck, and fingers, calcaneovalgus deformity of the feet, and an unusual facial appearance: hypertelorism, flat nose, antimongoloid slant of palpebral fissures, apparently low-set ears. One had a cleft palate. Internal malformations included: bilateral pulmonary hypoplasia, small heart, absence of the appendix, and attenuation of the ascending and transverse colon. One sporadic case of lethal popliteal pterygium with facial clefts was studied. Multiple anomalies included: ankyloblepharon filiforme adnatum, upslanting palpebral fissures, hypoplasia of nasal cartilages, frenula, clefts into the oropharynx lateral to the mouth, apparently low-set ears with slit-like canals, large popliteal pterygia, syndactyly with fusion of all digits in hands and feet, and hypoplastic labia. PMID:7124793

  16. Information on the Internet for asplenic patients: a systematic review

    PubMed Central

    Downing, Mark A.; Omar, Ahmed H.; Sabri, Elham; McCarthy, Anne E.

    2011-01-01

    Background Asplenic patients in general have poor knowledge about their condition. Patients are increasingly turning to the Internet for their health care information, therefore this is a resource that many asplenic patients will use. The aim of our study was to determine the quality of information on the Internet for asplenic patients. Methods We identified websites by entering “splenectomy OR spleen removal” into 3 Internet search engines on July 28, 2008. The top 50 English-language websites from each search engine were included in our analysis. We evaluated the websites with our own 21-point content scale as well as 4 commonly used quality-assessment tools. All websites were analyzed independently by 2 reviewers. Correlations were made between the quality assessment instruments, content, readability and target audience. Results We included 89 websites in the study. The mean content score percentage for all websites was 49% (95% confidence interval 44%–54%). The long-term risk of infection was mentioned in 84% of websites, and the need for vaccination was mentioned in 79%. The mean quality assessment tool score was 61%, and the mean reading grade level was 11. Conclusion Whereas websites on average did not cover most of the information that asplenic patients should receive, the long-term risk of serious infection and the need for vaccination was consistently mentioned. Websites were inconsistent with respect to adhering to standards advocated by the quality assessment instruments we used, and the mean reading grade level was far above what is recommended for patient literature. PMID:21651833

  17. An Approach to Tailoring Major Technical Reviews Based on Project Characteristics and Stakeholder Interests

    NASA Technical Reports Server (NTRS)

    Richstein, Alan B.; Nolte, Jerome T.; Pfarr, Barbara B.

    2004-01-01

    There are numerous technical reviews that occur throughout the systems engineering process life cycle. Many are well known by project managers and stakeholders such as developers and end users, an example of much is the critical design review (CDR). This major milestone for a large, complex new project may last two or more days, include an extensive agenda of topics, and entail hundreds of hours of developer time to prepare presentation materials and associated documents. Additionally, the weeks of schedule spent on review preparation is at least partly at the expense of other work. This paper suggests an approach for tailoring technical reviews, based on the project characteristics and the project manager s identification of the key stakeholders and understanding of their most important issues and considerations. With this insight the project manager can communicate to, manage expectations oc and establish formal agreement with the stakeholders as to which reviews, and at what depth, are most appropriate to achieve project success. The authors, coming from diverse organizations and backgrounds, have drawn on their personal experiences and summarized the best practices of their own organizations to create a common framework to provide guidance on the adaptation of design reviews to other system engineers.

  18. Interaction between ingested nutrients and gut endocrine cells in patients with irritable bowel syndrome (Review)

    PubMed Central

    EL-SALHY, MAGDY; GILJA, ODD HELGE; GUNDERSEN, DORIS; HATLEBAKK, JAN G.; HAUSKEN, TRYGVE

    2014-01-01

    Several endocrine cell abnormalities have been reported in different segments of the gastrointestinal tract of patients with irritable bowel syndrome (IBS). These cells have specialized microvilli that project into the lumen; they function as sensors for the gut contents and respond to luminal stimuli (mostly ingested nutrients) by releasing hormones into the lamina propria, where they exert their effects via a paracrine/endocrine mode of action. Certain food items trigger the symptoms experienced by IBS patients, including those rich in fermentable oligo-, di- and monosaccharides, and polyols (FODMAPs). In this review, we present the argument that the effects of both FODMAPs and the proportional intake of proteins, fats and carbohydrates on IBS symptoms may be caused by an interaction with the gut endocrine cells. Since the gut hormones control and regulate gastrointestinal motility and sensation, this interaction may be responsible for abnormal gastrointestinal motility and the visceral hypersensitivity observed in these patients. There is no consistent evidence that IBS patients suffer from food allergy. The role of gluten intolerance in the development of IBS symptoms in these patients remains a matter of controversy. Individual guidance on food management, which includes restrictions in the intake of FODMAP-rich foods and testing diets with different proportions of proteins, fats and carbohydrates has been found to reduce the symptoms, improve the quality of life, and make the habitual diet of IBS patients more healthy. PMID:24939595

  19. Mediators of Change in Psychosocial Interventions for Cancer Patients: A Systematic Review

    PubMed Central

    Moyer, Anne; Goldenberg, Matthew; Hall, Matthew A.; Knapp-Oliver, Sarah K.; Sohl, Stephanie J.; Sarma, Elizabeth A.; Schneider, Stefan

    2012-01-01

    Careful reviews and meta-analyses have made valuable contributions to understanding the efficacy of psychosocial interventions for cancer patients. An important next step is to determine the mediators that explain the influence of efficacious interventions on outcomes. This systematic review summarizes tests of mediating variables from twenty-two projects conducted from 1989–2010. Although all authors provided some type of rationale for considering particular mediating relationships, the investigations varied widely with respect to the extent to which formal theoretical constructs were tested, the type and goals of the interventions studied, and the broad types of outcomes and potential mediators examined. Although there was some evidence supporting selected mediating relationships, with positive findings often found when mediating variables represented behaviors targeted by an intervention, the findings were mixed. Expanding the focus of research to include mechanisms in psychosocial oncology intervention research is necessary for providing a unified picture of how mediating relationships may be operating in this field. PMID:22873734

  20. Review of BPA Funded Sturgeon, Resident Fish and Wildlife Projects for 1990/1991.

    SciTech Connect

    United States. Bonneville Power Administration.

    1990-12-01

    The Bonneville Power Administration (BPA) held a public meeting on November 19--21, 1991, for the purpose of review, coordination, and consultation of the BPA-funded projects for sturgeon, resident fish, and wildlife in the Columbia River Basin (Basin). The comments received after the meeting were favorable and the participants agreed that the meeting was stimulating and productive. The information exchanged should lead to better coordination with other projects throughout the Basin. This document list the projects by title, the project leaders and BPA's project officers, and an abstract of each leader's presentation.

