Science.gov

Sample records for accepted diagnostic criteria

  1. PML diagnostic criteria

    PubMed Central

    Aksamit, Allen J.; Clifford, David B.; Davis, Larry; Koralnik, Igor J.; Sejvar, James J.; Bartt, Russell; Major, Eugene O.; Nath, Avindra

    2013-01-01

    Objective: To establish criteria for the diagnosis of progressive multifocal leukoencephalopathy (PML). Methods: We reviewed available literature to identify various diagnostic criteria employed. Several search strategies employing the terms “progressive multifocal leukoencephalopathy” with or without “JC virus” were performed with PubMed, SCOPUS, and EMBASE search engines. The articles were reviewed by a committee of individuals with expertise in the disorder in order to determine the most useful applicable criteria. Results: A consensus statement was developed employing clinical, imaging, pathologic, and virologic evidence in support of the diagnosis of PML. Two separate pathways, histopathologic and clinical, for PML diagnosis are proposed. Diagnostic classification includes certain, probable, possible, and not PML. Conclusion: Definitive diagnosis of PML requires neuropathologic demonstration of the typical histopathologic triad (demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei) coupled with the techniques to show the presence of JC virus. The presence of clinical and imaging manifestations consistent with the diagnosis and not better explained by other disorders coupled with the demonstration of JC virus by PCR in CSF is also considered diagnostic. Algorithms for establishing the diagnosis have been recommended. PMID:23568998

  2. Reactor tank UT acceptance criteria

    SciTech Connect

    Daugherty, W.L.

    1990-01-30

    The SRS reactor tanks are constructed of type 304 stainless steel, with 0.5 inch thick walls. An ultrasonic (UT) in-service inspection program has been developed for examination of these tanks, in accordance with the ISI Plan for the Savannah River Production Reactors Process Water System (DPSTM-88-100-1). Prior to initiation of these inspections, criteria for the disposition of any indications that might be found are required. A working group has been formed to review available information on the SRS reactor tanks and develop acceptance criteria. This working group includes nationally recognized experts in the nuclear industry. The working group has met three times and produced three documents describing the proposed acceptance criteria, the technical basis for the criteria and a proposed initial sampling plan. This report transmits these three documents, which were prepared in accordance with the technical task plan and quality assurance plan for this task, task 88-001-A- 1. In addition, this report summarizes the acceptance criteria and proposed sampling plan, and provides further interpretation of the intent of these three documents where necessary.

  3. Diagnostic criteria for inclusion body myositis.

    PubMed

    Hilton-Jones, D; Brady, S

    2016-07-01

    Inclusion body myositis (IBM) was first identified as a specific disorder about 40 years ago and is now recognized to be the most frequently presenting primary myopathy in middle age and beyond. Initial characterization was based on the observation of specific pathological features distinguishing it from polymyositis. It was soon appreciated that there were also distinguishing clinical features. The earliest diagnostic criteria were heavily biased towards pathological features, but over time revised criteria have given increasing importance to certain clinical features. Until the specific cause of IBM is determined, and the basic pathogenetic mechanisms are better understood, there can be no diagnostic gold-standard against which to compare the sensitivity and specificity of any proposed diagnostic criteria, but such criteria are essential to ensure that patients entering clinical, epidemiological, genetic, pathological or therapeutic studies represent a homogeneous population. It is likely that any currently accepted diagnostic criteria will, once a gold-standard is eventually established, be shown to have 'missed' patients with atypical features, but that has to be accepted to make certain that current studies are not contaminated by patients who do not have IBM. In other words, in everyday clinical practice there will be the occasional patient who an experienced myologist strongly suspects has IBM, but does not meet current criteria - the criteria lack sensitivity. But if the criteria are so broad as to include all such atypical cases, they would be likely to include patients who do not in fact have IBM - they would lack specificity. The sensitivity and specificity of existing criteria have been reviewed recently, in so far as it is possible to do so, and found to have high specificity but variable sensitivity. PMID:27027255

  4. Incontinentia pigmenti diagnostic criteria update.

    PubMed

    Minić, S; Trpinac, D; Obradović, M

    2014-06-01

    In 1993 diagnostic criteria for incontinentia pigmenti (IP), a genodermatosis in which skin changes are usually combined with anomalies of other organs, were established. Approximately a decade ago, IKBKG gene mutation was discovered as a cause for IP. This finding has not been included in IP diagnosis so far. In addition, literature data pointed out a few other clinical findings as possible IP diagnostic criteria. Literature facts concerning IP diagnosis were analyzed. Different organ anomalies, their frequency and severity, were analyzed in the context of applicability as IP diagnostic criteria. Taking into account analyzed data from the literature, the proposal of updated IP diagnostic criteria was presented. We propose as major criteria one of the stages of IP skin lesions. As updated IP minor criteria in our proposal we included: dental, ocular; central nervous system (CNS), hair, nail, palate, breast and nipple anomalies; multiple male miscarriages, and IP pathohistological findings. In the diagnosis of IP, the presence of IKBKG mutation typical for IP, and existence of family relatives with diagnosed IP are taken into account. PMID:23802866

  5. Diagnostic criteria for neurocysticercosis, revisited

    PubMed Central

    Del Brutto, Oscar H

    2012-01-01

    Diagnosis of neurocysticercosis (NCC) can be a challenge. Clinical manifestations are non-specific, most neuroimaging findings are non-pathognomonic, and some serologic tests have low sensitivity or specificity. A set of diagnostic criteria was proposed in 2001 to avoid the over diagnosis of NCC that occurs in epidemiologic surveys, and to help clinicians evaluating patients with suspected NCC. The set included four stratified categories of criteria, including: (1) absolute: histological demonstration of cysticerci, cystic lesions showing the scolex on neuroimaging studies, and direct visualization of subretinal parasites by fundoscopic examination; (2) major: lesions highly suggestive of NCC on neuroimaging studies, positive serum enzyme-linked immunoelectrotransfer blot (EITB) for the detection of anticysticercal antibodies, resolution of intracranial cystic lesions after cysticidal drug therapy, and spontaneous resolution of single enhancing lesions; (3) minor: lesions compatible with NCC on neuroimaging studies, suggestive clinical manifestations, positive cerebrospinal fluid (CSF) ELISA for detection of anticysticercal antibodies or cysticercal antigens, and cysticercosis outside the nervous system; and (4) epidemiological: evidence of a household contact with Taenia solium infection, individuals coming from or living in cysticercosis endemic areas, and history of travel to disease-endemic areas. Interpretation of these criteria permits two degrees of diagnostic certainty: (1) definitive diagnosis, in patients who have one absolute criterion or in those who have two major plus one minor and one epidemiological criteria; and (2) probable diagnosis, in patients who have one major plus two minor criteria, in those who have one major plus one minor and one epidemiological criteria, and in those who have three minor plus one epidemiological criteria. After 10 years of usage, this set has been proved useful in both, field studies, and hospital settings. Recent

  6. Hanford Site Solid Waste Acceptance Criteria

    SciTech Connect

    MCDOWELL, A.K.; TRINER, G.C.

    2002-03-28

    DOE Order 435.1 requires that each treatment, storage, and/or disposal facility (referred to in this document as TSD unit) that manages low-level or transuranic (TRU) waste (including mixed waste and TSCA PCB waste) maintain waste acceptance criteria. These criteria must address the various requirements to operate the TSD unit in compliance with applicable safety and environmental requirements. This document sets forth the baseline criteria for acceptance of waste at TSD units operated by WMP. The criteria for each TSD unit have been established to ensure that waste accepted can be managed in a manner that is within the operating requirements of the unit, including environmental regulations, DOE Orders, permits, technical safety requirements, waste analysis plans, performance assessments, and other applicable requirements. Revisions to the acceptance criteria document require an Unreviewed Safety Question review to document that the changes are consistent with current applicable safety analysis. Acceptance criteria apply to the following TSD units: the Low-Level Burial Grounds (LLBG) including both the nonregulated portions of the LLBG and trenches 31 and 34 of the 218-W-5 Burial Ground for mixed waste disposal; Central Waste Complex (CWC); Waste Receiving and Processing (WRAP) Facility; and T-Plant facility. Waste from all generators, both from the Hanford Site and from offsite facilities, must comply with these criteria. Exceptions can be granted as provided in Section 1.6. Specific waste streams could have additional requirements based on the identified TSD pathway. These requirements are communicated in the waste specification records (WSRds) and/or waste stream profile sheet approvals. The Hanford Site manages nonradioactive waste through direct shipments to offsite contractors. The waste acceptance requirements of the offsite TSD facility must be met for these nonradioactive wastes. This document does not address the acceptance requirements of these offsite

  7. Nevada Test Site Waste Acceptance Criteria (NTSWAC)

    SciTech Connect

    NNSA /NSO Waste Management Project

    2008-06-01

    This document establishes the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, Nevada Test Site Waste Acceptance Criteria (NTSWAC). The NTSWAC provides the requirements, terms, and conditions under which the Nevada Test Site will accept low-level radioactive (LLW) and LLW Mixed Waste (MW) for disposal.

  8. Hanford Site Solid Waste Acceptance Criteria

    SciTech Connect

    Not Available

    1993-11-17

    This manual defines the Hanford Site radioactive, hazardous, and sanitary solid waste acceptance criteria. Criteria in the manual represent a guide for meeting state and federal regulations; DOE Orders; Hanford Site requirements; and other rules, regulations, guidelines, and standards as they apply to acceptance of radioactive and hazardous solid waste at the Hanford Site. It is not the intent of this manual to be all inclusive of the regulations; rather, it is intended that the manual provide the waste generator with only the requirements that waste must meet in order to be accepted at Hanford Site TSD facilities.

  9. NEVADA TEST SITE WASTE ACCEPTANCE CRITERIA

    SciTech Connect

    U.S. DEPARTMENT OF ENERGY, NATIONAL NUCLEAR SECURITY ADMINISTRATION, NEVADA SITE OFFICE

    2005-07-01

    This document establishes the U. S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) waste acceptance criteria (WAC). The WAC provides the requirements, terms, and conditions under which the Nevada Test Site will accept low-level radioactive and mixed waste for disposal. Mixed waste generated within the State of Nevada by NNSA/NSO activities is accepted for disposal. It includes requirements for the generator waste certification program, characterization, traceability, waste form, packaging, and transfer. The criteria apply to radioactive waste received at the Nevada Test Site Area 3 and Area 5 Radioactive Waste Management Site for storage or disposal.

  10. Hanford Site solid waste acceptance criteria

    SciTech Connect

    Ellefson, M.D.

    1998-07-01

    Order 5820.2A requires that each treatment, storage, and/or disposal facility (referred to in this document as TSD unit) that manages low-level or transuranic waste (including mixed waste and TSCA PCB waste) maintain waste acceptance criteria. These criteria must address the various requirements to operate the TSD unit in compliance with applicable safety and environmental requirements. This document sets forth the baseline criteria for acceptance of radioactive waste at TSD units operated by WMH. The criteria for each TSD unit have been established to ensure that waste accepted can be managed in a manner that is within the operating requirements of the unit, including environmental regulations, DOE Orders, permits, technical safety requirements, waste analysis plans, performance assessments, and other applicable requirements. Acceptance criteria apply to the following TSD units: the Low-Level Burial Grounds (LLBG) including both the nonregulated portions of the LLBG and trenches 31 and 34 of the 218-W-5 Burial Ground for mixed waste disposal; Central Waste Complex (CWC); Waste Receiving and Processing Facility (WRAP); and T Plant Complex. Waste from all generators, both from the Hanford Site and from offsite facilities, must comply with these criteria. Exceptions can be granted as provided in Section 1.6. Specific waste streams could have additional requirements based on the 1901 identified TSD pathway. These requirements are communicated in the Waste Specification Records (WSRds). The Hanford Site manages nonradioactive waste through direct shipments to offsite contractors. The waste acceptance requirements of the offsite TSD facility must be met for these nonradioactive wastes. This document does not address the acceptance requirements of these offsite facilities.

  11. Nevada Test Site Waste Acceptance Criteria

    SciTech Connect

    U. S. Department of Energy, National Nuclear Security Administration Nevada Site Office

    2005-10-01

    This document establishes the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO) waste acceptance criteria (WAC). The WAC provides the requirements, terms, and conditions under which the Nevada Test Site (NTS) will accept low-level radioactive (LLW) and mixed waste (MW) for disposal. It includes requirements for the generator waste certification program, characterization, traceability, waste form, packaging, and transfer. The criteria apply to radioactive waste received at the NTS Area 3 and Area 5 Radioactive Waste Management Complex (RWMC) for storage or disposal.

  12. Reactor tank UT acceptance criteria. Revision 2

    SciTech Connect

    Daugherty, W.L.

    1990-01-30

    The SRS reactor tanks are constructed of type 304 stainless steel, with 0.5 inch thick walls. An ultrasonic (UT) in-service inspection program has been developed for examination of these tanks, in accordance with the ISI Plan for the Savannah River Production Reactors Process Water System (DPSTM-88-100-1). Prior to initiation of these inspections, criteria for the disposition of any indications that might be found are required. A working group has been formed to review available information on the SRS reactor tanks and develop acceptance criteria. This working group includes nationally recognized experts in the nuclear industry. The working group has met three times and produced three documents describing the proposed acceptance criteria, the technical basis for the criteria and a proposed initial sampling plan. This report transmits these three documents, which were prepared in accordance with the technical task plan and quality assurance plan for this task, task 88-001-A- 1. In addition, this report summarizes the acceptance criteria and proposed sampling plan, and provides further interpretation of the intent of these three documents where necessary.

  13. Nevada National Security Site Waste Acceptance Criteria

    SciTech Connect

    NSTec Environmental Management

    2010-09-03

    This document establishes the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Nevada National Security Site Waste Acceptance Criteria (NNSSWAC). The NNSSWAC provides the requirements, terms, and conditions under which the Nevada National Security Site (NNSS) will accept low-level radioactive waste and mixed low-level waste for disposal. The NNSSWAC includes requirements for the generator waste certification program, characterization, traceability, waste form, packaging, and transfer. The criteria apply to radioactive waste received at the NNSS Area 3 and Area 5 Radioactive Waste Management Complex for disposal. The NNSA/NSO and support contractors are available to assist you in understanding or interpreting this document. For assistance, please call the NNSA/NSO Waste Management Project at (702) 295-7063 or fax to (702) 295-1153.

  14. Nevada National Security Site Waste Acceptance Criteria

    SciTech Connect

    NSTec Environmental Management

    2011-01-01

    This document establishes the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) Nevada National Security Site Waste Acceptance Criteria (NNSSWAC). The NNSSWAC provides the requirements, terms, and conditions under which the Nevada National Security Site (NNSS) will accept low-level radioactive waste and mixed low-level waste for disposal. The NNSSWAC includes requirements for the generator waste certification program, characterization, traceability, waste form, packaging, and transfer. The criteria apply to radioactive waste received at the NNSS Area 3 and Area 5 Radioactive Waste Management Complex for disposal. The NNSA/NSO and support contractors are available to assist you in understanding or interpreting this document. For assistance, please call the NNSA/NSO Waste Management Project at (702) 295-7063 or fax to (702) 295-1153.

  15. Acceptance Criteria Framework for Autonomous Biological Detectors

    SciTech Connect

    Dzenitis, J M

    2006-12-12

    The purpose of this study was to examine a set of user acceptance criteria for autonomous biological detection systems for application in high-traffic, public facilities. The test case for the acceptance criteria was the Autonomous Pathogen Detection System (APDS) operating in high-traffic facilities in New York City (NYC). However, the acceptance criteria were designed to be generally applicable to other biological detection systems in other locations. For such detection systems, ''users'' will include local authorities (e.g., facility operators, public health officials, and law enforcement personnel) and national authorities [including personnel from the Department of Homeland Security (DHS), the BioWatch Program, the Centers for Disease Control and Prevention (CDC), and the Federal Bureau of Investigation (FBI)]. The panel members brought expertise from a broad range of backgrounds to complete this picture. The goals of this document are: (1) To serve as informal guidance for users in considering the benefits and costs of these systems. (2) To serve as informal guidance for developers in understanding the needs of users. In follow-up work, this framework will be used to systematically document the APDS for appropriateness and readiness for use in NYC.

  16. Nevada National Security Site Waste Acceptance Criteria

    SciTech Connect

    none,

    2013-06-01

    This document establishes the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office (NNSA/NFO), Nevada National Security Site Waste Acceptance Criteria (NNSSWAC). The NNSSWAC provides the requirements, terms, and conditions under which the Nevada National Security Site (NNSS) will accept the following: • DOE hazardous and non-hazardous non-radioactive classified waste • DOE low-level radioactive waste (LLW) • DOE mixed low-level waste (MLLW) • U.S. Department of Defense (DOD) classified waste The LLW and MLLW listed above may also be classified waste. Classified waste is the only waste accepted for disposal that may be non-radioactive and shall be required to meet the waste acceptance criteria for radioactive waste as specified in this document. Classified waste may be sent to the NNSS as classified matter. Section 3.1.18 provides the requirements that must be met for permanent burial of classified matter. The NNSA/NFO and support contractors are available to assist the generator in understanding or interpreting this document. For assistance, please call the NNSA/NFO Environmental Management Operations (EMO) at (702) 295-7063, and the call will be directed to the appropriate contact.

  17. Nevada National Security Site Waste Acceptance Criteria

    SciTech Connect

    NSTec Environmental Management

    2012-02-28

    This document establishes the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO), Nevada National Security Site Waste Acceptance Criteria (NNSSWAC). The NNSSWAC provides the requirements, terms, and conditions under which the Nevada National Security Site (NNSS) will accept DOE non-radioactive classified waste, DOE non-radioactive hazardous classified waste, DOE low-level radioactive waste (LLW), DOE mixed low-level waste (MLLW), and U.S. Department of Defense (DOD) classified waste for permanent disposal. Classified waste is the only waste accepted for disposal that may be non-radioactive and will be required to meet the waste acceptance criteria for radioactive waste as specified in this document. The NNSA/NSO and support contractors are available to assist you in understanding or interpreting this document. For assistance, please call the NNSA/NSO Waste Management Project (WMP) at (702) 295-7063, and your call will be directed to the appropriate contact.

  18. Development of quantitative risk acceptance criteria

    SciTech Connect

    Griesmeyer, J. M.; Okrent, D.

    1981-01-01

    Some of the major considerations for effective management of risk are discussed, with particular emphasis on risks due to nuclear power plant operations. Although there are impacts associated with the rest of the fuel cycle, they are not addressed here. Several previously published proposals for quantitative risk criteria are reviewed. They range from a simple acceptance criterion on individual risk of death to a quantitative risk management framework. The final section discussed some of the problems in the establishment of a framework for the quantitative management of risk.

  19. Munchausen Syndrome by Proxy: Medical Diagnostic Criteria.

    ERIC Educational Resources Information Center

    Rosenberg, Donna Andrea

    2003-01-01

    Medical diagnostic criteria for Munchausen Syndrome by Proxy (a persistent fabrication by one individual of illness in another) are presented. Since the strength of the known facts may vary from case to case, diagnostic criteria are given for a definitive diagnosis, a possible diagnosis, an inconclusive determination, and the definitely excluded…

  20. Steam generator tube integrity flaw acceptance criteria

    SciTech Connect

    Cochet, B.

    1997-02-01

    The author discusses the establishment of a flaw acceptance criteria with respect to flaws in steam generator tubing. The problem is complicated because different countries take different approaches to the problem. The objectives in general are grouped in three broad areas: to avoid the unscheduled shutdown of the reactor during normal operation; to avoid tube bursts; to avoid excessive leak rates in the event of an accidental overpressure event. For each degradation mechanism in the tubes it is necessary to know answers to an array of questions, including: how well does NDT testing perform against this problem; how rapidly does such degradation develop; how well is this degradation mechanism understood. Based on the above information it is then possible to come up with a policy to look at flaw acceptance. Part of this criteria is a schedule for the frequency of in-service inspection and also a policy for when to plug flawed tubes. The author goes into a broad discussion of each of these points in his paper.

  1. Diagnostic criteria of autoimmune hepatitis.

    PubMed

    Liberal, Rodrigo; Grant, Charlotte R; Longhi, Maria Serena; Mieli-Vergani, Giorgina; Vergani, Diego

    2014-01-01

    Autoimmune hepatitis (AIH) is a chronic immune-mediated liver disorder characterised by female preponderance, elevated transaminase and immunoglobulin G levels, seropositivity for autoantibodies and interface hepatitis. Presentation is highly variable, therefore AIH should be considered during the diagnostic workup of any increase in liver enzyme levels. A set of inclusion and exclusion criteria for the diagnosis of AIH have been established by the International Autoimmune Hepatitis Group (IAIHG). There are two main types of AIH: type 1, positive for anti-nuclear (ANA) and/or anti-smooth muscle antibodies (SMAs) and type 2, defined by the presence of anti-liver kidney microsomal antibody type 1 (LKM-1) and/or anti-liver cytosol type 1 (LC-1) autoantibodies. The central role of autoantibodies in the diagnosis of AIH has led the IAIHG to produce a consensus statement detailing appropriate and effective methods for their detection. Autoantibodies should be tested by indirect immunofluorescence at an initial dilution of 1/40 in adults and 1/10 in children on a freshly prepared rodent substrate that includes kidney, liver and stomach sections to allow for the simultaneous detection of all reactivities relevant to AIH. Anti-LKM-1 is often confused with anti-mitochondrial antibody (AMA) if rodent kidney is used as the sole immunofluorescence substrate. The identification of the molecular targets of anti-LKM-1 and AMA has led to the establishment of immuno-assays based on the use of the recombinant or purified autoantigens. Perinuclear anti-nuclear neutrophil antibody (p-ANNA) is an additional marker of AIH-1; anti soluble liver antigen (SLA) antibodies are specific for autoimmune liver disease, can be present in AIH-1 and AIH-2 and are associated with a more severe clinical course. Anti-SLA are detectable by ELISA or radio-immuno-assays, but not by immunofluorescence. AIH is exquisitely responsive to immunosuppressive treatment, which should be instituted promptly to

  2. 7 CFR 42.107 - Lot acceptance criteria.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Lot acceptance criteria. 42.107 Section 42.107... § 42.107 Lot acceptance criteria. (a) The acceptability of the lot is determined by relating the number and class of defects enumerated on the worksheet to the acceptance and rejection numbers shown...

  3. 7 CFR 42.107 - Lot acceptance criteria.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 2 2011-01-01 2011-01-01 false Lot acceptance criteria. 42.107 Section 42.107... § 42.107 Lot acceptance criteria. (a) The acceptability of the lot is determined by relating the number and class of defects enumerated on the worksheet to the acceptance and rejection numbers shown...

  4. Waste acceptance criteria for closure generated waste

    SciTech Connect

    Not Available

    1992-05-01

    The PORTS Facility has been operating since 1954. The PORTS Facility is used to enrich uranium for nuclear navy applications and commercial nuclear reactors. The PORTS process uses molecular diffusion techniques to separate the U-235 isotope from the U-238 isotope. The PORTS Facility consists of a complex cascade of compressors and converters through which gaseous uranium hexafluoride feed is processed. The feed contains approximately 0.7 percent U-235 by weight while products contain from 4 to 97 percent U-235 by weight, depending on the final application. In general, the majority of the closure wastes generated at PORTS consists of personal protective equipment (PPE), rags, soils, decontamination solutions, and construction related debris. These hazardous wastes will be predominately characterized on the basis of process knowledge. PORTS assumes its conservative waste characterizations that are based on process knowledge are correct unless and until further investigation and/or analysis proves the constituents are not present or are present at concentrations below characteristic regulatory thresholds. Waste Acceptance Criteria for wastes generated by the closure of active and inactive RCRA facilities at PORTS has been developed. The criteria presented in this document govern the activities that are performed during the closure and subsequent generation of waste and relocation from the closure locations to the storage unit. These criteria are intended to ensure the proper handling, classification, processing, and storage of wastes in order to prevent hazardous waste release that may pose a threat to human health or the environment. Any wastes currently stored at each of the facilities that are to be closed will be transferred to the X-326 or X-7725 Storage Units. The waste transfers will be accomplished in accordance with the Container Transfer Plan.

  5. MDS clinical diagnostic criteria for Parkinson's disease.

    PubMed

    Postuma, Ronald B; Berg, Daniela; Stern, Matthew; Poewe, Werner; Olanow, C Warren; Oertel, Wolfgang; Obeso, José; Marek, Kenneth; Litvan, Irene; Lang, Anthony E; Halliday, Glenda; Goetz, Christopher G; Gasser, Thomas; Dubois, Bruno; Chan, Piu; Bloem, Bastiaan R; Adler, Charles H; Deuschl, Günther

    2015-10-01

    This document presents the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's disease (PD). The Movement Disorder Society PD Criteria are intended for use in clinical research but also may be used to guide clinical diagnosis. The benchmark for these criteria is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise in PD diagnosis. Although motor abnormalities remain central, increasing recognition has been given to nonmotor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the Movement Disorder Society PD Criteria retain motor parkinsonism as the core feature of the disease, defined as bradykinesia plus rest tremor or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies on three categories of diagnostic features: absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of the PD diagnosis). Two levels of certainty are delineated: clinically established PD (maximizing specificity at the expense of reduced sensitivity) and probable PD (which balances sensitivity and specificity). The Movement Disorder Society criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, the Movement Disorder Society criteria will need continuous revision to accommodate these advances. PMID:26474316

  6. Acceptance criteria for heat exchanger head staybolts

    SciTech Connect

    Sindelar, R.L.; Lam, P.S.; Barnes, D.M.; Placr, A.; Morrison, J.M.

    1991-01-01

    Each of the six primary coolant loop systems of the Savannah River Site production reactors contains two parallel single-pass heat exchangers to transfer heat from the primary coolant (D{sub 2}O) to the secondary cooling water (H{sub 2}O). The configuration of the heat exchangers includes a plenary space defined by the heat exchanger tubesheet and the heat exchanger head at both the heat exchanger inlet and outlet to the primary piping. The primary restraint of the heat exchanger head (Type 304 stainless steel) is provided by 84 staybolts (Type 303 stainless steel) which attach to the tubesheet. The staybolts were cap seal-welded in the mid-1960's and are immersed in moderator. Access to inspect the staybolts is limited to a recently-developed ultrasonic technique shooting a beam through the staybolt assembly. Acceptance Criteria to allow disposition of flaws detected by UT inspection have been developed. The structural adequacy to protect against collapse loading of the head is demonstrated by finite element analysis of the head assembly and fracture analysis of flaw postulates in the staybolts. Both normal operation and normal operation plus seismic loading conditions were considered. Several bounding cases containing various configurations of nonactive (exceeding critical flaw size) staybolts were analyzed. The model of the head assembly can be applied to evaluate any active staybolt configurations based on the results from future inspections. 9 refs.

  7. Acceptance criteria for heat exchanger head staybolts

    SciTech Connect

    Sindelar, R.L.; Lam, P.S.; Barnes, D.M.; Placr, A.; Morrison, J.M.

    1991-12-31

    Each of the six primary coolant loop systems of the Savannah River Site production reactors contains two parallel single-pass heat exchangers to transfer heat from the primary coolant (D{sub 2}O) to the secondary cooling water (H{sub 2}O). The configuration of the heat exchangers includes a plenary space defined by the heat exchanger tubesheet and the heat exchanger head at both the heat exchanger inlet and outlet to the primary piping. The primary restraint of the heat exchanger head (Type 304 stainless steel) is provided by 84 staybolts (Type 303 stainless steel) which attach to the tubesheet. The staybolts were cap seal-welded in the mid-1960`s and are immersed in moderator. Access to inspect the staybolts is limited to a recently-developed ultrasonic technique shooting a beam through the staybolt assembly. Acceptance Criteria to allow disposition of flaws detected by UT inspection have been developed. The structural adequacy to protect against collapse loading of the head is demonstrated by finite element analysis of the head assembly and fracture analysis of flaw postulates in the staybolts. Both normal operation and normal operation plus seismic loading conditions were considered. Several bounding cases containing various configurations of nonactive (exceeding critical flaw size) staybolts were analyzed. The model of the head assembly can be applied to evaluate any active staybolt configurations based on the results from future inspections. 9 refs.

  8. Structural acceptance criteria Remote Handling Building Tritium Extraction Facility

    SciTech Connect

    Mertz, G.

    1999-12-16

    This structural acceptance criteria contains the requirements for the structural analysis and design of the Remote Handling Building (RHB) in the Tritium Extraction Facility (TEF). The purpose of this acceptance criteria is to identify the specific criteria and methods that will ensure a structurally robust building that will safely perform its intended function and comply with the applicable Department of Energy (DOE) structural requirements.

  9. Nevada Test Site Waste Acceptance Criteria, December 2000

    SciTech Connect

    2000-12-01

    This document establishes the US Department of Energy, Nevada Operations Office waste acceptance criteria. The waste acceptance criteria provides the requirements, terms, and conditions under which the Nevada Test Site will accept low-level radioactive waste and mixed waste for disposal. It includes requirements for the generator waste certification program, characterization, traceability, waste form, packaging, and transfer. The criteria apply to radioactive waste received at the Nevada Test Site Area 3 and Area 5 Radioactive Waste Management Sites for storage or disposal.

  10. 46 CFR 164.120-7 - Acceptance criteria.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 6 2012-10-01 2012-10-01 false Acceptance criteria. 164.120-7 Section 164.120-7 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) EQUIPMENT, CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL MATERIALS Fire Retardant Resins for Lifeboats and Rescue Boats § 164.120-7 Acceptance criteria. (a) The laminating...

  11. Nevada Test Site Waste Acceptance Criteria

    SciTech Connect

    U.S. Department of Energy, Nevada Operations Office, Waste Acceptance Criteria

    1999-05-01

    This document provides the requirements, terms, and conditions under which the Nevada Test Site will accept low-level radioactive and mixed waste for disposal; and transuranic and transuranic mixed waste for interim storage at the Nevada Test Site.

  12. Nevada test site waste acceptance criteria

    SciTech Connect

    1996-09-01

    This document provides the requirements, terms, and conditions under which the Nevada Test Site (NTS) will accept low-level radioactive and mixed waste for disposal; and transuranic and transuranic mixed waste for interim storage at the NTS. Review each section of this document. This document is not intended to include all of the requirements; rather, it is meant as a guide toward meeting the regulations. All references in this document should be observed to avoid omission of requirements on which acceptance or rejection of waste will be based. The Department of Energy/Nevada Operations Office (DOE/NV) and support contractors are available to assist you in understanding or interpreting this document.

  13. Rett Syndrome: Revised Diagnostic Criteria and Nomenclature

    PubMed Central

    Neul, Jeffrey L.; Kaufmann, Walter E.; Glaze, Daniel G.; Christodoulou, John; Clarke, Angus J.; Bahi-Buisson, Nadia; Leonard, Helen; Bailey, Mark E. S.; Schanen, N. Carolyn; Zappella, Michele; Renieri, Alessandra; Huppke, Peter; Percy, Alan K.

    2010-01-01

    Objective Rett syndrome (RTT) is a severe neurodevelopmental disease that affects approximately 1 in 10,000 live female births and is often caused by mutations in Methyl-CpG-binding protein 2 (MECP2). Despite distinct clinical features, the accumulation of clinical and molecular information in recent years has generated considerable confusion regarding the diagnosis of RTT. The purpose of this work was revise and clarify 2002 consensus criteria for the diagnosis of RTT in anticipation of treatment trials. Method RettSearch members, representing the majority of the international clinical RTT specialists, participated in an iterative process to come to a consensus on a revised and simplified clinical diagnostic criteria for RTT. Results The clinical criteria required for the diagnosis of classic and atypical RTT were clarified and simplified. Guidelines for the diagnosis and molecular evaluation of specific variant forms of RTT were developed. Interpretation These revised criteria provide clarity regarding the key features required for the diagnosis of RTT and reinforce the concept that RTT is a clinical diagnosis based on distinct clinical criteria, independent of molecular findings. We recommend that these criteria and guidelines be utilized in any proposed clinical research. PMID:21154482

  14. Acceptance criteria considerations for miscellaneous wastes

    SciTech Connect

    Irvine, A.R.; Forsberg, C.W.

    1987-01-01

    EPA standards set forth limitations regarding releases to the accessible environment adjacent to a geologic repository. The NRC criteria pertaining to waste form and engineered barrier performance place certain restrictions on the physical and chemical nature of the waste form and require substantially complete confinement of radioactivity until the high-heat-production period is past. After this period, the annual release of radionuclides from the waste package is normally limited to 1 part in 100,000 of the amounts calculated to be present at 1000-y decay. The regulation permits deviation from these criteria in exceptional circumstances. One such circumstance might be the absence of a significant perturbation in temperature around the stored waste. The lack of significant heat release will eliminate the hydrologic driving force for dispersal of radionuclides. Exceptional circumstances which potentially could justify a less stringent long-term release criterion are: small quantity of radioactivity, the nature of the radioactive species, and the nature of the geology in which the waste is to be emplaced. Because the MW after a suitable decay period have low heat release rates per unit volume, they apparently could be so emplaced in a repository that there would be no compelling need, according to the reasoning presented in 10 CFR 60, for a 1000-y container. Regarding attainment of the specified long-term release rate criterion, neither the solubility limits for the various waste forms nor the conductance of potential migration barriers are currently adequately characterized. The relatively small total heat generation rate for the MW in combination with the usual low volumetric heat generation rate apparently will allow application of migration barriers in a low temperature environment where barrier performance would be expected to be unchanged with time.

  15. Heat exchanger, head and shell acceptance criteria

    SciTech Connect

    Lam, P.S.; Sindelar, R.L.

    1992-09-01

    Instability of postulated flaws in the head component of the heat exchanger could not produce a large break, equivalent to a DEGB in the PWS piping, due to the configuration of the head and restraint provided by the staybolts. Rather, leakage from throughwall flaws in the head would increase with flaw length with finite leakage areas that are bounded by a post-instability flaw configuration. Postulated flaws at instability in the shell of the heat exchanger or in the cooling water nozzles could produce a large break in the Cooling Water System (CWS) pressure boundary. An initial analysis of flaw stability for postulated flaws in the heat exchanger head was performed in January 1992. This present report updates that analysis and, additionally, provides acceptable flaw configurations to maintain defined structural or safety margins against flaw instability of the external pressure boundary components of the heat exchanger, namely the head, shell, and cooling water nozzles. Structural and flaw stability analyses of the heat exchanger tubes, the internal pressure boundary of the heat exchangers or interface boundary between the PWS and CWS, were previously completed in February 1992 as part of the heat exchanger restart evaluation and are not covered in this report.

  16. La composition academique: les limites de l'acceptabilite (Composition for Academic Purposes: Criteria for Acceptability).

    ERIC Educational Resources Information Center

    Grenall, G. M.

    1981-01-01

    Examines the pedagogical approaches and problems attendant to the development of English writing programs for foreign students. Discusses the skills necessary to handle course work, such as essay tests, term papers and reports, theses and dissertations, and focuses particularly on diagnostic problems and acceptability criteria. Societe Nouvelle…

  17. Strain-Based Acceptance Criteria for Energy-Limited Events

    SciTech Connect

    Spencer D. Snow; Dana K. Morton

    2009-07-01

    The American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel (B&PV) Code was primarily written with stress-based acceptance criteria. These criteria are applicable to force, displacement, and energy-controlled loadings and ensure a factor of safety against failure. However, stress-based acceptance criteria are often quite conservative for one time energy-limited events such as accidental drops and impacts. For several years, the ASME Working Group on Design of Division 3 Containments has been developing the Design Articles for Section III, Division 3, “Containments for Transportation and Storage of Spent Nuclear Fuel and High-Level Radioactive Material and Waste,” and has wanted to establish strain-based acceptance criteria for accidental drops of containments. This Division 3 working group asked the Working Group on Design Methodology (WGDM) to assist in developing these strain-based acceptance criteria. This paper discusses the current proposed strain-based acceptance criteria, associated limitations of use, its background development, and the current status.

  18. Performance-based waste acceptance criteria preliminary baseline assumptions

    SciTech Connect

    Not Available

    1994-10-24

    The Department of Energy`s (DOE`s) strategy for the management of transuranic (TRU) and TRU mixed wastes has focused on the development of the Waste Isolation Pilot Plant (WIPP). The WIPP repository is designated to receive DOE defense wastes that meet the established criteria for acceptance. As a national strategy [DOE, 1993], DOE does not intend to treat candidate wastes unless treatment or processing are necessary to meet the safety, health, and regulatory criteria for transport and disposal at WIPP. The WIPP WAC has evolved over the past 10 years to include criteria and requirements in support of the Waste Characterization program and other related compliance programs. In aggregate, the final health, safety and regulatory criteria for the waste will be documented in the Disposal WAC. This document serves two purposes. First, it familiarizes regulators and stakeholders with the concept of performance based waste acceptance criteria as an augmentation within a final Waste Isolation Pilot Plant (WIPP) Waste Acceptance Criteria. Second, the document preliminarily identifies certain waste characteristics that appear important to the performance assessment process for WIPP; therefore, these could become component characteristics in the Performance Based Waste Acceptance Criteria (PBWAC). Identification of the final PBWAC will be accomplished through iterative runs of the System Prioritization Method (SPM). These iterations will serve to more clearly isolate and identify those waste characteristics that directly and predominately impact on the performance assessment.

  19. Idaho CERCLA Disposal Facility Complex Waste Acceptance Criteria

    SciTech Connect

    W. Mahlon Heileson

    2006-10-01

    The Idaho Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) Disposal Facility (ICDF) has been designed to accept CERCLA waste generated within the Idaho National Laboratory. Hazardous, mixed, low-level, and Toxic Substance Control Act waste will be accepted for disposal at the ICDF. The purpose of this document is to provide criteria for the quantities of radioactive and/or hazardous constituents allowable in waste streams designated for disposal at ICDF. This ICDF Complex Waste Acceptance Criteria is divided into four section: (1) ICDF Complex; (2) Landfill; (3) Evaporation Pond: and (4) Staging, Storage, Sizing, and Treatment Facility (SSSTF). The ICDF Complex section contains the compliance details, which are the same for all areas of the ICDF. Corresponding sections contain details specific to the landfill, evaporation pond, and the SSSTF. This document specifies chemical and radiological constituent acceptance criteria for waste that will be disposed of at ICDF. Compliance with the requirements of this document ensures protection of human health and the environment, including the Snake River Plain Aquifer. Waste placed in the ICDF landfill and evaporation pond must not cause groundwater in the Snake River Plain Aquifer to exceed maximum contaminant levels, a hazard index of 1, or 10-4 cumulative risk levels. The defined waste acceptance criteria concentrations are compared to the design inventory concentrations. The purpose of this comparison is to show that there is an acceptable uncertainty margin based on the actual constituent concentrations anticipated for disposal at the ICDF. Implementation of this Waste Acceptance Criteria document will ensure compliance with the Final Report of Decision for the Idaho Nuclear Technology and Engineering Center, Operable Unit 3-13. For waste to be received, it must meet the waste acceptance criteria for the specific disposal/treatment unit (on-Site or off-Site) for which it is destined.