  1. A comprehensive review of palliative care in patients with cancer.

    PubMed

    Jaiswal, Reena; Alici, Yesne; Breitbart, William

    2014-02-01

    One of the most challenging roles for the psychiatrist is to help guide terminally ill patients physically, psychologically and spiritually through the dying process. Patients with advanced cancer, and other life-threatening medical illnesses are at increased risk for developing major psychiatric complications and have an enormous burden of both physical as well as psychological symptoms. In fact, surveys suggest that psychological symptoms such as depression, anxiety, and hopelessness are as frequent, if not more so, than pain and other physical symptoms in palliative care settings. Psychiatrists have a unique role and opportunity to offer competent and compassionate palliative care to those with life-threatening illness. In this article we provide a comprehensive review of basic concepts and definitions of palliative care and the experience of dying, and the role of the psychiatrist in palliative care including assessment and management of common psychiatric disorders in the terminally ill, with an emphasis on suicide and desire for hastened death. Psychotherapies developed for use in palliative care settings, and management of grief and bereavement are also reviewed. PMID:24716503

  2. Missed injuries in trauma patients: A literature review

    PubMed Central

    Pfeifer, Roman; Pape, Hans-Christoph

    2008-01-01

    Background Overlooked injuries and delayed diagnoses are still common problems in the treatment of polytrauma patients. Therefore, ongoing documentation describing the incidence rates of missed injuries, clinically significant missed injuries, contributing factors and outcome is necessary to improve the quality of trauma care. This review summarizes the available literature on missed injuries, focusing on overlooked muscoloskeletal injuries. Methods Manuscripts dealing with missed injuries after trauma were reviewed. The following search modules were selected in PubMed: Missed injuries, Delayed diagnoses, Trauma, Musculoskeletal injuires. Three time periods were differentiated: (n = 2, 1980–1990), (n = 6, 1990–2000), and (n = 9, 2000-Present). Results We found a wide spread distribution of missed injuries and delayed diagnoses incidence rates (1.3% to 39%). Approximately 15 to 22.3% of patients with missed injuries had clinically significant missed injuries. Furthermore, we observed a decrease of missed pelvic and hip injuries within the last decade. Conclusion The lack of standardized studies using comparable definitions for missed injuries and clinically significant missed injuries call for further investigations, which are necessary to produce more reliable data. Furthermore, improvements in diagnostic techniques (e.g. the use of multi-slice CT) may lead to a decreased incidence of missed pelvic injuries. Finally, the standardized tertiary trauma survey is vitally important in the detection of clinically significant missed injuries and should be included in trauma care. PMID:18721480

  3. 13 CFR 302.9 - Inter-governmental review of projects.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Project under EDA's Public Works and Economic Development program or a proposed construction Project or... required by 15 CFR part 13 and Executive Order 12372, “Intergovernmental Review of Federal Programs,” as... planning organizations in metropolitan areas, as provided for in 15 CFR part 13....

  4. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA... under § 806.4, and provided that the project sponsor is notified in writing by the Executive...

  5. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA... under § 806.4, and provided that the project sponsor is notified in writing by the Executive...

  6. Second and Third Grade Students in the Hunters Point-Bayview SEED Project: A Diagnostic Review.

    ERIC Educational Resources Information Center

    Counelis, James Steve

    This report supplements the first South East Education Development project (SEED) on first grade children. Full and partial records of 624 second grade students and 591 third grade students are the basis of this diagnostic review. The empirical data obtained for the SEED project students included: each student's sex and number of full days in…

  7. Independent Research Projects in General Chemistry Classes as an Introduction to Peer-Reviewed Literature

    ERIC Educational Resources Information Center

    Tribe, Lorena; Cooper, Evan L.

    2008-01-01

    A well-structured independent literature research project with a poster session was used to introduce students to peer-reviewed literature in a general chemistry course. Overall, students reported an enhanced appreciation of the course due to performing research at some level, using peer-reviewed literature, and presenting their results in a…

  8. A Review of the AIDP Project After the First Year.

    ERIC Educational Resources Information Center

    Broadbent, William A.

    This document provides an assessment of the progress Leeward Community College has made toward fulfilling the objectives of its five-year 1.4 million dollar Advanced Institutional Development Program (AIDP) grant at the end of the first year of funding. Essentially, the objectives of the project fall into four major program areas: community…

  9. Secondary Health Project: Concepts Review. Research Report 70.

    ERIC Educational Resources Information Center

    Agency for Instructional Television, Bloomington, IN.

    This report describes a preliminary evaluation in September 1979 of 12 program topics and their stated objectives for an instructional television series, the Secondary School Health Project, which addresses issues relevant to the personal and social growth of adolescents. The study addressed the following questions: (1) How can the series' topics…

  10. 77 FR 47337 - Project-Level Predecisional Administrative Review Process

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-08

    ... submitted specific written comments regarding the proposed project or activity unless the issue is based on... Chief of the Forest Service (Chief), to provide for a predecisional objection process based on Section... part 218 on January 9, 2004 (69 FR 1529), followed by a final rule on September 17, 2008 (73 FR...

  11. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... by the appropriate payment, in accordance with 44 CFR part 72. All such requests for CLOMAs shall be... MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... will be issued in the form of a letter, termed a Conditional Letter of Map Amendment. The data...

  12. Dropouts: A Review of Literature. Project Talent Search.

    ERIC Educational Resources Information Center

    Self, Timothy C.

    This report reviews the research literature from 1975-1983 on potential secondary school dropouts and strategies for effective dropout prevention programs. The information provided is intended to help communities in modifying and/or constructing treatment programs for potential dropouts. The report is divided into three sections. In the first…

  13. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program PROCEDURE FOR MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... property that may be included inadvertently in a Special Flood Hazard Area (SFHA) may request...

  14. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program PROCEDURE FOR MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... property that may be included inadvertently in a Special Flood Hazard Area (SFHA) may request...

  15. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program PROCEDURE FOR MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... property that may be included inadvertently in a Special Flood Hazard Area (SFHA) may request...

  16. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support such... Washington, DC, and shall be accompanied by the appropriate payment, in accordance with 44 CFR part 72. ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Review of proposed...

  17. Status of power-reactor projects undergoing licensing review

    SciTech Connect

    Silver, E.G.

    1982-07-01

    Recent regulatory and other actions relating to power reactors undergoing licensing review are summarized in Table 1 as of May 1, 1982. Except as otherwise noted, all the information presented in this article is taken from NRC press releases or from the reactor docket file, both of which are available at the NRC Public Document Room, 1717 H Street NW, Washington, DC 20555.

  18. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... by the appropriate payment, in accordance with 44 CFR part 72. All such requests for CLOMAs shall be... MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... will be issued in the form of a letter, termed a Conditional Letter of Map Amendment. The data...

  19. Solar Technology Assessment Project. Volume VII. A review of OTEC

    SciTech Connect

    Yuen, P.C.

    1981-04-01

    The Ocean Thermal Energy Conversion (OTEC) principle is discussed along with general system and cycle types, specific OTEC designs, applications, and the ocean thermal resource. the historic development and present status of OTEC are reviewed. Power system components of the more technically advanced closed-cycle OTEC concept are discussed: heat exchangers, corrosion and biofouling countermeasures, working fluids, ammonia power systems, and on-platform seawater sytems. Several open-cycle features are also discussed. A critical review of the ocean engineering aspects of the OTEC power system is presented. Major subsystems such as platform, cold water pipe, mooring system, dynamic positioning system and power transmission cable system are assessed for their relationships with the ocean environment and with each other. Nine available studies of OTEC costs are reviewed, and tentative comparisons are made between OTEC and traditional fuel costs. OTEC products and markets are considered. Possible environmental and social effects of OTEC development are discussed. International and national laws regulating OTEC plants are reviewed, specifically, the United Nations Third Conference on the Law of the Sea and the Ocean Thermal Energy Conversion Act of 1980. Coast Guard regulations, OSHA laws, and state and local government regulations are also considered as well as attitudes of the utilities. (LEW)

  20. Residential Segregation: A Review of the Literature. Project Report.

    ERIC Educational Resources Information Center

    Page, Douglas B.

    A review of the literature on residential segregation reveals that Blacks remain the most segregated group in American cities, despite the more recent arrival of Hispanic and Asian groups. By one measure--the index of dissimilarity with respect to Whites--Blacks are 1.6 times more segregated than Hispanics, and twice as segregated as Asians. Race…

  1. REVIEW ARTICLE: UHP lamp systems for projection applications

    NASA Astrophysics Data System (ADS)

    Derra, Guenther; Moench, Holger; Fischer, Ernst; Giese, Hermann; Hechtfischer, Ulrich; Heusler, Gero; Koerber, Achim; Niemann, Ulrich; Noertemann, Folke-Charlotte; Pekarski, Pavel; Pollmann-Retsch, Jens; Ritz, Arnd; Weichmann, Ulrich

    2005-09-01

    Projection systems have found widespread use in conference rooms and other professional applications during the last decade and are now entering the home TV market at a considerable pace. Projectors as small as about one litre are able to deliver several thousand screen lumens and are, with a system efficacy of over 10 lm W-1, the most efficient display systems realized today. Short arc lamps are a key component for projection systems of the highest efficiency for small-size projection displays. The introduction of the ultra high performance (UHP) lamp system by Philips in 1995 can be identified as one of the key enablers of the commercial success of projection systems. The UHP lamp concept features outstanding arc luminance, a well suited spectrum, long life and excellent lumen maintenance. For the first time it combines a very high pressure mercury discharge lamp with extremely short and stable arc gap with a regenerative chemical cycle keeping the discharge walls free from blackening, leading to lifetimes of over 10 000 h. Since the introduction of the UHP lamp system, many important new technology improvements have been realized: burner designs for higher lamp power, advanced ignition systems, miniaturized electronic drivers and innovative reflector concepts. These achievements enabled the impressive increase of projector light output, a remarkable reduction in projector size and even higher optical efficiency in projection systems during the last years. In this paper the concept of the UHP lamp system is described, followed by a discussion of the technological evolution the UHP lamp has undergone so far. Last, but not least, the important improvements of the UHP lamp system including the electronic driver and the reflector are discussed.

  2. Dosimetric review of cardiac implantable electronic device patients receiving radiotherapy.

    PubMed

    Prisciandaro, Joann I; Makkar, Akash; Fox, Colleen J; Hayman, James A; Horwood, Laura; Pelosi, Frank; Moran, Jean M

    2015-01-01

    A formal communication process was established and evaluated for the management of patients with cardiac implantable electronic devices (CIEDs) receiving radiation therapy (RT). Methods to estimate dose to the CIED were evaluated for their appropriateness in the management of these patients. A retrospective, institutional review board (IRB) approved study of 69 patients with CIEDs treated with RT between 2005 and 2011 was performed. The treatment sites, techniques, and the estimated doses to the CIEDs were analyzed and compared to estimates from published peripheral dose (PD) data and three treatment planning systems(TPSs) - UMPlan, Eclipse's AAA and Acuros algorithms. When measurements were indicated, radiation doses to the CIEDs ranged from 0.01-5.06 Gy. Total peripheral dose estimates based on publications differed from TLD measurements by an average of 0.94 Gy (0.05-4.49 Gy) and 0.51 Gy (0-2.74 Gy) for CIEDs within 2.5 cm and between 2.5 and 10 cm of the treatment field edge, respectively. Total peripheral dose estimates based on three TPSs differed from measurements by an average of 0.69 Gy (0.02-3.72 Gy) for CIEDs within 2.5 cm of the field edge. Of the 69 patients evaluated in this study, only two with defibrillators experienced a partial reset of their device during treatment. Based on this study, few CIED-related events were observed during RT. The only noted correlation with treatment parameters for these two events was beam energy, as both patients were treated with high-energy photon beams (16 MV). Differences in estimated and measured CIED doses were observed when using published PD data and TPS calculations. As such, we continue to follow conservative guidelines and measure CIED doses when the device is within 10 cm of the field or the estimated dose is greater than 2 Gy for pacemakers or 1 Gy for defibrillators. PMID:25679176

  3. Depression in cancer patients: Pathogenesis, implications and treatment (Review)

    PubMed Central

    SMITH, HAMISH R.

    2015-01-01

    Depression is a common comorbidity in cancer cases, affecting >10% of patients. A cancer diagnosis is life-changing, and is a source of considerable psychological and emotional stress. Non-pathological sadness may be a normal response to a cancer diagnosis, however, stress beyond the coping mechanisms of patients may result in major depressive disorder. The current review, in addition to the obvious psychosocial elements of depression, explores its biological mechanisms, including tissue damage, inflammatory mediators and the chronic stress response, and how these immune and endocrine pathways may underlie depression in cancer. Possible iatrogenic causes of depression in cancer are also explored. There is a strong need to identify and treat depression in cancer patients in order to increase quality of life and reduce mortality. The most popular clinical and potential future biochemical screening tools for depression in cancer are briefly discussed. The interventions used will vary for every patient, but may include psychosocial therapies or pharmacotherapy; however, a paucity of research on the most effective management of depression in cancer means the optimal combination of therapies is unknown. Selection of antidepressants should be carefully considered, given the common side effects of chemotherapy (such as nausea), and the necessity to avoid serious interactions, including reducing the effectiveness of chemotherapeutic drugs. The possible link between the chronic stress response, which may predispose patients to depression, and the risk of mortality from cancer is also explored. The complex interactions between the endocrine, nervous and immune systems, which continue to be elucidated, may offer the opportunity for the development of more rapid and efficacious treatments for depression in cancer in the future. PMID:25788991

  4. Multidisciplinary in-hospital teams improve patient outcomes: A review

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    Background: The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Methods: Acting like “well-oiled machines,” multidisciplinary in-hospital teams include “staff” from different levels of the treatment pyramid (e.g. staff including nurses’ aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the “silo effect” by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality) while improving patient and healthcare worker satisfaction. Results: Multiple articles across diverse disciplines incorporate a variety of concepts of “teamwork” for staff covering emergency rooms (ERs), hospital wards, intensive care units (ICUs), and most critically, operating rooms (ORs). Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS), and yielded greater patient “staff” satisfaction. Conclusion: Within hospitals, delivering the best medical/surgical care is a “team sport.” The goals include: Maximizing patient safety (e.g. limiting AE) and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers’ performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their “well-oiled machines” enhancing the quality/safety of patient care, while enabling “staff” to optimize their performance and enhance their job satisfaction. PMID:25289149

  5. A review on quality of life in keratinocyte carcinoma patients.

    PubMed

    Waalboer-Spuij, R; Nijsten, T E C

    2013-06-01

    Health-related quality of life issues in patients with cutaneous malignancies is being re-explored. This is motivated by the heavy burden they put on dermatological care, it is more and more considered a chronic disease and new non-invasive therapies are being introduced. The purpose of this review is to identify the relevant quality of life (QOL) issues and to summarize the instruments used for investigating QOL in keratinocyte carcinoma patients. With a systematic literature search in Embase, MEDLINE OvidSP, PubMed publisher and Cochrane Central, 10 questionnaires and 4 studies reporting on quality of life issues were identified. Generic (UK Sickness Impact profile [UKSIP], Short Form 36-item Health Survey [SF-36], Functional Assessment of Cancer Therapy-General [FACT-G]) and dermatology specific (Dermatology Life Quality Index [DLQI] and Skindex-29, -16, -17) instruments demonstrated little to no QOL impairment. This may be explained by failing to capture the relevant domains such as "emotions", "appearance" and "anxiety". Skin cancer specific questionnaires (Skin Cancer Index [SCI], Skin Cancer Quality of Life Impact Tool [SCQOLIT] and Actinic Keratosis Quality of Life [AKQoL]) demonstrated good validity and responsiveness and represent the effect on QOL properly. However, there are some points of critique to these questionnaires. Optimal management of patients with actinic neoplasia syndrome and the selection and evaluation of therapies may benefit from the use of PROs in this ever increasing population. PMID:23670061