  20. Acceptance criteria for corroded carbon steel piping containing weld defects

    SciTech Connect

    Mertz, G.E.; Lam, P.S.; Awadalla, N.G.

    1993-04-01

    Acceptance criteria for corroded low temperature, low pressure carbon steel piping containing weld defects is presented along with a typical application of these criteria. They are intended to preclude gross rupture or rapidly propagating failure due to uniform wall thinning, local wall thinning, pitting corrosion and weld defects. The minimum allowable uniform wail thickness is based on the code-of-record allowable stress and fracture criteria. Weld defects are postulated as potential sites for fracture initiation. CEGB/R6 failure assessment diagram is used as the fracture criteria to determine the minimum allowable wall thickness. Design of a large portion of the low temperature, low pressure piping is dominated by axial stresses. Existing local wall thinning acceptance criteria address high pressure piping where hoop stress dominates the design. The existing criteria is over conservative, in some cases, when used on low pressure piping. Local wall thinning criteria is developed to limit the axial stress on the locally thinned section, based on a reduced average thickness. Limits on pit density are also developed to provide acceptance criteria for pitted piping.

  1. Acceptance criteria for corroded carbon steel piping containing weld defects

    SciTech Connect

    Mertz, G.E.; Lam, P.S.; Awadalla, N.G.

    1993-01-01

    Acceptance criteria for corroded low temperature, low pressure carbon steel piping containing weld defects is presented along with a typical application of these criteria. They are intended to preclude gross rupture or rapidly propagating failure due to uniform wall thinning, local wall thinning, pitting corrosion and weld defects. The minimum allowable uniform wail thickness is based on the code-of-record allowable stress and fracture criteria. Weld defects are postulated as potential sites for fracture initiation. CEGB/R6 failure assessment diagram is used as the fracture criteria to determine the minimum allowable wall thickness. Design of a large portion of the low temperature, low pressure piping is dominated by axial stresses. Existing local wall thinning acceptance criteria address high pressure piping where hoop stress dominates the design. The existing criteria is over conservative, in some cases, when used on low pressure piping. Local wall thinning criteria is developed to limit the axial stress on the locally thinned section, based on a reduced average thickness. Limits on pit density are also developed to provide acceptance criteria for pitted piping.

  2. Rethinking the diagnostic criteria of polycythemia vera.

    PubMed

    Barbui, T; Thiele, J; Vannucchi, A M; Tefferi, A

    2014-06-01

    The aim of this review is to critically address the validity and clinical applicability of three major diagnostic classification systems for polycythemia vera (PV), that is, those proposed by the Polycythemia Vera Study Group (PVSG), the British Committee for Standards in Haematology (BCSH) and the World Health Organization (WHO). Special focus is on which one of the three red cell parameters (hemoglobin-HB, hematocrit-HCT and red cell mass-RCM) should be used as the diagnostic hallmark of PV. The revised BCSH employed a persistently raised HCT level as the first diagnostic criterion in combination with the presence of a JAK2V617F mutation. On the other hand, the WHO classification used a raised HB value as a surrogate for increased RCM in association with molecular markers and for the first time, the bone marrow (BM) morphology was included as a minor criterion. Ongoing controversy and discussion regards the use of certain threshold values for HCT and HB as surrogates for RCM as well as the existence of prodromal-latent disease, so-called masked PV (mPV). It has been shown that mPV can be recognized in patients not meeting the required HB or HCT threshold levels by both the WHO and BCSH criteria. These cases present with the same baseline clinical features as overt PV but present worsened survival. A critical reappraisal of the WHO criteria may suggest either to reduce the thresholds for HB or to consider HCT values as major diagnostic criterion, as in the BCSH, in association with JAK2V617F mutation. The clinical utility of using HCT as reference variable is supported also by results of clinical trials which explicitly recommend to use the HCT threshold for monitoring treatment. In questionable cases as in mPV, BM biopsy examinations should be mandated together with mutation analysis. PMID:24352199

  3. NEVADA TEST SITE WASTE ACCEPTANCE CRITERIA, JUNE 2006

    SciTech Connect

    U.S. DEPARTMENT OF ENERGY, NATIONAL NUCLEAR SECURITY ADMINISTRATION NEVADA SITE OFFICE

    2006-06-01

    This document establishes the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO) waste acceptance criteria (WAC). The WAC provides the requirements, terms, and conditions under which the Nevada Test Site (NTS) will accept low-level radioactive (LLW) and mixed waste (MW) for disposal. It includes requirements for the generator waste certification program, characterization, traceability, waste form, packaging, and transfer. The criteria apply to radioactive waste received at the NTS Area 3 and Area 5 Radioactive Waste Management Complex (RWMC) for storage or disposal.

  4. Anticipating Potential Waste Acceptance Criteria for Defense Spent Nuclear Fuel

    SciTech Connect

    Rechard, R.P.; Lord, M.E.; Stockman, C.T.; McCurley, R.D.

    1997-12-31

    The Office of Environmental Management of the U.S. Department of Energy is responsible for the safe management and disposal of DOE owned defense spent nuclear fuel and high level waste (DSNF/DHLW). A desirable option, direct disposal of the waste in the potential repository at Yucca Mountain, depends on the final waste acceptance criteria, which will be set by DOE`s Office of Civilian Radioactive Waste Management (OCRWM). However, evolving regulations make it difficult to determine what the final acceptance criteria will be. A method of anticipating waste acceptance criteria is to gain an understanding of the DOE owned waste types and their behavior in a disposal system through a performance assessment and contrast such behavior with characteristics of commercial spent fuel. Preliminary results from such an analysis indicate that releases of 99Tc and 237Np from commercial spent fuel exceed those of the DSNF/DHLW; thus, if commercial spent fuel can meet the waste acceptance criteria, then DSNF can also meet the criteria. In large part, these results are caused by the small percentage of total activity of the DSNF in the repository (1.5%) and regulatory mass (4%), and also because commercial fuel cladding was assumed to provide no protection.

  5. MCO combustible gas management leak test acceptance criteria

    SciTech Connect

    SHERRELL, D.L.

    1999-05-11

    Existing leak test acceptance criteria for mechanically sealed and weld sealed multi-canister overpacks (MCO) were evaluated to ensure that MCOs can be handled and stored in stagnant air without compromising the Spent Nuclear Fuel Project's overall strategy to prevent accumulation of combustible gas mixtures within MCO's or within their surroundings. The document concludes that the integrated leak test acceptance criteria for mechanically sealed and weld sealed MCOs (1 x 10{sup -5} std cc/sec and 1 x 10{sup -7} std cc/sec, respectively) are adequate to meet all current and foreseeable needs of the project, including capability to demonstrate compliance with the NFPA 60 Paragraph 3-3 requirement to maintain hydrogen concentrations [within the air atmosphere CSB tubes] t or below 1 vol% (i.e., at or below 25% of the LFL).

  6. Procedures and acceptance criteria for PAS-1 cask inspections

    SciTech Connect

    Mercado, J.E.

    1998-09-09

    The procedures and acceptance criteria that comprise this document were prepared to support a one-time test to certify two PAS-1 casks in accordance with US Department of Energy Certificate of Compliance US A/9184/B(U), which was issued in 1998. The specific inspections addressed in this document are the visual weld inspection and a dimensional inspection of the primary containment vessel.

  7. Establishing seismic design criteria to achieve an acceptable seismic margin

    SciTech Connect

    Kennedy, R.P.

    1997-01-01

    In order to develop a risk based seismic design criteria the following four issues must be addressed: (1) What target annual probability of seismic induced unacceptable performance is acceptable? (2). What minimum seismic margin is acceptable? (3) Given the decisions made under Issues 1 and 2, at what annual frequency of exceedance should the Safe Shutdown Earthquake ground motion be defined? (4) What seismic design criteria should be established to reasonably achieve the seismic margin defined under Issue 2? The first issue is purely a policy decision and is not addressed in this paper. Each of the other three issues are addressed. Issues 2 and 3 are integrally tied together so that a very large number of possible combinations of responses to these two issues can be used to achieve the target goal defined under Issue 1. Section 2 lays out a combined approach to these two issues and presents three potentially attractive combined resolutions of these two issues which reasonably achieves the target goal. The remainder of the paper discusses an approach which can be used to develop seismic design criteria aimed at achieving the desired seismic margin defined in resolution of Issue 2. Suggestions for revising existing seismic design criteria to more consistently achieve the desired seismic margin are presented.

  8. [Diagnostic criteria for primary osteoporosis : year 2012 revision].

    PubMed

    Soen, Satoshi

    2014-03-01

    In 1995, the Japanese Society for Bone and Mineral Metabolism (now the Japanese Society for Bone and Mineral Research) established The Osteoporosis Diagnostic Criteria Review Committee. Following discussion held at the 13th scientific meeting of the Society in 1996, the Committee, with the consensus of its members, proposed diagnostic criteria for primary osteoporosis. The Committee revised those criteria in 1996 and again in 2000. Japanese Society for Bone and Mineral Research and Japan Osteoporosis Society Joint Review Committee for the Revision of the Diagnostic Criteria for Primary Osteoporosis aimed at obtaining international consistency and made a revised edition based on the new findings in 2012. PMID:24576928

  9. 24 CFR 203.202 - Plan acceptability and acceptance renewal criteria-general.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... renewal criteria-general. 203.202 Section 203.202 Housing and Urban Development Regulations Relating to... initiation of sanctions against a Plan issuer or insurance backer, in accordance with 2 CFR part 2424. If HUD..., and the procedural safeguards of 2 CFR part 2424 will apply. (c) Unless renewed, Plan acceptance...

  10. 24 CFR 203.202 - Plan acceptability and acceptance renewal criteria-general.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... renewal criteria-general. 203.202 Section 203.202 Housing and Urban Development Regulations Relating to... initiation of sanctions against a Plan issuer or insurance backer, in accordance with 2 CFR part 2424. If HUD..., and the procedural safeguards of 2 CFR part 2424 will apply. (c) Unless renewed, Plan acceptance...

  11. 24 CFR 203.202 - Plan acceptability and acceptance renewal criteria-general.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... renewal criteria-general. 203.202 Section 203.202 Housing and Urban Development Regulations Relating to... initiation of sanctions against a Plan issuer or insurance backer, in accordance with 2 CFR part 2424. If HUD..., and the procedural safeguards of 2 CFR part 2424 will apply. (c) Unless renewed, Plan acceptance...

  12. 24 CFR 203.202 - Plan acceptability and acceptance renewal criteria-general.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... renewal criteria-general. 203.202 Section 203.202 Housing and Urban Development Regulations Relating to... initiation of sanctions against a Plan issuer or insurance backer, in accordance with 2 CFR part 2424. If HUD..., and the procedural safeguards of 2 CFR part 2424 will apply. (c) Unless renewed, Plan acceptance...

  13. 24 CFR 203.202 - Plan acceptability and acceptance renewal criteria-general.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... renewal criteria-general. 203.202 Section 203.202 Housing and Urban Development Regulations Relating to... initiation of sanctions against a Plan issuer or insurance backer, in accordance with 2 CFR part 2424. If HUD..., and the procedural safeguards of 2 CFR part 2424 will apply. (c) Unless renewed, Plan acceptance...

  14. Automated Transportation Management System (ATMS) V2.0 logistics module PBI acceptance criteria

    SciTech Connect

    Weidert, R.S.

    1995-02-28

    This document defines the acceptance criteria for the Automated Transportation Management System V2.0 Logistics Module Performance Based Incentive (PBI). This acceptance criteria will be the primary basis for the generation of acceptance test procedures. The purpose of this document is to define the minimum criteria that must be fulfilled to guarantee acceptance of the Logistics Module.

  15. Analytical method transfer: new descriptive approach for acceptance criteria definition.

    PubMed

    de Fontenay, Gérald

    2008-01-01

    Within the pharmaceutical industry, method transfers are now commonplace during the life cycle of an analytical method. Setting acceptance criteria for analytical transfers is, however, much more difficult than usually described. Criteria which are too wide may lead to the acceptance of a laboratory providing non-equivalent results, resulting in bad release/reject decisions for pharmaceutical products (a consumer risk). On the contrary, criteria which are too tight may lead to the rejection of an equivalent laboratory, resulting in time costs and delay in the transfer process (an industrial risk). The consumer risk has to be controlled first. But the risk does depend on the method capability (tolerance to method precision ratio). Analytical transfers were simulated for different scenarios (different method capabilities and transfer designs, 10,000 simulations per test). The results of the simulations showed that the method capability has a strong influence on the probability of success of its transfer. For the transfer design, the number of independent analytical runs to be performed on a same batch has much more influence than the number of replicates per run, especially when the inter-day variability of the method is high. A classic descriptive approach for analytical method transfer does not take into account the variability of the method, and therefore, no risks are controlled. Tools for designing analytical transfers and defining a new descriptive acceptance criterion, which take into account the intra- and inter-day variability of the method, are provided for a better risk evaluation by non-statisticians. PMID:17961955

  16. Establishment of noise acceptance criteria for wind turbines

    NASA Technical Reports Server (NTRS)

    Stephens, D. G.; Shepherd, K. P.; Grosveld, F.

    1981-01-01

    A program is being conducted to develop noise criteria for wind turbines which minimize annoyance and which can be used in design specifications for future machines. The approach consists of presenting wind turbine noise stimuli to test subjects in a laboratory listening chamber. The responses of the subjects are recorded for a range of stimuli which encompass the designs, operating conditions, and ambient noise levels of current and future installations. Results to date have established the threshold of detectability for a range of impulsive stimuli of the type associated with blade/tower-wake interactions. The status of the ongoing psychoacoustic tests, the subjective data, and the approach to the development of noise acceptance criteria are described.

  17. Waste acceptance criteria for the Waste Isolation Pilot Plant

    SciTech Connect

    1996-04-01

    The Waste Isolation Pilot Plant (WIPP) Waste Acceptance Criteria (WAC), DOE/WIPP-069, was initially developed by a U.S. Department of Energy (DOE) Steering Committee to provide performance requirements to ensure public health and safety as well as the safe handling of transuranic (TRU) waste at the WIPP. This revision updates the criteria and requirements of previous revisions and deletes those which were applicable only to the test phase. The criteria and requirements in this document must be met by participating DOE TRU Waste Generator/Storage Sites (Sites) prior to shipping contact-handled (CH) and remote-handled (RH) TRU waste forms to the WIPP. The WIPP Project will comply with applicable federal and state regulations and requirements, including those in Titles 10, 40, and 49 of the Code of Federal Regulations (CFR). The WAC, DOE/WIPP-069, serves as the primary directive for assuring the safe handling, transportation, and disposal of TRU wastes in the WIPP and for the certification of these wastes. The WAC identifies strict requirements that must be met by participating Sites before these TRU wastes may be shipped for disposal in the WIPP facility. These criteria and requirements will be reviewed and revised as appropriate, based on new technical or regulatory requirements. The WAC is a controlled document. Revised/changed pages will be supplied to all holders of controlled copies.

  18. Comparison of Diagnostic Criteria for Common Variable Immunodeficiency Disorder

    PubMed Central

    Ameratunga, Rohan; Brewerton, Maia; Slade, Charlotte; Jordan, Anthony; Gillis, David; Steele, Richard; Koopmans, Wikke; Woon, See-Tarn

    2014-01-01

    Common variable immunodeficiency disorders (CVIDs) are the most frequent symptomatic primary immune deficiency condition in adults. The genetic basis for the condition is not known and no single clinical feature or laboratory test can establish the diagnosis; it has been a diagnosis of exclusion. In areas of uncertainty, diagnostic criteria can provide valuable clinical information. Here, we compare the revised European society of immune deficiencies (ESID) registry (2014) criteria with the diagnostic criteria of Ameratunga et al. (2013) and the original ESID/pan American group for immune deficiency (ESID/PAGID 1999) criteria. The ESID/PAGID (1999) criteria either require absent isohemagglutinins or impaired vaccine responses to establish the diagnosis in patients with primary hypogammaglobulinemia. Although commonly encountered, infective and autoimmune sequelae of CVID were not part of the original ESID/PAGID (1999) criteria. Also excluded were a series of characteristic laboratory and histological abnormalities, which are useful when making the diagnosis. The diagnostic criteria of Ameratunga et al. (2013) for CVID are based on these markers. The revised ESID registry (2014) criteria for CVID require the presence of symptoms as well as laboratory abnormalities to establish the diagnosis. Once validated, criteria for CVID will improve diagnostic precision and will result in more equitable and judicious use of intravenous or subcutaneous immunoglobulin therapy. PMID:25309532

  19. DIAGNOSTIC CRITERIA FOR PROLIFERATIVE THYROID LESIONS IN BONY FISHES

    EPA Science Inventory

    Thyroid proliferative lesions are rather common in bony fishes but disagreement exists in the fish pathology community concerning diagnostic criteria for hyperplastic versus neoplastic lesions. To simplify the diagnosis of proliferative thyroid lesions and to reduce confusion reg...

  20. Community acceptance of helicopter noise: Criteria and application

    NASA Technical Reports Server (NTRS)

    Munch, C. L.; King, R. J.

    1974-01-01

    A study was conducted to define those criteria necessary for civil helicopter operations to be acoustically acceptable to the communities from which they operate and over which they fly. The study involved surveying existing domestic and foreign Federal regulations and guidelines, state and local noise ordinances, results of community noise annoyance studies, and results of individual aircraft noise annoyance studies, and results of individual aircraft noise annoyance studies in order to establish the criteria. The final criteria selection are based on the Day-Night Level, L sub DN, a measure of total noise exposure. The basic rating unit is the A weighted sound pressure level (dbA) which has accuracy comparable to other units currently used for aircraft. An L sub DN of 60 is recommended as a criterion for areas where the ambient noise is below 58 dbA. An L sub DN value 2 dbA above the local ambient is recommended for areas where the ambient is above 58 dbA.

  1. The DSM diagnostic criteria for vaginismus.

    PubMed

    Binik, Yitzchak M

    2010-04-01

    Vaginal spasm has been considered the defining diagnostic characteristic of vaginismus for approximately 150 years. This remarkable consensus, based primarily on expert clinical opinion, is preserved in the DSM-IV-TR. The available empirical research, however, does not support this definition nor does it support the validity of the DSM-IV-TR distinction between vaginismus and dyspareunia. The small body of research concerning other possible ways or methods of diagnosing vaginismus is critically reviewed. Based on this review, it is proposed that the diagnoses of vaginismus and dyspareunia be collapsed into a single diagnostic entity called "genito-pelvic pain/penetration disorder." This diagnostic category is defined according to the following five dimensions: percentage success of vaginal penetration; pain with vaginal penetration; fear of vaginal penetration or of genito-pelvic pain during vaginal penetration; pelvic floor muscle dysfunction; medical co-morbidity. PMID:19851855

  2. 78 FR 53484 - Inspections, Tests, Analyses, and Acceptance Criteria; Vogtle Electric Generating Plant, Unit 4

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-29

    ... COMMISSION Inspections, Tests, Analyses, and Acceptance Criteria; Vogtle Electric Generating Plant, Unit 4... acceptance criteria (ITAAC) completion. SUMMARY: The U.S. Nuclear Regulatory Commission (NRC) staff has... acceptance criteria are met for ITAAC E.2.5.04.05.05.02, for the Vogtle Electric Generating Plant, Unit...

  3. 78 FR 53483 - Inspections, Tests, Analyses, and Acceptance Criteria; Vogtle Electric Generating Plant, Unit 3

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-29

    ... COMMISSION Inspections, Tests, Analyses, and Acceptance Criteria; Vogtle Electric Generating Plant, Unit 3... acceptance criteria (ITAAC) completion. SUMMARY: The U.S. Nuclear Regulatory Commission (NRC) staff has... acceptance criteria are met for ITAAC E.2.5.04.05.05.02, for the Vogtle Electric Generating Plant, Unit...

  4. Rett syndrome diagnostic criteria: Lessons from the Natural History Study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Analysis of 819 participants enrolled in the Rett syndrome (RTT) Natural History Study, validates recently revised diagnostic criteria. Seven hundred sixty-five females fulfilled 2002 consensus criteria for classic (653/85.4%) or variant (112/14.6%) RTT. All participants classified as classic RTT fu...

  5. [Diagnostic Criteria for Atrophic Age-related Macular Degeneration].

    PubMed

    Takahashi, Kanji; Shiraga, Fumio; Ishida, Susumu; Kamei, Motohiro; Yanagi, Yasuo; Yoshimura, Nagahisa

    2015-10-01

    Diagnostic criteria for dry age-related macular degeneration is described. Criteria include visual acuity, fundscopic findings, diagnostic image findings, exclusion criteria and classification of severity grades. Essential findings to make diagnosis as "geographic atrophy" are, 1) at least 250 μm in diameter, 2) round/oval/cluster-like or geographic in shape, 3) sharp delineation, 4) hypopigmentation or depigmentation in retinal pigment epithelium, 5) choroidal vessels are more visible than in surrounding area. Severity grades were classified as mild, medium and severe by relation of geographic atrophy to the fovea and attendant findings. PMID:26571627

  6. Safety analysis, risk assessment, and risk acceptance criteria

    SciTech Connect

    Jamali, K.; Stack, D.W.; Sullivan, L.H.; Sanzo, D.L.

    1997-08-01

    This paper discusses a number of topics that relate safety analysis as documented in the Department of Energy (DOE) safety analysis reports (SARs), probabilistic risk assessments (PRA) as characterized primarily in the context of the techniques that have assumed some level of formality in commercial nuclear power plant applications, and risk acceptance criteria as an outgrowth of PRA applications. DOE SARs of interest are those that are prepared for DOE facilities under DOE Order 5480.23 and the implementing guidance in DOE STD-3009-94. It must be noted that the primary area of application for DOE STD-3009 is existing DOE facilities and that certain modifications of the STD-3009 approach are necessary in SARs for new facilities. Moreover, it is the hazard analysis (HA) and accident analysis (AA) portions of these SARs that are relevant to the present discussions. Although PRAs can be qualitative in nature, PRA as used in this paper refers more generally to all quantitative risk assessments and their underlying methods. HA as used in this paper refers more generally to all qualitative risk assessments and their underlying methods that have been in use in hazardous facilities other than nuclear power plants. This discussion includes both quantitative and qualitative risk assessment methods. PRA has been used, improved, developed, and refined since the Reactor Safety Study (WASH-1400) was published in 1975 by the Nuclear Regulatory Commission (NRC). Much debate has ensued since WASH-1400 on exactly what the role of PRA should be in plant design, reactor licensing, `ensuring` plant and process safety, and a large number of other decisions that must be made for potentially hazardous activities. Of particular interest in this area is whether the risks quantified using PRA should be compared with numerical risk acceptance criteria (RACs) to determine whether a facility is `safe.` Use of RACs requires quantitative estimates of consequence frequency and magnitude.

  7. The DSM diagnostic criteria for sexual sadism.

    PubMed

    Krueger, Richard B

    2010-04-01

    I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Sadism for the Sexual and Gender Identity Disorders Workgroup for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The results of this review were tabulated into a general summary of the criticisms relevant to the DSM diagnosis of Sexual Sadism, the assessment of Sexual Sadism utilizing the DSM in samples drawn from forensic populations, and the assessment of Sexual Sadism using the DSM in non-forensic populations. I conclude that the diagnosis of Sexual Sadism should be retained, that minimal modifications of the wording of this diagnosis are warranted, and that there is a need for the development of dimensional and structured diagnostic instruments. PMID:19997774

  8. CTOD-based acceptance criteria for heat exchanger head staybolts

    SciTech Connect

    Lam, P.S.; Sindelar, R.L.; Barnes, D.M.; Awadalla, N.G.

    1992-11-01

    The primary coolant piping system of the Savannah River Site (SRS) reactors contains twelve heat exchangers to remove the waste heat from the nuclear materials production. A large break at the inlet or outlet heads of the heat exchangers would occur if the restraint members of the heads become inactive. The heat exchanger head is attached to the tubesheet by 84 staybolts. The structural integrity of the heads is demonstrated by showing the redundant capacity of the staybolts to restrain the head at design conditions and under seismic loadings. The beat exchanger head is analyzed with a three- dimensional finite element model. The restraint provided by the staybolts is evaluated for several postulated cases of inactive or missing staybolts, that is, bolts that have a flaw exceeding the ultrasonic testing (UT) threshold depth of 25% of the bolt diameter. A limit of 6 inactive staybolts is reached with a fracture criterion based on the maximum allowable local displacement at the active staybolts which corresponds to the crack tip opening displacement (CTOD) of 0.032 inches. An acceptance criteria methodology has been developed to disposition flaws reported in the staybolt inspections while ensuring adequate restraint capacity of the staybolts to maintain integrity of the heat exchanger heads against collapse. The methodology includes an approach for the baseline and periodic inspections of the staybolts. A total of up to 6 staybolts, reported as containing flaws with depths at or exceeding 25% would be acceptable in the heat exchanger.

  9. The Use and Abuse of Diagnostic/Classification Criteria

    PubMed Central

    June, Rayford R.; Aggarwal, Rohit

    2015-01-01

    In rheumatic diseases, classification criteria have been developed to identify well-defined homogenous cohorts for clinical research. Although, they are commonly used in clinical practice, their use may not be appropriate for routine diagnostic clinical care. Classification criteria are being revised with improved methodology and further understanding of disease pathophysiology, but still may not encompass all unique clinical situations to be applied for diagnosis of heterogeneous, rare, evolving rheumatic diseases. Diagnostic criteria development is challenging primarily due to difficulty for universal application given significant differences in prevalence of rheumatic diseases based on geographical area and clinic settings. Despite these shortcomings, the clinician can still use classification criteria for understanding the disease as well as a guide for diagnosis with a few caveats. We present the limits of current classification criteria, describe their use and abuse in clinical practice, and how they should be used with caution when applied in clinics. PMID:26096094

  10. Problems with diagnostic criteria for depression.

    PubMed

    Carroll, B J

    1984-07-01

    Limitations of the three major psychiatric diagnostic systems are discussed, with particular reference to depression and its subtypes. The lack of demonstrated reliability and validity for standard diagnoses, and the use of these diagnoses as independent variables in clinical research, is criticized. Possible approaches to improving current classification methods include increased specificity and sensitivity of symptoms, differential weighting, and objective recording. Scientific validation procedures should be applied to the classification of depressions, including studies of natural history and course, specific antidepressant drug responses, and the use of laboratory markers such as the dexamethasone suppression test and sleep EEG parameters. PMID:6376481

  11. The DSM diagnostic criteria for fetishism.

    PubMed

    Kafka, Martin P

    2010-04-01

    The historical definitions of sexual Fetishism are reviewed. Prior to the advent of DSM-III-R (American Psychiatric Association, 1987), Fetishism was typically operationally described as persistent preferential sexual arousal in association with non-living objects, an over-inclusive focus on (typically non-sexual) body parts (e.g., feet, hands) and body secretions. In the DSM-III-R, Partialism, an "exclusive focus on part of the body," was cleaved from Fetishism and added to the Paraphilia Not Otherwise Specified category. The current literature reviewed suggests that Partialism and Fetishism are related, can be co-associated, and are non-exclusive domains of sexual behavior. The author suggests that since the advent and elaboration of the clinical significance criterion (Criterion B) for designating a psychiatric disorder in DSM-IV (American Psychiatric Association, 1994), a diagnostic distinction between Partialism and Fetishism is no longer clinically meaningful or necessary. It is recommended that the diagnostic Criterion A for Fetishism be modified to reflect the reintegration of Partialism and that a fetishistic focus on non-sexual body parts be a specifier of Fetishism. PMID:19795202

  12. Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria.

    PubMed

    Dubois, Bruno; Feldman, Howard H; Jacova, Claudia; Hampel, Harald; Molinuevo, José Luis; Blennow, Kaj; DeKosky, Steven T; Gauthier, Serge; Selkoe, Dennis; Bateman, Randall; Cappa, Stefano; Crutch, Sebastian; Engelborghs, Sebastiaan; Frisoni, Giovanni B; Fox, Nick C; Galasko, Douglas; Habert, Marie-Odile; Jicha, Gregory A; Nordberg, Agneta; Pasquier, Florence; Rabinovici, Gil; Robert, Philippe; Rowe, Christopher; Salloway, Stephen; Sarazin, Marie; Epelbaum, Stéphane; de Souza, Leonardo C; Vellas, Bruno; Visser, Pieter J; Schneider, Lon; Stern, Yaakov; Scheltens, Philip; Cummings, Jeffrey L

    2014-06-01

    In the past 8 years, both the International Working Group (IWG) and the US National Institute on Aging-Alzheimer's Association have contributed criteria for the diagnosis of Alzheimer's disease (AD) that better define clinical phenotypes and integrate biomarkers into the diagnostic process, covering the full staging of the disease. This Position Paper considers the strengths and limitations of the IWG research diagnostic criteria and proposes advances to improve the diagnostic framework. On the basis of these refinements, the diagnosis of AD can be simplified, requiring the presence of an appropriate clinical AD phenotype (typical or atypical) and a pathophysiological biomarker consistent with the presence of Alzheimer's pathology. We propose that downstream topographical biomarkers of the disease, such as volumetric MRI and fluorodeoxyglucose PET, might better serve in the measurement and monitoring of the course of disease. This paper also elaborates on the specific diagnostic criteria for atypical forms of AD, for mixed AD, and for the preclinical states of AD. PMID:24849862

  13. Historical Underpinnings of Bipolar Disorder Diagnostic Criteria.

    PubMed

    Mason, Brittany L; Brown, E Sherwood; Croarkin, Paul E

    2016-01-01

    Mood is the changing expression of emotion and can be described as a spectrum. The outermost ends of this spectrum highlight two states, the lowest low, melancholia, and the highest high, mania. These mood extremes have been documented repeatedly in human history, being first systematically described by Hippocrates. Nineteenth century contemporaries Falret and Baillarger described two forms of an extreme mood disorder, with the validity and accuracy of both debated. Regardless, the concept of a cycling mood disease was accepted before the end of the 19th century. Kraepelin then described "manic depressive insanity" and presented his description of a full spectrum of mood dysfunction which could be exhibited through single episodes of mania or depression or a complement of many episodes of each. It was this concept which was incorporated into the first DSM and carried out until DSM-III, in which the description of episodic mood dysfunction was used to build a diagnosis of bipolar disorder. Criticism of this approach is explored through discussion of the bipolar spectrum concept and some recent examinations of the clinical validity of these DSM diagnoses are presented. The concept of bipolar disorder in children is also explored. PMID:27429010

  14. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement

    PubMed Central

    Sachdev, Perminder; Kalaria, Raj; O’Brien, John; Skoog, Ingmar; Alladi, Suvarna; Black, Sandra E; Blacker, Deborah; Blazer, Dan; Chen, Christopher; Chui, Helena; Ganguli, Mary; Jellinger, Kurt; Jeste, Dilip V.; Pasquier, Florence; Paulsen, Jane; Prins, Niels; Rockwood, Kenneth; Roman, Gustavo; Scheltens, Philip

    2014-01-01

    Background Several sets of diagnostic criteria have been published for vascular dementia (VaD) since the 1960s. The continuing ambiguity in VaD definition warrants a critical re-examination. Methods Participants at a special symposium of the International Society for Vascular Behavioral and Cognitive Disorders (VASCOG) in 2009 critiqued the current criteria. They drafted a proposal for a new set of criteria, later reviewed through multiple drafts by the group, including additional experts and the members of the Neurocognitive Disorders Work Group of the DSM-5 Task Force. Results Cognitive disorders of vascular etiology are a heterogeneous group of disorders with diverse pathologies and clinical manifestations, discussed broadly under the rubric of vascular cognitive disorders (VCD). The continuum of vascular cognitive impairment is recognized by the categories of Mild Vascular Cognitive Disorder, and Vascular Dementia or Major Vascular Cognitive Disorder. Diagnostic thresholds are defined. Clinical and neuroimaging criteria are proposed for establishing vascular etiology. Subtypes of VCD are described, and the frequent co-occurrence of Alzheimer’s disease pathology emphasized. Conclusions The proposed criteria for VCD provide a coherent approach to the diagnosis of this diverse group of disorders, with a view to stimulating clinical and pathological validation studies. These criteria can be harmonized with the DSM-5 criteria such that an international consensus on the criteria for VCD may be achieved. PMID:24632990

  15. When is diagnostic testing inappropriate or irrational? Acceptable regret approach.

    PubMed

    Hozo, Iztok; Djulbegovic, Benjamin

    2008-01-01

    The authors provide a new model within the framework of theories of bounded rationality for the observed physicians' behavior that their ordering of diagnostic tests may not be rational. Contrary to the prevailing thinking, the authors find that physicians do not act irrationally or inappropriately when they order diagnostic tests in usual clinical practice. When acceptable regret (i.e., regret that a decision maker finds tolerable upon making a wrong decision) is taken into account, the authors show that physicians tend to order diagnostic tests at a higher level of pretest probability of disease than predicted by expected utility theory. They also show why physicians tend to overtest when regret about erroneous decisions is extremely small. Finally, they explain variations in the practice of medicine. They demonstrate that in the same clinical situation, different decision makers might have different acceptable regret thresholds for withholding treatment, for ordering a diagnostic test, or for administering treatment. This in turn means that for some decision makers, the most rational strategy is to do nothing, whereas for others, it may be to order a diagnostic test, and still for others, choosing treatment may be the most rational course of action. PMID:18480041

  16. Improving diagnostic criteria for Propionibacterium acnes osteomyelitis: a retrospective analysis.

    PubMed

    Asseray, Nathalie; Papin, Christophe; Touchais, Sophie; Bemer, Pascale; Lambert, Chantal; Boutoille, David; Tequi, Brigitte; Gouin, François; Raffi, François; Passuti, Norbert; Potel, Gilles

    2010-07-01

    The identification of Propionibacterium acnes in cultures of bone and joint samples is always difficult to interpret because of the ubiquity of this microorganism. The aim of this study was to propose a diagnostic strategy to distinguish infections from contaminations. This was a retrospective analysis of all patient charts of those patients with >or=1 deep samples culture-positive for P. acnes. Every criterion was tested for sensitivity, specificity, and positive likelihood ratio, and then the diagnostic probability of combinations of criteria was calculated. Among 65 patients, 52 (80%) were considered truly infected with P. acnes, a diagnosis based on a multidisciplinary process. The most valuable diagnostic criteria were: >or=2 positive deep samples, peri-operative findings (necrosis, hardware loosening, etc.), and >or=2 surgical procedures. However, no single criterion was sufficient to ascertain the diagnosis. The following combinations of criteria had a diagnostic probability of >90%: >or=2 positive cultures + 1 criterion among: peri-operative findings, local signs of infection, >or=2 previous operations, orthopaedic devices; 1 positive culture + 3 criteria among: peri-operative findings, local signs of infection, >or=2 previous surgical operations, orthopaedic devices, inflammatory syndrome. The diagnosis of P. acnes osteomyelitis was greatly improved by combining different criteria, allowing differentiation between infection and contamination. PMID:20141491

  17. Celiac disease: diagnostic criteria in progress

    PubMed Central

    Volta, U; Villanacci, V

    2011-01-01

    Until a few years ago, celiac disease (CD) was thought to be a rare food intolerance that was confined to childhood and characterized by severe malabsorption and flat intestinal mucosa. Currently, CD is regarded as an autoimmune disorder that is common in the general population (affecting 1 in 100 individuals), with possible onset at any age and with many possible presentations. The identification of CD is challenging because it can begin not only with diarrhea and weight loss but also with atypical gastrointestinal (constipation and recurrent abdominal pain) and extra-intestinal symptoms (anemia, raised transaminases, osteoporosis, recurrent miscarriages, aphthous stomatitis and associated autoimmune disorders), or it could be completely symptomless. Over the last 20 years, the diagnostic accuracy of serology for CD has progressively increased with the development of highly reliable tests, such as the detection of IgA tissue transglutaminase and antiendomysial and IgG antideamidated gliadin peptide antibodies. The routine use of antibody markers has allowed researchers to discover a very high number of ‘borderline' cases, characterized by positive serology and mild intestinal lesions or normal small intestine architecture, which can be classified as potential CD. Therefore, it is evident that the ‘old celiac disease' with flat mucosa is only a part of the spectrum of CD. It is possible that serology could identify CD in its early stages, before the appearance of severe intestinal damage. In cases with a positive serology but with mild or absent intestinal lesions, the detection of HLA-DQ2 and HLA-DQ8 can help reinforce or exclude the diagnosis of gluten sensitivity. PMID:21278763

  18. Data Quality Objectives for WTP Feed Acceptance Criteria - 12043

    SciTech Connect

    Arakali, Aruna V.; Benson, Peter A.; Duncan, Garth; Johnston, Jill C.; Lane, Thomas A.; Matis, George; Olson, John W.; Banning, Davey L.; Greer, Daniel A.; Seidel, Cary M.; Thien, Michael G.

    2012-07-01

    The Hanford Tank Waste Treatment and Immobilization Plant (WTP) is under construction for the U.S. Department of Energy by Bechtel National, Inc. and subcontractor URS Corporation (contract no. DE-AC27-01RV14136). The plant when completed will be the world's largest nuclear waste treatment facility. Bechtel and URS are tasked with designing, constructing, commissioning, and transitioning the plant to the long term operating contractor to process the legacy wastes that are stored in underground tanks (from nuclear weapons production between the 1940's and the 1980's). Approximately 56 million gallons of radioactive waste is currently stored in these tanks at the Hanford Site in southeastern Washington. There are three major WTP facilities being constructed for processing the tank waste feed. The Pretreatment (PT) facility receives feed where it is separated into a low activity waste (LAW) fraction and a high level waste (HLW) fraction. These fractions are transferred to the appropriate (HLW or LAW) facility, combined with glass former material, and sent to high temperature melters for formation of the glass product. In addition to PT, HLW and LAW, other facilities in WTP include the Laboratory (LAB) for analytical services and the Balance of Facilities (BOF) for plant maintenance, support and utility services. The transfer of staged feed from the waste storage tanks and acceptance in WTP receipt vessels require data for waste acceptance criteria (WAC) parameters from analysis of feed samples. The Data Quality Objectives (DQO) development was a joint team effort between WTP and Tank Operations Contractor (TOC) representatives. The focus of this DQO effort was to review WAC parameters and develop data quality requirements, the results of which will determine whether or not the staged feed can be transferred from the TOC to WTP receipt vessels. The approach involved systematic planning for data collection consistent with EPA guidance for the seven-step DQO process

  19. DIAGNOSTIC CRITERIA FOR PROLIFERATIVE THYROID LESIONS IN BONY FISHES II

    EPA Science Inventory

    Thyroid proliferative lesions are rather common in bony fishes but diagnostic terminology and criteria for these lesions are inconsistent in the literature. The diagnosis of proliferative thyroid lesions is especially challenging in fish due to the fact that the thyroid is not a ...