  6. Memory deficits in Alzheimer's patients: a comprehensive review.

    PubMed

    Carlesimo, G A; Oscar-Berman, M

    1992-06-01

    Despite considerable experimental work on Alzheimer's disease (AD), the underlying cognitive mechanisms as well as the precise localization of neuropathological changes critical for memory loss remains undefined. A review of the neuropsychological literature on long-term memory deficits in AD patients suggests that AD patients display (a) a pervasive deficit of explicit memory, (b) a partial deficiency of implicit memory for verbal and visuoperceptual material (as measured by repetition priming procedures), and (c) a substantial sparing of implicit memory for visuomotor skills. The explicit memory loss is likely a result of encoding as well as consolidation difficulties. A faulty lexical-semantic knowledge structure appears responsible for deficient repetition priming effects. Since neuropathological changes diffusely affect the brain of AD patients, establishing a clear relationship between localization of cerebral lesions and memory deficits is particularly difficult. Nevertheless, data suggest that extensive involvement of the hippocampal-amygdala complex plays a major role in explicit memory loss. Damage to associative cortical areas likely is involved in repetition priming deficits. The relative integrity of primary motor and sensory cortical areas and of the basal ganglia likely subsume, by contrast, the normal learning of visuomotor skills. PMID:1300219

  7. Older patients in the emergency department: a review.

    PubMed

    Samaras, Nikolaos; Chevalley, Thierry; Samaras, Dimitrios; Gold, Gabriel

    2010-09-01

    Older patients account for up to a quarter of all emergency department (ED) visits. Atypical clinical presentation of illness, a high prevalence of cognitive disorders, and the presence of multiple comorbidities complicate their evaluation and management. Increased frailty, delayed diagnosis, and greater illness severity contribute to a higher risk of adverse outcomes. This article will review the most common conditions encountered in older patients, including delirium, dementia, falls, and polypharmacy, and suggest simple and efficient strategies for their evaluation and management. It will discuss age-related changes in the signs and symptoms of acute coronary events, abdominal pain, and infection, examine the yield of different diagnostic approaches in this population, and list the underlying medical problems present in half of all "social" admission cases. Complete geriatric assessments are time consuming and beyond the scope of most EDs. We propose a strategy based on the targeting of high-risk patients and provide examples of simple and efficient tools that are appropriate for ED use. PMID:20619500

  8. Review on immunotherapy in airway allergen sensitised patients.

    PubMed

    van der Valk, J P M; de Jong, N W; Gerth van Wijk, R

    2015-07-01

    Allergen immunotherapy is a more than 100-year-old treatment in particular for birch pollen, grass pollen, house dust mite and cat dander sensitised allergic patients. The mechanism of allergen-specific immunotherapy is complex. Different hypotheses have been postulated to explain the mode of action, such as a decrease of the number of tissue mast cells, eosinophils and basophils, an increase of IgG4 and IgA synthesis, a shift from Th2 to Th1 cells and an increase in the number and function of IL-10 producing T-regulatory cells (T-reg). All these immunological effects may contribute to immune tolerance and long-term changes in the immune system. The efficacy and safety of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) with pollen and house dust mite have been investigated in many trials, meta-analyses and reviews. Nowadays grass pollen SLIT and SCIT, and birch pollen and house dust mite SCIT are implemented in clinical practice to treat therapy-resistant patients. However, the treatment is not effective for all patients and often not without side effects. Therefore, the development of new, safer and more effective immunotherapies is needed. These are approached along novel routes, including improved administration, combined treatment with immune response modifiers, fusion with immune response modifiers, allergen coupled to adjuvants and reconstruction of natural extracts with multiple recombinant allergens or with modified allergens. These developments are promising, but more research is required to implement them in clinical practice. PMID:26228190

  9. Nasal reconstruction in children: a review of 29 patients.

    PubMed

    Pittet, B; Montandon, D

    1998-11-01

    Acquired large nasal defects are much more common in adulthood than in childhood because of the frequency of skin tumors after a certain age. However, from their experience in treating a number of children with sequelae of noma and burns, the authors have collected a series of 17 total and 12 partial nasal reconstructions in children aged 1 to 15 years. After reviewing the various methods used for recreating the lining, the support, and the skin cover in the whole series, three cases are reported in detail. A 1-year-old patient received a tempororetroauricular flap after total amputation of the nose and was observed for 17 years. Another patient, who was burned as a baby, underwent reconstruction at age 10 with a deltopectoral flap and was observed for 7 years. The third patient underwent total nose reconstruction at age 12 with an Indian forehead flap. From their experience, the authors conclude that, for psychosocial reasons, nasal reconstruction should be started early, despite possible reoperation at a later age. The best results are certainly obtained at the end of growth or at least after the age of 12. Adjacent bone or soft tissue defects further enhance the difficult challenge of restoring a satisfactory aesthetic appearance in these children. PMID:10029764

  10. Constructing a Patient Education System: A Performance Technology Project

    ERIC Educational Resources Information Center

    Bell, Edith E.

    2009-01-01

    The purpose of the patient education system described here was to distribute patient education material to and within medical practices managed by a small medical practice management company. The belief was that patient education opportunities improved health care outcomes and increased patient participation in health care decisions and compliance…

  11. Summary for the Next Generation Nuclear Plant Project in Review

    SciTech Connect

    L.E. Demick

    2010-08-01

    This paper reports on the major progress that the NGNP Project has made toward developing and commercializing the HTGR technology. Significant R&D progress has been made in addressing key technical issues for qualification of the HTGR fuel and graphite, codification of high temperature materials and verification and validation of design codes. Work is also progressing in heat transfer/transport design and testing and in development of the high temperature steam electrolysis hydrogen production process. A viable licensing strategy has been formulated in coordination with the NRC and DOE. White papers covering key licensing issues have been and will continue to be submitted and necessary discussions of these key issues have begun with the NRC. Continued government support is needed to complete the Project objectives as established in the 2005 Energy Policy Act.

  12. Summary for the Next Generation Nuclear Plant Project in Review

    SciTech Connect

    L.E. Demick

    2010-09-01

    This paper reports on the major progress that the NGNP Project has made toward developing and commercializing the HTGR technology. Significant R&D progress has been made in addressing key technical issues for qualification of the HTGR fuel and graphite, codification of high temperature materials and verification and validation of design codes. Work is also progressing in heat transfer/transport design and testing and in development of the high temperature steam electrolysis hydrogen production process. A viable licensing strategy has been formulated in coordination with the NRC and DOE. White papers covering key licensing issues have been and will continue to be submitted and necessary discussions of these key issues have begun with the NRC. Continued government support is needed to complete the Project objectives as established in the 2005 Energy Policy Act.

  13. A review of NASA-sponsored technology assessment projects

    NASA Technical Reports Server (NTRS)

    Mascy, A. C.; Alexander, A. D., III; Wood, R. D.

    1978-01-01

    Recent technology assessment studies sponsored by NASA are reviewed, and a summary of the technical results as well as a critique of the methodologies are presented. The reviews include Assessment of Lighter-Than-Air Technology, Technology Assessment of Portable Energy RDT&P, Technology Assessment of Future Intercity Passenger Transportation Systems, and Technology Assessment of Space Disposal of Radioactive Nuclear Waste. The use of workshops has been introduced as a unique element of some of these assessments. Also included in this report is a brief synopsis of a method of quantifying opinions obtained through such group interactions. Representative of the current technology assessments, these studies cover a broad range of socio-political factors and issues in greater depth than previously considered in NASA sponsored studies. In addition to the lessons learned through the conduct of these studies, a few suggestions for improving the effectiveness of future technology assessments are provided.