  20. Metabolic syndrome: Performance of five different diagnostic criterias

    PubMed Central

    Onesi, S Ogedengbe; Ignatius, U Ezeani

    2014-01-01

    Background: The aim of this study is to describe the metabolic syndrome (MS) and to evaluate five diagnostic criteria of the MS with respect to their sensitivity and specificity in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: It is a cross-sectional case control study of T2DM patients and their first degree relatives (FDRs) recruited using convenience sampling and data collected through questionnaire administered technique. Variables of interest included anthropometric indices, blood pressure, serum lipid profile, fasting blood sugar (FBS), proteinuria, and microalbuminuria. The Chi-square test was used for comparison of proportions. A P value of less than 0.05 was taken as statistically significant. Kappa statistic was used to test the degree of agreement between the diagnostic criteria. Results: The World Health Organization (WHO), International Diabetes Federation (IDF), revised National Cholesterol Education Program (NCEP-R), NCEP Adult Treatment Panel (ATP)-III, and American Association of Clinical Endocrinologists (AACE) criteria reported a prevalence of 87.1, 64.5, 61.3, 55.6, and 22.6%, respectively in persons with T2DM. Using the WHO criteria as a reference or gold standard, the sensitivity of the IDF, NCEP-R, NCEP ATP-III, and AACE criteria among persons with T2DM were 71.3, 67.6, 61.1, and 25.9% respectively. Using the WHO criteria as a reference or gold standard, the specificity of the IDF, NCEP-R, NCEP ATP-III, and AACE criteria among persons with T2DM were 81.3, 81.3, 81.3, and 100%, respectively. Using the WHO criteria as a reference or gold standard, the level of agreement of the IDF, NCEP-R, NCEP ATP-III, and AACE criteria with the WHO criteria among persons with T2DM (as estimated by the kappa statistics) were 0.30, 0.26, 0.21, and 0.08 respectively. Conclusion: The level of agreement appears to be generally poor, though the IDF criteria showed a fair level of agreement with the WHO criteria: Therefore the IDF criteria is

  1. Visual weld acceptance criteria: Volume 1, Visual weld acceptance criteria for structural welding at nuclear power plants (NCIG-01, Revision 2): Final report

    SciTech Connect

    Not Available

    1987-09-01

    The Nuclear Construction Issues Group (NCIG) was formed to resolve common problems being experienced at nuclear power plants in the assurance of hardware quality for which common solutions likely existed. The initial activity undertaken by this group was development of visual weld acceptance criteria and inspection guidance for structural welds. This report, Volume 1, documents the results of this NCIG activity in describing the visual weld acceptance criteria for structural welding at nuclear power plants (NCIG-01, Revision 2).

  2. Canine atopic dermatitis diagnostic criteria: evaluation of four sets of published criteria among veterinary students.

    PubMed

    Le Roy, Lucile; Le Poder, Sophie; Desquilbet, Loïc; Perrot, Sebastien; Cavana, Paola; Marignac, Geneviève

    2015-01-01

    Canine atopic dermatitis (cAD) is a major teaching point as its diagnosis and treatment are difficult. During 11 weeks, 140 dogs and students (third, fourth, and fifth years) were recruited and paired. One of the four lists of diagnostic criteria was randomly attributed to each student. Concordance results, calculated with Cohen's kappa, ranged from slight (κ=0.07) to moderate (κ=0.53). Favrot's diagnostic criteria received the best results. It has been observed that results are improved with clinical experience. We observed that students often forgot that Favrot's criteria apply only to pruritic dogs and that the fulfillment of the criteria allows only a suspicion, not a diagnosis, of cAD. Primary pruritus and corticosteroid-responsive pruritus were often misunderstood. PMID:25588943

  3. Characteristics of binge eating disorder in relation to diagnostic criteria.

    PubMed

    Wilfley, Denise E; Citrome, Leslie; Herman, Barry K

    2016-01-01

    The objective of this review was to examine the evidentiary basis for binge eating disorder (BED) with reference to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) diagnostic criteria for BED. A PubMed search restricted to titles and abstracts of English-language reviews, meta-analyses, clinical trials, randomized controlled trials, journal articles, and letters using human participants was conducted on August 7, 2015, using keywords that included "binge eating disorder," DSM-5, DSM-IV, guilt, shame, embarrassment, quantity, psychological, behavior, and "shape and weight concerns." Of the 257 retrieved publications, 60 publications were considered relevant to discussions related to DSM-5 diagnostic criteria and were included in the current review, and 20 additional references were also included on the basis of the authors' knowledge and/or on a review of the reference lists from relevant articles obtained through the literature search. Evidence supports the duration/frequency criterion for BED and the primary importance of loss of control and marked distress in identifying individuals with BED. Although overvaluation of shape/weight is not a diagnostic criterion, its relationship to the severity of BED psychopathology may identify a unique subset of individuals with BED. Additionally, individuals with BED often exhibit a clinical profile consisting of psychiatric (eg, mood, obsessive-compulsive, and impulsive disorders) and medical (eg, gastrointestinal symptoms, metabolic syndrome, and type 2 diabetes) comorbidities and behavioral profiles (eg, overconsumption of calories outside of a binge eating episode and emotional eating). Future revisions of the BED diagnostic criteria should consider the inclusion of BED subtypes, perhaps based on the overvaluation of shape/weight, and an evidence-based reassessment of severity criteria. PMID:27621631

  4. Characteristics of binge eating disorder in relation to diagnostic criteria

    PubMed Central

    Wilfley, Denise E; Citrome, Leslie; Herman, Barry K

    2016-01-01

    The objective of this review was to examine the evidentiary basis for binge eating disorder (BED) with reference to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) diagnostic criteria for BED. A PubMed search restricted to titles and abstracts of English-language reviews, meta-analyses, clinical trials, randomized controlled trials, journal articles, and letters using human participants was conducted on August 7, 2015, using keywords that included “binge eating disorder,” DSM-5, DSM-IV, guilt, shame, embarrassment, quantity, psychological, behavior, and “shape and weight concerns.” Of the 257 retrieved publications, 60 publications were considered relevant to discussions related to DSM-5 diagnostic criteria and were included in the current review, and 20 additional references were also included on the basis of the authors’ knowledge and/or on a review of the reference lists from relevant articles obtained through the literature search. Evidence supports the duration/frequency criterion for BED and the primary importance of loss of control and marked distress in identifying individuals with BED. Although overvaluation of shape/weight is not a diagnostic criterion, its relationship to the severity of BED psychopathology may identify a unique subset of individuals with BED. Additionally, individuals with BED often exhibit a clinical profile consisting of psychiatric (eg, mood, obsessive–compulsive, and impulsive disorders) and medical (eg, gastrointestinal symptoms, metabolic syndrome, and type 2 diabetes) comorbidities and behavioral profiles (eg, overconsumption of calories outside of a binge eating episode and emotional eating). Future revisions of the BED diagnostic criteria should consider the inclusion of BED subtypes, perhaps based on the overvaluation of shape/weight, and an evidence-based reassessment of severity criteria. PMID:27621631

  5. 7 CFR 42.107 - Lot acceptance criteria.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... acceptance (Ac) and rejection (Re) numbers in the sampling plan. (1) Accept the lot after examining the single sample or first sample of a double sampling plan when all of the following conditions are met: (i... first sample of a double sampling plan when any one or more of the following conditions occur: (i)...

  6. 7 CFR 42.107 - Lot acceptance criteria.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... acceptance (Ac) and rejection (Re) numbers in the sampling plan. (1) Accept the lot after examining the single sample or first sample of a double sampling plan when all of the following conditions are met: (i... first sample of a double sampling plan when any one or more of the following conditions occur: (i)...

  7. 7 CFR 42.107 - Lot acceptance criteria.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... acceptance (Ac) and rejection (Re) numbers in the sampling plan. (1) Accept the lot after examining the single sample or first sample of a double sampling plan when all of the following conditions are met: (i... first sample of a double sampling plan when any one or more of the following conditions occur: (i)...

  8. 10 CFR 50.46a - Acceptance criteria for reactor coolant system venting systems.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Acceptance criteria for reactor coolant system venting systems. 50.46a Section 50.46a Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION FACILITIES Standards for Licenses, Certifications, and Regulatory Approvals § 50.46a Acceptance criteria for reactor coolant...

  9. 46 CFR 54.05-17 - Weld toughness test acceptance criteria.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Weld toughness test acceptance criteria. 54.05-17 Section 54.05-17 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE ENGINEERING PRESSURE VESSELS Toughness Tests § 54.05-17 Weld toughness test acceptance criteria. (a) For Charpy...

  10. 46 CFR 54.05-17 - Weld toughness test acceptance criteria.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 2 2011-10-01 2011-10-01 false Weld toughness test acceptance criteria. 54.05-17 Section 54.05-17 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE ENGINEERING PRESSURE VESSELS Toughness Tests § 54.05-17 Weld toughness test acceptance criteria. (a) For Charpy...

  11. 46 CFR 54.05-17 - Weld toughness test acceptance criteria.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... PRESSURE VESSELS Toughness Tests § 54.05-17 Weld toughness test acceptance criteria. (a) For Charpy V-notch impact tests the energy absorbed in both the weld metal and heat affected zone impact tests in weld... 46 Shipping 2 2012-10-01 2012-10-01 false Weld toughness test acceptance criteria....

  12. 46 CFR 54.05-17 - Weld toughness test acceptance criteria.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... PRESSURE VESSELS Toughness Tests § 54.05-17 Weld toughness test acceptance criteria. (a) For Charpy V-notch impact tests the energy absorbed in both the weld metal and heat affected zone impact tests in weld... 46 Shipping 2 2014-10-01 2014-10-01 false Weld toughness test acceptance criteria....

  13. 46 CFR 54.05-17 - Weld toughness test acceptance criteria.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... PRESSURE VESSELS Toughness Tests § 54.05-17 Weld toughness test acceptance criteria. (a) For Charpy V-notch impact tests the energy absorbed in both the weld metal and heat affected zone impact tests in weld... 46 Shipping 2 2013-10-01 2013-10-01 false Weld toughness test acceptance criteria....

  14. 46 CFR 28.275 - Acceptance criteria for instructors and course curricula.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the contingencies listed in 46 CFR 28.270(a) including— (i) Experience as an instructor; or (ii... 46 Shipping 1 2010-10-01 2010-10-01 false Acceptance criteria for instructors and course curricula... the Aleutian Trade § 28.275 Acceptance criteria for instructors and course curricula. (a) A...

  15. 78 FR 65007 - Inspections, Tests, Analyses, and Acceptance Criteria; Vogtle Electric Generating Plant, Unit 3

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-30

    ...The U.S. Nuclear Regulatory Commission (NRC) staff has determined that the inspections, tests, and analyses have been successfully completed, and that the specified acceptance criteria are met for Inspections, Tests, Analyses, and Acceptance Criteria (ITAAC), 2.1.03.11 for the Vogtle Electric Generating Plant, Unit...

  16. Comparative analysis of current diagnostic criteria for gestational diabetes mellitus

    PubMed Central

    Boyadzhieva, Mariya V; Atanasova, Iliana; Zacharieva, Sabina; Tankova, Tsvetalina; Dimitrova, Violeta

    2012-01-01

    Background To compare current guidelines for diagnosis of gestational diabetes mellitus (GDM) and to identify the ones that are the most relevant for application among pregnant Bulgarian population. Methods A total of 800 pregnant women at high risk for GDM underwent 75 g oral glucose tolerance test between 24 and 28 weeks of gestation as antenatal screening. The results were interpreted and classified according to the guidelines of the International Association of Diabetes and Pregnancy Study Groups (IADPSG), American Diabetes Association (ADA), Australasian Diabetes in Pregnancy Society, Canadian Diabetes Association, European Association for the Study of Diabetes, New Zealand Society for the study of Diabetes and World Health Organization. Results The application of different diagnostic criteria resulted in prevalences of GDM between 10.8% and 31.6%. Using any two sets of criteria, women who were classified differently varied between 0.1% and 21.1% (P < 0.001).The IADPSG criteria were the most inclusive criteria and resulted in the highest prevalence of GDM. There was a significant difference in the major metabolic parameters between GDM and control groups, regardless of which of the diagnostic criteria applied. GDM diagnosed according to all criteria resulted in increased proportion of delivery by caesarean section (CS). However, only ADA and IADPSG criteria identified both increased macrosomia (odds ratio, 2.36; 2.29) and CS rate. Conclusion The need for GDM screening is indisputable. In our view, the new IADPSG guidelines offer a unique opportunity for a unified national and global approach to GDM.

  17. When Less Is More: How Fewer Diagnostic Criteria Can Indicate Greater Severity

    ERIC Educational Resources Information Center

    Cooper, Luke D.; Balsis, Steve

    2009-01-01

    For diagnosing many mental disorders, the current "Diagnostic and Statistical Manual of Mental Disorders" ("DSM") system weights each diagnostic criterion equally--each criterion counts the same toward meeting the diagnostic threshold. Research on the diagnostic efficiency of criteria, however, reveals that some diagnostic criteria are more useful…

  18. 46 CFR 164.120-7 - Acceptance criteria.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... manufacturer and must be performed by an independent laboratory. (1) Polyester resins. (i) The resin must meet the specifications of Grade A, Class O resin of MIL-R-7575C (incorporated by reference, see § 164.120... criteria. (a) The laminating resin must pass the inspections and tests specified in this section....

  19. 46 CFR 164.120-7 - Acceptance criteria.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... manufacturer and must be performed by an independent laboratory. (1) Polyester resins. (i) The resin must meet the specifications of Grade A, Class O resin of MIL-R-7575C (incorporated by reference, see § 164.120... criteria. (a) The laminating resin must pass the inspections and tests specified in this section....

  20. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders

    PubMed Central

    Banwell, Brenda; Bennett, Jeffrey L.; Cabre, Philippe; Carroll, William; Chitnis, Tanuja; de Seze, Jérôme; Fujihara, Kazuo; Greenberg, Benjamin; Jacob, Anu; Jarius, Sven; Lana-Peixoto, Marco; Levy, Michael; Simon, Jack H.; Tenembaum, Silvia; Traboulsee, Anthony L.; Waters, Patrick; Wellik, Kay E.

    2015-01-01

    Neuromyelitis optica (NMO) is an inflammatory CNS syndrome distinct from multiple sclerosis (MS) that is associated with serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG). Prior NMO diagnostic criteria required optic nerve and spinal cord involvement but more restricted or more extensive CNS involvement may occur. The International Panel for NMO Diagnosis (IPND) was convened to develop revised diagnostic criteria using systematic literature reviews and electronic surveys to facilitate consensus. The new nomenclature defines the unifying term NMO spectrum disorders (NMOSD), which is stratified further by serologic testing (NMOSD with or without AQP4-IgG). The core clinical characteristics required for patients with NMOSD with AQP4-IgG include clinical syndromes or MRI findings related to optic nerve, spinal cord, area postrema, other brainstem, diencephalic, or cerebral presentations. More stringent clinical criteria, with additional neuroimaging findings, are required for diagnosis of NMOSD without AQP4-IgG or when serologic testing is unavailable. The IPND also proposed validation strategies and achieved consensus on pediatric NMOSD diagnosis and the concepts of monophasic NMOSD and opticospinal MS. PMID:26092914

  1. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders.

    PubMed

    Wingerchuk, Dean M; Banwell, Brenda; Bennett, Jeffrey L; Cabre, Philippe; Carroll, William; Chitnis, Tanuja; de Seze, Jérôme; Fujihara, Kazuo; Greenberg, Benjamin; Jacob, Anu; Jarius, Sven; Lana-Peixoto, Marco; Levy, Michael; Simon, Jack H; Tenembaum, Silvia; Traboulsee, Anthony L; Waters, Patrick; Wellik, Kay E; Weinshenker, Brian G

    2015-07-14

    Neuromyelitis optica (NMO) is an inflammatory CNS syndrome distinct from multiple sclerosis (MS) that is associated with serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG). Prior NMO diagnostic criteria required optic nerve and spinal cord involvement but more restricted or more extensive CNS involvement may occur. The International Panel for NMO Diagnosis (IPND) was convened to develop revised diagnostic criteria using systematic literature reviews and electronic surveys to facilitate consensus. The new nomenclature defines the unifying term NMO spectrum disorders (NMOSD), which is stratified further by serologic testing (NMOSD with or without AQP4-IgG). The core clinical characteristics required for patients with NMOSD with AQP4-IgG include clinical syndromes or MRI findings related to optic nerve, spinal cord, area postrema, other brainstem, diencephalic, or cerebral presentations. More stringent clinical criteria, with additional neuroimaging findings, are required for diagnosis of NMOSD without AQP4-IgG or when serologic testing is unavailable. The IPND also proposed validation strategies and achieved consensus on pediatric NMOSD diagnosis and the concepts of monophasic NMOSD and opticospinal MS. PMID:26092914

  2. Nevada Test Site waste acceptance criteria [Revision 1

    SciTech Connect

    1997-08-01

    Revision one updates the requirements, terms, and conditions under which the Nevada Test Site (NTS) will accept low-level radioactive and mixed waste for disposal; and transuranic and transuranic mixed waste for interim storage at the NTS. Review each section of this document. This document is not intended to include all of the requirements; rather, it is meant as a guide toward meeting the regulations. All references in this document should be observed to avoid omission of requirements on which acceptance or rejection of waste will be based. The Department of Energy/Nevada Operations Office (DOE/NV) and support contractors are available to assist you in understanding or interpreting this document.

  3. Example Procedures for Developing Acceptance-Range Criteria for BESTEST-EX

    SciTech Connect

    Judkoff, R.; Polly, B.; Bianchi, M.; Neymark, J.

    2010-08-01

    This document provides an example procedure for establishing acceptance-range criteria to assess results from software undergoing BESTEST-EX. This example method for BESTEST-EX is a modified version of the method described in HERS BESTEST.

  4. Definition and diagnostic criteria of sleep-related hypermotor epilepsy

    PubMed Central

    Bisulli, Francesca; Cross, J.H.; Hesdorffer, Dale; Kahane, Philippe; Nobili, Lino; Provini, Federica; Scheffer, Ingrid E.; Tassi, Laura; Vignatelli, Luca; Bassetti, Claudio; Cirignotta, Fabio; Derry, Christopher; Gambardella, Antonio; Guerrini, Renzo; Halasz, Peter; Licchetta, Laura; Mahowald, Mark; Manni, Raffaele; Marini, Carla; Mostacci, Barbara; Naldi, Ilaria; Parrino, Liborio; Picard, Fabienne; Pugliatti, Maura; Ryvlin, Philippe; Vigevano, Federico; Zucconi, Marco; Berkovic, Samuel; Ottman, Ruth

    2016-01-01

    The syndrome known as nocturnal frontal lobe epilepsy is recognized worldwide and has been studied in a wide range of clinical and scientific settings (epilepsy, sleep medicine, neurosurgery, pediatric neurology, epidemiology, genetics). Though uncommon, it is of considerable interest to practicing neurologists because of complexity in differential diagnosis from more common, benign sleep disorders such as parasomnias, or other disorders like psychogenic nonepileptic seizures. Moreover, misdiagnosis can have substantial adverse consequences on patients' lives. At present, there is no consensus definition of this disorder and disagreement persists about its core electroclinical features and the spectrum of etiologies involved. To improve the definition of the disorder and establish diagnostic criteria with levels of certainty, a consensus conference using formal recommended methodology was held in Bologna in September 2014. It was recommended that the name be changed to sleep-related hypermotor epilepsy (SHE), reflecting evidence that the attacks are associated with sleep rather than time of day, the seizures may arise from extrafrontal sites, and the motor aspects of the seizures are characteristic. The etiology may be genetic or due to structural pathology, but in most cases remains unknown. Diagnostic criteria were developed with 3 levels of certainty: witnessed (possible) SHE, video-documented (clinical) SHE, and video-EEG-documented (confirmed) SHE. The main research gaps involve epidemiology, pathophysiology, treatment, and prognosis. PMID:27164717

  5. Definition and diagnostic criteria of sleep-related hypermotor epilepsy.

    PubMed

    Tinuper, Paolo; Bisulli, Francesca; Cross, J H; Hesdorffer, Dale; Kahane, Philippe; Nobili, Lino; Provini, Federica; Scheffer, Ingrid E; Tassi, Laura; Vignatelli, Luca; Bassetti, Claudio; Cirignotta, Fabio; Derry, Christopher; Gambardella, Antonio; Guerrini, Renzo; Halasz, Peter; Licchetta, Laura; Mahowald, Mark; Manni, Raffaele; Marini, Carla; Mostacci, Barbara; Naldi, Ilaria; Parrino, Liborio; Picard, Fabienne; Pugliatti, Maura; Ryvlin, Philippe; Vigevano, Federico; Zucconi, Marco; Berkovic, Samuel; Ottman, Ruth

    2016-05-10

    The syndrome known as nocturnal frontal lobe epilepsy is recognized worldwide and has been studied in a wide range of clinical and scientific settings (epilepsy, sleep medicine, neurosurgery, pediatric neurology, epidemiology, genetics). Though uncommon, it is of considerable interest to practicing neurologists because of complexity in differential diagnosis from more common, benign sleep disorders such as parasomnias, or other disorders like psychogenic nonepileptic seizures. Moreover, misdiagnosis can have substantial adverse consequences on patients' lives. At present, there is no consensus definition of this disorder and disagreement persists about its core electroclinical features and the spectrum of etiologies involved. To improve the definition of the disorder and establish diagnostic criteria with levels of certainty, a consensus conference using formal recommended methodology was held in Bologna in September 2014. It was recommended that the name be changed to sleep-related hypermotor epilepsy (SHE), reflecting evidence that the attacks are associated with sleep rather than time of day, the seizures may arise from extrafrontal sites, and the motor aspects of the seizures are characteristic. The etiology may be genetic or due to structural pathology, but in most cases remains unknown. Diagnostic criteria were developed with 3 levels of certainty: witnessed (possible) SHE, video-documented (clinical) SHE, and video-EEG-documented (confirmed) SHE. The main research gaps involve epidemiology, pathophysiology, treatment, and prognosis. PMID:27164717

  6. 10 CFR 50.46a - Acceptance criteria for reactor coolant system venting systems.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Acceptance criteria for reactor coolant system venting... criteria for reactor coolant system venting systems. Each nuclear power reactor must be provided with high point vents for the reactor coolant system, for the reactor vessel head, and for other systems...

  7. 10 CFR 50.46a - Acceptance criteria for reactor coolant system venting systems.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Acceptance criteria for reactor coolant system venting... criteria for reactor coolant system venting systems. Each nuclear power reactor must be provided with high point vents for the reactor coolant system, for the reactor vessel head, and for other systems...

  8. 10 CFR 50.46a - Acceptance criteria for reactor coolant system venting systems.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Acceptance criteria for reactor coolant system venting... criteria for reactor coolant system venting systems. Each nuclear power reactor must be provided with high point vents for the reactor coolant system, for the reactor vessel head, and for other systems...

  9. A comparison and cross-reference of commercial low-level radioactive waste acceptance criteria

    SciTech Connect

    Kerr, T.A.

    1997-04-01

    This document, prepared by the National Low-Level Waste Management Program at the Idaho National Engineering and Environmental Laboratory, is a comparison and cross-reference of commercial low-level radioactive waste acceptance criteria. Many of these are draft or preliminary criteria as well as implemented criteria at operating low-level radioactive waste management facilities. Waste acceptance criteria from the following entities are included: US Nuclear Regulatory Commission, South Carolina, Washington, Utah, Nevada, California, illinois, Texas, North Carolina, Nebraska, Pennsylvania, New York, and the Midwest Compact Region. Criteria in the matrix include the following: physical form, chemical form, liquid limits, void space in packages, concentration averaging, types of packaging, chelating agents, solidification media, stability requirements, sorptive media, gas, oil, biological waste, pyrophorics, source material, special nuclear material, package dimensions, incinerator ash, dewatered resin, transuranics, and mixed waste. Each criterion in the matrix is cross-referenced to its source document so that exact requirements can be determined.

  10. Diagnostic criteria for atopic dermatitis in Thai children.

    PubMed

    Wisuthsarewong, Wanee; Viravan, Suchitra

    2004-12-01

    Atopic dermatitis (AD) is a common skin disease in Thai children. There is no clinical or laboratory gold standard for the diagnosis. It is generally based on the guideline proposed by Hanifin and Rajka. Many studies have shown that some criteria are probably not all that significant in making the diagnosis. This study was designed to evaluate the frequency and diagnostic significance of clinical features of AD in Thai children. The authors studied 108 patients with AD and 103 controls including patients with other skin diseases. The AD group consisted of 60 girls and 48 boys. The mean age was 60.3+/-36.1 months. All previously proposed features were evaluated and the difference infrequency was tested with the chi-square test. History of pruritus, rash on typical distribution, chronically relapsing course, duration more than 6 months, personal or family history of atopy, age of onset before 2 years, recurrent conjunctivitis, itch when sweating, intolerance to rough textile, food and milk intolerance, history of dry skin, seasonal variation, visible dermatitis, dermatitis of a typical distribution, xerosis, ichthyosis vulgaris, foot dermatitis, Dennie-Morgan infraorbital fold, orbital darkening, periorbital dermatitis, pityriasis alba, peri-auricular dermatitis, anterior neck fold, truncal dermatitis, perifollicular accentuation, white dermographism and diffuse scaling of scalp were all significantly more frequent in AD (p < 0.05). A minimum set of diagnostic criteria for AD was derived by using multiple stepwise logistic regression technique. It consisted of history of itchy rash, history of flexural dermatitis, chronicity more than 6 months, and visible xerosis, periorbital dermatitis and perifollicular accentuation. PMID:15822547

  11. [Categorical and dimensional diagnostic approach to acute psychosis in view of operational diagnostic criteria].

    PubMed

    Sakamoto, Kaoru

    2011-01-01

    "Acute psychosis" is the tentative diagnosis made for the patients presenting acute onset of delusion, hallucination, confusion and emotional instability. "Acute psychosis" was focused in view of operational diagnostic criteria, ie, DSM-IV-TR and ICD-10. The diagnostic categories in the DSM-IV-TR corresponding to "acute psychosis" were brief psychotic disorder, schizophreniform disorder, schizo-affective disorder and mood disorder with psychotic features. Although brief psychotic disorder is representative of "acute psychosis" in the DSM-TR, it lacks in clinical usefulness, because its diagnostic criteria, based on no historical background, lack clinical validity in terms of symptom definition and duration (1 month>). On the other hand, in the ICD-10, a diagnostic category of acute transient psychotic disorder was based on the traditional "acute psychosis" concept that has been bred in the European Psychiatry. Among the acute transient psychotic disorders, acute polymorphic psychotic disorder is the diagnostic category made according to traditional concept of "bouffées délirantes" and cycloid psychosis. It is a clinically useful diagnostic category, because it could predict favorable episode outcome, if a person with fairly good premorbid social adaptation presents acute onset of polymorphic psychotic symptoms. One of the most prominent points of the revision of DSM-IV-TR to DSM-5 is the adoption of dimensional approach evaluation (diagnosis) in a disorder-crossing fashion. In addition to insomnia, depressive mood and anxiety, symptomatic domain such as acute onset, bipolarity, polymorphism of psychotic symptoms, and furthermore such domain as premorbid social adaptation, life event and episode outcome should be evaluated in the course of treatment, contributing to the clinical practice of the patients with acute psychosis. PMID:22352007

  12. The DSM diagnostic criteria for paraphilia not otherwise specified.

    PubMed

    Kafka, Martin P

    2010-04-01

    The category of "Not Otherwise Specified" (NOS) for DSM-based psychiatric diagnosis has typically retained diagnoses whose rarity, empirical criterion validation or symptomatic expression has been insufficient to be codified. This article reviews the literature on Telephone Scatologia, Necrophilia, Zoophilia, Urophilia, Coprophilia, and Partialism. Based on extant data, no changes are suggested except for the status of Partialism. Partialism, sexual arousal characterized by "an exclusive focus on part of the body," had historically been subsumed as a type of Fetishism until the advent of DSM-III-R. The rationale for considering the removal of Partialism from Paraphilia NOS and its reintegration as a specifier for Fetishism is discussed here and in a companion review on the DSM diagnostic criteria for fetishism (Kafka, 2009). In the DSM-IV and DSM-IV-TR, the essential features of a Paraphilia are recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving nonhuman objects, the suffering or humiliation of oneself or one's partner, or children or other nonconsenting persons that occur over a period of at least 6 months (Criterion A). Given consideration for the erotic focus of Partialism and Autoerotic Asphyxia, amending the operational criteria for Paraphilia should be considered to include an atypical focus involving human subjects (self or others). PMID:19779971

  13. Validation of Anamnestic Diagnostic Criteria for Recurrent Aphthous Stomatitis

    PubMed Central

    Baccaglini, Lorena; Theriaque, Douglas W.; Shuster, Jonathan J.; Serrano, Giselle; Lalla, Rajesh V.

    2014-01-01

    BACKGROUND Recurrent aphthous stomatitis (RAS) is characterized by painful recurrent oral ulcers and is typically diagnosed via history and clinical examination. Our aim was to validate a set of anamnestic diagnostic criteria (RASDX) to increase the accuracy of RAS diagnosis, particularly when a clinical examination is not feasible. METHODS Participants were enrolled during an unmatched case-control study. RASDX consisted of an initial phone screening using standardized questionnaires and recognition of RAS photos in the clinic. The proportion of agreement with an examination by an oral medicine expert was calculated. RESULTS A total of 115 participants were scheduled for a clinical diagnostic visit and 11 were withdrawn. The remaining 104 participants were aged 18–50 years, 54% female, 64% White and 20% Hispanic. Of these, all 49 controls with negative RASDX had no clinical ulcers. Of the 54 cases diagnosed with RAS by RASDX, 53 were clinically confirmed to have RAS lesions (99% agreement; exact 1-sided 95% CI=95–100%). CONCLUSIONS RASDX, based on a combination of history and photograph recognition, was highly accurate compared to a diagnosis that employed an oral examination. PMID:23106421

  14. Diagnostic criteria for mass lesions differentiating in electrical impedance mammography

    NASA Astrophysics Data System (ADS)

    A, Karpov; M, Korotkova

    2013-04-01

    The purpose of this research was to determine the diagnostic criteria for differentiating volumetric lesions in the mammary gland in electrical impedance mammography. The research was carried out utilizing the electrical impedance computer mammograph llMEIK v.5.6gg®, which enables to acquire images of 3-D conductivity distribution layers within mamma's tissues up to 5 cm depth. The weighted reciprocal projection method was employed to reconstruct the 3-D electric conductivity distribution of the examined organ. The results of 3,710 electrical impedance examinations were analyzed. The analysis of a volumetric lesion included assessment of its shape, contour, internal electrical structure and changes of the surrounding tissues. Moreover, mammary gland status was evaluated with the help of comparative and age-related electrical conductivity curves. The diagnostic chart is provided. Each criterion is measured in points. Using the numerical score for evaluation of mass and non-volumetric lesions within the mammary gland in electrical impedance mammography allowed comparing this information to BI-RADS categories developed by American College of Radiology experts. The article is illustrated with electrical impedance mammograms and tables.

  15. Selective serotonin reuptake inhibitor discontinuation syndrome: proposed diagnostic criteria.

    PubMed Central

    Black, K; Shea, C; Dursun, S; Kutcher, S

    2000-01-01

    OBJECTIVE: To establish specific criteria by which selective serotonin reuptake inhibitor (SSRI) discontinuation syndrome may be identified. DATA SOURCES: MEDLINE and PSYCHLIT databases were searched for case reports published from 1986 to 1997 inclusive, and references of relevant articles were also searched. STUDY SELECTION: Forty-six case reports of symptoms following the discontinuation of fluoxetine, fluvoxamine, paroxetine or sertraline were selected. Three studies of SSRI discontinuation were also reviewed. DATA EXTRACTION: Demographic and treatment information, as well as the timing, duration, number, nature and frequency of dicontinuation symptoms. DATA SYNTHESIS: Paroxetine was most frequently implicated. The drug had been tapered in half of the cases. In some cases, symptom onset began during taper, whereas, in most cases, symptoms began within 1 to 3 days of drug discontinuation. Fifty-three different symptoms were reported, with dizziness being the most common. Other common symptoms were nausea or emesis, fatigue, headache, gait instability and insomnia. Shock-like sensations, paresthesia and visual disturbances were the most rare. Without intervention, symptoms persisted for more than a week in half of the cases. In cases in which the SSRI was restarted, symptoms resolved within 72 hours. In some cases, withdrawal symptoms recurred when the same SSRI was again discontinued. CONCLUSIONS: Findings were used to construct diagnostic criteria for the SSRI discontinuation syndrome. These criteria are 2 or more of the following symptoms developing within 1 to 7 days of discontinuation or reduction in dosage of an SSRI after at least 1 month's use, when these symptoms cause clinically significant distress or impairment and are not due to a general medical condition or recurrence of a mental disorder: dizziness, light-headedness, vertigo or feeling faint; shock-like sensations or paresthesia; anxiety; diarrhea; fatigue; gait instability; headache; insomnia

  16. Nevada Test Site Waste Acceptance Criteria (NTSWAC), Rev. 7-01

    SciTech Connect

    NSTec Environmental Management

    2009-05-01

    This document establishes the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, Nevada Test Site Waste Acceptance Criteria (NTSWAC). The NTSWAC provides the requirements, terms, and conditions under which the Nevada Test Site (NTS) will accept low-level radioactive waste and mixed low-level waste for disposal. The NTSWAC includes requirements for the generator waste certification program, characterization, traceability, waste form, packaging, and transfer. The criteria apply to radioactive waste received at the NTS Area 3 and Area 5 Radioactive Waste Management Complex for disposal.

  17. Consensus diagnostic criteria for fetal alcohol spectrum disorders in Australia: a modified Delphi study

    PubMed Central

    Watkins, Rochelle E; Elliott, Elizabeth J; Mutch, Raewyn C; Payne, Janet M; Jones, Heather M; Latimer, Jane; Russell, Elizabeth; Fitzpatrick, James P; Hayes, Lorian; Burns, Lucinda; Halliday, Jane; D'Antoine, Heather A; Wilkins, Amanda; Peadon, Elizabeth; Miers, Sue; Carter, Maureen; O'Leary, Colleen M; McKenzie, Anne; Bower, Carol

    2012-01-01

    Objective To evaluate health professionals' agreement with components of published diagnostic criteria for fetal alcohol spectrum disorders (FASD) in order to guide the development of standard diagnostic guidelines for Australia. Design A modified Delphi process was used to assess agreement among health professionals with expertise or experience in FASD screening or diagnosis. An online survey, which included 36 Likert statements on diagnostic methods, was administered over two survey rounds. For fetal alcohol syndrome (FAS), health professionals were presented with concepts from the Institute of Medicine (IOM), University of Washington (UW), Centers for Disease Control (CDC), revised IOM and Canadian diagnostic criteria. For partial FAS (PFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD), concepts based on the IOM and the Canadian diagnostic criteria were compared. Setting/participants 130 Australian and 9 international health professionals. Results Of 139 health professionals invited to complete the survey, 103 (74.1%) responded, and 74 (53.2%) completed one or more questions on diagnostic criteria. We found consensus agreement among participants on the diagnostic criteria for FAS, with the UW criteria most commonly endorsed when compared with all other published criteria for FAS. When health professionals were presented with concepts based on the Canadian and IOM diagnostic criteria, we found consensus agreement but no clear preference for either the Canadian or IOM criteria for the diagnosis of PFAS, and no consensus agreement on diagnostic criteria for ARND. We also found no consensus on the IOM diagnostic criteria for ARBD. Conclusions Participants indicated clear support for use of the UW diagnostic criteria for FAS in Australia. These findings should be used to develop guidelines to facilitate improved awareness of, and address identified gaps in the infrastructure for, FASD diagnosis in Australia. PMID

  18. Neurogenic thoracic outlet syndrome: current diagnostic criteria and advances in MRI diagnostics.

    PubMed

    Magill, Stephen T; Brus-Ramer, Marcel; Weinstein, Philip R; Chin, Cynthia T; Jacques, Line

    2015-09-01

    Neurogenic thoracic outlet syndrome (nTOS) is caused by compression of the brachial plexus as it traverses from the thoracic outlet to the axilla. Diagnosing nTOS can be difficult because of overlap with other complex pain and entrapment syndromes. An nTOS diagnosis is made based on patient history, physical exam, electrodiagnostic studies, and, more recently, interpretation of MR neurograms with tractography. Advances in high-resolution MRI and tractography can confirm an nTOS diagnosis and identify the location of nerve compression, allowing tailored surgical decompression. In this report, the authors review the current diagnostic criteria, present an update on advances in MRI, and provide case examples demonstrating how MR neurography (MRN) can aid in diagnosing nTOS. The authors conclude that improved high-resolution MRN and tractography are valuable tools for identifying the source of nerve compression in patients with nTOS and can augment current diagnostic modalities for this syndrome. PMID:26323825

  19. Waste acceptance criteria for the Waste Isolation Pilot Plant. Revision 4

    SciTech Connect

    Not Available

    1991-12-01

    This Revision 4 of the Waste Acceptance Criteria (WAC), WIPP-DOE-069, identifies and consolidates existing criteria and requirements which regulate the safe handling and preparation of Transuranic (TRU) waste packages for transportation to and emplacement in the Waste Isolation Pilot Plant (WIPP). This consolidation does not invalidate any existing certification of TRU waste to the WIPP Operations and Safety Criteria (Revision 3 of WIPP-DOE--069) and/or Transportation: Waste Package Requirements (TRUPACT-II Safety Analysis Report for Packaging [SARP]). Those documents being consolidated, including Revision 3 of the WAC, currently support the Test Phase.

  20. Problematic internet use: proposed classification and diagnostic criteria.

    PubMed

    Shapira, Nathan A; Lessig, Mary C; Goldsmith, Toby D; Szabo, Steven T; Lazoritz, Martin; Gold, Mark S; Stein, Dan J

    2003-01-01

    Since the mid-1990s, there have been frequent reports of individuals whose use of the computer and internet is problematic. Given the recent expansion and the expected increase in internet availability and usage in the coming years, it is important that healthcare professionals be informed about this behavior and its associated problems. Recently, psychological and psychiatric literature has described individuals that exhibit problematic internet use who often suffer from other psychiatric disorders. In the face of this comorbidity, it is essential to evaluate whether these individuals represent a distinct class of disorder, or a manifestation/coping mechanism related to other underlying diagnosis. In either event, problematic internet use negatively impacts social and emotional functioning. Based on the current limited empirical evidence, problematic internet use may best be classified as an impulse control disorder. It is therefore imperative that problematic internet use be appropriately identified among symptomatic individuals. For these reasons, we propose specific diagnostic criteria that will allow for consistent identification and assist in further study of this behavior. PMID:12820176

  1. Hypercortisolism in childhood: shortcomings of conventional diagnostic criteria.

    PubMed

    Streeten, D H; Faas, F H; Elders, M J; Dalakos, T G; Voorhess, M

    1975-11-01

    Two patients are described in whom hypercortisolism occurred prepubertally as a consequence of bilateral adrenocortical hyperplasia. In contrast with the manifestations of Cushing's syndrome in adults, these children presented with obesity and reduced stature and no other symptoms. Both patients excreted amounts of urinary 17-OHCS before and during a conventional suppression test with dexamethasone (0.5 mg every six hours) which were within the usual normal range. However, when urinary 17-OHCS excretion was expressed per gram of urinary creatinine or per square meter of surface area, and when the dose of dexamethasone was tailored to body mass (20mug/kg/day) the results were clearly abnormal, as were plasma corticoids and (in one patient) cortisol secretion rate. Resumption of linear growth occurred after bilateral adrenalectomy in both patients and was associated, in the one patient so studied, by a return of hypoglycemia-stimulated increases in plasma growth hormone levels from previously suppressed values to the normal range, and by a slight increase in the fasting plasma somatomedin concentration. The observations suggest that pediatric patients with hypercortisolism are likely to be overlooked when conventional criteria for laboratory diagnosis are used, but can be recognized by the simple diagnostic modifications used in these studies. PMID:1196738

  2. Updated Diagnostic Criteria and Staging System for Multiple Myeloma.

    PubMed

    Rajkumar, S Vincent

    2016-01-01

    There has been remarkable progress made in the diagnosis and treatment of multiple myeloma (MM). The median survival of the disease has doubled as a result of several new active drugs. These advances have necessitated a revision of the disease definition and staging of MM. Until recently, MM was defined by the presence of end-organ damage, specifically hypercalcemia, renal failure, anemia, and bone lesions (CRAB features) that can be attributed to the clonal process. In 2014, the International Myeloma Working Group (IMWG) updated the diagnostic criteria for MM to add three specific biomarkers that can be used to diagnose the disease in patients who did not have CRAB features: clonal bone marrow plasma cells greater than or equal to 60%, serum free light chain (FLC) ratio greater than or equal to 100 provided involved FLC level is 100 mg/L or higher, or more than one focal lesion on MRI. In addition, the definition was revised to allow CT and PET-CT to diagnose MM bone disease. These changes enable early diagnosis and allow the initiation of effective therapy to prevent the development of end-organ damage for patients who are at the highest risk. A new staging system has been developed that incorporates high-risk cytogenetic abnormalities in addition to standard laboratory markers of prognosis. PMID:27249749

  3. Diagnostic criteria for psychosomatic research and somatic symptom disorders.

    PubMed

    Sirri, Laura; Fava, Giovanni A

    2013-02-01

    The Diagnostic Criteria for Psychosomatic Research (DCPR) were introduced in 1995 by an international group of investigators to expand the traditional domains of the disease model. The DCPR are a set of 12 'psychosomatic syndromes' which provide operational tools for psychosocial variables with prognostic and therapeutic implications in clinical settings. Eight syndromes concern the main manifestations of abnormal illness behaviour: somatization, hypochondriacal fears and beliefs, and illness denial. The other four syndromes (alexithymia, type A behaviour, demoralization and irritable mood) refer to the domain of psychological factors affecting medical conditions. This review describes the conceptual bases of the DCPR and the main findings concerning their application, with particular reference to the incremental information they added to the customary psychiatric classification. The DCPR were also compared with the provisional DSM-5 somatic symptom disorders. The DCPR were found to be more sensitive than DSM-IV in identifying subthreshold psychological distress and characterizing patients' psychological response to medical illness. DSM-5 somatic symptom disorders seem to neglect important clinical phenomena, such as illness denial, resulting in a narrow view of patients' functioning. The additional information provided by the DCPR may enhance the decision-making process. PMID:23383664

  4. 48 CFR 915.607 - Criteria for acceptance and negotiation of an unsolicited proposal.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... and negotiation of an unsolicited proposal. 915.607 Section 915.607 Federal Acquisition Regulations System DEPARTMENT OF ENERGY CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Unsolicited Proposals 915.607 Criteria for acceptance and negotiation of an unsolicited proposal. (c) DOE's...

  5. 48 CFR 15.607 - Criteria for acceptance and negotiation of an unsolicited proposal.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... and negotiation of an unsolicited proposal. 15.607 Section 15.607 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Unsolicited Proposals 15.607 Criteria for acceptance and negotiation of an unsolicited proposal. (a)...

  6. 48 CFR 915.607 - Criteria for acceptance and negotiation of an unsolicited proposal.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... and negotiation of an unsolicited proposal. 915.607 Section 915.607 Federal Acquisition Regulations System DEPARTMENT OF ENERGY CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Unsolicited Proposals 915.607 Criteria for acceptance and negotiation of an unsolicited proposal. (c) DOE's...

  7. Technical Basis For Radiological Acceptance Criteria For Uranium At The Y-12 National Security Complex

    SciTech Connect

    Veinot, K. G.

    2009-07-22

    The purpose of this report is to establish radiological acceptance criteria for uranium. Other factors for acceptance not considered include criticality safety concerns, contaminants to the process stream, and impacts to the Safety Basis for the affected facilities. Three types of criteria were developed in this report. They include limits on external penetrating and non-penetrating radiation and on the internal hazard associated with inhalation of the material. These criteria are intended to alleviate the need for any special controls beyond what are normally utilized for worker protection from uranium hazards. Any proposed exceptions would require case-by-case evaluations to determine cost impacts and feasibility. Since Y-12 has set rigorous ALARA goals for worker doses, the external limits are based on assumptions of work time involved in the movement of accepted material plus the desire that external doses normally received are not exceeded, and set so that no special personnel monitoring would be required. Internal hazard controls were established so that dose contributions from non-uranium nuclides would not exceed 10% of that expected from the uranium component. This was performed using a Hazard Index (HI) previously established for work in areas contaminated with non-uranium nuclides. The radiological acceptance criteria for uranium are summarized in Table 1. Note that these limits are based on the assumption that radioactive daughter products have reached equilibrium.

  8. 76 FR 27925 - Requirements for Maintenance of Inspections, Tests, Analyses, and Acceptance Criteria

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-13

    ...) part 52, ``Licenses, Certifications, and Approvals for Nuclear Power Plants,'' on April 18, 1989 (54 FR... construction was complete. See 54 FR 15371; April 18, 1989; at 15383 (second column). On August 28, 2007 (72 FR... Section 189.a(1)(B) of the AEA threshold for requesting a hearing on acceptance criteria. See 72 FR...

  9. 46 CFR 164.019-5 - Standard components; acceptance criteria and procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 6 2010-10-01 2010-10-01 false Standard components; acceptance criteria and procedures. 164.019-5 Section 164.019-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) EQUIPMENT, CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL MATERIALS Personal Flotation...

  10. Wall thinning acceptance criteria for degraded carbon steel piping systems using FAD methodology

    SciTech Connect

    Lam, P.S.; Gupta, N.K.

    1995-02-01

    As part of the structural integrity assessment for Savannah River Site (SRS) piping systems, an acceptance criteria methodology for minimum pipe wall thickness has been developed for carbon steel piping. If a measured pipe thickness during inspection cannot meet the 87.5% of the nominal wall thickness specified in the ASME Code Case N-480, the acceptance criteria must be invoked. For a particular pipe, the larger of the two minimum thickness values obtained from the code stress check and the CEGB-R6 Failure Assessment Diagram (FAD) methodology is the minimum wall thickness for the acceptance criteria. The code stress check is based on the ASME/ANSI B31.1 Code, ASME Code Case N-480, and the SRS reactor restart criteria. The pipe wall thickness is calculated from the code equations and the applied loads. In fracture analysis, three types of axial and circumferential flaws are assumed to exist in the pipes based on the weld defects found in service history. For each flaw configuration, the stress intensity factors and the limit load solutions are calculated. These quantities are input to FAD to solve for the corresponding wall thickness required for the pipe to sustain the postulated flaws and to meet ASME safety margins under the applied loads.

  11. TRU waste acceptance criteria for the Waste Isolation Pilot Plant: Revision 3

    SciTech Connect

    Not Available

    1989-01-01

    This document is intended to delineate the criteria by which unclassified waste will be accepted for emplacement at the Waste Isolation Pilot Plant (WIPP) in southeastern New Mexico and describe the bases upon which these criteria were established. These criteria are not intended to be specifications but rather limits that will allow waste generating and shipping sites to develop their own procedures and specifications for preparation of TRU waste for shipment to the WIPP. These criteria will also allow waste generating sites to plan future facilities for waste preparation that will produce TRU waste forms compatible with WIPP waste emplacement and isolation requirements. These criteria only apply to contract-handled (CH) and remote-handled (RH) transuranic (TRU) waste forms and are not intended to apply to beta-gamma wastes, spent fuel, high-level waste (HLW), low-level waste (LLW), low specific activity (LSA) waste, or forms of radioactive waste for experimental purposes. Specifications for receipt of experimental waste forms will be prepared by the responsible projects in conjunction with the staff of the WIPP project at a later date. In addition, these criteria only apply to waste emplaced in bedded rock salt. Technical bases for these criteria may differ significantly from those for other host rocks. 25 refs. 4 figs., 1 tab.

  12. HOW TO DEAL WITH WASTE ACCEPTANCE UNCERTAINTY USING THE WASTE ACCEPTANCE CRITERIA FORECASTING AND ANALYSIS CAPABILITY SYSTEM (WACFACS)

    SciTech Connect

    Redus, K. S.; Hampshire, G. J.; Patterson, J. E.; Perkins, A. B.

    2002-02-25

    The Waste Acceptance Criteria Forecasting and Analysis Capability System (WACFACS) is used to plan for, evaluate, and control the supply of approximately 1.8 million yd3 of low-level radioactive, TSCA, and RCRA hazardous wastes from over 60 environmental restoration projects between FY02 through FY10 to the Oak Ridge Environmental Management Waste Management Facility (EMWMF). WACFACS is a validated decision support tool that propagates uncertainties inherent in site-related contaminant characterization data, disposition volumes during EMWMF operations, and project schedules to quantitatively determine the confidence that risk-based performance standards are met. Trade-offs in schedule, volumes of waste lots, and allowable concentrations of contaminants are performed to optimize project waste disposition, regulatory compliance, and disposal cell management.

  13. Development of Waste Acceptance Criteria at 221-U Building: Initial Flow and Transport Scoping Calculations

    SciTech Connect

    Freedman, Vicky L.; Zhang, Z. F.; Keller, Jason M.; Chen, Yousu

    2007-05-30

    This report documents numerical flow and transport simulations performed that establish initial waste acceptance criteria for the potential waste streams that may be safely sequestered in the 221-U Building and similar canyon structures. Specifically, simulations were executed to identify the maximum loading of contaminant mass (without respect to volume) that can be emplaced within the 221-U Building with no more than 1 pCi/m2 of contaminant migrating outside the structure within a 1,000 year time period. The initial scoping simulations were executed in one dimension to assess important processes, and then two dimensions to establish waste acceptance criteria. Two monolithic conditions were assessed: (1) a grouted canyon monolith; and (2) a canyon monolith filled with sand, both assuming no cracks or fissures were present to cause preferential transport. A three-staged approach was taken to account for different processes that may impact the amount of contaminant that can be safely sequestered in canyon structure. In the first stage, flow and transport simulations established waste acceptance criteria based on a linear (Kd) isotherm approach. In the second stage, impacts on thermal loading were examined and the differences in waste acceptance criteria quantified. In the third stage of modeling, precipitation/dissolution reactions were considered on the release and transport of the contaminants, and the subsequent impact on the maximum contaminant loading. The reactive transport modeling is considered a demonstration of the reactive transport capability, and shows the importance of its use for future performance predictions once site-specific data have been obtained.

  14. 10 CFR 50.60 - Acceptance criteria for fracture prevention measures for lightwater nuclear power reactors for...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Acceptance criteria for fracture prevention measures for... of Licenses and Construction Permits § 50.60 Acceptance criteria for fracture prevention measures for... certifications required under § 50.82(a)(1) have been submitted, must meet the fracture toughness and...

  15. 10 CFR 50.60 - Acceptance criteria for fracture prevention measures for lightwater nuclear power reactors for...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Acceptance criteria for fracture prevention measures for... of Licenses and Construction Permits § 50.60 Acceptance criteria for fracture prevention measures for... certifications required under § 50.82(a)(1) have been submitted, must meet the fracture toughness and...

  16. 10 CFR 50.60 - Acceptance criteria for fracture prevention measures for lightwater nuclear power reactors for...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Acceptance criteria for fracture prevention measures for... of Licenses and Construction Permits § 50.60 Acceptance criteria for fracture prevention measures for... certifications required under § 50.82(a)(1) have been submitted, must meet the fracture toughness and...

  17. 10 CFR 50.60 - Acceptance criteria for fracture prevention measures for lightwater nuclear power reactors for...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Acceptance criteria for fracture prevention measures for... of Licenses and Construction Permits § 50.60 Acceptance criteria for fracture prevention measures for... certifications required under § 50.82(a)(1) have been submitted, must meet the fracture toughness and...

  18. Corrosion control acceptance criteria for sacrificial anode type, cathodic protection systems (user guide)

    NASA Astrophysics Data System (ADS)

    Hock, Vincent F.; Noble, Michael; McLeod, Malcolm E.

    1994-07-01

    The Army currently operates and maintains more than 20,000 underground storage tanks and over 3000 miles of underground gas pipelines, all of which require some form of corrosion control. Cathodic protection is one method of corrosion control used to prevent corrosion-induced leaks when a steel structure is exposed to an aggressive soil. The corrosion control acceptance criteria for sacrificial anode type CP systems provides guidelines for the DEH/DPW cathodic protection installation inspectors whose responsibilities are to ensure that the materials and equipment specified are delivered to the job site and subsequently installed in accordance with the engineering drawings and specifications. The sacrificial anode CP acceptance criteria includes all components for the sacrificial anode system such as insulated conductors, anodes, anode backfills, and auxiliary equipment. The sacrificial anode CP acceptance criteria is composed of a checklist that lists each component and that contains a space for the inspector to either check 'yes' or 'no' to indicate whether the component complies with the job specifications. In some cases, the inspector must measure and record physical dimensions or electrical output and compare the measurements to standards shown in attached tables.

  19. DIAGNOSTIC CRITERIA FOR PROLIFERATIVE THYROID LESIONS IN BONY FISHES

    EPA Science Inventory

    Criteria for distinguishing hyperplastic thyroid lesions from thyroid neoplasia in bony fishes have long been debated by scientists. Confusion exists because the thyroid tissue in most teleosts is unencapsulated, is occasionally found in ectopic sites, and is frequently predispos...

  20. A Pilot Study on Modeling of Diagnostic Criteria Using OWL and SWRL.

    PubMed

    Hong, Na; Jiang, Guoqian; Pathak, Jyotishiman; Chute, Christopher G

    2015-01-01

    The objective of this study is to describe our efforts in a pilot study on modeling diagnostic criteria using a Semantic Web-based approach. We reused the basic framework of the ICD-11 content model and refined it into an operational model in the Web Ontology Language (OWL). The refinement is based on a bottom-up analysis method, in which we analyzed data elements (including value sets) in a collection (n=20) of randomly selected diagnostic criteria. We also performed a case study to formalize rule logic in the diagnostic criteria of metabolic syndrome using the Semantic Web Rule Language (SWRL). The results demonstrated that it is feasible to use OWL and SWRL to formalize the diagnostic criteria knowledge, and to execute the rules through reasoning. PMID:26262392

  1. International Harmonization of Nomenclature and Diagnostic Criteria (INHAND) progress to date and future plans.

    PubMed

    Keenan, Charlotte M; Baker, Julia F; Bradley, Alys E; Goodman, Dawn G; Harada, Takanori; Herbert, Ronald; Kaufmann, Wolfgang; Kellner, Rupert; Mahler, Beth; Meseck, Emily; Nolte, Thomas; Rittinghausen, Susanne; Vahle, John; Yoshizawa, Katsuhiko

    2015-01-01

    The INHAND Proposal (International Harmonization of Nomenclature and Diagnostic Criteria for Lesions in Rats and Mice) has been operational since 2005. A Global Editorial Steering Committee (GESC) manages the overall objectives of the project and the development of harmonized terminology for each organ system is the responsibility of the Organ Working Groups (OWG), drawing upon experts from North America, Europe and Japan.Great progress has been made with 9 systems published to date - Respiratory, Hepatobiliary, Urinary, Central/Peripheral Nervous Systems, Male Reproductive and Mammary, Zymbals, Clitoral and Preputial Glands in Toxicologic Pathology and the Integument and Soft Tissue and Female Reproductive System in the Journal of Toxicologic Pathology as supplements and on a web site - www.goreni.org. INHAND nomenclature guides offer diagnostic criteria and guidelines for recording lesions observed in rodent toxicity and carcinogenicity studies. The guides provide representative photo-micrographs of morphologic changes, information regarding pathogenesis, and key references. During 2012, INHAND GESC representatives attended meetings with representatives of the FDA Center for Drug Evaluation and Research (CDER), Clinical Data Interchange Standards Consortium (CDISC), and the National Cancer Institute (NCI) Enterprise Vocabulary Services (EVS) to begin incorporation of INHAND terminology as preferred terminology for SEND (Standard for Exchange of Nonclinical Data) submissions to the FDA. The interest in utilizing the INHAND nomenclature, based on input from industry and government toxicologists as well as information technology specialists, suggests that there will be wide acceptance of this nomenclature. The purpose of this publication is to provide an update on the progress of INHAND. PMID:26023262

  2. International Harmonization of Nomenclature and Diagnostic Criteria (INHAND) progress to date and future plans

    PubMed Central

    Keenan, Charlotte M.; Baker, Julia F.; Bradley, Alys E.; Goodman, Dawn G.; Harada, Takanori; Herbert, Ronald; Kaufmann, Wolfgang; Kellner, Rupert; Mahler, Beth; Meseck, Emily; Nolte, Thomas; Rittinghausen, Susanne; Vahle, John; Yoshizawa, Katsuhiko

    2014-01-01

    The INHAND Proposal (International Harmonization of Nomenclature and Diagnostic Criteria for Lesions in Rats and Mice) has been operational since 2005. A Global Editorial Steering Committee (GESC) manages the overall objectives of the project and the development of harmonized terminology for each organ system is the responsibility of the Organ Working Groups (OWG), drawing upon experts from North America, Europe and Japan.Great progress has been made with 9 systems published to date – Respiratory, Hepatobiliary, Urinary, Central/Peripheral Nervous Systems, Male Reproductive and Mammary, Zymbals, Clitoral and Preputial Glands in Toxicologic Pathology and the Integument and Soft Tissue and Female Reproductive System in the Journal of Toxicologic Pathology as supplements and on a web site – www.goreni.org. INHAND nomenclature guides offer diagnostic criteria and guidelines for recording lesions observed in rodent toxicity and carcinogenicity studies. The guides provide representative photo-micrographs of morphologic changes, information regarding pathogenesis, and key references. During 2012, INHAND GESC representatives attended meetings with representatives of the FDA Center for Drug Evaluation and Research (CDER), Clinical Data Interchange Standards Consortium (CDISC), and the National Cancer Institute (NCI) Enterprise Vocabulary Services (EVS) to begin incorporation of INHAND terminology as preferred terminology for SEND (Standard for Exchange of Nonclinical Data) submissions to the FDA. The interest in utilizing the INHAND nomenclature, based on input from industry and government toxicologists as well as information technology specialists, suggests that there will be wide acceptance of this nomenclature. The purpose of this publication is to provide an update on the progress of INHAND. PMID:26023262

  3. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus

    PubMed Central

    Bäckström, Torbjorn; Brown, Candace; Dennerstein, Lorraine; Endicott, Jean; Epperson, C. Neill; Eriksson, Elias; Freeman, Ellen; Halbreich, Uriel; Ismail, Khaled M. K.; Panay, Nicholas; Pearlstein, Teri; Rapkin, Andrea; Reid, Robert; Schmidt, Peter; Steiner, Meir; Studd, John; Yonkers, Kimberley

    2014-01-01

    Premenstrual disorders (PMD) are characterised by a cluster of somatic and psychological symptoms of varying severity that occur during the luteal phase of the menstrual cycle and resolve during menses (Freeman and Sondheimer, Prim Care Companion J Clin Psychiatry 5:30–39, 2003; Halbreich, Gynecol Endocrinol 19:320–334, 2004). Although PMD have been widely recognised for many decades, their precise cause is still unknown and there are no definitive, universally accepted diagnostic criteria. To consider this issue, an international multidisciplinary group of experts met at a face-to-face consensus meeting to review current definitions and diagnostic criteria for PMD. This was followed by extensive correspondence. The consensus group formally became established as the International Society for Premenstrual Disorders (ISPMD). The inaugural meeting of the ISPMD was held in Montreal in September 2008. The primary aim was to provide a unified approach for the diagnostic criteria of PMD, their quantification and guidelines on clinical trial design. This report summarises their recommendations. It is hoped that the criteria proposed here will inform discussions of the next edition of the World Health Organisation's International Classification of Diseases (ICD-11), and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) criteria that are currently under consideration. It is also hoped that the proposed definitions and guidelines could be used by all clinicians and investigators to provide a consistent approach to the diagnosis and treatment of PMD and to aid scientific and clinical research in this field. PMID:21225438

  4. Multi Canister Overpack (MCO) Combustible Gas Management Leak Test Acceptance Criteria (OCRWM)

    SciTech Connect

    SHERRELL, D.L.

    2000-10-10

    The purpose of this document is to support the Spent Nuclear Fuel Project's combustible gas management strategy while avoiding the need to impose any requirements for oxygen free atmospheres within storage tubes that contain multi-canister overpacks (MCO). In order to avoid inerting requirements it is necessary to establish and confirm leak test acceptance criteria for mechanically sealed and weld sealed MCOs that are adequte to ensure that, in the unlikely event the leak test results for any MCO were to approach either of those criteria, it could still be handled and stored in stagnant air without compromising the SNF Project's overall strategy to prevent accumulation of combustible gas mixtures within MCOs or within their surroundings. To support that strategy, this document: (1) establishes combustible gas management functions and minimum functional requirements for the MCO's mechanical seals and closure weld(s); (2) establishes a maximum practical value for the minimum required initial MCO inert backfill gas pressure; and (3) based on items 1 and 2, establishes and confirms leak test acceptance criteria for the MCO's mechanical seal and final closure weld(s).

  5. Applying Objective Diagnostic Criteria to Students in a College Support Program for Learning Disabilities

    ERIC Educational Resources Information Center

    Sparks, Richard L.; Lovett, Benjamin J.

    2013-01-01

    This study examined whether a large group of postsecondary students participating in a support program for students classified as having learning disabilities (LD) met criteria for five objective diagnostic models for LD: IQ-achievement discrepancy (1.0 SD, 1.5 SD, and greater than 2.0 SD) models, a "Diagnostic and Statistical Manual of…

  6. The Beck Depression Inventory and Research Diagnostic Criteria: Congruence in an Older Population.

    ERIC Educational Resources Information Center

    Gallagher, Dolores; And Others

    1983-01-01

    Examined the congruence between conventional cutoff scores on the Beck Depression Inventory (BDI) and selected diagnostic classifications of the Research Diagnostic Criteria in a sample of 102 elders seeking psychological treatment. Findings supported the utility of the BDI as a screening instrument for identification of clinically depressed…

  7. Diagnostic Clast-Texture Criteria for Recognition of Impact Deposits

    NASA Technical Reports Server (NTRS)

    Marshall, J. R.; Bratton, C.; Pope, K. O.; Ocampo, A. C.

    1999-01-01

    It is difficult to find definitive evidence for impact in the geological record because there are many endogenous geological processes that can produce diamictites similar to those generated by impact ejecta. The classic impact criteria of shock fabrics in certain minerals, and iridium layers, for example, may be either difficult to find, or long-since erased from the impact site (shock fabrics also anneal with time). It is important to be able to recognize impact-generated materials in order to understand earth's crustal development and biological evolution. In future exploration of Mars and other solar-system bodies, recognition of impact materials will be important for elucidating planetary evolution, planetary volatile inventories, and exobiological issues. The cobble depicted is typical of many that have been found in diamictite deposits in Belize generated by the Chicxulub K-T impact event. The pebbles are roughly-hewn in general shape with smoothed corners and edges. Surfaces are almost uniformly frosted (on both protuberances and hollows), but some asperities are glazed. Optical microscopy and thin-section petrographic microscopy reveal the frosting to be only a few microns thick, with a well-defined granular structure; grains are the same size as those composing the bulk of the limestone, but their clearer appearance may represent annealing. One or two adjacent pebble faces are often decorated with striated gouges and closely-spaced hemispherical depressions representing indentation hollows produced by well-rounded impacting clasts of up to 0.5 cm in diameter. Some of the impactors are still embedded in the cobble surface. Non-destructive x-ray diffraction techniques showed the impactors to be of the same mineralogy as the target cobble. We believe this unusual glazing and frosting to be related to the impact event, but this must be reconciled with its survival for over 60 my. since it is composed of one of the most alterable substances, CaCO3. We focus

  8. Diagnostic Clast-Texture Criteria for Recognition of Impact Deposits

    NASA Technical Reports Server (NTRS)

    Marshall, J. R.; Bratton, C.; Pope, K. O.; Ocampo, A. C.

    1999-01-01

    It is difficult to find definitive evidence for impact in the geological record because there are many endogenous geological processes that can produce diamictites similar to those generated by impact ejecta. The classic impact criteria of shock fabrics in certain minerals, and iridium layers, for example, may be either difficult to find, or long-since erased from the impact site (shock fabrics also anneal with time). It is important to be able to recognize impact-generated materials in order to understand earth's crustal development and biological evolution. In future exploration of Mars and other solar-system bodies, recognition of impact materials will be important for elucidating planetary evolution, planetary volatile inventories, and exobiological issues. The cobble depicted is typical of many that have been found in diamictite deposits in Belize generated by the Chicxulub K-T impact event. The pebbles are roughly-hewn in general shape with smoothed corners and edges. Surfaces are almost uniformly frosted (on both protuberances and hollows), but some asperities are glazed. Optical microscopy and thin-section petrographic microscopy reveal the frosting to be only a few microns thick, with a well-defined granular structure; grains are the same size as those composing the bulk of the limestone, but their clearer appearance may represent annealing. One or two adjacent pebble faces are often decorated with striated gouges and closely-spaced hemispherical depressions representing indentation hollows produced by well-rounded impacting clasts of up to 0.5 cm in diameter. Some of the impactors are still embedded in the cobble surface. Non-destructive x-ray diffraction techniques showed the impactors to be of the same mineralogy as the target cobble. We believe this unusual glazing and frosting to be related to the impact event, but this must be reconciled with its survival for over 60 my. since it is composed of one of the most alterable substances, CaCO3. We focus

  9. Diagnostic Clast-Texture Criteria for Recognition of Impact Deposits

    NASA Astrophysics Data System (ADS)

    Marshall, J. R.; Bratton, C.; Pope, K. O.; Ocampo, A. C.

    1999-09-01

    It is difficult to find definitive evidence for impact in the geological record because there are many endogenous geological processes that can produce diamictites similar to those generated by impact ejecta. The classic impact criteria of shock fabrics in certain minerals, and iridium layers, for example, may be either difficult to find, or long-since erased from the impact site (shock fabrics also anneal with time). It is important to be able to recognize impact-generated materials in order to understand earth's crustal development and biological evolution. In future exploration of Mars and other solar-system bodies, recognition of impact materials will be important for elucidating planetary evolution, planetary volatile inventories, and exobiological issues. The cobble depicted is typical of many that have been found in diamictite deposits in Belize generated by the Chicxulub K-T impact event. The pebbles are roughly-hewn in general shape with smoothed corners and edges. Surfaces are almost uniformly frosted (on both protuberances and hollows), but some asperities are glazed. Optical microscopy and thin-section petrographic microscopy reveal the frosting to be only a few microns thick, with a well-defined granular structure; grains are the same size as those composing the bulk of the limestone, but their clearer appearance may represent annealing. One or two adjacent pebble faces are often decorated with striated gouges and closely-spaced hemispherical depressions representing indentation hollows produced by well-rounded impacting clasts of up to 0.5 cm in diameter. Some of the impactors are still embedded in the cobble surface. Non-destructive x-ray diffraction techniques showed the impactors to be of the same mineralogy as the target cobble. We believe this unusual glazing and frosting to be related to the impact event, but this must be reconciled with its survival for over 60 my. since it is composed of one of the most alterable substances, CaCO3. We focus

  10. Training in Structured Diagnostic Assessment Using DSM-IV Criteria

    ERIC Educational Resources Information Center

    Ponniah, Kathryn; Weissman, Myrna M.; Bledsoe, Sarah E.; Verdeli, Helen; Gameroff, Marc J.; Mufson, Laura; Fitterling, Heidi; Wickramaratne, Priya

    2011-01-01

    Objectives: Determining a patient's psychiatric diagnosis is an important first step for the selection of empirically supported treatments and a critical component of evidence-based practice. Structured diagnostic assessment covers the range of psychiatric diagnoses and is usually more complete and accurate than unstructured assessment. Method: We…

  11. Comparative Capabilities of Clinical Assessment, Diagnostic Criteria, and Polysomnography in Detecting Sleep Bruxism

    PubMed Central

    Palinkas, Marcelo; De Luca Canto, Graziela; Rodrigues, Laíse Angélica Mendes; Bataglion, César; Siéssere, Selma; Semprini, Marisa; Regalo, Simone Cecilio Hallak

    2015-01-01

    Objective: To evaluate the diagnostic capability of signs and symptoms of sleep bruxism (SB) as per the American Academy of Sleep Medicine (AASM) criteria and a diagnostic grading system proposed by international experts for assessing SB. Methods: The study was conducted in three phases (interview, physical examination, and sleep studies). Subjects were asked about self-reported tooth grinding sounds occurring during sleep, muscle fatigue, temporal headaches, jaw muscle pain, and jaw locking. A visual examination was conducted to check for presence of abnormal tooth wear. A full-night polysomnography (PSG) was performed. After three phases, the subjects were divided into two groups matched by age and gender: Case Group, 45 SB subjects, and Control Group, 45 non-SB subjects. Diagnostic accuracy measurements were calculated for each sign or symptom individually and for the two diagnostic criteria analyzed. Results: Muscle fatigue, temporal headaches, and AASM criteria were associated with highest sensitivity (78%, 67%, 58%, respectively) and also with highest diagnostic odds ratio (OR = 9.63, 9.25, 6.33, respectively). Jaw locking, muscle pain, and the criterion of “probable SB” were associated with the worst sensitivity (16%, 18%, 22%, respectively). Conclusions: Presence of muscle fatigue and temporal headaches can be considered good tools to screen SB patients. None of the diagnostic criteria evaluated was able to accurately identify patients with SB. AASM criteria had the strongest diagnostic capabilities and—although they do not attain diagnostic values high enough to replace the current gold standard (PSG)—should be used as a screening tool to identify SB. Citation: Palinkas M, De Luca Canto G, Rodrigues LA, Bataglion C, Siéssere S, Semprini M, Regalo SC. Comparative capabilities of clinical assessment, diagnostic criteria, and polysomnography in detecting sleep bruxism. J Clin Sleep Med 2015;11(11):1319–1325. PMID:26235152

  12. Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems

    PubMed Central

    2013-01-01

    Background This article reviews the current debate on developmental trauma disorder (DTD) with respect to formalizing its diagnostic criteria. Victims of abuse, neglect, and maltreatment in childhood often develop a wide range of age-dependent psychopathologies with various mental comorbidities. The supporters of a formal DTD diagnosis argue that post-traumatic stress disorder (PTSD) does not cover all consequences of severe and complex traumatization in childhood. Discussion Traumatized individuals are difficult to treat, but clinical experience has shown that they tend to benefit from specific trauma therapy. A main argument against inclusion of formal DTD criteria into existing diagnostic systems is that emphasis on the etiology of the disorder might force current diagnostic systems to deviate from their purely descriptive nature. Furthermore, comorbidities and biological aspects of the disorder may be underdiagnosed using the DTD criteria. Summary Here, we discuss arguments for and against the proposal of DTD criteria and address implications and consequences for the clinical practice. PMID:23286319

  13. ENVIROCARE OF UTAH: EXPANDING WASTE ACCEPTANCE CRITERIA TO PROVIDE LOW-LEVEL AND MIXED WASTE DISPOSAL OPTIONS

    SciTech Connect

    Rogers, B.; Loveland, K.

    2003-02-27

    Envirocare of Utah operates a low-level radioactive waste disposal facility 80 miles west of Salt Lake City in Clive, Utah. Accepted waste types includes NORM, 11e2 byproduct material, Class A low-level waste, and mixed waste. Since 1988, Envirocare has offered disposal options for environmental restoration waste for both government and commercial remediation projects. Annual waste receipts exceed 12 million cubic feet. The waste acceptance criteria (WAC) for the Envirocare facility have significantly expanded to accommodate the changing needs of restoration projects and waste generators since its inception, including acceptable physical waste forms, radiological acceptance criteria, RCRA requirements and treatment capabilities, PCB acceptance, and liquids acceptance. Additionally, there are many packaging, transportation, and waste management options for waste streams acceptable at Envirocare. Many subcontracting vehicles are also available to waste generators for both government and commercial activities.

  14. [Infantile Munchausen syndrome. Etiology, diagnostic criteria, and treatment].

    PubMed

    Morales-Franco, B; de la Morena-Fernández, M L

    1995-01-01

    In this paper, we study a special kind of child abuse, the Münchhausen Syndrome by proxy, which consists of a group of diseases that some parents invent in their own children. These parents describe false symptoms of disease in their children, or manipulate the bodies of their children in order to cause alterations. Their purpose is that the doctor will carry out diagnostic tests and medical treatments with the children who really aren't ill. Our objective is to understand this syndrome, so we can report the factors that influence its appearance, study the diagnostic guidelines and the importance of doing a correct differential diagnostic with other real pathologies, and we analyze the preventive and therapeutic measures that health professionals must carry out in children and in their parents. When these professionals understand this syndrome they will be able to detect it before children are subjected to more unnecessary suffering. And, they will be able to prevent that these aggressions on children continue. PMID:8582571

  15. Clinical criteria to screen for inpatient diagnostic errors: a scoping review

    PubMed Central

    Shenvi, Edna C.; El-Kareh, Robert

    2015-01-01

    Diagnostic errors are common and costly, but difficult to detect. “Trigger” tools have promise to facilitate detection, but have not been applied specifically for inpatient diagnostic error. We performed a scoping review to collate all individual “trigger” criteria that have been developed or validated that may indicate that an inpatient diagnostic error has occurred. We searched three databases and screened 8568 titles and abstracts to ultimately include 33 articles. We also developed a conceptual framework of diagnostic error outcomes using real clinical scenarios, and used it to categorize the extracted criteria. Of the multiple criteria we found related to inpatient diagnostic error and amenable to automated detection, the most common were death, transfer to a higher level of care, arrest or “code”, and prolonged length of hospital stay. Several others, such as abrupt stoppage of multiple medications or change in procedure, may also be useful. Validation for general adverse event detection was done in 15 studies, but only one performed validation for diagnostic error specifically. Automated detection was used in only two studies. These criteria may be useful for developing diagnostic error detection tools. PMID:26097801

  16. Clinical comparison of human and canine atopic dermatitis using human diagnostic criteria (Japanese Dermatological Association, 2009): proposal of provisional diagnostic criteria for canine atopic dermatitis.

    PubMed

    Terada, Yuri; Nagata, Masahiko; Murayama, Nobuo; Nanko, Hiroko; Furue, Masutaka

    2011-08-01

    Atopic dermatitis (AD) is a common skin disease encountered in both humans and dogs. Canine AD can be used in the analysis of naturally occurring AD; however, details of clinical comparison have been lacking. The purpose of this study is to compare those clinical features using the human diagnostic criteria (Japanese Dermatological Association, 2009). Fifty-one dogs with canine AD were evaluated by the human criteria. Prior to this study, canine AD was basically diagnosed by the fulfillment of two authentic canine AD criteria and a positive reaction against Dermatophagoides farinae in serum immunoglobulin E levels and/or in intradermal tests. Among the human AD criteria items, behavior corresponding to pruritus was observed in all 51 dogs. Skin lesions corresponding to eczematous dermatitis were seen in 50 dogs, and symmetrical distribution of skin lesions was noted in all 51 dogs. A chronic or chronically relapsing course was observed in 50 dogs. Based on these results, the concordance rate for the criteria was 96% (49/51). Differential diagnoses of AD were also investigated in the same manner. The concordance rate for the criteria was 0% (0/69) in scabies, 2% (1/50) in pyoderma, 0% (0/50) in demodicosis, 0% (0/9) in cutaneous lymphoma, 0% (0/2) in ichthyosis, 25% (2/7) in flea allergy, 48% (24/50) in seborrheic dermatitis and 75% (3/4) in food allergy. Canine AD is thus indicated as a valuable counterpart to human AD in clinical aspects. In addition, the human AD criteria could be applicable, with some modification, as provisional diagnostic criteria for canine AD. PMID:21434981

  17. Technical basis for acceptance criteria on the susceptibility of digital systems to electromagnetic interference

    SciTech Connect

    Ewing, P.D.; Korsah, K.; Antonescu, C.

    1992-12-31

    This paper discusses the development of the technical basis for establishing acceptance criteria on the susceptibility of digital systems to electromagnetic interference (EMI). The effort is sponsored by the US Nuclear Regulatory Commission and stems from the safety-related issues that need to be addressed with the application of digital instrumentation and controls systems in nuclear power plants. Designers of digital circuits are incorporating increasingly higher clock frequencies and lower logic voltage levels, thereby leading to the risk of susceptibility when spurious interference is misinterpreted as legitimate logic. Development of the technical basis for acceptance criteria centers around establishing good engineering practices to ensure that sufficient levels of electromagnetic compatibility (EMC) are maintained between the nuclear power plant`s electronic and electromechanical systems. First, good EMC design and installation practices are needed to control the emissions from interference sources and their impact on other nearby circuits and systems. Then, a test and evaluation program is needed to outline the EMI tests to be performed, the associated test methods to be followed, and adequate test limits to ensure that the circuit or system under test meets the recommended guidelines. Test and evaluation should be followed by periodic maintenance to assess whether the recommended EMI control practices continue to be adhered to as part of the routine operation of the nuclear power plant. By following these steps, the probability of encountering safety-related problems associated with EMI will be greatly reduced.