  14. How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time

    PubMed Central

    Baines, Rebecca; Langelaan, Maaike; de Bruijne, Martine; Spreeuwenberg, Peter; Wagner, Cordula

    2015-01-01

    Objectives To assess whether, compared with previous years, hospital care became safer in 2011/2012, expressing itself in a fall in preventable adverse event (AE) rates alongside patient safety initiatives. Design Retrospective patient record review at three points in time. Setting In three national AE studies, patient records of 2004, 2008 and 2011/2012 were reviewed in, respectively, 21 hospitals in 2004, 20 hospitals in 2008 and 20 hospitals in 2011/2012. In each hospital, 400, 200 and 200 patient records were sampled, respectively. Participants In total, 15 997 patient admissions were included in the study, 7926 patient admissions from 2004, 4023 from 2008 and 4048 from 2011/2012. Interventions The main patient safety initiatives in hospital care at a national level between 2004 and 2012 have been small as well as large-scale multifaceted programmes. Main outcome measures Rates of both AEs and preventable AEs. Results Uncorrected crude overall AE rates showed no change in 2011/2012 in comparison with 2008, whereas preventable AE rates showed a reduction of 45%. After multilevel corrections, the decrease in preventable AE rate in 2011/2012 was still clearly visible with a decrease of 30% in comparison to 2008 (p=0.10). In 2011/2012, fewer preventable AEs were found in older age groups, or related to the surgical process, in comparison with 2008. Conclusions Our study shows some improvements in preventable AEs in the areas that were addressed during the comprehensive national safety programme. There are signs that such a programme has a positive impact on patient safety. PMID:26150548

  15. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    receiving all elements of the COPD admission care bundle, versus 63% in September 2014. Appropriate blood gas analysis, nebuliser administration, and respiratory review also improved. Prescription of steroids and antibiotics remained static, with 96% of patients receiving these treatments within four hours in the emergency department (ED). The only criteria which showed a decline was appropriate oxygen prescription, which dipped from 97% to 87%. After the effect of initial strategies plateaued, this quality improvement project facilitated a further increase in compliance with the CQUIN targets, both improving patient care, and safeguarding continued CQUIN funding. There is further work to be done to maintain and support further improvement in standards, and to encourage use of the COPD admission bundle paperwork for documentation purposes. PMID:26734406

  16. Patient-based radiographic exposure factor selection: a systematic review

    PubMed Central

    Ching, William; Robinson, John; McEntee, Mark

    2014-01-01

    Introduction Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Methods Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. Results The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Conclusion Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system. PMID:26229654

  17. Measurement of patient safety: a systematic review of the reliability and validity of adverse event detection with record review

    PubMed Central

    Hanskamp-Sebregts, Mirelle; Zegers, Marieke; Vincent, Charles; van Gurp, Petra J; de Vet, Henrica C W; Wollersheim, Hub

    2016-01-01

    Objectives Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review. Design A systematic review of the literature. Methods We searched PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library and from their inception through February 2015. We included all studies that aimed to describe the reliability and/or validity of record review. Two reviewers conducted data extraction. We pooled κ values (κ) and analysed the differences in subgroups according to number of reviewers, reviewer experience and training level, adjusted for the prevalence of adverse events. Results In 25 studies, the psychometric data of the Global Trigger Tool (GTT) and the Harvard Medical Practice Study (HMPS) were reported and 24 studies were included for statistical pooling. The inter-rater reliability of the GTT and HMPS showed a pooled κ of 0.65 and 0.55, respectively. The inter-rater agreement was statistically significantly higher when the group of reviewers within a study consisted of a maximum five reviewers. We found no studies reporting on the validity of the GTT and HMPS. Conclusions The reliability of record review is moderate to substantial and improved when a small group of reviewers carried out record review. The validity of the record review method has never been evaluated, while clinical data registries, autopsy or direct observations of patient care are potential reference methods that can be used to test concurrent validity. PMID:27550650

  18. Electronic band structure and photoemission: A review and projection

    SciTech Connect

    Falicov, L.M.

    1987-09-01

    A brief review of electronic-structure calculations in solids, as a means of interpreting photoemission spectra, is presented. The calculations are, in general, of three types: ordinary one-electron-like band structures, which apply to bulk solids and are the basis of all other calculations; surface modified calculations, which take into account, self-consistently if at all possible, the presence of a vacuum-solid interface and of the electronic modifications caused thereby; and many-body calculations, which go beyond average-field approximations and consider dynamic rearrangement effects caused by electron-electron correlations during the photoemission process. 44 refs.

  19. Acupuncture for patients with chronic urticaria: a systematic review protocol

    PubMed Central

    Yao, Qin; Ye, Yongming; Liu, Xiaoxu; Qin, Zongshi; Liu, Zhishun

    2015-01-01

    Introduction This systematic review protocol aims to describe a meta-analysis to assess the effectiveness and safety of acupuncture therapy for patients with chronic urticaria. Methods and analysis We will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, the Web of Science, Traditional Chinese Medicine, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database) and Wan-Fang Database from their inception. Other sources will also be searched, including the reference lists of identified publications and conference proceedings. Any clinical randomised controlled trials related to acupuncture for treating chronic urticaria without restriction of publication status and languages will be included. Study selection, data extraction and assessment of study quality will be performed independently by 2 researchers. Data will be synthesised by either the fixed-effects or random-effects model according to a heterogeneity test. Improvement in pruritus and wheals will be assessed as the primary outcomes. Adverse events, quality of life and the recurrence rate after at least 3 months of the treatment will also be evaluated as secondary outcomes. RevMan V.5.2 statistical software will be used for meta-analysis, if possible. If it is not appropriate for a meta-analysis, then a descriptive analysis or a subgroup analysis will be conducted. The results will be expressed as a risk ratio for dichotomous data and mean difference (MD) or standardised MD for continuous data. Dissemination and ethics The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised. Trial registration number PROSPERO CRD42015015702. PMID:26338683

  20. Independent management and financial review, Yucca Mountain Project, Nevada. Final report

    SciTech Connect

    1995-07-15

    The Yucca Mountain Project is one part of the Department of Energy`s Office of Civilian Radioactive Waste Management Program (the Program) which was established by the Nuclear Waste Policy Act of 1982, and as amended in 1987. The Program`s goal is to site the nation`s first geologic repository for the permanent disposal of high-level nuclear waste, in the form of spent fuel rod assemblies, generated by the nuclear power industry and a smaller quantity of Government radioactive waste. The Program, which also encompasses the transportation system and the multipurpose canister system was not the subject of this Report. The subject of this Review was only the Yucca Mountain Project in Nevada. While the Review was directed toward the Yucca Mountain Project rather than the Program as a whole, there are certain elements of the Project which cannot be addressed except through discussion of some Program issues. An example is the Total System Life Cycle Cost addressed in Section 7 of this report. Where Program issues are discussed in this Report, the reader is reminded of the scope limitations of the National Association of Regulatory Utility Commissioners (NARUC) contract to review only the Yucca Mountain Project. The primary scope of the Review was to respond to the specific criteria contained in the NARUC scope of work. In responding to these criteria, the Review Team understood that some interested parties have expressed concern over the requirements of the Nuclear Waste Policy Act relative to the Yucca Mountain Project and the nature of activities currently being carried out by the Department of Energy at the Yucca Mountain Project site. The Review Team has attempted to analyze relevant portions of the Nuclear Waste Policy Act as Amended, but has not conducted a thorough analysis of this legislation that could lead to any specific legal conclusions about all aspects of it.