  18. Methods for verifying compliance with low-level radioactive waste acceptance criteria

    SciTech Connect

    1993-09-01

    This report summarizes the methods that are currently employed and those that can be used to verify compliance with low-level radioactive waste (LLW) disposal facility waste acceptance criteria (WAC). This report presents the applicable regulations representing the Federal, State, and site-specific criteria for accepting LLW. Typical LLW generators are summarized, along with descriptions of their waste streams and final waste forms. General procedures and methods used by the LLW generators to verify compliance with the disposal facility WAC are presented. The report was written to provide an understanding of how a regulator could verify compliance with a LLW disposal facility`s WAC. A comprehensive study of the methodology used to verify waste generator compliance with the disposal facility WAC is presented in this report. The study involved compiling the relevant regulations to define the WAC, reviewing regulatory agency inspection programs, and summarizing waste verification technology and equipment. The results of the study indicate that waste generators conduct verification programs that include packaging, classification, characterization, and stabilization elements. The current LLW disposal facilities perform waste verification steps on incoming shipments. A model inspection and verification program, which includes an emphasis on the generator`s waste application documentation of their waste verification program, is recommended. The disposal facility verification procedures primarily involve the use of portable radiological survey instrumentation. The actual verification of generator compliance to the LLW disposal facility WAC is performed through a combination of incoming shipment checks and generator site audits.

  19. Elastic-Plastic Strain Acceptance Criteria for Structures Subject to Rapidly Applied Transient Dynamic Loading

    SciTech Connect

    W.R. Solonick

    2003-04-01

    Rapidly applied transient dynamic loads produce stresses and deflections in structures that typically exceed those from static loading conditions. Previous acceptance criteria for structures designed for rapidly applied transient dynamic loading limited stresses to those determined from elastic analysis. Different stress limits were established for different grades of structure depending upon the amount of permanent set considered acceptable. Structure allowed to sustain very limited permanent set is designed to stress limits not significantly greater than yield stress. Greater permanent set in structure under rapidly applied transient dynamic loading conditions is permitted by establishing stress limits that are significantly greater than yield stress but still provide adequate safety margin (with respect to failure). This paper presents a strain-based elastic-plastic (i.e., inelastic) analysis criterion developed as an alternative to the more conservative stress-based elastic analysis stress criterion for structures subjected to rapidly applied transient dynamic loading. The strain limits established are based on material ductility considerations only and are set as a fraction of the strain at ultimate stress obtained from an engineering stress/strain curve of the material. Strains limits are categorized by type as membrane or surface and by region as general, local , or concentrated. The application of the elastic-plastic criterion provides a more accurate, less conservative design/analysis basis for structures than that used in elastic stress-based analysis criteria, while still providing adequate safety margins.

  20. Initial Acceptance Criteria Concepts and Data for Assessing Longevity of Low-Voltage Cable Insulations and Jackets

    SciTech Connect

    Gary toman

    2005-03-30

    This report establishes a basis for acceptance criteria, provides a method for estimating remaining low-voltage cable life, and provides aging profiles under various thermal and radiation conditions for available cable polymer condition-monitoring techniques. This report is not meant to be the final comprehensive source of acceptance criteria, but rather is intended for trial usage so that it can be further refined for easier reference in the future.

  1. An examination of cancer-related fatigue through proposed diagnostic criteria in a sample of cancer patients in Taiwan

    PubMed Central

    2011-01-01

    Background Fatigue among cancer patients has often been reported in the literature; however, great variations have been documented, ranging from 15% to 90%, probably due to the lack of a widely accepted definition and established diagnostic criteria for cancer-related fatigue. The objective of this study was to evaluate the proposed International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) criteria in a sample of cancer patients from a medical center and a regional teaching hospital in northern Taiwan. More accurate prevalence estimates of CRF may result in improved diagnoses and management of one of the most common symptoms associated with cancer and its treatment. Methods Since self-reporting from patients is the most effective and efficient method to measure fatigue, the ICD-10 criteria for fatigue were used. The ICD-10 criteria questionnaire was translated into Chinese and was approved by experts. Patients were recruited from outpatient palliative and oncology clinics and from palliative and oncology inpatient units. Results Of the 265 cancer patients that were interviewed between 21 October 2008 and 28 October 2009, 228 (86%) reported having at least 2 weeks of fatigue in the past month, and further evaluation with the ICD-10 criteria showed that 132 (49.8%) had cancer-related fatigue. Internal consistency was very good, which was indicated by a Cronbach alpha of 0.843. Conclusion The prevalence of diagnosable CRF in the patients in this sample, of whom most were under palliative treatment, was 49.8%, which was probably somewhat lower than in some of the previous reports that have used less-strict criteria. In addition, among the various criteria of the proposed diagnostic criteria, the most frequently reported symptoms in our sample populations were regarding sleep disturbance and physical factors. Although they will require further replication in other samples, these formal diagnostic criteria can serve as a

  2. Diagnostic electrocardiographic dyad criteria of emphysema in left ventricular hypertrophy

    PubMed Central

    Lanjewar, Swapnil S; Chhabra, Lovely; Chaubey, Vinod K; Joshi, Saurabh; Kulkarni, Ganesh; Kothagundla, Chandrasekhar; Kaul, Sudesh; Spodick, David H

    2013-01-01

    Background The electrocardiographic diagnostic dyad of emphysema, namely a combination of the frontal vertical P-vector and a narrow QRS duration, can serve as a quasidiagnostic marker for emphysema, with specificity close to 100%. We postulated that the presence of left ventricular hypertrophy in emphysema may affect the sensitivity of this electrocardiographic criterion given that left ventricular hypertrophy generates prominent left ventricular forces and may increase the QRS duration. Methods We reviewed the electrocardiograms and echocardiograms for 73 patients with emphysema. The patients were divided into two groups based on the presence or absence of echocardiographic evidence of left ventricular hypertrophy. The P-vector, QRS duration, and forced expiratory volume in one second (FEV1) were computed and compared between the two subgroups. Results There was no statistically significant difference in qualitative lung function (FEV1) between the subgroups. There was no statistically significant difference in mean P-vector between the subgroups. The mean QRS duration was significantly longer in patients with left ventricular hypertrophy as compared with those without left ventricular hypertrophy. Conclusion The presence of left ventricular hypertrophy may not affect the sensitivity of the P-vector verticalization when used as a lone criterion for diagnosing emphysema. However, the presence of left ventricular hypertrophy may significantly reduce the sensitivity of the electrocardiographic diagnostic dyad in emphysema, as it causes a widening of the QRS duration. PMID:24293995

  3. Dynamic light scattering in veterinary medicine: refinement of diagnostic criteria

    NASA Astrophysics Data System (ADS)

    Dubin, Stephen; Zietz, Stanley; Gabriel, Karl L.; Gabriel, David; DellaVecchia, Michael A.; Ansari, Rafat R.

    2001-05-01

    In dynamic light scattering (DLS), the structure or material of interest, suspended in a fluid, is illuminated by a beam of laser light and the scattered light is interpreted in terms of diffusion coefficient, particle size or its distribution. DLS has shown clear promise as a non-invasive, objective and precise diagnostic modality for investigation of lens opacity (cataract) and other medical and toxicological problems. The clinical potential of LDS has been demonstrated in several species both in vivo and in vitro. In many clinical cases, discernment between normal and diseased patients is possible by simple inspection of the particle size distribution. However a more rigorous and sensitive classification scheme is needed, particularly for evaluation of therapy and estimation of tissue injury. The data supplied by DLS investigation is inherently multivariate and its most efficient interpretation requires a multivariate approach which includes the variability among specimens as well as any correlation among the variables (e.g. across the particle size distribution). We present a brief review of DLS methodology, illustrative data and our efforts toward a diagnostic classification scheme. In particular we will describe application of the Mahalanobis distance and related statistical methods to DLS data.

  4. 21 CFR 212.70 - What controls and acceptance criteria must I have for my finished PET drug products?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... for my finished PET drug products? 212.70 Section 212.70 Food and Drugs FOOD AND DRUG ADMINISTRATION... What controls and acceptance criteria must I have for my finished PET drug products? (a) Specifications. You must establish specifications for each PET drug product, including criteria for...

  5. 21 CFR 212.70 - What controls and acceptance criteria must I have for my finished PET drug products?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... for my finished PET drug products? 212.70 Section 212.70 Food and Drugs FOOD AND DRUG ADMINISTRATION... acceptance criteria must I have for my finished PET drug products? (a) Specifications. You must establish specifications for each PET drug product, including criteria for determining identity, strength, quality,...

  6. Contact-Handled Transuranic Waste Acceptance Criteria for the Waste Isolation Pilot Plant

    SciTech Connect

    Washington TRU Solutions LLC

    2005-12-29

    The purpose of this document is to summarize the waste acceptance criteria applicable to the transportation, storage, and disposal of contact-handled transuranic (CH-TRU) waste at the Waste Isolation Pilot Plant (WIPP). These criteria serve as the U.S. Department of Energy's (DOE) primary directive for ensuring that CH-TRU waste is managed and disposed of in a manner that protects human health and safety and the environment.The authorization basis of WIPP for the disposal of CH-TRU waste includes the U.S.Department of Energy National Security and Military Applications of Nuclear EnergyAuthorization Act of 1980 (reference 1) and the WIPP Land Withdrawal Act (LWA;reference 2). Included in this document are the requirements and associated criteriaimposed by these acts and the Resource Conservation and Recovery Act (RCRA,reference 3), as amended, on the CH-TRU waste destined for disposal at WIPP.|The DOE TRU waste sites must certify CH-TRU waste payload containers to thecontact-handled waste acceptance criteria (CH-WAC) identified in this document. Asshown in figure 1.0, the flow-down of applicable requirements to the CH-WAC istraceable to several higher-tier documents, including the WIPP operational safetyrequirements derived from the WIPP CH Documented Safety Analysis (CH-DSA;reference 4), the transportation requirements for CH-TRU wastes derived from theTransuranic Package Transporter-Model II (TRUPACT-II) and HalfPACT Certificates ofCompliance (references 5 and 5a), the WIPP LWA (reference 2), the WIPP HazardousWaste Facility Permit (reference 6), and the U.S. Environmental Protection Agency(EPA) Compliance Certification Decision and approval for PCB disposal (references 7,34, 35, 36, and 37). The solid arrows shown in figure 1.0 represent the flow-down of allapplicable payload container-based requirements. The two dotted arrows shown infigure 1.0 represent the flow-down of summary level requirements only; i.e., the sitesmust reference the regulatory source

  7. Swallow Syncope: Clinical Presentation, Diagnostic Criteria, and Therapeutic Options

    PubMed Central

    Garg, Shashank; Girotra, Mohit; Glasser, Stephen; Dutta, Sudhir K.

    2014-01-01

    We recently encountered three patients with episodes of syncope associated with food ingestion. A 31-year-old woman had an episode of syncope in the hospital while drinking soda. Transient asystole was noted on the telemonitor, confirming the diagnosis of swallow syncope. The other two patients were 78- and 80 year old gentlemen, respectively, who presented with recurrent and transient episodes of dizziness during deglutition. Extensive work-up of syncope was negative in both cases and a diagnosis of swallow syncope was made by clinical criteria. These cases illustrate the challenging problem of swallow syncope. The diagnosis can be suspected on the basis of clinical presentation and confirmed with the demonstration of transient brady-arrhythmia during deglutition. Medical management includes avoiding trigger foods, use of anticholinergics, and/or placement of a permanent cardiac pacemaker. PMID:25038205

  8. Cancer diagnostics: decision criteria for marker utilization in the clinic.

    PubMed

    Taube, Sheila E; Jacobson, James W; Lively, Tracy G

    2005-01-01

    A new diagnostic tool must pass three major tests before it is adopted for routine clinical use. First, the tool must be robust and reproducible; second, the clinical value of the tool must be proven, i.e. the tool should reliably trigger a clinical decision that results in patient benefit; and, third, the clinical community has to be convinced of the need for this tool and the benefits it affords. Another factor that can influence the adoption of new tools relates to the cost and the vagaries of insurance reimbursement. The Cancer Diagnosis Program (CDP) of the US National Cancer Institute (NCI) launched the Program for the Assessment of Clinical Cancer Tests (PACCT) in 2000 to develop a process for moving the results of new technologies and new understanding of cancer biology more efficiently and effectively into clinical practice. PACCT has developed an algorithm that incorporates the iterative nature of assay development into an evaluation process that includes developers and end users. The effective introduction of new tests into clinical practice has been hampered by a series of common problems that are best described using examples of successes and failures. The successful application of the PACCT algorithm is described in the discussion of the recent development of the OncotypeDX assay and plan for a prospective trial of this assay by the NCI-supported Clinical Trials Cooperative Groups. The assay uses reverse transcription (RT)-PCR evaluation of a set of 16 genes that were shown to strongly associate with the risk of recurrence of breast cancer in women who presented with early stage disease (hormone responsive, and no involvement of the auxiliary lymph nodes). The test is highly reproducible. It provides information to aid the physician and patient in making important clinical decisions, including the aggressiveness of the therapy that should be recommended. A trial is planned to test whether OncotypeDX can be used as a standalone trigger for specific

  9. Diagnostic Criteria, Clinical Features, and Incidence of Thyroid Storm Based on Nationwide Surveys

    PubMed Central

    Satoh, Tetsurou; Isozaki, Osamu; Suzuki, Atsushi; Wakino, Shu; Iburi, Tadao; Tsuboi, Kumiko; Monden, Tsuyoshi; Kouki, Tsuyoshi; Otani, Hajime; Teramukai, Satoshi; Uehara, Ritei; Nakamura, Yosikazu; Nagai, Masaki; Mori, Masatomo

    2012-01-01

    Background Thyroid storm (TS) is life threatening. Its incidence is poorly defined, few series are available, and population-based diagnostic criteria have not been established. We surveyed TS in Japan, defined its characteristics, and formulated diagnostic criteria, FINAL-CRITERIA1 and FINAL-CRITERIA2, for two grades of TS, TS1, and TS2 respectively. Methods We first developed diagnostic criteria based on 99 patients in the literature and 7 of our patients (LIT-CRITERIA1 for TS1 and LIT-CRITERIA2 for TS2). Thyrotoxicosis was a prerequisite for TS1 and TS2 as well as for combinations of the central nervous system manifestations, fever, tachycardia, congestive heart failure (CHF), and gastrointestinal (GI)/hepatic disturbances. We then conducted initial and follow-up surveys from 2004 through 2008, targeting all hospitals in Japan, with an eight-layered random extraction selection process to obtain and verify information on patients who met LIT-CRITERIA1 and LIT-CRITERIA2. Results We identified 282 patients with TS1 and 74 patients with TS2. Based on these data and information from the Ministry of Health, Labor, and Welfare of Japan, we estimated the incidence of TS in hospitalized patients in Japan to be 0.20 per 100,000 per year. Serum-free thyroxine and free triiodothyroine concentrations were similar among patients with TS in the literature, Japanese patients with TS1 or TS2, and a group of patients with thyrotoxicosis without TS (Tox-NoTS). The mortality rate was 11.0% in TS1, 9.5% in TS2, and 0% in Tox-NoTS patients. Multiple organ failure was the most common cause of death in TS1 and TS2, followed by CHF, respiratory failure, arrhythmia, disseminated intravascular coagulation, GI perforation, hypoxic brain syndrome, and sepsis. Glasgow Coma Scale results and blood urea nitrogen (BUN) were associated with irreversible damages in 22 survivors. The only change in our final diagnostic criteria for TS as compared with our initial criteria related to serum

  10. Proposed GTA welding specification and acceptance criteria for the MC4163

    SciTech Connect

    Kwiatkowski, J.J.

    1991-04-12

    This specification documents the gas tungsten arc (GTA) welding process and production weld acceptance criteria requirements for the MC4163. This document is written specifically to apply to the welds on the MC4163 and is not to be used as a general gas tungsten arc welding specification. All sections of this specification must be complied with unless specifically exempted in writing. There are a total of five welds with three different joint designs required to fabricate the MC4163. In the order of fabrication they are (1) initiator closure disc, (2) nozzle to case girth welds, two and, (3) nozzle closure disc welds, two. This specification will only address the nozzle to case girth welds and the nozzle closure disc welds.

  11. The diagnostic criteria of blood-stasis syndrome: considerations for standardization of pattern identification.

    PubMed

    Li, Si-ming; Xu, Hao; Chen, Ke-ji

    2014-07-01

    Pattern identification (PI), also called Bian Zheng ([symbols; see text]), syndrome differentiation, pattern diagnosis, or pattern classification, is the basic principle and the key concept of Chinese medicine (CM). The core of PI is CM syndrome, on which CM theory, therapeutic method, prescribing formula and the use of Chinese herbal medicine are basically based. PI, in fact, is another classification method anticipated to improve the clinical efficacy. How to make an exact PI seems to be very important for taking full advantage of PI in clinical practice. Therefore, the establishment of diagnostic criterion of pattern has been the prerequisite for the standardization of PI. In recent years, a lot of diagnostic criteria of different CM patterns have been formulated. Taking the diagnostic criteria for blood-stasis syndrome as a model, the methodologies and considerations in establishing a pattern diagnostic criterion were discussed in this paper, which might be of great reference value in future PI standardization research. PMID:24610412

  12. CHARACTERIZATION OF TANK 50 SLURRY FOR SALTSTONE WASTE ACCEPTANCE CRITERIA, APRIL 2007 SAMPLES

    SciTech Connect

    Zeigler, K; Ned Bibler, N; David Diprete, D

    2007-12-07

    This report summarizes the results from the characterization of the second quarter April 2007 sampling of Tank 50H for the Saltstone Waste Acceptance Criteria (WAC). Six one liter samples were taken in polyethylene bottles to analyze for the WAC contaminants and a 200 mL sample was taken in a steel container for analysis of volatile organic compounds. The information from this characterization will be given to Waste Solidification Engineering personnel to qualify the transfer of aqueous waste to the Saltstone Facility. The following conclusions are drawn from the analytical results found in this report: (1) All six of the one liter samples taken in April 2007 from the mixed slurry in Tank 50 have the same compositions within the experimental uncertainty of the analyses. (2) Of the ninety-one process, chemical, and radioactive WAC target or limit contaminants listed in Revision 7 of the 'Waste Acceptance Criteria for Aqueous Waste sent to the Z-Area Saltstone Production Facility', eighty-nine had concentrations that were unequivocally less than the WAC limit or target. (3) The two contaminants whose concentrations could not be shown to be less than their WAC targets were methanol and radioactive Nb-93m. Currently the AD Section of SRNL does not have a method for measuring methanol in caustic solutions. For Nb-93m the results are ambiguous due to possible interferences in the ICP-MS analysis from Zr-93 or Mo-93. (4) Of the six additional chemical and radioactive contaminants requested in the TTR for Saltstone qualification, five were measured or calculated. These were Sb, Be, Tl, along with total beta and gamma. The AD Section does not have a method to measure the 6th contaminant which was the cyanide ion.

  13. A 27-Year-Old Patient Fulfilling the Diagnostic Criteria of Both CMML and JMML

    PubMed Central

    Manzoor, Mohmmed U.; AlMishari, Mai A.; Ibrahim, Mamoun H.

    2016-01-01

    Chronic myelomonocytic leukaemia (CMML) and juvenile myelomonocytic leukaemia (JMML) are two disease entities that come under the myelodysplastic/myeloproliferative neoplasms category. Each of the two conditions has its own diagnostic criteria. In addition, they have different ages of presentation; while CMML is typically a disease of the elderly, JMML is a disease of young children. Here we are presenting the case of a 27-year-old male patient who, at the time of diagnosis, fulfilled the diagnostic criteria of both diseases. In addition he had radiological changes of type 1 neurofibromatosis. Possible explanations of the patient case have been discussed. PMID:27034866

  14. Lung transplantation from donors outside standard acceptability criteria--are they really marginal?

    PubMed

    Zych, Bartlomiej; García Sáez, Diana; Sabashnikov, Anton; De Robertis, Fabio; Amrani, Mohamed; Bahrami, Toufan; Mohite, Prashant N; Patil, Nikhil P; Weymann, Alexander; Popov, Aron F; Reed, Anna; Carby, Martin; Simon, André R

    2014-11-01

    Lung transplantation (LTx) from "extended donor criteria" donors may reduce significantly organ shortage. However, its influence on results remains unclear. In this study, we evaluate retrospectively the results of LTx from donors outside standard criteria: PaO2/FiO2 ratio < 300 mmHg, age over 55 years, and history of smoking > 20 pack-years. Two hundred and forty-eight patients underwent first time LTx in our institution between January 2007 and January 2013. Seventy-nine patients (Group I) received organs from "extended donor criteria" and 169 patients (Group II) from "standard donor criteria." Recipients' and donors' demographics, perioperative variables, and outcome were compared. Donors from Group I were significantly older [median (interquartile range)]: 52.5 (44;58) vs. 42 (28.5;48.5) years (P < 0.001) with lower PaO2/FiO2 ratio: 366 ± 116.1 455 ± 80.5 mmHg (P < 0.001), higher incidence of smoking history: 57.7% vs. 41.8% (P = 0.013), and more extensive smoking history: 24(15;30) vs. 10(3.75;14) pack-years (P < 0.001). Other parameters were comparable. Recipients' gender, diagnosis, percentage of patients operated on pump and receiving double LTx were also comparable. Recipients from Group I were significantly older: 50 (42;57) vs. 44 (29.5;53.5) years (P = 001). There were no differences observed in recipients' prevalence of primary graft dysfunction (PGD) grade 3 over first three postoperative days, duration of mechanical ventilation, intensive care and hospital length of stay, prevalence of rejection, and bronchiolitis obliterans syndrome (BOS). 90-day, 1-year, and 5-year survival (Group I vs. II) were also similar: 88.6% vs. 91.7%, 83.2% vs. 84.6%, and 59% vs. 68.2% (log rank P = 0.367). Carefully selected donor lungs from outside the standard acceptability criteria may expand existing donor pool with no detrimental effect on LTx outcome. PMID:25070600

  15. Diagnostic criteria for selenium toxicosis in aquatic birds: histologic lesions

    USGS Publications Warehouse

    Green, D.E.; Albers, P.H.

    1997-01-01

    Chronic selenium toxicosis was induced in 1-year-old male mallard ducks (Anas platyrhynchos) by feeding selenium, as seleno-DL-methionine, in amounts of 0, 10, 20, 40, and 80 parts per million (ppm) to five groups of 21 ducks each for 16 wk during March to July 1988. All mallards in the 80 ppm group, three in the 40 ppm group, and one in the 20 ppm group died. Histologic lesions in mallards that died of selenosis were hepatocellular vacuolar degeneration progressing to centrolobular and panlobular necrosis, nephrosis, apoptosis of pancreatic exocrine cells, hypermaturity and avascularity of contour feathers of the head with atrophy of feather follicles, lymphocytic necrosis and atrophy of lymphoid organs (spleen, gut-associated lymphoid tissue, and lumbar lymph nodes), and severe atrophy and degeneration of fat. Histologic lesions in surviving mallards in the 40 ppm group, which had tissue residues of selenium comparable to mallards that died, were fewer and much milder than mallards that died; lesions consisted of atrophy of lymphoid tissue, hyalinogranular swelling of hepatocytes, atrophy of seminiferous tubules, and senescence of feathers. No significant histologic lesions were detected in euthanized mallards in the 0, 10 and 20 ppm groups. Based on tissue residues and histologic findings, primarily in the liver, there was a threshold of selenium accumulation above which pathophysiologic changes were rapid and fatal. Pathognomonic histologic lesions of fatal and nonfatal selenosis were not detected. Criteria for diagnosis of fatal selenosis in aquatic birds include consistent histologic lesions in the liver, kidneys, and organs of the immune system. Although histologic changes were present in cases of chronic non-fatal selenosis, these were inconsistent. Consistent features of fatal and non-fatal chronic selenosis were marked weight loss and elevated concentrations of selenium in organs.

  16. Autoimmune pulmonary alveolar proteinosis: clinical course and diagnostic criteria.

    PubMed

    Ben-Dov, Issahar; Segel, Michael J

    2014-01-01

    Pulmonary alveolar proteinosis (PAP) is caused by accumulation of surfactant components in the alveoli and terminal airways. All forms of PAP are caused by insufficient surfactant clearance by alveolar macrophages. Autoimmune PAP, a rare, antibody-mediated disease, that compromises 90% of cases of PAP, is causes by IgG autoantibodies that block GM-CSF effect, a crucial step for macrophage maturation. Alveolar filling may progress to respiratory insufficiency, but the course of the disease is variable. Patients usually complain of dyspnea, mainly with exertion, and cough. Chest CT shows highly suggestive ground grass opacification crossed by heavy septal lines, leading to the typical "crazy paving" appearance. Bronchoalveolar lavage reveals "milky" fluid, containing semisolid remnants of surfactant components, packed as lamellar bodies. The surfactant appears granular and pink on PAS staining, and lung architecture is preserved. These cytological and pathological characteristics are diagnostic for PAP. In addition, a high titer of IgG anti GM-CSF autoantibodies is highly sensitive and specific for the diagnosis. The trigger for antibodies formation and their role (if any) in regulation GM-CSF activity in the normal state are unknown. Based on the specificity of these characteristics we suggest a structured framework for the diagnosis of Autoimmune PAP. Lung lavage with a large volume of saline is the standard therapy, and is effective in most patients. However, immune-modulatory therapy, by either supplying exogenous GM-CSF, or by inhibiting the CD20+ antibody forming cells, with Rituximab, is also effective in many patients. The precise role of each therapy, alone or in combination, should be systematically studied. PMID:24424195

  17. [Hypersensitivity pneumonitis: Diagnostic criteria, treatment, prognosis and prevention].

    PubMed

    Jędrych, Małgorzata E; Szturmowicz, Monika; Bestry, Iwona; Kuś, Jan

    2016-01-01

    Hypersensitivity pneumonitis (HP) is caused by inhalation of environmental antigens. Farmers and bird keepers are most frequently affected by this desease. The HP diagnosis is based on clinical symptoms (cough, dyspnea) in a person exposed to environmental antigens, and the presence of characteristic changes in high resolution chest computed tomography (HRCT) (bilateral, mosaic, ground glass opacities in the middle and lower lung zones, ill-defined centrilobular nodules and the sign of air-trapping on expiration). This type of HRCT pattern is most frequently found in the patients with subacute HP. Bronchioloalveolar lavage fluid (BALF) examination is helpful in establishing the HP diagnosis, when the increased total number of cells, with the predominance of T lymphocytes (> 50%), and the increased number of neutrophils (> 3%) and mastocytes (> 1%) are found. The presence of specific serum precipitins increases the likelihood of HP. In case of atypical clinical presentation, lung biopsy is recommended. The diagnostic criterion of HP is the presence of ill-defined non-necrotising granulomas, after excluding other granulomatous lung diseases. The prevention and treatment of HP is based on the elimination of the antigen from the environment. Corticosteroids may contribute to the improvement in the acute and sub-acute form of the disease but their long term effectiveness is uncertain. The prognosis of HP patients is generally perceived as good, especially in those patients in whom antigen avoidance is possible. Nevertheless, in some patients progressive pulmonary fibrosis and development of severe respiratory insufficiency is observed. Med Pr 2016;67(4):517-527. PMID:27623832

  18. Heat exchanger staybolt acceptance criteria. Task number: 90-058-1

    SciTech Connect

    Lam, P.S.; Sindelar, R.L.; Barnes, D.M.

    1992-02-01

    The structural integrity demonstration of the primary coolant piping system includes evaluating the structural capacity of each component against a large break or equivalent Double-Ended Guillotine Break. A large break at the inlet or outlet heads of the heat exchangers would occur if the restraint members of the heads become inactive. The structural integrity of the heads is demonstrated by showing the redundant capacity of the staybolts to restrain the head at design conditions and under seismic loadings. The Savannah River Site heat exchanger head is attached to the tubesheet by 84 staybolts. Access to the staybolts is limited due to a welded seal cap over the staybolts. An ultrasonic testing (UT) inspection technique to provide an in-situ examination of the staybolts has recently been developed at SRS. Examination of the staybolts will be performed to ensure their service condition and configuration is within acceptance limits. An acceptance criteria methodology has been developed to disposition flaws reported in the staybolt inspections while ensuring adequate restraint capacity of the staybolts to maintain integrity of the heat exchanger heads against collapse. The methodology includes an approach for the baseline and periodic inspections of the staybolts. The heat exchanger head is analyzed with a three-dimensional finite element model. The restraint provided by the staybolts is evaluated for several postulated cases of inactive or missing staybolts. Evaluation of specific, inactive staybolt configurations based on the UT results can be performed with the finite element model and fracture methodology in this report.

  19. CTOD-based acceptance criteria for heat exchanger head staybolts. [Crack Tip Opening Displacement (CTOD)

    SciTech Connect

    Lam, P.S.; Sindelar, R.L.; Barnes, D.M.; Awadalla, N.G.

    1992-01-01

    The primary coolant piping system of the Savannah River Site (SRS) reactors contains twelve heat exchangers to remove the waste heat from the nuclear materials production. A large break at the inlet or outlet heads of the heat exchangers would occur if the restraint members of the heads become inactive. The heat exchanger head is attached to the tubesheet by 84 staybolts. The structural integrity of the heads is demonstrated by showing the redundant capacity of the staybolts to restrain the head at design conditions and under seismic loadings. The beat exchanger head is analyzed with a three- dimensional finite element model. The restraint provided by the staybolts is evaluated for several postulated cases of inactive or missing staybolts, that is, bolts that have a flaw exceeding the ultrasonic testing (UT) threshold depth of 25% of the bolt diameter. A limit of 6 inactive staybolts is reached with a fracture criterion based on the maximum allowable local displacement at the active staybolts which corresponds to the crack tip opening displacement (CTOD) of 0.032 inches. An acceptance criteria methodology has been developed to disposition flaws reported in the staybolt inspections while ensuring adequate restraint capacity of the staybolts to maintain integrity of the heat exchanger heads against collapse. The methodology includes an approach for the baseline and periodic inspections of the staybolts. A total of up to 6 staybolts, reported as containing flaws with depths at or exceeding 25% would be acceptable in the heat exchanger.

  20. Visual weld acceptance criteria: Volume 3, Training manual for inspectors of structural welds at nuclear power plants using the acceptance criteria of NCIG-01 (NCIG-03, Revision 1): Final report

    SciTech Connect

    Not Available

    1987-09-01

    The Nuclear Construction Issues Group (NCIG) was formed to resolve common problems being experienced at nuclear power plants in the assurance of hardware quality for which common solutions likely existed. The initial activity undertaken by this group was development of visual weld acceptance criteria and inspection guidance for structural welds. This report documents the results of this NCIC - activity the discussion of a training manual for inspectors of structural welds at nuclear power plants using the acceptance criteria of NCIG-01 (NCIG-03, Revision 1).

  1. Functional Nausea in Children: A Review of the Literature and Need for Diagnostic Criteria.

    PubMed

    Russell, Alexandra C; Stone, Amanda L; Walker, Lynn S

    2016-01-01

    Nausea is common amongst children with functional gastrointestinal disorders and is associated with a high burden of somatic and psychosocial comorbidities in both the short and long-term. Current treatments including medications, phytotherapy, stress-reduction techniques, and gastric electrical stimulation for recalcitrant cases, are reviewed. Functional nausea merits its own diagnostic criteria as a pediatric functional gastrointestinal disorder. PMID:27417243

  2. Evaluation of Diagnostic Criteria for Night Eating Syndrome Using Item Response Theory Analysis

    PubMed Central

    Allison, Kelly C.; Engel, Scott G.; Crosby, Ross D.; de Zwaan, Martina; O’Reardon, John P.; Wonderlich, Stephen A.; Mitchell, James E.; West, Delia Smith; Wadden, Thomas A.; Stunkard, Albert J.

    2008-01-01

    Uniform diagnostic criteria for the night eating syndrome (NES), a disorder characterized by a delay in the circadian pattern of eating, have not been established. Proposed criteria for NES were evaluated using item response theory (IRT) analysis. Six studies yielded 1,481 Night Eating Questionnaires which were coded to reflect the presence/absence of five night eating symptoms. Symptoms were evaluated based on the clinical usefulness of their diagnostic information and on the assumptions of IRT analysis (unidimensionality, monotonicity, local item independence, correct model specification), using a two parameter logistic (2PL) IRT model. Reports of (1) nocturnal eating and/or evening hyperphagia, (2) initial insomnia, and (3) night awakenings showed high precision in discriminating those with night eating problems, while morning anorexia and delayed morning meal provided little additional information. IRT is a useful tool for evaluating the diagnostic criteria of psychiatric disorders and can be used to evaluate potential diagnostic criteria of NES empirically. Behavioral factors were identified as useful discriminators of NES. Future work should also examine psychological factors in conjunction with those identified here. PMID:18928902

  3. Updating of Safety Criteria for Basic Diagnostic Indicators of Dam at the Sayano-Shushenskaya HPP

    SciTech Connect

    Gordon, L. A.; Skvortsova, A. E.

    2013-09-15

    Values of diagnostic indicators [K]-limitations placed on radial displacements and turn angles of horizontal sections of the dam - which are permitted for each upper-pool level within the range from 520 to 539 m are determined and proposed for inclusion in the Declaration of Safety. Empirical relationships used to develop safety criteria K1 and K2 are modified.

  4. Functional Nausea in Children: A Review of the Literature and Need for Diagnostic Criteria

    PubMed Central

    Russell, Alexandra C.; Stone, Amanda L.; Walker, Lynn S.

    2016-01-01

    Nausea is common amongst children with functional gastrointestinal disorders and is associated with a high burden of somatic and psychosocial comorbidities in both the short and long-term. Current treatments including medications, phytotherapy, stress-reduction techniques, and gastric electrical stimulation for recalcitrant cases, are reviewed. Functional nausea merits its own diagnostic criteria as a pediatric functional gastrointestinal disorder. PMID:27417243

  5. Sensitivity and Specificity of Proposed "DSM-5" Diagnostic Criteria for Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    McPartland, James C.; Reichow, Brian; Volkmar, Fred R.

    2012-01-01

    Objective: This study evaluated the potential impact of proposed "DSM-5" diagnostic criteria for autism spectrum disorder (ASD). Method: The study focused on a sample of 933 participants evaluated during the "DSM-IV" field trial; 657 carried a clinical diagnosis of an ASD, and 276 were diagnosed with a non-autistic disorder. Sensitivity and…

  6. Exploratory Factor Analysis of Diagnostic and Statistical Manual, 5th Edition, Criteria for Posttraumatic Stress Disorder.

    PubMed

    McSweeney, Lauren B; Koch, Ellen I; Saules, Karen K; Jefferson, Stephen

    2016-01-01

    One change to the posttraumatic stress disorder (PTSD) nomenclature highlighted in the Diagnostic and Statistical Manual, 5th Edition (DSM-5; American Psychiatric Association, 2013) is the conceptualization of PTSD as a diagnostic category with four distinct symptom clusters. This article presents exploratory factor analysis to test the structural validity of the DSM-5 conceptualization of PTSD via an online survey that included the PTSD Checklist-5. The study utilized a sample of 113 college students from a large Midwestern university and 177 Amazon Mechanical Turk users. Participants were primarily female, Caucasian, single, and heterosexual with an average age of 32 years. Approximately 30% to 35% of participants met diagnostic criteria for PTSD based on two different scoring criteria. Results of the exploratory factor analysis revealed five distinct symptom clusters. The implications for the classification of PTSD are discussed. PMID:26669983

  7. Diagnostic Criteria for Problematic Internet Use among U.S. University Students: A Mixed-Methods Evaluation.

    PubMed

    Li, Wen; O'Brien, Jennifer E; Snyder, Susan M; Howard, Matthew O

    2016-01-01

    Empirical studies have identified increasing rates of problematic Internet use worldwide and a host of related negative consequences. However, researchers disagree as to whether problematic Internet use is a subtype of behavioral addiction. Thus, there are not yet widely accepted and validated diagnostic criteria for problematic Internet use. To address this gap, we used mixed-methods to examine the extent to which signs and symptoms of problematic Internet use mirror DSM-5 diagnostic criteria for substance use disorder, gambling disorder, and Internet gaming disorder. A total of 27 university students, who self-identified as intensive Internet users and who reported Internet-use-associated health and/or psychosocial problems were recruited. Students completed two measures that assess problematic Internet use (Young's Diagnostic Questionnaire and the Compulsive Internet Use Scale) and participated in focus groups exploring their experiences with problematic Internet use. Results of standardized measures and focus group discussions indicated substantial overlap between students' experiences of problematic Internet use and the signs and symptoms reflected in the DSM-5 criteria for substance use disorder, gambling disorder, and Internet gaming disorder. These signs and symptoms included: a) use Internet longer than intended, b) preoccupation with the Internet, c) withdrawal symptoms when unable to access the Internet, d) unsuccessful attempts to stop or reduce Internet use, e) craving, f) loss of interest in hobbies or activities other than the Internet, g) excessive Internet use despite the knowledge of related problems, g) use of the Internet to escape or relieve a negative mood, and h) lying about Internet use. Tolerance, withdrawal symptoms, and recurrent Internet use in hazardous situations were uniquely manifested in the context of problematic Internet use. Implications for research and practice are discussed. PMID:26751569

  8. Diagnostic Criteria for Problematic Internet Use among U.S. University Students: A Mixed-Methods Evaluation

    PubMed Central

    Li, Wen; O’Brien, Jennifer E.; Snyder, Susan M.; Howard, Matthew O.

    2016-01-01

    Empirical studies have identified increasing rates of problematic Internet use worldwide and a host of related negative consequences. However, researchers disagree as to whether problematic Internet use is a subtype of behavioral addiction. Thus, there are not yet widely accepted and validated diagnostic criteria for problematic Internet use. To address this gap, we used mixed-methods to examine the extent to which signs and symptoms of problematic Internet use mirror DSM-5 diagnostic criteria for substance use disorder, gambling disorder, and Internet gaming disorder. A total of 27 university students, who self-identified as intensive Internet users and who reported Internet-use-associated health and/or psychosocial problems were recruited. Students completed two measures that assess problematic Internet use (Young’s Diagnostic Questionnaire and the Compulsive Internet Use Scale) and participated in focus groups exploring their experiences with problematic Internet use. Results of standardized measures and focus group discussions indicated substantial overlap between students’ experiences of problematic Internet use and the signs and symptoms reflected in the DSM-5 criteria for substance use disorder, gambling disorder, and Internet gaming disorder. These signs and symptoms included: a) use Internet longer than intended, b) preoccupation with the Internet, c) withdrawal symptoms when unable to access the Internet, d) unsuccessful attempts to stop or reduce Internet use, e) craving, f) loss of interest in hobbies or activities other than the Internet, g) excessive Internet use despite the knowledge of related problems, g) use of the Internet to escape or relieve a negative mood, and h) lying about Internet use. Tolerance, withdrawal symptoms, and recurrent Internet use in hazardous situations were uniquely manifested in the context of problematic Internet use. Implications for research and practice are discussed. PMID:26751569

  9. Expanding the Taxonomy of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)

    PubMed Central

    Peck, Christopher C.; Goulet, Jean-Paul; Lobbezoo, Frank; Schiffman, Eric L.; Alstergren, Per; Anderson, Gary C.; de Leeuw, Reny; Jensen, Rigmor; Michelotti, Ambra; Ohrbach, Richard; Petersson, Arne; List, Thomas

    2014-01-01

    Background There is a need to expand the current temporomandibular disorder (TMD) classification to include less common, but clinically important disorders. The immediate aim was to develop a consensus-based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long-term aim was to establish a foundation, vis-à-vis this classification system, that will stimulate data collection, validity testing, and further criteria refinement. Methods A working group [members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies] reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria, and the ability to operationalize and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMD taxonomy was presented for feedback at international meetings. Results Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders, and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalized diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. Conclusions The expanded TMD taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalize and test the proposed taxonomy and diagnostic criteria. PMID:24443898

  10. Evaluation of ISDP Batch 2 Qualification Compliance to 512-S, DWPF, Tank Farm, and Saltstone Waste Acceptance Criteria

    SciTech Connect

    Shafer, A.

    2010-05-05

    The purpose of this report is to document the acceptability of the second macrobatch (Salt Batch 2) of Tank 49H waste to H Tank Farm, DWPF, and Saltstone for operation of the Interim Salt Disposition Project (ISDP). Tank 49 feed meets the Waste Acceptance Criteria (WAC) requirements specified by References 11, 12, and 13. Salt Batch 2 material is qualified and ready to be processed through ARP/MCU to the final disposal facilities.

  11. The Revised Research Diagnostic Criteria for Temporomandibular Disorders: Methods used to Establish and Validate Revised Axis I Diagnostic Algorithms

    PubMed Central

    Schiffman, Eric L.; Ohrbach, Richard; Truelove, Edmond L.; Feng, Tai; Anderson, Gary C.; Pan, Wei; Gonzalez, Yoly M.; John, Mike T.; Sommers, Earl; List, Thomas; Velly, Ana M.; Kang, Wenjun; Look, John O.

    2011-01-01

    AIMS To derive reliable and valid revised Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms for clinical TMD diagnoses. METHODS The multi-site RDC/TMD Validation Project’s dataset (614 TMD community and clinic cases, and 91 controls) was used to derive revised algorithms for Axis I TMD diagnoses. Validity of diagnostic algorithms was assessed relative to reference standards, the latter based on consensus diagnoses rendered by 2 TMD experts using criterion examination data, including temporomandibular joint imaging. Cut-offs for target validity were sensitivity ≥ 0.70 and specificity ≥ 0.95. Reliability of revised algorithms was assessed in 27 study participants. RESULTS Revised algorithm sensitivity and specificity exceeded the target levels for myofascial pain (0.82, 0.99, respectively) and myofascial pain with limited opening (0.93, 0.97). Combining diagnoses for any myofascial pain showed sensitivity of 0.91 and specificity of 1.00. For joint pain, target sensitivity and specificity were observed (0.92, 0.96) when arthralgia and osteoarthritis were combined as “any joint pain.” Disc displacement without reduction with limited opening demonstrated target sensitivity and specificity (0.80, 0.97). For the other Group II disc displacements and Group III osteoarthritis and osteoarthrosis, sensitivity was below target (0.35 to 0.53), and specificity ranged from 0.80 to meeting target. Kappa for revised algorithm diagnostic reliability was ≥ 0.63. CONCLUSION Revised RDC/TMD Axis I TMD diagnostic algorithms are recommended for myofascial pain and joint pain as reliable and valid. However, revised clinical criteria alone, without recourse to imaging, are inadequate for valid diagnosis of two of the three disc displacements and osteoarthritis/osteoarthrosis. PMID:20213032

  12. Characterization of Tank 23H Supernate Per Saltstone Waste Acceptance Criteria Analysis Requirements -2005

    SciTech Connect

    Oji, L

    2005-05-05

    Variable depth Tank 23H samples (22-inch sample [HTF-014] and 185-inch sample [HTF-013]) were pulled from Tank 23H in February, 2005 for characterization. The characterization of the Tank 23H low activity waste is part of the overall liquid waste processing activities. This characterization examined the species identified in the Saltstone Waste Acceptance Criteria (WAC) for the transfer of waste into the Salt-Feed Tank (SFT). The samples were delivered to the Savannah River National Laboratory (SRNL) and analyzed. Apart from radium-226 with an average measured detection limit of < 2.64E+03 pCi/mL, which is about the same order of magnitude as the WAC limit (< 8.73E+03 pCi/mL), none of the species analyzed was found to approach the limits provided in the Saltstone WAC. The concentration of most of the species analyzed for the Tank 23H samples were 2-5 orders of magnitude lower than the WAC limits. The achievable detection limits for a number of the analytes were several orders of magnitude lower than the WAC limits, but one or two orders of magnitude higher than the requested detection limits. Analytes which fell into this category included plutonium-241, europium-154/155, antimony-125, tin-126, ruthenium/rhodium-106, selenium-79, nickel-59/63, ammonium ion, copper, total nickel, manganese and total organic carbon.

  13. Characterization of Tank 23H Supernate Per Saltstone Waste Acceptance Criteria Analysis Requirements-2005

    SciTech Connect

    Oji, L

    2005-06-01

    Variable depth Tank 23H samples (22-inch sample [HTF-014] and 185-inch sample [HTF-013]) were pulled from Tank 23H in February, 2005 for characterization. The characterization of the Tank 23H low activity waste is part of the overall liquid waste processing activities. This characterization examined the species identified in the Saltstone Waste Acceptance Criteria (WAC) for the transfer of waste into the Salt-Feed Tank (SFT). The samples were delivered to the Savannah River National Laboratory (SRNL) and analyzed. Apart from radium-226 with an average measured detection limit of < 2.64E+03 pCi/mL, which is about the same order of magnitude as the WAC limit (< 8.73E+03 pCi/mL), none of the species analyzed was found to approach the limits provided in the Saltstone WAC. The concentration of most of the species analyzed for the Tank 23H samples were 2-5 orders of magnitude lower than the WAC limits. The achievable detection limits for a number of the analytes were several orders of magnitude lower than the WAC limits, but one or two orders of magnitude higher than the requested detection limits. Analytes which fell into this category included plutonium-241, europium-154/155, antimony-125, tin-126, ruthenium/rhodium-106, selenium-79, nickel-59/63, ammonium ion, copper, total nickel, manganese and total organic carbon.

  14. Development of flaw acceptance criteria for aging management of spent nuclear fuel multiple-purpose canisters

    SciTech Connect

    Lam, P.; Sindelar, R.

    2015-03-09

    A typical multipurpose canister (MPC) is made of austenitic stainless steel and is loaded with spent nuclear fuel assemblies. The canister may be subject to service-induced degradation when it is exposed to aggressive atmospheric environments during a possibly long-term storage period if the permanent repository is yet to be identified and readied. Because heat treatment for stress relief is not required for the construction of an MPC, stress corrosion cracking may be initiated on the canister surface in the welds or in the heat affected zone. An acceptance criteria methodology is being developed for flaw disposition should the crack-like defects be detected by periodic In-service Inspection. The first-order instability flaw sizes has been determined with bounding flaw configurations, that is, through-wall axial or circumferential cracks, and part-through-wall long axial flaw or 360° circumferential crack. The procedure recommended by the American Petroleum Institute (API) 579 Fitness-for-Service code (Second Edition) is used to estimate the instability crack length or depth by implementing the failure assessment diagram (FAD) methodology. The welding residual stresses are mostly unknown and are therefore estimated with the API 579 procedure. It is demonstrated in this paper that the residual stress has significant impact on the instability length or depth of the crack. The findings will limit the applicability of the flaw tolerance obtained from limit load approach where residual stress is ignored and only ligament yielding is considered.

  15. Development of flaw acceptance criteria for aging management of spent nuclear fuel multi-purpose canisters

    SciTech Connect

    Lam, Poh -Sang; Sindelar, Robert L.

    2015-03-09

    A typical multipurpose canister (MPC) is made of austenitic stainless steel and is loaded with spent nuclear fuel assemblies. The canister may be subject to service-induced degradation when it is exposed to aggressive atmospheric environments during a possibly long-term storage period if the permanent repository is yet to be identified and readied. Because heat treatment for stress relief is not required for the construction of an MPC, stress corrosion cracking may be initiated on the canister surface in the welds or in the heat affected zone. An acceptance criteria methodology is being developed for flaw disposition should the crack-like defects be detected by periodic in-service Inspection. The first-order instability flaw sizes has been determined with bounding flaw configurations, that is, through-wall axial or circumferential cracks, and part-through-wall long axial flaw or 360° circumferential crack. The procedure recommended by the American Petroleum Institute (API) 579 Fitness-for-Service code (Second Edition) is used to estimate the instability crack length or depth by implementing the failure assessment diagram (FAD) methodology. The welding residual stresses are mostly unknown and are therefore estimated with the API 579 procedure. It is demonstrated in this paper that the residual stress has significant impact on the instability length or depth of the crack. The findings will limit the applicability of the flaw tolerance obtained from limit load approach where residual stress is ignored and only ligament yielding is considered.

  16. Validating new diagnostic imaging criteria for primary progressive aphasia via anatomical likelihood estimation meta-analyses.

    PubMed

    Bisenius, S; Neumann, J; Schroeter, M L

    2016-04-01

    Recently, diagnostic clinical and imaging criteria for primary progressive aphasia (PPA) have been revised by an international consortium (Gorno-Tempini et al. Neurology 2011;76:1006-14). The aim of this study was to validate the specificity of the new imaging criteria and investigate whether different imaging modalities [magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (FDG-PET)] require different diagnostic subtype-specific imaging criteria. Anatomical likelihood estimation meta-analyses were conducted for PPA subtypes across a large cohort of 396 patients: firstly, across MRI studies for each of the three PPA subtypes followed by conjunction and subtraction analyses to investigate the specificity, and, secondly, by comparing results across MRI vs. FDG-PET studies in semantic dementia and progressive nonfluent aphasia. Semantic dementia showed atrophy in temporal, fusiform, parahippocampal gyri, hippocampus, and amygdala, progressive nonfluent aphasia in left putamen, insula, middle/superior temporal, precentral, and frontal gyri, logopenic progressive aphasia in middle/superior temporal, supramarginal, and dorsal posterior cingulate gyri. Results of the disease-specific meta-analyses across MRI studies were disjunct. Similarly, atrophic and hypometabolic brain networks were regionally dissociated in both semantic dementia and progressive nonfluent aphasia. In conclusion, meta-analyses support the specificity of new diagnostic imaging criteria for PPA and suggest that they should be specified for each imaging modality separately. PMID:26901360

  17. Standardized diagnostic interviews, criteria, and algorithms for mental disorders: garbage in, garbage out.

    PubMed

    Linden, Michael; Muschalla, Beate

    2012-09-01

    There is a general consensus that diagnoses for mental disorders should be based on criteria and algorithms as given in ICD or DSM. Standardized clinical interviews are recommended as diagnostic methods. In ICD and DSM, much emphasis is put on algorithms, while the underlying criteria get much less attention. The question is how valid are the criteria that are collected by structured diagnostic interviews. 209 patients from a cardiology inpatient unit were interviewed with the Mini International Neuropsychiatric Interview (MINI). 32 (15.3%) were diagnosed as suffering from a major depressive episode or dysthymia. Additionally, a thorough clinical examination was done by a psychiatric expert in 15 patients. The standardized diagnosis of present major depression was reaffirmed in one. In total, four patients were suffering from some kind of depressive disorder presently or life time. Two patients were suffering from anxiety disorders, two from adjustment disorders, and four from different types of organic brain disorders. Most important, there are 3 out of 15 who are not mentally ill. Our observations show that standardized diagnostic interviews cannot be used to make specific differential diagnoses, but rather catch unspecific syndromes. This is partly due to the fact that the wording, definition, and understanding of the underlying criteria is rather vague. This is an even greater problem if there is any somatic comorbidity. In the revision of ICD and DSM, a glossary of psychopathological terms and guidelines for the training of clinicians should be included. PMID:22274737

  18. Antidepressant discontinuation manic states: a critical review of the literature and suggested diagnostic criteria.

    PubMed

    Narayan, Vinesh; Haddad, Peter M

    2011-03-01

    We critically appraised all published reports of hypomania and mania following antidepressant termination. To increase reliability and validity we devised diagnostic criteria for an antidepressant discontinuation or withdrawal 'manic state' based primarily on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition substance withdrawal criteria. A systematic literature review identified 24 reports meeting our criteria. Mean age was 39 years (range 18-74), men and women were approximately equally represented, and more cases involved people with unipolar (n = 19) than bipolar disorder (n = 4). The median duration of preceding antidepressant treatment was 12 weeks (range 4 weeks-12 years). All major antidepressant classes were involved (tricyclic antidepressants = 13; selective serotonin reuptake inhibitors = 5; monoamine oxidase inhibitors = 3; selective serotonin-norepinephrine reuptake inhibitors = 2; miscellaneous = 1). More cases followed abrupt antidepressant withdrawal (n = 11) than a tapered withdrawal (n = 6). Six cases appeared to meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition for a manic episode, with two cases requiring inpatient admission. Of the 24 cases, nine resolved spontaneously without treatment (median duration = 25.5 days), six responded to antimanic drugs, four resolved following antidepressant reinstatement, and treatment was unclear in five cases. We conclude that antidepressant discontinuation hypomania/mania is a valid syndrome. It should be added to the differential diagnosis of hypomania/mania. The clinical implications and possible mechanisms are discussed. PMID:20156925

  19. Validity of the Research Diagnostic Criteria for Temporomandibular Disorders Axis I in clinical and research settings.

    PubMed

    Steenks, Michel H; de Wijer, Anton

    2009-01-01

    The lack of standardized diagnostic criteria for defining clinical subtypes of temporomandibular disorders (TMD) was the main motive to create the Research Diagnostic Criteria for TMD (RDC/TMD), which were provided to allow standardization and replication of research into the most common forms of muscle- and joint-related TMD. The RDC/TMD offered improvement compared to the older literature: the use of one system classifying TMD subgroups and the introduction of a dual-axis classification. The aim of this Focus Article is to appraise the RDC/TMD Axis I (physical findings). Since the original publication in 1992, no modification of the RDC/TMD has taken place, although research has yielded important new findings. The article outlines several concerns, including diagnostic issues in Axis I, classification criteria, feasibility of palpation sites, the myofascial diagnostic algorithm, the lack of joint tests (compression, traction), and missing subgroups. Using a gold standard examiner may improve calibration and offer better reliability; it does not improve any of the diagnostic validity issues. It is also noted that in the 2004 mission statement of the International Consortium For RDC/TMD-Based Research, the RDC/TMD are also advocated for clinical settings. Clinicians may eagerly embrace the RDC/TMD, believing that the clinical use of the RDC/TMD as a diagnostic procedure is already supported by evidence, but its application is not indicated in clinical settings. The article concludes that given the research developments, there is a need to update the RDC/TMD Axis I in the clinical research setting. PMID:19264032

  20. Creutzfeldt-Jakob disease: updated diagnostic criteria, treatment algorithm, and the utility of brain biopsy.

    PubMed

    Manix, Marc; Kalakoti, Piyush; Henry, Miriam; Thakur, Jai; Menger, Richard; Guthikonda, Bharat; Nanda, Anil

    2015-11-01

    Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative condition with a rapid disease course and a mortality rate of 100%. Several forms of the disease have been described, and the most common is the sporadic type. The most challenging aspect of this disease is its diagnosis-the gold standard for definitive diagnosis is considered to be histopathological confirmation-but newer tests are providing means for an antemortem diagnosis in ways less invasive than brain biopsy. Imaging studies, electroencephalography, and biomarkers are used in conjunction with the clinical picture to try to make the diagnosis of CJD without brain tissue samples, and all of these are reviewed in this article. The current diagnostic criteria are limited; test sensitivity and specificity varies with the genetics of the disease as well as the clinical stage. Physicians may be unsure of all diagnostic testing available, and may order outdated tests or prematurely request a brain biopsy when the diagnostic workup is incomplete. The authors review CJD, discuss the role of brain biopsy in this patient population, provide a diagnostic pathway for the patient presenting with rapidly progressive dementia, and propose newer diagnostic criteria. PMID:26646926

  1. 10 CFR 50.46 - Acceptance criteria for emergency core cooling systems for light-water nuclear power reactors.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Acceptance criteria for emergency core cooling systems for light-water nuclear power reactors. 50.46 Section 50.46 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC... include the rupture opening. (3) Maximum hydrogen generation. The calculated total amount of...

  2. 32 CFR 37.530 - What criteria do I use in deciding whether to accept a recipient's cost sharing?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... and development (IR&D) costs, as described at 32 CFR 34.13(a)(5)(ii), that meet all of the criteria in paragraphs (a) through (e) of this section. IR&D is acceptable as cost sharing, even though it may be... principles at 48 CFR part 31 allow a for-profit firm that has expenditure-based, Federal...

  3. 32 CFR 37.530 - What criteria do I use in deciding whether to accept a recipient's cost sharing?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... and development (IR&D) costs, as described at 32 CFR 34.13(a)(5)(ii), that meet all of the criteria in paragraphs (a) through (e) of this section. IR&D is acceptable as cost sharing, even though it may be... principles at 48 CFR part 31 allow a for-profit firm that has expenditure-based, Federal...

  4. 32 CFR 37.530 - What criteria do I use in deciding whether to accept a recipient's cost sharing?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... and development (IR&D) costs, as described at 32 CFR 34.13(a)(5)(ii), that meet all of the criteria in paragraphs (a) through (e) of this section. IR&D is acceptable as cost sharing, even though it may be... principles at 48 CFR part 31 allow a for-profit firm that has expenditure-based, Federal...

  5. 32 CFR 37.530 - What criteria do I use in deciding whether to accept a recipient's cost sharing?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... and development (IR&D) costs, as described at 32 CFR 34.13(a)(5)(ii), that meet all of the criteria in paragraphs (a) through (e) of this section. IR&D is acceptable as cost sharing, even though it may be... principles at 48 CFR part 31 allow a for-profit firm that has expenditure-based, Federal...

  6. Compliance with Waste Acceptance Criteria of WIPP and NTS for Vitrified Low-Level and TRU Waste Forms

    SciTech Connect

    Harbour, J.R.; Andrews, M.K.

    1998-07-01

    A joint project between the Oak Ridge National Laboratory (ORNL) and the Savannah River Technology Center (SRTC) has been established to evaluate vitrification as an option for the immobilization of waste within ORNL tank farms. This paper presents details of calculations based on current best available analyses of the Oak Ridge Tanks on the limits for waste loadings imposed by the waste acceptance criteria.

  7. 21 CFR 212.70 - What controls and acceptance criteria must I have for my finished PET drug products?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... POSITRON EMISSION TOMOGRAPHY DRUGS Finished Drug Product Controls and Acceptance § 212.70 What controls and... specifications for each PET drug product, including criteria for determining identity, strength, quality, purity... each batch of a PET drug product conforms to specifications, except for sterility. For a PET...

  8. 21 CFR 212.70 - What controls and acceptance criteria must I have for my finished PET drug products?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... POSITRON EMISSION TOMOGRAPHY DRUGS Finished Drug Product Controls and Acceptance § 212.70 What controls and... specifications for each PET drug product, including criteria for determining identity, strength, quality, purity... each batch of a PET drug product conforms to specifications, except for sterility. For a PET...

  9. 21 CFR 212.70 - What controls and acceptance criteria must I have for my finished PET drug products?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... POSITRON EMISSION TOMOGRAPHY DRUGS Finished Drug Product Controls and Acceptance § 212.70 What controls and... specifications for each PET drug product, including criteria for determining identity, strength, quality, purity... each batch of a PET drug product conforms to specifications, except for sterility. For a PET...

  10. 40 CFR 91.608 - Compliance with acceptable quality level and passing and failing criteria for selective...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Compliance with acceptable quality level and passing and failing criteria for selective enforcement audits. 91.608 Section 91.608 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM MARINE SPARK-IGNITION...

  11. 40 CFR 90.510 - Compliance with acceptable quality level and passing and failing criteria for selective...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Compliance with acceptable quality level and passing and failing criteria for selective enforcement audits. 90.510 Section 90.510 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM NONROAD SPARK-IGNITION ENGINES AT...

  12. 40 CFR 89.510 - Compliance with acceptable quality level and passing and failing criteria for selective...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Compliance with acceptable quality level and passing and failing criteria for selective enforcement audits. 89.510 Section 89.510 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM NEW AND IN-USE...

  13. 10 CFR 51.108 - Public hearings on Commission findings that inspections, tests, analyses, and acceptance criteria...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... CFR 52.103(b), the Commission will not admit any contentions on environmental issues, the adequacy of... finding under 10 CFR 52.103(g). materials licenses ..., tests, analyses, and acceptance criteria of combined licenses are met. 51.108 Section 51.108...

  14. 10 CFR 50.60 - Acceptance criteria for fracture prevention measures for lightwater nuclear power reactors for...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Acceptance criteria for fracture prevention measures for lightwater nuclear power reactors for normal operation. 50.60 Section 50.60 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF PRODUCTION AND UTILIZATION FACILITIES Issuance, Limitations, and Conditions of Licenses and Construction Permits...

  15. Evaluation of Sludge Batch 5 Qualification with ISDP Salt Batch 1 Compliance to DWPF Waste Acceptance Criteria

    SciTech Connect

    Shafer, A.

    2010-05-05

    The purpose of this report is to document the acceptability of Sludge Batch 5 with the initial macrobatch operation of the Interim Salt Disposition Project (ISDP) waste to the Defense Waste Processing Facility (DWPF). This report was prepared to comply with the requirements listed in the Waste Acceptance Criteria for Sludge, Actinide Removal Process (ARP), and Modular Caustic Side Solvent Extraction Unit (MCU) Process Transfers to 512-S and DWPF. The requirements for transfers to 512-S were evaluated during ISDP Salt Batch 1 qualification. The calculations of sludge concentrations are based entirely on the Tank 51 sample processed at SRNL. This is conservative because Tank 51 is blended with the dilute feed in the DWPF Feed Tank (Tank 40). This report documents the acceptability of sludge only as well as Sludge Batch 5 sludge slurry combined with ARP/MCU products for feed to DWPF. All criteria were met for unblended Tank 51 material.

  16. Spent Nuclear Fuel (SNF) Project Acceptance Criteria for Light Water Reactor Spent Fuel Storage System [OCRWM PER REV2

    SciTech Connect

    JOHNSON, D.M.

    2000-12-20

    As part of the decommissioning of the 324 Building Radiochemical Engineering Cells there is a need to remove commercial Light Water Reactor (LWR) spent nuclear fuel (SNF) presently stored in these hot cells. To enable fuel removal from the hot cells, the commercial LWR SNF will be packaged and shipped to the 200 Area Interim Storage Area (ISA) in a manner that satisfies site requirements for SNF interim storage. This document identifies the criteria that the 324 Building Radiochemical Engineering Cell Clean-out Project must satisfy for acceptance of the LWR SNF by the SNF Project at the 200 Area ISA. In addition to the acceptance criteria identified herein, acceptance is contingent on adherence to applicable Project Hanford Management Contract requirements and procedures in place at the time of work execution.

  17. Application of diagnostic and treatment criteria for common variable immunodeficiency disorder.

    PubMed

    Ameratunga, Rohan; Storey, Peter; Barker, Russell; Jordan, Anthony; Koopmans, Wikke; Woon, See-Tarn

    2016-03-01

    Common variable immunodeficiency disorder (CVID) is the most frequent symptomatic primary immune deficiency disorder in adults. It probably comprises a spectrum of polygenic disorders, with hypogammaglobulinemia being the overarching feature. While the majority of patients with CVID can be identified with relative ease, a significant proportion can present with minimal symptoms in spite of profound laboratory abnormalities. Here we discuss three patients who were presented to the Auckland Hospital immunoglobulin treatment committee to determine if they qualified for immunoglobulin replacement. Two were asymptomatic with profound laboratory abnormalities while the third patient was severely ill with extensive bronchiectasis. The third patient had less severe laboratory abnormalities compared with the two asymptomatic patients. We have applied four sets of published diagnostic and treatment criteria to these patients to compare their clinical utility. We have chosen these patients from the broad phenotypic spectrum of CVID, as this often illustrates differences in diagnostic and treatment criteria. PMID:26623716

  18. Diagnostic Criteria, Classification and Treatment Goals in Multiple Sclerosis: The Chronicles of Time and Space.

    PubMed

    Ntranos, Achilles; Lublin, Fred

    2016-10-01

    Multiple sclerosis (MS) is one of the most diverse human diseases. Since its first description by Charcot in the nineteenth century, the diagnostic criteria, clinical course classification, and treatment goals for MS have been constantly revised and updated to improve diagnostic accuracy, physician communication, and clinical trial design. These changes have improved the clinical outcomes and quality of life for patients with the disease. Recent technological and research breakthroughs will almost certainly further change how we diagnose, classify, and treat MS in the future. In this review, we summarize the key events in the history of MS, explain the reasoning behind the current criteria for MS diagnosis, classification, and treatment, and provide suggestions for further improvements that will keep enhancing the clinical practice of MS. PMID:27549391

  19. Diagnostic criteria for selenium toxicosis in aquatic birds: dietary exposure, tissue concentrations, and macroscopic effects.

    PubMed

    Albers, P H; Green, D E; Sanderson, C J

    1996-07-01

    A feeding study with mallard ducks (Anas platyrhynchos) was conducted during March to July 1988 in Laurel, Maryland (USA), to identify diagnostic criteria for selenium toxicosis in birds. One-year-old male mallards in groups of 21 were fed diets containing 0, 10, 20, 40, or 80 parts per million (ppm) selenium, as seleno-DL-methionine, for 16 weeks. All ducks receiving 80 ppm died. Ducks receiving 40 or 80 ppm selenium consumed less feed than ducks in the other treatment groups. Body weights of ducks receiving 40 or 80 ppm selenium declined during the study. The post-breeding molt was delayed in ducks receiving 40 ppm; most ducks receiving 80 ppm selenium died prior to the onset of molt. At necropsy, numerous abnormalities were observed in ducks that died but only a small number of abnormalities were observed in ducks surviving to the end of the study in the 40 ppm group. Weights of the heart, spleen, and pancreas were mostly lower and weights of the kidney were higher for ducks dying during the study than for euthanized ducks. Liver weights were unaffected. Selenium accumulated in soft tissues approximately in proportion to dietary concentrations. Selenium concentrations in tissues of all ducks that died were different from those of surviving ducks in the 0, 10, and 20 ppm groups, but were not different from those of surviving ducks in the 40 ppm group. Proposed diagnostic criteria for fatal chronic selenosis were derived from body weight, macroscopic abnormalities, organ weights, and concentrations of selenium in the liver. Proposed diagnostic criteria for non-fatal chronic selenosis were derived from body weight, plumage condition, macroscopic abnormalities, concentrations of selenium in the liver, reproductive failure, and alterations of blood and tissue chemistries. Lead or dioxin poisoning have diagnostic criteria most similar to selenium toxicosis. PMID:8827673

  20. Diagnostic criteria for selenium toxicosis in aquatic birds: dietary exposure, tissue concentrations, and macroscopic effects

    USGS Publications Warehouse

    Albers, P.H.; Green, D.E.; Sanderson, C.J.

    1996-01-01

    A feeding study with mallard ducks (Anas platyrhynchos) was conducted during March-July, 1988 in Laurel, Maryland, to identify diagnostic criteria for selenium toxicosis in birds. One-year-old male mallards in groups of 21 were fed diets containing 0, 10, 20, 40, or 80 parts per million (ppm) selenium, as seleno-DL-methionine, for 16 weeks. All ducks receiving 80 ppm died. Ducks receiving 40 or 80 ppm selenium consumed less feed than ducks in the other treatment groups. Body weights of ducks receiving 40 or 80 ppm selenium declined during the study. The post-breeding molt was delayed in ducks receiving 40 ppm; most ducks receiving 80 ppm selenium died prior to the onset of molt. At necropsy, numerous abnormalities were observed in ducks that died but only a small number of abnormalities were observed in ducks surviving to the end of the study in the 40 ppm group. Weights of the heart, spleen, and pancreas were mostly lower and weights of the kidney were higher for ducks dying during the study than for euthanized ducks. Liver weights were unaffected. Selenium accumulated in soft tissues approximately in proportion to dietary concentrations. Selenium concentrations in tissues of all ducks that died were different from those of surviving ducks in the 0, 10, and 20 ppm groups, but were not different from those of surviving ducks in the 40 ppm group. Proposed diagnostic criteria for fatal chronic selenosis were derived from body weight, macroscopic abnormalities, organ weights, and concentrations of selenium in the liver. Proposed diagnostic criteria for non-fatal chronic selenosis were derived from body weight, plumage condition, macroscopic abnormalities, concentrations of selenium in the liver, reproductive failure, and alterations of blood and tissue chemistries. Lead or dioxin poisoning have diagnostic criteria most similar to selenium toxicosis.

  1. Fetal alcohol spectrum disorder: development of consensus referral criteria for specialist diagnostic assessment in Australia

    PubMed Central

    2014-01-01

    criteria among health professionals and evaluate their feasibility, acceptability and capacity to improve the identification of FASD in Australia. PMID:25005425

  2. Reliability and Diagnostic Performance of CT Imaging Criteria in the Diagnosis of Tuberculous Meningitis

    PubMed Central

    Botha, Hugo; Ackerman, Christelle; Candy, Sally; Carr, Jonathan A.; Griffith-Richards, Stephanie; Bateman, Kathleen J.

    2012-01-01

    Introduction Abnormalities on CT imaging may contribute to the diagnosis of tuberculous meningitis (TBM). Recently, an expert consensus case definition (CCD) and set of imaging criteria for diagnosing basal meningeal enhancement (BME) have been proposed. This study aimed to evaluate the sensitivity, specificity and reliability of these in a prospective cohort of adult meningitis patients. Methods Initial diagnoses were based on the CCD, classifying patients into: ‘Definite TBM’ (microbiological confirmation), ‘Probable TBM’ (diagnostic score ≥10), ‘Possible TBM’ (diagnostic score 6–9), ‘Not TBM’ (confirmation of an alternative diagnosis) or ‘Uncertain’ (diagnostic score of <6). CT images were evaluated independently on two occasions by four experienced reviewers. Intra-rater and inter-rater agreement were calculated using the kappa statistic. Sensitivities and specificities were calculated using both ‘Definite TBM’ and either ‘Definite TBM’ or ‘Probable TBM’ as gold standards. Results CT scan criteria for BME had good intra-rater agreement (κ range 0.35–0.78) and fair to moderate inter-rater agreement (κ range 0.20–0.52). Intra- and inter-rater agreement on the CCD components were good to fair (κ  =  ranges 0.47–0.81 and 0.21–0.63). Using ‘Definite TBM’ as a gold standard, the criteria for BME were very specific (61.5%–100%), but insensitive (5.9%–29.4%). Similarly, the imaging components of the CCD were highly specific (69.2–100%) but lacked sensitivity (0–56.7%). Similar values were found when using ‘Definite TBM’ or ‘Probable TBM’ as a gold standard. Discussion The fair to moderate inter-rater agreement and poor sensitivities of the criteria for BME suggest that little reliance should be placed in these features in isolation. While the presence of the CCD criteria of acute infarction or tuberculoma(s) appears useful as rule-in criteria, their absence is of little help in excluding TBM. The

  3. The diagnostic criteria for multiple sclerosis: From Charcot to McDonald.

    PubMed

    Gafson, Arie; Giovannoni, Gavin; Hawkes, Christopher H

    2012-01-01

    The history of diagnostic criteria for multiple sclerosis (MS) from Charcot to McDonald is reviewed. Although the criteria have evolved positively with each revision we think there is still room for improvement. It is proposed that the 2010 revision to the McDonald criteria should be used for research or drug trials and comprise two categories: 'MS' and 'Not MS'. McDonald 2010 could be used optionally for routine clinical purposes. The categories 'probable' and 'possible' are permissible for everyday clinical activity, particularly where there is limited access to MRI, but they would not be appropriate for research or drug trials. Future updates should make it mandatory to perform MRI of the brain, and possibly spinal cord, and the definition of 'an attack' should be revised to include information from physical examination or MRI. Finally, we suggest that certain paroxysmal symptoms (e.g. Lhermitte phenomenon) should be incorporated in any further revision. PMID:25876446

  4. Commentary on pathologic diagnosis of asbestosis and critique of the 2010 Asbestosis Committee of the College of American Pathologists (CAP) and Pulmonary Pathology Society's (PPS) update on the diagnostic criteria for pathologic asbestosis.

    PubMed

    Hammar, Samuel P; Abraham, Jerrold L

    2015-10-01

    We reviewed the 2010 Asbestosis Committee's update on the diagnostic criteria for pathologic asbestosis. We must respectfully disagree with many of the criteria set forth therein, especially for recognizing asbestosis at its earliest stages; with statements focusing on the number of asbestos bodies needed in order to make a pathologic diagnosis of asbestosis; and regarding the benefits and pitfalls of relying on fiber analysis for diagnostic purposes, especially where chrysotile asbestos is concerned, including the methodology used for fiber determination. This critique has become even more relevant with the 2014 Helsinki criteria publication, which adopted the 2010 CAP/PPS criteria. Based on our review of these newer criteria and our experience in this field, we find that the CAP-NIOSH 1982 criteria is still the most acceptable method for the pathologic diagnosis and grading of asbestosis, which can be described as pulmonary fibrosis caused by inhalation of asbestos fibers. PMID:26374489

  5. Acceptance criteria for ultrasonic flaw indications in the inner liner of double-shell waste storage tanks

    SciTech Connect

    Simonen, F.A.; Graves, R.E.; Johnson, K.I.

    1995-07-01

    Radioactive defense waste, resulting from the chemical processing of spent nuclear fuel, has been stored in double-shell tanks (DSTS) at the Hanford Site since 1970. As part of the program to assure that the DSTs maintain their structural integrity, an inspection plan is being developed and implemented. This report provides recommendations and technical bases for acceptance criteria for flaw indications detected during ultrasonic inspection of inner liners of the DSTS. The types of indications addressed are crack-like flaws, wall thinning, and pitting. In establishing acceptable flaw sizes, the evaluations have taken into consideration the potential for crack growth by the mechanism of stress corrosion cracking. Consideration was given to technical approaches used in ASME Codes, for reactor tanks at the Department of Energy Savannah River facilities, and in recommendations by the Tank Structural Integrity Panel. The goal was to ensure that indications discovered during inspections are not large enough to ever cause a leak or rupture of the tank inner liner. The acceptance criteria are intended to be simple to apply using a set of tables giving acceptable flaw sizes. These tables are sufficiently conservative to be applicable to all double-shell tanks. In those cases that a flaw exceeds the size permitted by the tables, it is proposed that additional criteria permit more detailed and less conservative evaluations to address specific conditions of stress levels, operating temperature, flaw location, and material properties.

  6. Determination of optimal diagnostic criteria for purulent vaginal discharge and cytological endometritis in dairy cows.

    PubMed

    Denis-Robichaud, J; Dubuc, J

    2015-10-01

    The objectives of this observational study were to identify the optimal diagnostic criteria for purulent vaginal discharge (PVD) and cytological endometritis (ENDO) using vaginal discharge, endometrial cytology, and leukocyte esterase (LE) tests, and to quantify their effect on subsequent reproductive performance. Data generated from 1,099 untreated Holstein cows (28 herds) enrolled in a randomized clinical trial were used in this study. Cows were examined at 35 (± 7) d in milk for PVD using vaginal discharge scoring and for ENDO using endometrial cytology and LE testing. Optimal combinations of diagnostic criteria were determined based on the lowest Akaike information criterion (AIC) to predict pregnancy status at first service. Once identified, these criteria were used to quantify the effect of PVD and ENDO on pregnancy risk at first service and on pregnancy hazard until 200 d in milk (survival analysis). Predicting ability of these diagnostic criteria was determined using area under the curve (AUC) values. The prevalence of PVD and ENDO was calculated as well as the agreement between endometrial cytology and LE. The optimal diagnostic criteria (lowest AIC) identified in this study were purulent vaginal discharge or worse (≥ 4), ≥ 6% polymorphonuclear leukocytes (PMNL) by endometrial cytology, and small amounts of leukocytes or worse (≥ 1) by LE testing. When using the combination of vaginal discharge and PMNL percentage as diagnostic tools (n = 1,099), the prevalences of PVD and ENDO were 17.1 and 36.2%, respectively. When using the combination of vaginal discharge and LE (n = 915), the prevalences of PVD and ENDO were 17.1 and 48.4%. The optimal strategies for predicting pregnancy status at first service were the use of LE only (AUC = 0.578) and PMNL percentage only (AUC = 0.575). Cows affected by PVD and ENDO had 0.36 and 0.32 times the odds, respectively, of being pregnant at first service when using PMNL percentage compared with that of unaffected

  7. Diagnostic and differential diagnostic criteria of lymphoid neoplasms in bone marrow trephine biopsies: a study of 87 cases.