  1. Radiocarpal and Midcarpal Instability in Rheumatoid Patients: A Systematic Review

    PubMed Central

    Raven, Eric E.J.; van den Bekerom, Michel P.J.; Beumer, Annechien; van Dijk, C. Niek

    2015-01-01

    Background: This study was aimed at identifying the criteria for the diagnosis of Radiocarpal instability in rheumatoid arthritis RA). Methods: The main databases were searched to identify studies describing the pathophysiology of Radiocarpal instability in patients with RA. We focussed on the epidemiology, radiographic parameters, criteria for instability and on treatment options. Results. In the search 108 articles were found, of these 12 studies were included for this review. Instability occurs in at an average of 35.2% of the rheumatoid wrists. The instability was found between 8 and 13 years after onset of rheumatoid arthritis. A strong correlation was found between instability, duration of RA and Larsen score. Several radiographic methods were described to evaluate Radiocarpal instability in RA. Several treatment options for instability in patients with RA are described. All with their own indications and limitations. Conclusion: On a standard AP radiograph deformity can be measured using the carpal height and the ulnar translation index of Chamay. This gives an indication for instability. For describing the deterioration of the joints the Larsen score is most used. If there are more radiographs in time the Simmen classification can be used. For real assessment of instability dynamic radiographs are needed. Level of Evidence: Level IV. PMID:26448803

  2. The multiple lifestyle modification for patients with prehypertension and hypertension patients: a systematic review protocol

    PubMed Central

    Li, Juan; Zheng, Hui; Du, Huai-bin; Tian, Xiao-ping; Jiang, Yi-jing; Zhang, Shao-lan; Kang, Yu; Li, Xiang; Chen, Jie; Lu, Chao; Lai, Zhen-hong; Liang, Fan-rong

    2014-01-01

    Introduction The objective of this systematic review is to investigate the effectiveness, efficacy and safety of multiple concomitant lifestyle modification therapies for patients with hypertension or prehypertension. Methods and analysis Electronic searches will be performed in the Cochrane Library, OVID, EMBASE, etc, along with manual searches in the reference lists of relevant papers found during electronic search. We will identify eligible randomised controlled trials utilising multiple lifestyle modifications to lower blood pressure. The control could be drug therapy, single lifestyle change or no intervention. Changes in systolic blood pressure and diastolic blood pressure constitute primary end points, and secondary end points include the number of patients meeting the office target blood pressure, the number of patients reporting microvascular or macrovascular complications, etc. We will extract descriptive, methodological and efficacy data from identified randomised controlled trials (RCTs). We will calculate the relative risk for proportion of patients with a normal blood pressure in the experimental group. Dichotomous data will be analysed using risk difference and continuous data using weighted mean differences, both with 95% CI. We will use the χ2 test and the I2 statistic to assess heterogeneity. We will use the fixed effects model to compute the efficacy unless there is evidence of heterogeneity. If heterogeneity of effect size persists with respect to blood pressure change, further metaregression will be performed within groups. We will examine the potential for publication bias by using a funnel plot. Dissemination We will synthesise results from RCTs which provide more precise and accurate information on the effect of multiple lifestyle changes on blood pressure. The results of this review will increase the understanding of multiple lifestyle modifications for patients with hypertension or prehypertension. Trail registration number Our protocol

  3. Breckinridge Project, initial effort. Report XI, Volume V. Critical review of the design basis. [Critical review

    SciTech Connect

    1982-01-01

    Report XI, Technical Audit, is a compendium of research material used during the Initial Effort in making engineering comparisons and decisions. Volumes 4 and 5 of Report XI present those studies which provide a Critical Review of the Design Basis. The Critical Review Report, prepared by Intercontinental Econergy Associates, Inc., summarizes findings from an extensive review of the data base for the H-Coal process design. Volume 4 presents this review and assessment, and includes supporting material; specifically, Design Data Tabulation (Appendix A), Process Flow Sheets (Appendix B), and References (Appendix C). Volume 5 is a continuation of the references of Appendix C. Studies of a proprietary nature are noted and referenced, but are not included in these volumes. They are included in the Limited Access versions of these reports and may be reviewed by properly cleared personnel in the offices of Ashland Synthetic Fuels, Inc.

  4. Breckinridge Project, initial effort. Report XI, Volume IV. Critical review of the design basis. [Critical review

    SciTech Connect

    1981-05-01

    Report XI, Technical Audit, is a compendium of research material used during the Initial Effort in making engineering comparisons and decisions. Volumes 4 and 5 of Report XI present those studies which provide a Critical Review of the Design Basis. The Critical Review Report, prepared by Intercontinental Econergy Associates, Inc., summarizes findings from an extensive review of the data base for the H-Coal process design. Volume 4 presents this review and assessment, and includes supporting material; specifically, Design Data Tabulation (Appendix A), Process Flow Sheets (Appendix B), and References (Appendix C). Volume 5 is a continuation of the references of Appendix C. Studies of a proprietary nature are noted and referenced, but are not included in these volumes. They are included in the Limited Access versions of these reports and may be reviewed by properly cleared personnel in the offices of Ashland Synthetic Fuels, Inc.

  5. Assessment of Smolt Condition for Travel Time Analysis Project, 1987-1997 Project Review.

    SciTech Connect

    Schrock, Robin M.; Hans, Karen M.; Beeman, John W.

    1997-12-01

    The assessment of Smolt Condition for Travel Time Analysis Project (Bonneville Power Administration Project 87-401) monitored attributes of salmonid smolt physiology in the Columbia and Snake River basins from 1987 to 1997, under the Northwest Power Planning Council Fish and Wildlife Program, in cooperation with the Smolt Monitoring Program of the Fish Passage Center. The primary goal of the project was to investigate the physiological development of juvenile salmonids related to migration rates. The assumption was made that the level of smolt development, interacting with environmental factos such as flow, would be reflected in travel times. The Fish Passage Center applied the physiological measurements of smolt condition to Water Budget management, to regulate flows so as to decrease travel time and increase survival.

  6. Culture, cultural factors and psychiatric diagnosis: review and projections

    PubMed Central

    ALARCÓN, RENATO D.

    2009-01-01

    This paper aims to provide conceptual justifications for the inclusion of culture and cultural factors in psychiatric diagnosis, and logistic suggestions as to the content and use of this approach. A discussion of the scope and limitations of current diagnostic practice, criticisms from different quarters, and the role and relevance of culture in the diagnostic encounter, precede the examination of advantages and disadvantages of the approach. The cultural content of psychiatric diagnosis should include the main, well-recognized cultural variables, adequate family data, explanatory models, and strengths and weaknesses of every individual patient. The practical aspects include the acceptance of “cultural discordances” as a component of an updated definition of mental disorder, and the use of a refurbished cultural formulation. Clinical “telescoping” strategies to obtain relevant cultural data during the diagnostic interview, and areas of future research (including field trials on the cultural formulation and on “culture bound syndromes”), are outlined. PMID:19812742

  7. Review of BPA Funded Sturgeon, Resident Fish and Wildlife Projects, 1989/1990.

    SciTech Connect

    United States. Bonneville Power Administration.