    PubMed

    Horváth, Emoke; Mezei, T; Pávai, Z; Turcu, M; Demian, Smaranda; Tóth, Erika; Chira, Liliana; Jung, I

    2009-01-01

    The aim of this study is to present the diagnostic and differential diagnostic criteria of the bone marrow specimen involved by lymphomas based on the histomorphological immunophenotype features and clonality of the tumor cells, patterns of lymphoproliferation and diagnostic pitfalls. BMB material obtained from the right posterior iliac crest was represented from 87 untreated and treated patients with BM involving malignant lymphoma, stained with Hematoxylin-Eosin, Giemsa, Periodic Acid Schiff and Gömöri's Silver. In order to perform immunohistochemistry examination we used a large antibody panel. B-cell clonality was determined in six cases. We found eight reactive lymphoproliferative responses and 79 lymphoid neoplasms of which 45 were diagnosed as de novo lymphoma, the rest of 34 samples being examined for staging. The predominant lymphoma was CLL (30 cases), over followed by DLBCL (18 cases). The most frequent patterns of involvement were the interstitial (29%) and mixed (15%) ones. In eight cases, we found reactive lymphoid aggregates. The B-cell clonality test showed four monoclonal, one oligoclonal and one polyclonal diseases form. Diagnosis of lymphoma versus reactive aggregate has been based on the combination of a lot of antibodies and involvement pattern. Although investigation of gene rearrangement was necessary for the establishment of the correct diagnosis in only 6.9% of cases, it should be emphasized that it is of great importance in disease monitoring. PMID:19690765

  8. Posttraumatic stress disorder diagnostic criteria and suicidal ideation in a South African Police sample

    PubMed Central

    Steyn, R; Vawda, N; Wyatt, GE; Williams, JK; Madu, SN

    2014-01-01

    Objective Exposure to traumatic events may precipitate suicidal ideation. Once an individual is diagnosed with PTSD, a suicide risk assessment often follows. This study explores how PTSD symptom criteria correlate with suicidal ideation in a sample of police officers. While the psychometric measures of PTSD often mirror the DSM-IV-TR criteria, focusing on exposure, symptom, and duration criteria, suicidal ideation measures often focus on concepts quite different from that. In this report the focus was on investigating how PTSD symptom criteria correlate with the suicidal ideation. Method A group of South African police officers (N = 217) were assessed by means of the Posttraumatic Diagnostic Scale and a short version of the Adult Suicide Ideation Questionnaire. Linear and hierarchical regressions were used to determine which PTSD symptom criteria best predict suicidal ideation. Results Hyperarousal was the primary predictor of suicidal ideation (R2 [adjusted] = 0.249). Intrusive thoughts added only marginally to the model, contributing a further 2.5% to the declared variance. The contributions of the other two symptom types were negligible. Conclusion In this study hyperarousal correlated significantly with suicidal ideation. It is suggested that practitioners be alert to these symptoms as possible indicators of suicidal ideation. Implications for suicide risk assessment and prevention measures are discussed. PMID:23417631

  9. AB031. Standardizing Gestational Diabetes Mellitus diagnostic criteria and systematic management in China

    PubMed Central

    Yang, Huixia

    2015-01-01

    Objective Type 2 diabetes has been dramatically increasing and becoming a major public issue in China. Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy causing severe complications both for the gravida and offspring without systematic management. Furthermore, GDM can also increase the risk of developing metabolic syndrome for the mother and offspring in the long-term. However, several issues regarding GDM are still controversial such as systematical screening, diagnosis strategy and management as well as postpartum follow up issues. Our study aimed to standardize GDM diagnostic criteria and systematic management in China. Methods We have conducted multiple studies to verify the adverse outcome of GDM and establish suitable screening and diagnostic criteria for GDM of our country. Such as Prospective case control study and large clinical researches, large clinical multicenter study and randomized controlled trial. Results Through a prospective case control study and large clinical researches, we confirmed it is beneficial to monitor and control blood glucose level during pregnancy. As early as 1993 we have reported blood glucose management playing important role in reducing adverse outcome, also proposed full term GDM patients can not routinely to promote fetal lung maturity before termination of pregnancy. After standardized management of GDM, the perinatal mortality and incidence of macrosomia had been significantly decreased. Through the research of threshold on 50 g Glucose Challenge Test (GCT) and the 75 g oral glucose tolerance test (OGTT), we gradually established suitable screening and diagnostic criteria for GDM of our country. We proposed to cancel 75 g OGTT 3 h value based on 535 GDM cases before the international new recommendation in 2010. According to the research of more than 16,000 cases of GDM multicenter study, principal investigator composed the national GDM clinical recommendations and published it in

  10. Spontaneous Tumor Lysis Syndrome: A Case Report and Critical Evaluation of Current Diagnostic Criteria and Optimal Treatment Regimens.

    PubMed

    Weeks, Alicia C; Kimple, Michelle E

    2015-01-01

    Tumor lysis syndrome (TLS) is a known complication of malignancy and its treatment. The incidence varies on malignancy type, but is most common with hematologic neoplasms during cytotoxic treatment. Spontaneous TLS is thought to be rare. This case study is of a 62-year-old female admitted with multisystem organ failure, with subsequent diagnosis of aggressive B cell lymphoma. On admission, laboratory abnormalities included renal failure, elevated uric acid (20.7 mg/dL), and 3+ amorphous urates on urinalysis. Oliguric renal failure persisted despite aggressive hydration and diuretic use, requiring initiation of hemodialysis prior to chemotherapy. Antihyperuricemic therapy and hemodialysis were used to resolve hyperuricemia. However, due to multisystem organ dysfunction syndrome with extremely poor prognosis, the patient ultimately expired in the setting of a terminal ventilator wean. Although our patient did not meet current TLS criteria, she required hemodialysis due to uric acid nephropathy, a complication of TLS. This poses the clinical question of whether adequate diagnostic criteria exist for spontaneous TLS and if the lack of currently accepted guidelines has resulted in the underestimation of its incidence. Allopurinol and rasburicase are commonly used for prevention and treatment of TLS. Although both drugs decrease uric acid levels, allopurinol mechanistically prevents formation of the substrate rasburicase acts to solubilize. These drugs were administered together in our patient, although no established guidelines recommend combined use. This raises the clinical question of whether combined therapy is truly beneficial or, conversely, detrimental to patient outcomes. PMID:26904699

  11. DSM-V diagnostic criteria for bereavement-related disorders in children and adolescents: developmental considerations.

    PubMed

    Kaplow, Julie B; Layne, Christopher M; Pynoos, Robert S; Cohen, Judith A; Lieberman, Alicia

    2012-01-01

    Two bereavement-related disorders are proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V): Adjustment Disorder Related to Bereavement, to be located in the main body of the text as an official diagnostic entity; and Bereavement-Related Disorder, including a Traumatic Death Specifier, to be located in the Appendix as an invitation for further research. These diagnoses currently do not include developmentally informed criteria, despite the importance of developmental processes in the ways children and adolescents grieve. In this article, we draw upon a selective review of the empirical literature and expert clinical knowledge to recommend developmentally informed modifications and specifiers of the proposed criteria for both bereavement disorders and strategies to improve future research. This article is derived from an invited report submitted to the DSM-V Posttraumatic Stress Disorder, Trauma, and Dissociative Disorders Sub-Work Group, and suggested modifications have received preliminary approval to be incorporated into the DSM-V at the time of this writing. Adoption of these proposals will have far-reaching consequences, given that DSM-V criteria will influence both critical treatment choices for bereaved youth and the next generation of research studies. PMID:22913501

  12. Are the revised diagnostic criteria for Alzheimer's disease useful in low- and middle-income countries?

    PubMed

    Cece, Yang; Shifu, Xiao

    2015-04-25

    Alzheimer's Disease (AD) is a leading cause of disease burden among elderly individuals that is increasingly important in middle-income countries like China where improvements in overall health (which increase longevity) and other factors are leading to a rapidly aging population. The diagnostic criteria for AD have recently been revised to reflect advances in the understanding of the condition over the past three decades. Different international organizations have proposed algorithms for diagnosing AD that subdivide the AD spectrum into overlapping stages and, in some cases, require the concurrent presence of memory impairment and specific biomarkers. There are, however, several substantial limitations to these revised criteria: highly trained clinicians are needed to make the fine discriminations between the stages; the role of the proposed biomarkers in the onset and course of AD remain uncertain; and assessment of these biomarkers requires the use of expensive, high-tech equipment by well-trained technicians. These problems limit the clinical utility of these diagnostic criteria, particularly in low-resource settings where the clinicians responsible for identifying and treating individuals with AD have limited training and where the equipment needed to identify the biomarkers are either non-existent or in short supply. PMID:26120262

  13. The U.S. Nuclear Regulatory Commission's Strategy for Revising the RIA Acceptance Criteria

    SciTech Connect

    Clifford, Paul M.

    2007-07-01

    The U.S. Nuclear Regulatory Commission (NRC) has issued interim criteria and guidance for the reactivity-initiated accident (RIA) within the latest revision to NUREG-0800, 'Standard Review Plan' (SRP), Section 4.2, 'Fuel System Design', Appendix B (Revision 03, March 2007). The purpose of this paper is as follows: 1. present a change in regulatory staff position regarding the requirements of 10 CFR 50, Appendix A, General Design Criteria 28 (GDC28) and changes in regulatory guidance provided in Regulatory Guide (RG) 1.77, RG 1.195, RG 1.183, and previous versions of NUREG-0800 SRP; 2. describe the implementation strategy and schedule for both new reactors and the existing fleet; and 3. encourage licensees and nuclear fuel vendors to (1) develop improved core physics analytical methods to allow a more deliberate transition to the new fuel cladding failure criteria and (2) develop the technical basis to address the new core coolability criteria. (authors)

  14. The DSM-5 diagnostic criteria for anorexia nervosa may change its population prevalence and prognostic value.

    PubMed

    Mustelin, Linda; Silén, Yasmina; Raevuori, Anu; Hoek, Hans W; Kaprio, Jaakko; Keski-Rahkonen, Anna

    2016-06-01

    The definition of anorexia nervosa was revised for the Fifth Edition of the Diagnostic and Statistical Manual (DSM-5). We examined the impact of these changes on the prevalence and prognosis of anorexia nervosa. In a nationwide longitudinal study of Finnish twins born 1975-1979, the women (N = 2825) underwent a 2-stage screening for eating disorders at mean age 24. Fifty-five women fulfilled DSM-IV criteria for lifetime anorexia nervosa. When we recoded the interviews using DSM-5 criteria, we detected 37 new cases. We contrasted new DSM-5 vs. DSM-IV cases to assess their clinical characteristics and prognosis. We also estimated lifetime prevalences and incidences and tested the association of minimum BMI with prognosis. We observed a 60% increase in the lifetime prevalence of anorexia nervosa using the new diagnostic boundaries, from 2.2% to 3.6%. The new cases had a later age of onset (18.8 y vs. 16.5, p = 0.002), higher minimum BMI (16.9 vs. 15.5 kg/m(2), p = 0.0004), a shorter duration of illness (one year vs. three years, p = 0.002), and a higher 5-year probability or recovery (81% vs. 67%, p = 0.002). Minimum BMI was not associated with prognosis. It therefore appears that the substantial increase in prevalence of anorexia nervosa is offset by a more benign course of illness in new cases. Increased diagnostic heterogeneity underscores the need for reliable indicators of disease severity. Our findings indicate that BMI may not be an ideal severity marker, but should be complemented by prognostically informative criteria. Future studies should focus on identifying such factors in prospective settings. PMID:27014849

  15. Fatigue acceptance test limit criteria for larger diameter rolled thread fasteners

    SciTech Connect

    Kephart, A.R.

    1999-05-19

    This document describes a fatigue lifetime acceptance test criterion by which studs having rolled threads, larger than 1.0 inches (25 mm) in diameter, can be assured to meet minimum quality attributes associated with a controlled rolling process.

  16. Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment

    PubMed Central

    Ismail, Zahinoor; Smith, Eric E.; Geda, Yonas; Sultzer, David; Brodaty, Henry; Smith, Gwenn; Agüera-Ortiz, Luis; Sweet, Rob; Miller, David; Lyketsos, Constantine G.

    2015-01-01

    Neuropsychiatric symptoms (NPS) are common in dementia and in predementia syndromes such as mild cognitive impairment (MCI). NPS in MCI confer a greater risk for conversion to dementia in comparison to MCI patients without NPS. NPS in older adults with normal cognition also confers a greater risk of cognitive decline in comparison to older adults without NPS. Mild behavioral impairment (MBI) has been proposed as a diagnostic construct aimed to identify patients with an increased risk of developing dementia, but who may or may not have cognitive symptoms. We propose criteria that include MCI in the MBI framework, in contrast to prior definitions of MBI. Although MBI and MCI can co-occur, we suggest that they are different and that both portend a higher risk of dementia. These MBI criteria extend the previous literature in this area and will serve as a template for validation of the MBI construct from epidemiologic, neurobiological, treatment, and prevention perspectives. PMID:26096665

  17. Adrenocortical Oncocytic Carcinoma: A Case Report and Review of the Histopathologic Diagnostic Criteria.

    PubMed

    Arik, Deniz; Canaz, Funda; Dündar, Emine

    2016-01-01

    Oncocytic tumors are rare in the adrenal gland. The histopathological diagnosis of adrenocortical carcinoma is difficult due to the lack of precise diagnostic criteria for malignancy. A 44-year-old man was admitted to our hospital with left flank pain. Radiologically an adrenal mass was detected. After the excision and histopathologic evaluation of the mass, a diagnosis of adrenocortical oncocytic carcinoma was made. At least one of the features of more than 5 mitoses in 50 high power fields, atypical mitotic figures or venous invasion is required for the diagnosis of malignancy in adrenocortical tumors. It has been suggested that tumors that have more than one of the minor criteria of large size ( > 10 cm or > 200 gr), necrosis, capsular or sinusoidal invasion, should be evaluated as having uncertain malignant potential. PMID:27562395

  18. Diagnostic criteria for proliferative hepatic lesions in brown bullhead Ameiurus nebulosus

    USGS Publications Warehouse

    Blazer, V.S.; Fournie, J.W.; Wolf, J.C.; Wolfe, M.J.

    2006-01-01

    Brown bullhead Ameiurus nebulosus is used as indicator species for contaminant effects at areas of concern (AOC) in the Great Lakes and other areas. One of the beneficial use impairments at numerous AOC is 'fish tumors and other deformities'. An impairment occurs when the prevalence of fish tumors and other deformities exceeds those at unimpacted or control sites or when survey data confirm the presence of neoplastic or preneoplastic liver lesions in bullhead or white sucker Catostomus commersonii. Numerous surveys have been conducted over the years assessing neoplasia in these fishes, both liver and skin tumors. However, a major problem in comparing the results has been a lack of consistent criteria for evaluating histological changes in bullhead livers. As individual AOC develop and implement remedial action plans, realistic and attainable delisting targets need to be specified. For this to occur and be consistent from site to site there must be standardization of the criteria being used to evaluate specific impairments. In this report, specific diagnostic criteria are provided for both non-neoplastic and neoplastic proliferative hepatocellular and biliary lesions. These criteria should assist fish pathologists in describing and categorizing proliferative liver lesions from brown bullhead. ?? Inter-Research 2006.

  19. Paediatric Multiple Sclerosis: Update on Diagnostic Criteria, Imaging, Histopathology and Treatment Choices.

    PubMed

    Chou, I-Jun; Wang, Huei-Shyong; Whitehouse, William P; Constantinescu, Cris S

    2016-07-01

    Paediatric multiple sclerosis (MS) represents less than 5 % of the MS population, but patients with paediatric-onset disease reach permanent disability at a younger age than adult-onset patients. Accurate diagnosis at presentation and optimal long-term treatment are vital to mitigate ongoing neuroinflammation and irreversible neurodegeneration. However, it may be difficult to early differentiate paediatric MS from acute disseminated encephalomyelitis (ADEM) and neuromyelitis optica spectrum disorders (NMOSD), as they often have atypical presentation that differs from that of adult-onset MS. The purpose of this review is to summarize the updated views on diagnostic criteria, imaging, histopathology and treatment choices. PMID:27271748

  20. [Myocardial infarction and acute coronary syndrome: definitions, classification, and diagnostic criteria].

    PubMed

    Zaĭrat'iants, O V; Mishnev, O D; Kakturskiĭ, L V

    2014-01-01

    The review gives the definitions and classification of and diagnostic criteria for myocardial infarction and acute coronary syndrome in accordance with the "The third universal definition of myocardial infarction" adopted in 2012 (Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, 2012). It also discusses the clinical and morphological comparisons of and the problems in the differential diagnosis of myocardial infarction as a nosological entity within coronary heart disease with other coronarogenic and non-coronarogenic necroses of the myocardium. PMID:25842920

  1. Objective evaluation of speech signal quality by the prediction of multiple foreground diagnostic acceptability measure attributes.

    PubMed

    Sen, Deep; Lu, W

    2012-05-01

    A methodology is described to objectively diagnose the quality of speech signals by predicting the perceptual detectability of a selected set of distortions. The distortions are a statistically selected subset of the broad number of distortions used in diagnostic acceptability measure (DAM) testing. The justification for such a methodology is established from the analysis of a set of speech signals representing a broad set of distortions and their respective DAM scores. At the heart of the ability to isolate and diagnose the perceptibility of the individual distortions is a physiologically motivated cochlear model. The philosophy and methodology is thus distinct from traditional objective measures that are typically designed to predict mean opinion scores (MOS) using well versed functional psychoacoustic models. Even so, a weighted sum of these objectively predicted set of distortions is able to predict accurate and robust MOS scores, even when the reference speech signals have been subject to the Lombard effect. PMID:22559381

  2. Variability among Research Diagnostic Interview Instruments in the Application of "DSM-IV-TR" Criteria for Pediatric Bipolar Disorder

    ERIC Educational Resources Information Center

    Galanter, Cathryn A.; Hundt, Stephanie R.; Goyal, Parag; Le, Jenna; Fisher, Prudence W.

    2012-01-01

    Objective: The "DSM-IV-TR "criteria for a manic episode and bipolar disorder (BD) were developed for adults but are used for children. The manner in which clinicians and researchers interpret these criteria may have contributed to the increase in BD diagnoses given to youth. Research interviews are designed to improve diagnostic reliability and…

  3. Riluzole treatment, survival and diagnostic criteria in Parkinson plus disorders: the NNIPPS study.

    PubMed

    Bensimon, Gilbert; Ludolph, Albert; Agid, Yves; Vidailhet, Marie; Payan, Christine; Leigh, P Nigel

    2009-01-01

    Parkinson plus diseases, comprising mainly progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are rare neurodegenerative conditions. We designed a double-blind randomized placebo-controlled trial of riluzole as a potential disease-modifying agent in Parkinson plus disorders (NNIPPS: Neuroprotection and Natural History in Parkinson Plus Syndromes). We analysed the accuracy of our clinical diagnostic criteria, and studied prognostic factors for survival. Patients with an akinetic-rigid syndrome diagnosed as having PSP or MSA according to modified consensus diagnostic criteria were considered for inclusion. The psychometric validity (convergent and predictive) of the NNIPPS diagnostic criteria were tested prospectively by clinical and pathological assessments. The study was powered to detect a 40% decrease in relative risk of death within PSP or MSA strata. Patients were randomized to riluzole or matched placebo daily and followed up to 36 months. The primary endpoint was survival. Secondary efficacy outcomes were rates of disease progression assessed by functional measures. A total of 767 patients were randomized and 760 qualified for the Intent to Treat (ITT) analysis, stratified at entry as PSP (362 patients) or MSA (398 patients). Median follow-up was 1095 days (range 249-1095). During the study, 342 patients died and 112 brains were examined for pathology. NNIPPS diagnostic criteria showed for both PSP and MSA excellent convergent validity with the investigators' assessment of diagnostic probability (point-biserial correlation: MSA r(pb) = 0.93, P < 0.0001; PSP, r(pb) = 0.95, P < 0.0001), and excellent predictive validity against histopathology [sensitivity and specificity (95% CI) for PSP 0.95 (0.88-0.98) and 0.84 (0.77-0.87); and for MSA 0.96 (0.88-0.99) and 0.91 (0.86-0.93)]. There was no evidence of a drug effect on survival in the PSP or MSA strata (3 year Kaplan-Meier estimates PSP-riluzole: 0.51, PSP-placebo: 0.50; MSA-riluzole: 0

  4. Riluzole treatment, survival and diagnostic criteria in Parkinson plus disorders: The NNIPPS Study

    PubMed Central

    Bensimon, Gilbert; Ludolph, Albert; Agid, Yves; Vidailhet, Marie; Payan, Christine; Leigh, P. Nigel

    2009-01-01

    Parkinson plus diseases, comprising mainly progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are rare neurodegenerative conditions. We designed a double-blind randomized placebo-controlled trial of riluzole as a potential disease-modifying agent in Parkinson plus disorders (NNIPPS: Neuroprotection and Natural History in Parkinson Plus Syndromes). We analysed the accuracy of our clinical diagnostic criteria, and studied prognostic factors for survival. Patients with an akinetic-rigid syndrome diagnosed as having PSP or MSA according to modified consensus diagnostic criteria were considered for inclusion. The psychometric validity (convergent and predictive) of the NNIPPS diagnostic criteria were tested prospectively by clinical and pathological assessments. The study was powered to detect a 40% decrease in relative risk of death within PSP or MSA strata. Patients were randomized to riluzole or matched placebo daily and followed up to 36 months. The primary endpoint was survival. Secondary efficacy outcomes were rates of disease progression assessed by functional measures. A total of 767 patients were randomized and 760 qualified for the Intent to Treat (ITT) analysis, stratified at entry as PSP (362 patients) or MSA (398 patients). Median follow-up was 1095 days (range 249–1095). During the study, 342 patients died and 112 brains were examined for pathology. NNIPPS diagnostic criteria showed for both PSP and MSA excellent convergent validity with the investigators’ assessment of diagnostic probability (point-biserial correlation: MSA rpb = 0.93, P < 0.0001; PSP, rpb = 0.95, P < 0.0001), and excellent predictive validity against histopathology [sensitivity and specificity (95% CI) for PSP 0.95 (0.88–0.98) and 0.84 (0.77–0.87); and for MSA 0.96 (0.88–0.99) and 0.91 (0.86–0.93)]. There was no evidence of a drug effect on survival in the PSP or MSA strata (3 year Kaplan–Meier estimates PSP-riluzole: 0.51, PSP-placebo: 0.50; MSA

  5. Acceptance criteria for the evaluation of Category 1 fuel cycle facility physical security plans

    SciTech Connect

    Dwyer, P.A.

    1991-10-01

    This NUREG document presents criteria developed from US Nuclear Regulatory Commission regulations for the evaluation of physical security plans submitted by Category 1 fuel facility licensees. Category 1 refers to those licensees who use or possess a formula quantity of strategic special nuclear material.

  6. 10 CFR 50.46a - Acceptance criteria for reactor coolant system venting systems.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... operated from the control room. (b) The design of the vents and associated controls, instruments and power sources must conform to appendix A and appendix B of this part. (c) The vent system must be designed to... criteria for reactor coolant system venting systems. Each nuclear power reactor must be provided with...

  7. High-Dimensional Medial Lobe Morphometry: An Automated MRI Biomarker for the New AD Diagnostic Criteria

    PubMed Central

    Valdivia, Fernando

    2014-01-01

    Introduction. Medial temporal lobe atrophy assessment via magnetic resonance imaging (MRI) has been proposed in recent criteria as an in vivo diagnostic biomarker of Alzheimer's disease (AD). However, practical application of these criteria in a clinical setting will require automated MRI analysis techniques. To this end, we wished to validate our automated, high-dimensional morphometry technique to the hypothetical prediction of future clinical status from baseline data in a cohort of subjects in a large, multicentric setting, compared to currently known clinical status for these subjects. Materials and Methods. The study group consisted of 214 controls, 371 mild cognitive impairment (147 having progressed to probable AD and 224 stable), and 181 probable AD from the Alzheimer's Disease Neuroimaging Initiative, with data acquired on 58 different 1.5 T scanners. We measured the sensitivity and specificity of our technique in a hierarchical fashion, first testing the effect of intensity standardization, then between different volumes of interest, and finally its generalizability for a large, multicentric cohort. Results. We obtained 73.2% prediction accuracy with 79.5% sensitivity for the prediction of MCI progression to clinically probable AD. The positive predictive value was 81.6% for MCI progressing on average within 1.5 (0.3 s.d.) year. Conclusion. With high accuracy, the technique's ability to identify discriminant medial temporal lobe atrophy has been demonstrated in a large, multicentric environment. It is suitable as an aid for clinical diagnostic of AD. PMID:25254139

  8. International Harmonization of Nomenclature and Diagnostic Criteria (INHAND): Progress to Date and Future Plans.

    PubMed

    Keenan, C M; Baker, J; Bradley, A; Goodman, D G; Harada, T; Herbert, R; Kaufmann, W; Kellner, R; Mahler, B; Meseck, E; Nolte, T; Rittinghausen, S; Vahle, J; Yoshizawa, K

    2015-07-01

    The International Harmonization of Nomenclature and Diagnostic Criteria for Lesions in Rats and Mice proposal (INHAND) has been operational since 2005. A Global Editorial Steering Committee manages the overall objectives of the project, and the development of harmonized terminology for each organ system is the responsibility of the Organ Working Groups, drawing upon experts from North America, Europe, and Japan. Great progress has been made with 9 systems published to date--respiratory, hepatobiliary, urinary, central/peripheral nervous systems, male reproductive and mammary, zymbals, clitoral, and preputial glands in Toxicologic Pathology and the integument and soft tissue and female reproductive in the Journal of Toxicologic Pathology as supplements and on a Web site--www.goReni.org. INHAND nomenclature guides offer diagnostic criteria and guidelines for recording lesions observed in rodent toxicity and carcinogenicity studies. The guides provide representative photomicrographs of morphologic changes, information regarding pathogenesis, and key references. The purpose of this brief communication is to provide an update on the progress of INHAND. PMID:25530274

  9. Data Acceptance Criteria for Standardized Human-Associated Fecal Source Identification Quantitative Real-Time PCR Methods.

    PubMed

    Shanks, Orin C; Kelty, Catherine A; Oshiro, Robin; Haugland, Richard A; Madi, Tania; Brooks, Lauren; Field, Katharine G; Sivaganesan, Mano

    2016-05-01

    There is growing interest in the application of human-associated fecal source identification quantitative real-time PCR (qPCR) technologies for water quality management. The transition from a research tool to a standardized protocol requires a high degree of confidence in data quality across laboratories. Data quality is typically determined through a series of specifications that ensure good experimental practice and the absence of bias in the results due to DNA isolation and amplification interferences. However, there is currently a lack of consensus on how best to evaluate and interpret human fecal source identification qPCR experiments. This is, in part, due to the lack of standardized protocols and information on interlaboratory variability under conditions for data acceptance. The aim of this study is to provide users and reviewers with a complete series of conditions for data acceptance derived from a multiple laboratory data set using standardized procedures. To establish these benchmarks, data from HF183/BacR287 and HumM2 human-associated qPCR methods were generated across 14 laboratories. Each laboratory followed a standardized protocol utilizing the same lot of reference DNA materials, DNA isolation kits, amplification reagents, and test samples to generate comparable data. After removal of outliers, a nested analysis of variance (ANOVA) was used to establish proficiency metrics that include lab-to-lab, replicate testing within a lab, and random error for amplification inhibition and sample processing controls. Other data acceptance measurements included extraneous DNA contamination assessments (no-template and extraction blank controls) and calibration model performance (correlation coefficient, amplification efficiency, and lower limit of quantification). To demonstrate the implementation of the proposed standardized protocols and data acceptance criteria, comparable data from two additional laboratories were reviewed. The data acceptance criteria

  10. Diagnostic criteria patterns of U.S. children with Metabolic Syndrome: NHANES 1999–2002

    PubMed Central

    Kranz, Sibylle; Mahood, Lindsey J; Wagstaff, David A

    2007-01-01

    Background As childhood obesity increases in the U.S., the Metabolic Syndrome (MS) can be assumed to be increasing in the pediatric population as well. To date, there is lack of information on the most prevalent risk factors of MS in children and the patterns of risk factors present in children met the criteria for MS. Methods Anthropometric and medical data of children 2–18 years old of a nationally representative data set (NHANES 1999–2002) were obtained and the diagnostic criteria of Cook et al. employed to determine MS prevalence. Three samples were examined: a) Children 2–18 years old with non-missing data on at least three of the five diagnostic criteria but missing blood glucose data (n = 5,172), b) a subsample of 12–18 year olds also providing fasting glucose data but who were not overweight or obese using the International Obesity Task Force (IOTF) standards (n = 1,064), and c) 12–18 year olds with blood glucose data who were overweight or obese (n = 641). Results Disease prevalence estimates were 2%, 0.7%, and 23% in the three populations. More than 10% of the children providing fasting blood levels had hyperglycemia. 2% of the overweight or obese 12–18 year olds with fasting blood glucose data met all five diagnostic criteria for MS. In all groups, elevated total triglycerides but low high density lipoprotein (HDL) level affected a large proportion of the population. Conclusion Results indicate a reason for concern, since the prevalence of MS risk factors in children was high. Dyslipidemia (concurrent high total triglyceride levels and low HDL levels) were prevalent in large portions of the population, even in the non-overweight. Thus, chronic disease prevention efforts in the pediatric population should not only encourage healthy body weight but also include dietary recommendations to consume diets moderately low in fat with emphasis on polyunsaturated and monounsaturated fats within recommended ratios of omega-6 and omega-3 fatty acids

  11. Preliminary waste acceptance criteria for the ICPP spent fuel and waste management technology development program

    SciTech Connect

    Taylor, L.L.; Shikashio, R.

    1993-09-01

    The purpose of this document is to identify requirements to be met by the Producer/Shipper of Spent Nuclear Fuel/High-LeveL Waste SNF/HLW in order for DOE to be able to accept the packaged materials. This includes defining both standard and nonstandard waste forms.

  12. Sporadic Creutzfeldt-Jakob disease with focal findings: caveats to current diagnostic criteria

    PubMed Central

    Mader, Edward C.; El-Abassi, Rima; Villemarette-Pittman, Nicole R.; Santana-Gould, Lenay; Olejniczak, Piotr W.; England, John D.

    2013-01-01

    The clinical diagnosis of Creutzfeldt-Jakob disease (CJD) is largely based on the 1998 World Health Organization diagnostic criteria. Unfortunately, rigid compliance with these criteria may result in failure to recognize sporadic CJD (sCJD), especially early in its course when focal findings predominate and traditional red flags are not yet present. A 61-year-old man presented with a 3-week history of epilepsia partialis continua (jerking of the left upper extremity) and a 2-week history of forgetfulness and left hemiparesis; left hemisensory neglect was also detected on admission. Repeated brain magnetic resonance imaging (MRI) showed areas of restricted diffusion in the cerebral cortex, initially on the right but later spreading to the left. Electroence-phalography (EEG) on hospital days 7, 10, and 14 showed right-sided periodic lateralized epileptiform discharges. On day 20, the EEG showed periodic sharp wave complexes leading to a diagnosis of probable sCJD and subsequently to definite sCJD with brain biopsy. Neurological decline was relatively fast with generalized myoclonus and akinetic mutism developing within 7 weeks from the onset of illness. CJD was not immediately recognized because of the patient's focal/lateralized manifestations. Focal/lateralized clinical, EEG, and MRI findings are not uncommon in sCJD and EEG/MRI results may not be diagnostic in the early stages of sCJD. Familiarity with these caveats and with the most current criteria for diagnosing probable sCJD (University of California San Francisco 2007, MRI-CJD Consortium 2009) will enhance the ability to recognize sCJD and implement early safety measures. PMID:23717780

  13. Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder Running Head: DSM-5 ASD

    PubMed Central

    McPartland, James C.; Reichow, Brian; Volkmar, Fred R.

    2012-01-01

    Objective This study evaluated the potential impact of proposed DSM-5 diagnostic criteria for autism spectrum disorder (ASD). Method This study focused on a sample of 977 participants evaluated during the DSM-IV field trial; 657 carried a clinical diagnosis of an ASD, and 276 were diagnosed with a non-autistic disorder. Sensitivity and specificity for proposed DSM-5 diagnostic criteria were evaluated using field trial symptom checklists as follows: (a) individual field trial checklist items (e.g., nonverbal communication), (b) checklist items grouped together as described by a single DSM-5 symptom (e.g., nonverbal and verbal communication), (c) individual DSM-5 criterion (e.g., social-communicative impairment), and (d) overall diagnostic criteria. Results When applying proposed DSM-5 diagnostic criteria for ASD, 60.6% (95% confidence interval: 57–64%) of cases with a clinical diagnosis of an ASD met revised DSM-5 diagnostic criteria for ASD. Overall specificity was high, with 94.9% (95% confidence interval: 92–97%) of individuals accurately excluded from the spectrum. Sensitivity varied by diagnostic subgroup (Autistic Disorder =.76; Asperger’s Disorder = .25; PDD-NOS = .28) and cognitive ability (IQ < 70 = .70; IQ ≥ 70 = .46). Conclusions Proposed DSM-5 criteria substantially alter the composition of the autism spectrum. Revised criteria improve specificity, but exclude a substantial portion of cognitively able individuals and those with ASDs other than Autistic Disorder. A more stringent diagnostic rubric holds significant public health ramifications regarding service eligibility and compatibility of historical and future research. PMID:22449643

  14. Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda

    PubMed Central

    2010-01-01

    Background Many malarious countries plan to introduce artemisinin combination therapy (ACT) at community level using community health workers (CHWs) for treatment of uncomplicated malaria. Use of ACT with reliance on presumptive diagnosis may lead to excessive use, increased costs and rise of drug resistance. Use of rapid diagnostic tests (RDTs) could address these challenges but only if the communities will accept their use by CHWs. This study assessed community acceptability of the use of RDTs by Ugandan CHWs, locally referred to as community medicine distributors (CMDs). Methods The study was conducted in Iganga district using 10 focus group discussions (FGDs) with CMDs and caregivers of children under five years, and 10 key informant interviews (KIIs) with health workers and community leaders. Pre-designed FGD and KII guides were used to collect data. Manifest content analysis was used to explore issues of trust and confidence in CMDs, stigma associated with drawing blood from children, community willingness for CMDs to use RDTs, and challenges anticipated to be faced by the CMDs. Results CMDs are trusted by their communities because of their commitment to voluntary service, access, and the perceived effectiveness of anti-malarial drugs they provide. Some community members expressed fear that the blood collected could be used for HIV testing, the procedure could infect children with HIV, and the blood samples could be used for witchcraft. Education level of CMDs is important in their acceptability by the community, who welcome the use of RDTs given that the CMDs are trained and supported. Anticipated challenges for CMDs included transport for patient follow-up and picking supplies, adults demanding to be tested, and caregivers insisting their children be treated instead of being referred. Conclusion Use of RDTs by CMDs is likely to be acceptable by community members given that CMDs are properly trained, and receive regular technical supervision and logistical

  15. How do the Properties of Allan Hills 84001 Compare With Accepted Criteria for Evidence of Ancient Life?

    NASA Technical Reports Server (NTRS)

    Gibson, E. K., Jr.; McKay, D. S.; Thomas-Keprta, K.; Westall, F.; Romanek, C. A.

    1998-01-01

    Criteria for Past Life: To be confident that any sample contains evidence of past life or biogenic activity, one must determine beyond a shadow of a doubt that certain well-established features or biomarker signatures are present in the sample. In the case of martian samples, the criteria for past life have not been established because if life existed on the planet, we have no way of knowing its detailed characteristics. Lacking independent evidence about the nature of possible past life on Mars, the scientific community must use, for the time being, the criteria established for ancient samples from the Earth: (1) Do we know the geologic context of the sample? Is it compatible with past life? (2) Do we know the age of the sample and its stratigraphic location? Are they understood enough to relate possible life to geologic history? (3) Does the sample contain evidence of cellular morphology? (4) What structural remains of colonies or communities exist within the samples? (5) Is there any evidence of biominerals showing chemical or mineral disequilibria? (6) Is there any evidence of stable isotope patterns unique to biology? (7) Are there any organic biomarkers present? (8) Are the features indigenous to the sample? For acceptance of past life in a geologic sample, essentially all of these criteria must he met.

  16. Prototype Training Materials for Acceptance Criteria of Maintenance ASAP Events Occurring Within Social Context

    NASA Technical Reports Server (NTRS)

    Taylor, J. C.

    2004-01-01

    The aviation maintenance community is at a crossroads with respect to implementing the Aviation Safety Action Program (ASAP). While there is considerable interest, several key issues have emerged that cast doubt on how to assure a successful implementation, including buy-in from all levels of the company and training for key participants. There are two objectives for the present report. The first is to provide an examination of limits (or more properly, examples) of the degree of acceptability of more problematic events for risk-based decisions within the current ASAP guidelines. The second objective is to apply these limits of community standards to a set of further refined ASAP training scenarios.

  17. Facilities and diagnostic criteria in sexually transmitted disease clinics in England and Wales.

    PubMed Central

    Adler, M W; Belsey, E M; O'Connor, B H; Catterall, R D; Miller, D L

    1978-01-01

    A study was conducted to collect information from consultants about the facilities and diagnostic criteria used in clinics for sexually transmitted diseases in England and Wales. Most of the information was obtained by personal interview with a response rate of 92%. Half the clinics were open for 10 hours or less a week, the mean length of time for all clinics was 14 1/2 hours a week. Eighty per cent of clinics had a full or part-time contact-tracing service. All the clinics had microscopical and serological services and almost all (99%) had cultural facilities. The policy concerning the most efficient use of these facilities is discussed. PMID:580411

  18. Diagnostic criteria for adverse health effects in the environs of wind turbines.

    PubMed

    McMurtry, Robert Y; Krogh, Carmen Me

    2014-10-01

    In an effort to address climate change, governments have pursued policies that seek to reduce greenhouse gases. Alternative energy, including wind power, has been proposed by some as the preferred approach. Few would debate the need to reduce air pollution, but the means of achieving this reduction is important not only for efficiency but also for health protection. The topic of adverse health effects in the environs of industrial wind turbines (AHE/IWT) has proven to be controversial and can present physicians with challenges regarding the management of an exposure to IWT. Rural physicians in particular must be aware of the possibility of people presenting to their practices with a variety of sometimes confusing complaints. An earlier version of the diagnostic criteria for AHE/IWT was published in August 2011. A revised case definition and a model for a study to establish a confirmed diagnosis is proposed. PMID:25383200

  19. Diagnostic criteria for adverse health effects in the environs of wind turbines

    PubMed Central

    Krogh, Carmen ME

    2014-01-01

    Summary In an effort to address climate change, governments have pursued policies that seek to reduce greenhouse gases. Alternative energy, including wind power, has been proposed by some as the preferred approach. Few would debate the need to reduce air pollution, but the means of achieving this reduction is important not only for efficiency but also for health protection. The topic of adverse health effects in the environs of industrial wind turbines (AHE/IWT) has proven to be controversial and can present physicians with challenges regarding the management of an exposure to IWT. Rural physicians in particular must be aware of the possibility of people presenting to their practices with a variety of sometimes confusing complaints. An earlier version of the diagnostic criteria for AHE/IWT was published in August 2011. A revised case definition and a model for a study to establish a confirmed diagnosis is proposed. PMID:25383200

  20. Proposed Diagnostic Criteria, Classification Schema, and Review of Literature of Notochord-Derived Ecchordosis Physaliphora

    PubMed Central

    Lagman, Carlito; Sarmiento, J. Manuel; Turtz, Alan R; Chitale, Rohan V

    2016-01-01

    Ecchordosis physaliphora (EP) is a benign notochordal remnant derived from ectopic nests found along the craniospinal axis. It typically presents asymptomatically and is diagnosed using classic radiologic features, particularly location, T1-hypointensity, T2-hyperintensity, and lack of enhancement following gadolinium (Gd) contrast administration. Distinguishing EP from its malignant counterpart, chordoma, is of paramount importance, given the aggressive nature of the latter. Advances in imaging and immunohistochemistry have aided in diagnosis to an extent but, to our knowledge, identification of the genetic fingerprint of EP has yet to take place. Further cytological analysis of these lesions in search of a genetic link is warranted. We propose here a set of diagnostic criteria based on features consistently cited in the literature. In this literature review, 23 case reports were identified and collated into a summary of symptomatic cases of ecchordosis physaliphora. An illustrative case report of two patients was also included.  PMID:27158576

  1. Acute Cyclophosphamide Hemorrhagic Myopericarditis: Dilemma Case Report, Literature Review and Proposed Diagnostic Criteria

    PubMed Central

    2015-01-01

    Cyclophosphamide is a potent DNA alkylating agent used in chemotherapy and immunosuppression. Although an old agent, its use in the present day has expanded for cases of refractory autoimmune disease. In this report, a case of haemorrhagic myopericarditis resulting from high-dose cyclophosphamide for chronic inflammatory demyelinating polyneuropathy is presented. The patient had no predisposing cardiovascular risk factors and a structurally normal heart on previous echocardiogram. Following administration of high-dose cyclophosphamide, the patient developed acute congestive heart failure. Serial echocardiography demonstrated pericardial effusion, myocardial thickening, and progressive right ventricular dysfunction. Histopathology on autopsy revealed acute myocardial necrosis, intra-myocardial extravasation of blood, fibrin, and fibrin-platelet microthrombi compatible with the diagnosis of haemorrhagic myopericarditis. The ante-mortem diagnostic dilemma is described to emphasize the need for pattern recognition and clinical criteria for diagnosis. Subsequent comprehensive literature review was performed to identify features that will facilitate earlier diagnosis of haemorrhagic myopericarditis by healthcare providers. PMID:26674419

  2. Building Energy Simulation Test for Existing Homes (BESTEST-EX): Instructions for Implementing the Test Procedure, Calibration Test Reference Results, and Example Acceptance-Range Criteria

    SciTech Connect

    Judkoff, R.; Polly, B.; Bianchi, M.; Neymark, J.; Kennedy, M.