    1990-12-01

    The Bonneville Power Administration (BPA) held a public meeting on November 6-7, 1990, for the purpose of review, coordination, and consultation of the BPA-funded projects for sturgeon, resident fish, and wildlife in the Columbia River Basin (Basin). The comments received after the meeting were favorable and the participants agreed that the meeting was stimulating and productive. The information exchanged should lead to better coordination with other projects throughout the Basin. The following pages list the projects by title, the project leaders and BPA's project officers, and an abstract of each leaders presentation. These summaries are in some cases preliminary; they are subject to change and should not be quoted without consulting the project leader.

  8. Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review

    PubMed Central

    Birgisson, Natalia E.; Zhao, Qiuhong; Secura, Gina M.; Madden, Tessa

    2015-01-01

    Abstract The Contraceptive CHOICE Project (CHOICE) sought to reduce unintended pregnancies in the St. Louis Region by removing cost, education, and access barriers to highly effective contraception. CHOICE was a prospective cohort study of over 9,000 women 14–45 years of age who received tiered contraceptive counseling to increase awareness of all reversible methods available, particularly long-acting reversible contraceptive (LARC) methods. Participants were provided with contraception of their choice at no cost for 2–3 years. We studied contraceptive method choice, continuation, and population outcomes of repeat abortion and teen pregnancy. Seventy-five percent of study participants chose one of the three LARC methods (46% levonorgestrel intrauterine system, 12% copper intrauterine device, and 17% subdermal implant). LARC users reported greater continuation than non-LARC users at 12 months (87% versus 57%) and 24 months (77% versus 41%). In our cohort, LARC methods were 20 times more effective than non-LARC methods. As a result, we observed a reduction in the percent of repeat abortions from 2006 to 2010 in St. Louis compared with Kansas City and nonmetropolitan Missouri and found substantial reductions in teen pregnancy, birth, and abortion (34.0, 19.4, and 9.7 per 1000 teens, respectively) compared with national rates among sexually experienced teens (158.5, 94.0, and 41.5 per 1000, respectively). Improved access to LARC methods can result in fewer unintended pregnancies and abortions and considerable cost savings to the health care system. PMID:25825986

  9. Preoperative Imatinib Treatment in Patients With Advanced Gastrointestinal Stromal Tumors: Patient Experiences and Systematic Review of 563 Patients

    PubMed Central

    Xu, Jia; Ling, Tian-Long; Wang, Ming; Zhao, Wen-Yi; Cao, Hui

    2015-01-01

    Preoperative IM therapy for GIST is now a research focus. Due to the low incidence of the disease, there are few RCTs on the preoperative treatment for advanced GIST, let alone relevant meta-analysis. Efficacy of this therapy and targeting population are still undetermined. Therefore, the first part of this article is composed of a controlled retrospective study and demonstrates that preoperative therapy with IM can significantly improve the outcome of advanced GIST. In the second part of the paper, we further investigated what portion of advanced GIST patients benefit more from the therapy, based on a meta-analysis. As the disease is relatively rare, we involved 563 cases in the meta-analysis, much higher than in the controlled clinical studies (51 cases). The objective of this paper is to investigate effects of surgical resection on imatinib-treated advanced GIST. Twenty-two consecutive advanced GIST patients (Group A) with preoperative IM treatment were compared to 29 patients (Group B) who underwent initial tumor resection during the same period. Subsequently, a systematic review of 563 patients was applied to identify the benefit of the advanced GIST patients receiving imatinib before surgery. Compared with Group B, less patients in Group A underwent multivisceral resection (18.2% versus 48.3%, P = 0.026) or suffered tumor rupture at time of surgery (0% versus 17.2%, P = 0.04). The 3-year estimated progression-free survival of Group A (94.4%) was also superior to that of Group B (61.4%; P = 0.045). Subsequent meta-analysis indicated that primarily unresectable patients had higher complete resection and 2-year PFS rates than recurrent/metastasis patients (P = 0.005 and 0.20, respectively); (b) stable disease (SD) patients had better outcome in resection including resectability rate (P < 0.0001), PFS (P < 0.00001) and OS (P = 0.0008) than progressive disease (PD) patients; (c) in recurrent/metastatic PD patients, surgery played a minor role, because they had a

  10. A Review of NASA's Radiation-Hardened Electronics for Space Environments Project

    NASA Technical Reports Server (NTRS)

    Keys, Andrew S.; Adams, James H.; Patrick, Marshall C.; Johnson, Michael A.; Cressler, John D.

    2008-01-01

    NASA's Radiation Hardened Electronics for Space Exploration (RHESE) project develops the advanced technologies required to produce radiation hardened electronics, processors, and devices in support of the requirements of NASA's Constellation program. Over the past year, multiple advancements have been made within each of the RHESE technology development tasks that will facilitate the success of the Constellation program elements. This paper provides a brief review of these advancements, discusses their application to Constellation projects, and addresses the plans for the coming year.

  11. Summary of the National Demonstration Project and recommendations for the patient-centered medical home.

    PubMed

    Crabtree, Benjamin F; Nutting, Paul A; Miller, William L; Stange, Kurt C; Stewart, Elizabeth E; Jaén, Carlos Roberto

    2010-01-01

    This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was launched in June 2006 as the first national test of a particular PCMH model in a diverse sample of 36 family practices, randomized to facilitated or self-directed groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical record audits, and patient and clinical staff surveys. Peer-reviewed manuscripts from the NDP provide answers to 4 key questions: (1) Can the NDP model be built? (2) What does it take to build the NDP model? (3) Does the NDP model make a difference in quality of care? and (4) Can the NDP model be widely disseminated? We find that although it is feasible to transform independent practices into the NDP conceptualization of a PCMH, this transformation requires tremendous effort and motivation, and benefits from external support. Most practices will need additional resources for this magnitude of transformation. Recommendations focus on the need for the PCMH model to continue to evolve, for delivery system reform, and for sufficient resources for implementing personal and practice development plans. In the meantime, we find that much can be done before larger health system reform. PMID:20530397

  12. Summary of the National Demonstration Project and Recommendations for the Patient-Centered Medical Home

    PubMed Central

    Crabtree, Benjamin F.; Nutting, Paul A.; Miller, William L.; Stange, Kurt C.; Stewart, Elizabeth E.; Jaén, Carlos Roberto

    2010-01-01

    This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was launched in June 2006 as the first national test of a particular PCMH model in a diverse sample of 36 family practices, randomized to facilitated or self-directed groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical record audits, and patient and clinical staff surveys. Peer-reviewed manuscripts from the NDP provide answers to 4 key questions: (1) Can the NDP model be built? (2) What does it take to build the NDP model? (3) Does the NDP model make a difference in quality of care? and (4) Can the NDP model be widely disseminated? We find that although it is feasible to transform independent practices into the NDP conceptualization of a PCMH, this transformation requires tremendous effort and motivation, and benefits from external support. Most practices will need additional resources for this magnitude of transformation. Recommendations focus on the need for the PCMH model to continue to evolve, for delivery system reform, and for sufficient resources for implementing personal and practice development plans. In the meantime, we find that much can be done before larger health system reform. PMID:20530397

  13. Fish Habitat Improvement Projects in the Fifteenmile Creek and Trout Creek Basins of Central Oregon: Field Review and Management Recommendations.

    SciTech Connect

    Kauffman, J. Boone

    1993-07-01

    A field review of stream habitat improvement project sites in the lower Deschutes River Basin was conducted by riparian ecology, fisheries, and hydrology specialists. Habitat management objectives, limiting factors, project implementation, land use history, and other factors were discussed at each site. This information, in conjunction with the reviewer`s field inspections of portions of a particular habitat project, provided the basis for this report.

  14. Columbia Basin Fish and Wildlife Authority Project Abstracts; May 25-27, Portland, Oregon, 1997 Annual Review.

    SciTech Connect

    Allee, Brian J.

    1997-06-26

    Abstracts are presented from the 1997 Columbia Basin Fish and Wildlife Program Review of Projects. The purpose was to provide information and education on the approximate 127 million dollars in Northwest electric ratepayer fish and wildlife mitigation projects funded annually.

  15. A Review of Psychosocial Outcomes for Patients Seeking Cosmetic Surgery

    PubMed Central

    Honigman, Roberta J.; Phillips, Katharine A.; Castle, David J.

    2006-01-01

    The authors reviewed the literature on psychological and psychosocial outcomes for individuals undergoing cosmetic surgery, to address whether elective cosmetic procedures improve psychological well-being and psychosocial functioning and whether there are identifiable predictors of an unsatisfactory psychological outcome. They conducted a search of appropriate computerized databases for studies that evaluated psychological and psychosocial status both before and after elective cosmetic surgery. They identified 37 relevant studies of varying cosmetic procedures that utilized disparate methodologies. Overall, patients appeared generally satisfied with the outcome of their procedures, although some exhibited transient and some exhibited longer-lasting psychological disturbance. Factors associated with poor psychosocial outcome included being young, being male, having unrealistic expectations of the procedure, previous unsatisfactory cosmetic surgery, minimal deformity, motivation based on relationship issues, and a history of depression, anxiety, or personality disorder. Body dysmorphic disorder was also recognized by some studies as a predictor of poor outcome, a finding reinforced by reference to the psychiatric literature. The authors conclude that although most people appear satisfied with the outcome of cosmetic surgical procedures, some are not, and attempts should be made to screen for such individuals in cosmetic surgery settings. PMID:15083026

  16. Patterns of patient safety culture: a complexity and arts-informed project of knowledge translation.

    PubMed

    Mitchell, Gail J; Tregunno, Deborah; Gray, Julia; Ginsberg, Liane

    2011-01-01

    The purpose of this paper is to describe patterns of patient safety culture that emerged from an innovative collaboration among health services researchers and fine arts colleagues. The group engaged in an arts-informed knowledge translation project to produce a dramatic expression of patient safety culture research for inclusion in a symposium. Scholars have called for a deeper understanding of the complex interrelationships among structure, process and outcomes relating to patient safety. Four patterns of patient safety culture--blinding familiarity, unyielding determination, illusion of control and dismissive urgency--are described with respect to how they informed creation of an arts-informed project for knowledge translation. PMID:22273559

  17. Learning to Live Together: A Review of UNESCO's Associated Schools Project Network

    ERIC Educational Resources Information Center

    Schweisfurth, Michele

    2005-01-01

    Some 7400 schools belong to the global network of UNESCO's Associated School Project Network. They are committed to promoting ideals such as human rights, intercultural understanding, peace and environmental protection. This study is based on an extensive review undertaken in 2003. It discusses the origins and analyzes the achievements of the…

  18. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false What is the typical IHS environmental review process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Nepa Process...

  19. NAIT CPD. Competency Profile Development: A Systems Approach for Program Review Projects.

    ERIC Educational Resources Information Center

    Dhariwal, Mave

    The Engineering Technologies Division of the Northern Alberta Institute of Technology (NAIT) in Canada has developed a systems approach to program review called Competency Profile Development (CPD). This approach utilizes a combination of organizational communication, project management, management-by-objectives, a modified Developing A Curriculum…

  20. A May American Economic Review Papers Seminar and an Analytic Project for Advanced Undergraduates

    ERIC Educational Resources Information Center

    Elliott, Catherine S.

    2004-01-01

    The author describes two learning activities for teaching economics at the advanced undergraduate level: a May American Economic Review (AER) papers seminar and an analytic project. Both activities help students learn to "do economics." The May AER papers seminar promotes in-depth synthesis and interpretation on the basis of printed session papers…

  1. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... restoration of real property submitted by a project applicant to the Trust for its review, and which the... EA regarding its proposal for the Trust's evaluation and revision. In accordance with 40 CFR 1506.5(b... CFR 1506.5(c), the EIS shall be prepared by the Trust and/or by contractors who are selected by...

  2. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... restoration of real property submitted by a project applicant to the Trust for its review, and which the... EA regarding its proposal for the Trust's evaluation and revision. In accordance with 40 CFR 1506.5(b... CFR 1506.5(c), the EIS shall be prepared by the Trust and/or by contractors who are selected by...

  3. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... restoration of real property submitted by a project applicant to the Trust for its review, and which the... EA regarding its proposal for the Trust's evaluation and revision. In accordance with 40 CFR 1506.5(b... CFR 1506.5(c), the EIS shall be prepared by the Trust and/or by contractors who are selected by...

  4. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... restoration of real property submitted by a project applicant to the Trust for its review, and which the... EA regarding its proposal for the Trust's evaluation and revision. In accordance with 40 CFR 1506.5(b... CFR 1506.5(c), the EIS shall be prepared by the Trust and/or by contractors who are selected by...

  5. In-Service Workshop Model. Development Work, Volunteer Service and Project Review. Core Curriculum Resource Materials.

    ERIC Educational Resources Information Center

    Edwards, Dan

    A model is provided for an inservice workshop to provide systematic project review, conduct individual volunteer support and problem solving, and conduct future work planning. Information on model use and general instructions are presented. Materials are provided for 12 sessions covering a 5-day period. The first session on climate setting and…

  6. Biggest Pork Barrel Ever: $225-Million for Projects That Bypassed Merit Reviews.

    ERIC Educational Resources Information Center

    Cordes, Colleen

    1988-01-01

    Congress has quietly approved millions of dollars for campus research projects not subjected to traditional merit reviews. The wisdom of allowing legislators to direct federal money to specific campuses is questioned less and less, and the practice is more prevalent than ever. (MSE)

  7. Chemical research projects office fuel tank sealants review. [flight testing of fluorosilicone sealants

    NASA Technical Reports Server (NTRS)

    Rosser, R. W.; Parker, J. A.

    1974-01-01

    The status of high-temperature fuel tank sealants for military and potentially commercial supersonic aircraft is examined. The interrelationships of NASA's sealants program comprise synthesis and development of new fluoroether elastomers, sealant prediction studies, flight simulation and actual flight testing of best state-of-the-art fluorosilicone sealants. The technical accomplishments of these projects are reviewed.

  8. Phase 5 storage (Project W-112) Central Waste Complex operational readiness review, final report

    SciTech Connect

    Wight, R.H.

    1997-05-30

    This document is the final report for the RFSH conducted, Contractor Operational Readiness Review (ORR) for the Central Waste Complex (CWC) Project W-112 and Interim Safety Basis implementation. As appendices, all findings, observations, lines of inquiry and the implementation plan are included.

  9. 77 FR 58111 - Notice of Submission for OMB Review; Institute of Education Sciences; FAFSA Completion Project...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-19

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF EDUCATION Notice of Submission for OMB Review; Institute of Education Sciences; FAFSA Completion Project Evaluation SUMMARY: The Institute of Education Sciences (IES) at the U.S. Department of Education (ED) is...

  10. 78 FR 59011 - Improving Performance of Federal Permitting and Review of Infrastructure Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ..., 2013 (78 FR 53436) is extended to October 31, 2013. ADDRESSES: Comments should be addressed to: Julie A... Request for Information (RFI) in the Federal Register (78 FR 53436) seeking information on a draft IIP... Improving Performance of Federal Permitting and Review of Infrastructure Projects AGENCY: Office...