    2011-08-01

    This publication summarizes building energy simulation test for existing homes (BESTEST-EX): instructions for implementing the test procedure, calibration tests reference results, and example acceptance-range criteria.

  3. Air Force use of civil airworthiness criteria for testing and acceptance of military derivative transport aircraft

    SciTech Connect

    Marx, R.I.; Chapman, D.M.; Langley, M.J.; Fouts, R.S.

    1990-01-01

    A review of commercial aircraft programs and the use of FAA certification criteria in the acquisition of off-the-shelf transport aircraft by the USAF to fulfill its airlift requirements is presented. In addition, major differences between military and commercial test programs and acquisition are cited to illustrate the principal benefits to the Air Force of this method. Significantly reduced acquisition time, and reduced ground and flight testing and development costs are shown as benefits of this process. The unique aspects of certification of military derivatives, recent initiatives to codify the processes, and the impacts on changes required in the manner in which the USAF currently contracts for aircraft are discussed. 20 refs.

  4. Validation of Three Early Ejaculation Diagnostic Tools: A Composite Measure Is Accurate and More Adequate for Diagnosis by Updated Diagnostic Criteria

    PubMed Central

    Jern, Patrick; Piha, Juhana; Santtila, Pekka

    2013-01-01

    Purpose To validate three early ejaculation diagnostic tools, and propose a new tool for diagnosis in line with proposed changes to diagnostic criteria. Significant changes to diagnostic criteria are expected in the near future. Available screening tools do not necessarily reflect proposed changes. Materials and Methods Data from 148 diagnosed early ejaculation patients (Mage = 42.8) and 892 controls (Mage = 33.1 years) from a population-based sample were used. Participants responded to three different questionnaires (Premature Ejaculation Profile; Premature Ejaculation Diagnostic Tool; Multiple Indicators of Premature Ejaculation). Stopwatch measured ejaculation latency times were collected from a subsample of early ejaculation patients. We used two types of responses to the questionnaires depending on the treatment status of the patients 1) responses regarding the situation before starting pharmacological treatment and 2) responses regarding current situation. Logistic regressions and Receiver Operating Characteristics were used to assess ability of both the instruments and individual items to differentiate between patients and controls. Results All instruments had very good precision (Areas under the Curve ranging from .93-.98). A new five-item instrument (named CHecklist for Early Ejaculation Symptoms – CHEES) consisting of high-performance variables selected from the three instruments had validity (Nagelkerke R2 range .51-.79 for backwards/forwards logistic regression) equal to or slightly better than any individual instrument (i.e., had slightly higher validity statistics, but these differences did not achieve statistical significance). Importantly, however, this instrument was more in line with proposed changes to diagnostic criteria. Conclusions All three screening tools had good validity. A new 5-item diagnostic tool (CHEES) based on the three instruments had equal or somewhat more favorable validity statistics compared to the other three tools, but is

  5. Sotos syndrome: a study of the diagnostic criteria and natural history.

    PubMed Central

    Cole, T R; Hughes, H E

    1994-01-01

    Seventy-nine patients with a provisional diagnosis of Sotos syndrome were clinically assessed, and their photographs between the ages of 1 and 6 years evaluated. These photographs, together with photographs of first degree relatives, also at ages 1 to 6 years, were reviewed by four clinical geneticists. Forty-one probands (but no first degree relatives) were identified in whom the facial gestalt was thought to be characteristic of Sotos syndrome. Comparison of anthropometric measurements, bone age, and developmental delay in these 41 probands showed marked differences between them and the remaining 38 probands, and allowed the formulation of guidelines for the diagnosis of Sotos syndrome. Length was identified as the most significantly increased prenatal parameter. In childhood occipitofrontal head circumference (OFC), height, and weight were all increased. OFC remained above the 97th centile in all but one case throughout childhood and adulthood, whereas height and weight had a tendency to return towards the mean. This 'normalisation' was more pronounced in females and was probably related to their early puberty. Early developmental delay and an advanced bone age, seen in 100% and 84% respectively of study cases, may be invariable in Sotos syndrome, but selection bias and limited data prevented confirmation of this supposition. The authors suggest that facial gestalt, growth pattern, bone age, and developmental delay are the major diagnostic criteria. Using these criteria, no affected first degree relatives were identified. There were few long term medical complications in the probands, but behavioural difficulties caused considerable parental concern. Images PMID:7512144

  6. Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment.

    PubMed

    Ismail, Zahinoor; Smith, Eric E; Geda, Yonas; Sultzer, David; Brodaty, Henry; Smith, Gwenn; Agüera-Ortiz, Luis; Sweet, Rob; Miller, David; Lyketsos, Constantine G

    2016-02-01

    Neuropsychiatric symptoms (NPS) are common in dementia and in predementia syndromes such as mild cognitive impairment (MCI). NPS in MCI confer a greater risk for conversion to dementia in comparison to MCI patients without NPS. NPS in older adults with normal cognition also confers a greater risk of cognitive decline in comparison to older adults without NPS. Mild behavioral impairment (MBI) has been proposed as a diagnostic construct aimed to identify patients with an increased risk of developing dementia, but who may or may not have cognitive symptoms. We propose criteria that include MCI in the MBI framework, in contrast to prior definitions of MBI. Although MBI and MCI can co-occur, we suggest that they are different and that both portend a higher risk of dementia. These MBI criteria extend the previous literature in this area and will serve as a template for validation of the MBI construct from epidemiologic, neurobiological, treatment, and prevention perspectives. PMID:26096665

  7. Proposed diagnostic criteria, disease severity classification and treatment strategy for TAFRO syndrome, 2015 version.

    PubMed

    Masaki, Yasufumi; Kawabata, Hiroshi; Takai, Kazue; Kojima, Masaru; Tsukamoto, Norifumi; Ishigaki, Yasuhito; Kurose, Nozomu; Ide, Makoto; Murakami, Jun; Nara, Kenji; Yamamoto, Hiroshi; Ozawa, Yoko; Takahashi, Hidekazu; Miura, Katsuhiro; Miyauchi, Tsutomu; Yoshida, Shinichirou; Momoi, Akihito; Awano, Nobuyasu; Ikushima, Soichiro; Ohta, Yasunori; Furuta, Natsue; Fujimoto, Shino; Kawanami, Haruka; Sakai, Tomoyuki; Kawanami, Takafumi; Fujita, Yoshimasa; Fukushima, Toshihiro; Nakamura, Shigeo; Kinoshita, Tomohiro; Aoki, Sadao

    2016-06-01

    TAFRO syndrome is a systemic inflammatory disorder characterized by thrombocytopenia, anasarca including pleural effusion and ascites, fever, renal insufficiency, and organomegaly including hepatosplenomegaly and lymphadenopathy. Its onset may be acute or sub-acute, but its etiology is undetermined. Although several clinical and pathological characteristics of TAFRO syndrome resemble those of multicentric Castleman disease (MCD), other specific features can differentiate between them. Some TAFRO syndrome patients have been successfully treated with glucocorticoids and/or immunosuppressants, including cyclosporin A, tocilizumab and rituximab, whereas others are refractory to treatment, and eventually succumb to the disease. Early and reliable diagnoses and early treatments with appropriate agents are essential to enhancing patient survival. The present article reports the 2015 updated diagnostic criteria, disease severity classification and treatment strategy for TAFRO syndrome, as formulated by Japanese research teams. These criteria and classification have been applied and retrospectively validated on clinicopathologic data of 28 patients with this and similar conditions (e.g. MCD with serositis and thrombocytopenia). PMID:27084250

  8. How Preclinical Models Evolved to Resemble the Diagnostic Criteria of Drug Addiction.

    PubMed

    Belin-Rauscent, Aude; Fouyssac, Maxime; Bonci, Antonello; Belin, David

    2016-01-01

    Drug addiction is a complex neuropsychiatric disorder that affects a subset of the individuals who take drugs. It is characterized by maladaptive drug-seeking habits that are maintained despite adverse consequences and intense drug craving. The pathophysiology and etiology of addiction is only partially understood despite extensive research because of the gap between current preclinical models of addiction and the clinical criteria of the disorder. This review presents a brief overview, based on selected methodologies, of how behavioral models have evolved over the last 50 years to the development of recent preclinical models of addiction that more closely mimic diagnostic criteria of addiction. It is hoped that these new models will increase our understanding of the complex neurobiological mechanisms whereby some individuals switch from controlled drug use to compulsive drug-seeking habits and relapse to these maladaptive habits. Additionally, by paving the way to bridge the gap that exists between biobehavioral research on addiction and the human situation, these models may provide new perspectives for the development of novel and effective therapeutic strategies for drug addiction. PMID:25747744

  9. Consensus diagnostic histopathological criteria for acute gastrointestinal graft versus host disease improve interobserver reproducibility.

    PubMed

    Kreft, Andreas; Mottok, Anja; Mesteri, Ildiko; Cardona, Diana M; Janin, Anne; Kühl, Anja A; Andrulis, Mindaugas; Brunner, Andrea; Shulman, Howard M; Negri, Giovanni; Tzankov, Alexandar; Huber, Elisabeth

    2015-09-01

    Graft versus host disease (GvHD) is a clinically important complication after allogeneic hematopoietic stem cell transplantation (HSCT). Its diagnosis relies on clinical and histopathological findings. In order to evaluate and improve inter-institutional diagnostic agreement on histological diagnosis and grading of acute gastrointestinal GvHD, we conducted a round robin test, which included 33 biopsies from 23 patients after HSCT. Five pathologists from different institutions independently evaluated the original sections from the biopsies submitted for diagnosis. Based on their results, consensus qualitative criteria for the assessment of typical histological features of GvHD (e.g., apoptosis, crypt destruction, mucosa denudation) were proposed, including detailed descriptions as well as histological images. In a second round robin test with involvement of the same pathologists, the reproducibility of both diagnosis and grading had improved. Remaining differences were mostly related to differential diagnostic considerations, including viral infection or toxic side effects of medication, which should be resolved by integrating histopathological findings with proper clinical information. PMID:26164839

  10. Redefined clinical features and diagnostic criteria in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy

    PubMed Central

    Ferre, Elise M.N.; Rose, Stacey R.; Rosenzweig, Sergio D.; Burbelo, Peter D.; Romito, Kimberly R.; Niemela, Julie E.; Rosen, Lindsey B.; Break, Timothy J.; Gu, Wenjuan; Hunsberger, Sally; Browne, Sarah K.; Hsu, Amy P.; Rampertaap, Shakuntala; Swamydas, Muthulekha; Collar, Amanda L.; Kong, Heidi H.; Lee, Chyi-Chia Richard; Chascsa, David; Simcox, Thomas; Pham, Angela; Bondici, Anamaria; Natarajan, Mukil; Monsale, Joseph; Kleiner, David E.; Quezado, Martha; Alevizos, Ilias; Moutsopoulos, Niki M.; Yockey, Lynne; Frein, Cathleen; Soldatos, Ariane; Calvo, Katherine R.; Adjemian, Jennifer; Similuk, Morgan N.; Lang, David M.; Stone, Kelly D.; Uzel, Gulbu; Kopp, Jeffrey B.; Bishop, Rachel J.; Holland, Steven M.; Olivier, Kenneth N.; Fleisher, Thomas A.; Heller, Theo; Winer, Karen K.; Lionakis, Michail S.

    2016-01-01

    Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare primary immunodeficiency disorder typically caused by homozygous AIRE mutations. It classically presents with chronic mucocutaneous candidiasis and autoimmunity that primarily targets endocrine tissues; hypoparathyroidism and adrenal insufficiency are most common. Developing any two of these classic triad manifestations establishes the diagnosis. Although widely recognized in Europe, where nonendocrine autoimmune manifestations are uncommon, APECED is less defined in patients from the Western Hemisphere. We enrolled 35 consecutive American APECED patients (33 from the US) in a prospective observational natural history study and systematically examined their genetic, clinical, autoantibody, and immunological characteristics. Most patients were compound heterozygous; the most common AIRE mutation was c.967_979del13. All but one patient had anti–IFN-ω autoantibodies, including 4 of 5 patients without biallelic AIRE mutations. Urticarial eruption, hepatitis, gastritis, intestinal dysfunction, pneumonitis, and Sjögren’s-like syndrome, uncommon entities in European APECED cohorts, affected 40%–80% of American cases. Development of a classic diagnostic dyad was delayed at mean 7.38 years. Eighty percent of patients developed a median of 3 non-triad manifestations before a diagnostic dyad. Only 20% of patients had their first two manifestations among the classic triad. Urticarial eruption, intestinal dysfunction, and enamel hypoplasia were prominent among early manifestations. Patients exhibited expanded peripheral CD4+ T cells and CD21loCD38lo B lymphocytes. In summary, American APECED patients develop a diverse syndrome, with dramatic enrichment in organ-specific nonendocrine manifestations starting early in life, compared with European patients. Incorporation of these new manifestations into American diagnostic criteria would accelerate diagnosis by approximately 4 years and

  11. Self-reported dietary fructose intolerance in irritable bowel syndrome: Proposed diagnostic criteria

    PubMed Central

    Berg, Leif Kyrre; Fagerli, Erik; Myhre, Arnt-Otto; Florholmen, Jon; Goll, Rasmus

    2015-01-01

    AIM: To study the criteria for self-reported dietary fructose intolerance (DFI) and to evaluate subjective global assessment (SGA) as outcome measure. METHODS: Irritable bowel syndrome (IBS) patients were randomized in an open study design with a 2 wk run-in on a habitual IBS diet, followed by 12 wk with/without additional fructose-reduced diet (FRD). Daily registrations of stool frequency and consistency, and symptoms on a visual analog scale (VAS) were performed during the first 4 wk. SGA was used for weekly registrations during the whole study period. Provocation with high-fructose diet was done at the end of the registration period. Fructose breath tests (FBTs) were performed. A total of 182 subjects performed the study according to the protocol (88 FRD, 94 controls). RESULTS: We propose a new clinically feasible diagnostic standard for self-reported fructose intolerance. The instrument is based on VAS registrations of symptom relief on FRD combined with symptom aggravation upon provocation with fructose-rich diet. Using these criteria 43 of 77 patients (56%) in the present cohort of IBS patients had self-reported DFI. To improve the concept for clinical evaluation, we translated the SGA scale instrument to Norwegian and validated it in the context of the IBS diet regimen. The validation procedures showed a sensitivity, specificity and κ value for SGA detecting the self-reported DFI group by FRD response within the IBS patients of 0.79, 0.75 and 0.53, respectively. Addition of the provocation test yielded values of 0.84, 0.76 and 0.61, respectively. The corresponding validation results for FBT were 0.57, 0.34 and -0.13, respectively. CONCLUSION: FRD improves symptoms in a subgroup of IBS patients. A diet trial followed by a provocation test evaluated by SGA can identify most responders to FRD. PMID:25987795

  12. A study of diagnostic criteria established for two oral mucous diseases by HMME-fluorescence spectroscopy.

    PubMed

    Lv, Moyang; Qin, Feng; Mao, Limin; Zhang, Lei; Lv, Shaohua; Jin, Jian; Zhang, Zhiguo

    2015-11-01

    Malignant oral ulcers are common pathological occurrence in oral and maxillofacial tumors. A noninvasive method for diagnosis of malignant oral ulcers was developed in the study, which is based on hematoporphyrin monomethylether (HMME) fluorescence spectroscopy. The objective of this work is to determine the feasibility of this method in differentiating the malignant tissues from the inflammatory ones in the hamster cheek pouch model. Adult hamsters were used for the study and a cheek pouch model was established. For the malignant model, the 9, 10-dimethyl-1, 2-benzanthracene carcinogenesis was applied to one cheek pouch for 10 weeks (N = 35). The simple ulcers were created on buccal cheek mucosa in a simple manner (N = 10). Prior to sacrifice, HMME solution was injected into the tissues. The induced fluorescence spectra of the cheek tissues were recorded by a fiber spectrometer with excitation at 405 nm. A spectral algorithm was used to eliminate the effect of autofluorescence, and a spectral parameter S was selected as diagnostic criterion. After fluorescence measurement, the animals were sacrificed and the measured tissues were collected. Histological staining was performed and the results of histopathological evaluation were documented. The diagnostic criteria that reflected the fluorescence intensity were set as follows: normal, S ≤ 10; simple ulcer, 230 ≤ S ≤ 290; and malignant ulcer, 140 ≤ S ≤ 200. The sensitivity and specificity of this detection method was verified by scalpel biopsy, and the overall accuracy was over 90%. The results of this study showed that the fluorescence spectroscopic method implemented by HMME can accurately differentiate the two kinds of clinically indistinguishable diseases. PMID:26071098

  13. Hepatocellular Carcinoma, Fibrolamellar Variant: Diagnostic Pathologic Criteria and Molecular Pathology Update. A Primer

    PubMed Central

    Sergi, Consolato M.

    2015-01-01

    Fibrolamellar hepatocellular carcinoma (FL-HCC) is generally a fairly rare event in routine pathology practice. This variant of hepatocellular carcinoma (HCC) is peculiarly intriguing and,in addition, poorly understood. Young people or children are often the target individuals with this type of cancer. Previously, I highlighted some pathology aspects of FL-HCC, but in this review, the distinctive clinico-pathologic features of FL-HCC and the diagnostic pathologic criteria of FL-HCC are fractionally reviewed and expanded upon. Further, molecular genetics update data with reference to this specific tumor are particularly highlighted as a primer for general pathologists and pediatric histopathologists. FL-HCC may present with metastases, and regional lymph nodes may be sites of metastatic spread. However, peritoneal and pulmonary metastatic foci have also been reported. To the best of our knowledge, FL-HCC was initially considered having an indolent course, but survival outcomes have recently been updated reconsidering the prognosis of this tumor. Patients seem to respond well to surgical resection, but recurrences are common. Thus, alternative therapies, such as chemotherapy and radiation, are ongoing. Overall, it seems that this aspect has not been well-studied for this variant of HCC and should be considered as target for future clinical trials. Remarkably, FL-HCC data seem to point to a liver neoplasm of uncertain origin and unveiled outcome. A functional chimeric transcript incorporating DNAJB1 and PRKACA was recently added to FL-HCC. This sensational result may give remarkable insights into the understanding of this rare disease and potentially provide the basis for its specific diagnostic marker. Detection of DNAJB1-PRKACA seems to be, indeed, a very sensitive and specific finding in supporting the diagnosis of FL-HCC. In a quite diffuse opinion, prognosis of this tumor should be reconsidered following the potentially mandatory application of new molecular

  14. A Comparison of DSM-5 and DSM-IV Diagnostic Criteria for Posttraumatic Stress Disorder in Traumatized Refugees.

    PubMed

    Schnyder, Ulrich; Müller, Julia; Morina, Naser; Schick, Matthis; Bryant, Richard A; Nickerson, Angela

    2015-08-01

    The aim of this study was to compare the prevalence rate and factor structure of posttraumatic stress disorder (PTSD) based on the diagnostic criteria of the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; DSM-5; American Psychiatric Association, , ) in traumatized refugees. There were 134 adult treatment-seeking, severely and multiply traumatized patients from various refugee backgrounds were assessed in their mother tongue using a computerized set of questionnaires consisting of a trauma list, the Posttraumatic Diagnostic Scale, and the new PTSD items that had been suggested by the DSM-5 Task Force of the American Psychiatric Association. Using DSM-IV, 60.4% of participants met diagnostic criteria for PTSD; using DSM-5, only 49.3% fulfilled all criteria (p < .001). Confirmatory factor analysis of DSM-IV and DSM-5 items showed good and comparable model fits. Furthermore, classification functions in the DSM-5 were satisfactory. The new Cluster D symptoms showed relatively high sensitivity, specificity, positive predictive power, and negative predictive power. The DSM-5 symptom structure appears to be applicable to traumatized refugees. Negative alterations in cognitions and mood may be especially useful for clinicians, not only to determine the extent to which an individual refugee is likely to meet criteria for PTSD, but also in providing targets for clinical intervention. PMID:26194738

  15. Emotion Perception in Asperger's Syndrome and High-Functioning Autism: The Importance of Diagnostic Criteria and Cue Intensity

    ERIC Educational Resources Information Center

    Mazefsky, Carla A.; Oswald, Donald P.

    2007-01-01

    This study compared emotion perception accuracy between children with Asperger's syndrome (AS) and high-functioning autism (HFA). Thirty children were diagnosed with AS or HFA based on empirically supported diagnostic criteria and administered an emotion perception test consisting of facial expressions and tone of voice cues that varied in…

  16. [The criteria of differentiated diagnostics of early arthritis on the basis of analysis of serum hyaluronidase and deoxyribonuclease activity].

    PubMed

    Volkova, M V; Kunder, E V

    2012-10-01

    The study analyzed serum hyaluronidase and deoxyribonuclease activity in patients with early arthritis--early rheumatoid arthritis and acute reactive arthritis. The criteria of their differential diagnostics were developed on the basis of data obtained. The genuine methods were applied to analyze hyaluronidase and deoxyribonuclease activity of blood serum based on formation of clot of etacridine acetate (rivanol) with hyaluronic acid and DNA inversely proportionally to their polymerization under the impact of enzymes. The increased serum hyaluronidase and deoxyribonuclease activity was established in patients with early arthritis as compared with control group (p < 0.001). The prevalence of mentioned types of activity under early rheumatoid arthritis as compared with acute reactive arthritis was detected too. The rests for differentiate diagnostics of early rheumatoid arthritis and acute reactive arthritis were developed conformed to criteria of the most useful diagnostic tests in rheumatology. PMID:23265051

  17. Validity of proposed DSM-5 diagnostic criteria for nicotine use disorder: results from 734 Israeli lifetime smokers

    PubMed Central

    Shmulewitz, D.; Wall, M.M.; Aharonovich, E.; Spivak, B.; Weizman, A.; Frisch, A.; Grant, B. F.; Hasin, D.

    2013-01-01

    Background The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) proposes aligning nicotine use disorder (NUD) criteria with those for other substances, by including the current DSM fourth edition (DSM-IV) nicotine dependence (ND) criteria, three abuse criteria (neglect roles, hazardous use, interpersonal problems) and craving. Although NUD criteria indicate one latent trait, evidence is lacking on: (1) validity of each criterion; (2) validity of the criteria as a set; (3) comparative validity between DSM-5 NUD and DSM-IV ND criterion sets; and (4) NUD prevalence. Method Nicotine criteria (DSM-IV ND, abuse and craving) and external validators (e.g. smoking soon after awakening, number of cigarettes per day) were assessed with a structured interview in 734 lifetime smokers from an Israeli household sample. Regression analysis evaluated the association between validators and each criterion. Receiver operating characteristic analysis assessed the association of the validators with the DSM-5 NUD set (number of criteria endorsed) and tested whether DSM-5 or DSM-IV provided the most discriminating criterion set. Changes in prevalence were examined. Results Each DSM-5 NUD criterion was significantly associated with the validators, with strength of associations similar across the criteria. As a set, DSM-5 criteria were significantly associated with the validators, were significantly more discriminating than DSM-IV ND criteria, and led to increased prevalence of binary NUD (two or more criteria) over ND. Conclusions All findings address previous concerns about the DSM-IV nicotine diagnosis and its criteria and support the proposed changes for DSM-5 NUD, which should result in improved diagnosis of nicotine disorders. PMID:23312475

  18. On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.

    PubMed

    Dunn, Thomas M; Bratman, Steven

    2016-04-01

    There has been a growing interest among clinicians and researchers about a condition where people restrict their diet based not on quantity of food they consume, but based on its quality. Bratman (1997) coined the term "orthorexia nervosa" to describe people whose extreme diets - intended for health reasons - are in fact leading to malnutrition and/or impairment of daily functioning. There has also recently been intense media interest in people whose highly restrictive "healthy" diet leads to disordered eating. Despite this condition being first described in the U.S., and receiving recent media interest here, orthorexia has largely gone unnoticed in the North American literature. This review article details the literature of orthorexia nervosa, describing its emergence as a condition first described by a physician in a yoga magazine, to its being discussed in the scientific literature. It also reviews prevalence studies and discusses marked shortcomings in the literature. Finally, diagnostic criteria are proposed, as are future directions for research. PMID:26724459

  19. Gestational diabetes mellitus: An update on the current international diagnostic criteria

    PubMed Central

    Agarwal, Mukesh M

    2015-01-01

    The approach to screening and diagnosis of gestational diabetes mellitus (GDM) around the world is disorderly. The protocols for diagnosis vary not only in-between countries, but also within countries. Furthermore, in any country, this disparity occurs in-between its hospitals and often exists within a single hospital. There are many reasons for these differences. There is the lack of an international consensus among preeminent health organizations (e.g., American College of Gynecologists and World Health Organization). Often there is a disagreement between the country’s national diabetes organization, its local health society and its regional obstetric organization with each one recommending a different option for approaching GDM. Sometimes the causes for following an alternate approach are very obvious, e.g., a resource strapped hospital is unable to follow the ivory-tower demanding recommendation of its obstetric organization. But more often than not, the rationale for following or not following a guideline, or following different guideline within the same geographic area is without any perceivable explanation. This review is an attempt to understand the problems afflicting the screening and diagnosis of GDM globally. It traces the major temporal changes in the diagnostic criteria of (1) some respected health organizations; and (2) a few selected countries. With an understanding of the reasons for this disparity, a way forward can be found to reach the ultimate goal: a single global guideline for GDM followed worldwide. PMID:26131321

  20. Pathology and diagnostic criteria of Clostridium difficile enteric infection in horses.

    PubMed

    Diab, S S; Rodriguez-Bertos, A; Uzal, F A

    2013-11-01

    Clostridium difficile is commonly associated with diarrhea and colitis in humans and other mammals, including horses. To this date, the epidemiologic, microbiologic, clinical, and diagnostic aspects of C. difficile-associated disease (CDAD) in horses have been thoroughly described. However, reports describing the enteric pathology of this disease in horses are limited. This study presents a comprehensive description of the pathologic characteristics of CDAD in 21 horses and discusses the criteria for the diagnosis of the disease. Case selection was based on C. difficile A/B toxins detection (enzyme-linked immunosorbent assay) in intestinal content samples accompanied by compatible gross and microscopic enteric lesions. Grossly, multifocal, segmental, or diffuse hemorrhage; congestion; and/or marked gelatinous edema of the intestinal wall with abundant bloody or green watery contents were observed. Histologically, the most common lesion was severe necrotizing or necrohemorrhagic enteritis, colitis, or typhlocolitis, with mucosal and/or submucosal thrombosis and marked submucosal edema. The pathology of CDAD in horses is similar to that caused by other equine enteric pathogens; therefore, a definitive diagnosis requires detection of C. difficile A/B toxins in the intestinal contents. PMID:23686768

  1. ALS diagnostic criteria, El Escorial, and Philip II of Spain: a historical perspective.

    PubMed

    Belsh, J M

    1999-12-01

    El Escorial, a magnificent palace-monastery in central Spain, was the setting in 1990 for a meeting of ALS experts who developed a consensus document called the El Escorial ALS Diagnostic Criteria. El Escorial was originally conceived by the Spanish Habsburg monarch, Philip II (1527-1598), as an elaborate burial place for his parents, Emperor Charles V and Isabella. It soon became a symbol of the Spanish empire and Philip's Catholic leadership of the Counter-Reformation. El Escorial included a monastery, palace, basilica, mausoleum, seminary, library, and hospital. Nothing was spared by Philip in obtaining the finest examples of religious art, architecture, music, and books. Philip, as absolute monarch, inherited a vast empire which stretched over Europe, Asia, North Africa, and the New World. His style of personal micro-management and poor economic planning hampered his ability to manage both national and foreign affairs. Philip had a special interest in medicine, including royal hospitals, improved government standards for physicians, medicinal plants, and the health benefits of alchemy and sacred relics. El Escorial's grand scale has generated both illustrious praise and critical condemnation over the last four centuries. Its place in Spanish and world history is assured. PMID:12365069

  2. Rationale for revision and proposed changes of the WHO diagnostic criteria for polycythemia vera, essential thrombocythemia and primary myelofibrosis

    PubMed Central

    Barbui, T; Thiele, J; Vannucchi, A M; Tefferi, A

    2015-01-01

    The 2001/2008 World Health Organization (WHO)-based diagnostic criteria for polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF) were recently revised to accomodate new information on disease-specific mutations and underscore distinguishing morphologic features. In this context, it seems to be reasonable to compare first major diagnostic criteria of the former WHO classifications for myeloproliferative neoplasm (MPN) and then to focus on details that have been discussed and will be proposed for the upcoming revision of diagnostic guidelines. In PV, a characteristic bone marrow (BM) morphology was added as one of three major diagnostic criteria, which allowed lowering of the hemoglobin/hematocrit threshold for diagnosis, which is another major criterion, to 16.5 g/dl/49% in men and 16 g/dl/48% in women. The presence of a JAK2 mutation remains the third major diagnostic criterion in PV. Subnormal serum erythropoietin level is now the only minor criterion in PV and is used to capture JAK2-unmutated cases. In ET and PMF, mutations that are considered to confirm clonality and specific diagnosis now include CALR, in addition to JAK2 and MPL. Also in the 2015 discussed revision, overtly fibrotic PMF is clearly distinguished from early/prefibrotic PMF and each PMF variant now includes a separate list of diagnostic criteria. The main rationale for these changes was to enhance the distinction between so-called masked PV and JAK2-mutated ET and between ET and prefibrotic early PMF. The proposed changes also underscore the complementary role, as well as limitations of mutation analysis in morphologic diagnosis. On the other hand, discovery of new biological markers may probably be expected in the future to enhance discrimination of the different MPN subtypes in accordance with the histological BM patterns and corresponding clinical features. PMID:26832847

  3. Ultrastructurally confirmed myofibrosarcoma: a series of 10 new cases, with a discussion on diagnostic criteria.

    PubMed

    Shenjere, Patrick; Eyden, Brian; Banerjee, S Sankar; Chakrabarty, Bipasha; Shanks, Jonathan H; Sikand, Kanwal A; Menasce, Lia P

    2013-02-01

    Some view ultrastructure as key to myofibrosarcoma diagnosis, whereas others argue that electron microscopy is too little used in contemporary practice to be considered an important diagnostic tool. These views are discussed in the context of 10 ultrastructurally confirmed cases of myofibrosarcoma, some occurring at rare sites such as skin and penis. Patient age ranged from 21 to 83 years, with a 6:4 male to female ratio. Size ranged from 2 to 7.5 cm and all had infiltrative margins. Histologically, all consisted of variably cellular fascicles of spindle cells with mild to moderately pleomorphic nuclei, small punctate nucleoli, and eosinophilic cytoplasm. All cases showed α-smooth muscle actin positivity and 2 showed very focal weak positivity for desmin. Ultrastructurally, the tumor cells contained rough endoplasmic reticulum, mainly peripheral smooth-muscle myofilaments, and fibronectin fibrils or fibronexus junctions at the cell surface. The most confident diagnosis of myofibrosarcoma is provided by ultrastructural examination. However, given the right histological appearance, use of a panel of antibodies that includes α-smooth muscle actin, desmin, and h-caldesmon, serves as an acceptable practical way of diagnosing myofibrosarcoma. PMID:22843641

  4. Which Diagnostic Criteria are Most Useful in Discriminating Between Social Gamblers and Individuals with Gambling Problems? An Examination of DSM-IV and DSM-5 Criteria.

    PubMed

    Temcheff, Caroline E; Paskus, Thomas S; Potenza, Marc N; Derevensky, Jeffrey L

    2016-09-01

    The current study sought to identify which diagnostic criteria for gambling disorder have the greatest ability to differentiate between social and problem gamblers. This study was conducted on a sample of male and female college student athletes across the U.S. (n = 8674). Classification and regression tree analysis represents an appropriate technique when addressing the question of an item's diagnostic value, as it sequentially selects variables to isolate sets of observations with similar outcomes. The current results suggest that the item related to preoccupation ("Have there been periods in the past year where you spent a lot of time thinking about gambling?") was the DSM-5 item best able to differentiate between male and female social and problem gamblers in this sample. When considering only the nine criteria retained in the DSM-5, three criteria were identified as key for distinguishing between social and disordered gamblers among men, and one criterion was identified for distinguishing between groups of women. In addition, these results do not support the notion that the illegal acts criterion has a particularly low base rate and found that it can be an important indicator of disordered gambling in a college-aged sample. PMID:26846481

  5. Comparing Symptoms of Autism Spectrum Disorders Using the Current "DSM-IV-TR" Diagnostic Criteria and the Proposed "DSM-V" Diagnostic Criteria

    ERIC Educational Resources Information Center

    Worley, Julie A.; Matson, Johnny L.

    2012-01-01

    The American Psychiatric Association has proposed major revisions for the diagnostic category encompassing Autism Spectrum Disorders (ASD), which will reportedly increase the specificity and maintain the sensitivity of diagnoses. As a result, the aim of the current study was to compare symptoms of ASD in children and adolescents (N = 208) who met…

  6. Factorial structure and diagnostic efficiency of DSM-IV criteria for avoidant personality disorder in patients with binge eating disorder.

    PubMed

    Grilo, Carlos M

    2004-10-01

    This study examined the factorial structure and diagnostic efficiency of the DSM-IV criteria for avoidant personality disorder (AVPD). Two hundred and twenty-eight consecutive outpatients (181 females and 47 males) with a primary diagnosis of binge eating disorder were reliably assessed with diagnostic interviews. Internal consistency of AVPD criteria was good, as suggested by coefficient alpha of 0.87, the pattern of inter-item correlations (range 0.41 to 0.64), and the lack of changes in alpha if any criteria are deleted. Exploratory factor analysis revealed a one-factor solution (56% of variance) supporting the unidimensionality of the AVPD criteria. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa coefficients) were calculated for each AVPD criterion, for the entire study group and separately by gender. Overall, the best inclusion criterion was 'fears being ridiculed,' which was also the best predictor overall. These psychometric findings did not differ by gender. The findings support certain important aspects of the AVPD diagnosis. PMID:15350855

  7. New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin

    PubMed Central

    Ameratunga, R; Woon, S-T; Gillis, D; Koopmans, W; Steele, R

    2013-01-01

    Common variable immune deficiency (CVID) is the most frequent symptomatic primary immune deficiency in adults. The standard of care is intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (scIG) therapy. The cause of CVID is currently unknown, and there is no universally accepted definition of CVID. This creates problems in determining which patients will benefit from IVIG/scIG treatment. In this paper, we review the difficulties with the commonly used European Society of Immune Deficiencies (ESID) and the Pan American Group for Immune Deficiency (PAGID) definition of CVID. We propose new criteria for the diagnosis of CVID, which are based on recent scientific discoveries. Improved diagnostic precision will assist with treatment decisions including IVIG/scIG replacement. We suggest that asymptomatic patients with mild hypogammaglobulinaemia are termed hypogammaglobulinaemia of uncertain significance (HGUS). These patients require long-term follow-up, as some will evolve into CVID. PMID:23859429

  8. New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin.

    PubMed

    Ameratunga, R; Woon, S-T; Gillis, D; Koopmans, W; Steele, R

    2013-11-01

    Common variable immune deficiency (CVID) is the most frequent symptomatic primary immune deficiency in adults. The standard of care is intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (scIG) therapy. The cause of CVID is currently unknown, and there is no universally accepted definition of CVID. This creates problems in determining which patients will benefit from IVIG/scIG treatment. In this paper, we review the difficulties with the commonly used European Society of Immune Deficiencies (ESID) and the Pan American Group for Immune Deficiency (PAGID) definition of CVID. We propose new criteria for the diagnosis of CVID, which are based on recent scientific discoveries. Improved diagnostic precision will assist with treatment decisions including IVIG/scIG replacement. We suggest that asymptomatic patients with mild hypogammaglobulinaemia are termed hypogammaglobulinaemia of uncertain significance (HGUS). These patients require long-term follow-up, as some will evolve into CVID. PMID:23859429

  9. The diagnostic criteria for iron deficiency in infants should be reevaluated.

    PubMed

    Domellöf, Magnus; Dewey, Kathryn G; Lönnerdal, Bo; Cohen, Roberta J; Hernell, Olle

    2002-12-01

    Diagnostic criteria for iron deficiency (ID) and iron deficiency anemia (IDA) in infants are poorly defined. Our aim was to establish appropriate cut-off values for hemoglobin (Hb), plasma ferritin, erythrocyte mean cell volume (MCV), zinc protoporphyrin (ZPP) and soluble transferrin receptors (TfR) in infancy. Exclusively breast-fed infants (n = 263) in Honduras and Sweden were randomly assigned to receive iron supplementation or placebo, and blood samples were obtained at 4, 6 and 9 mo of age. Reference ranges were determined using three different approaches for defining iron-replete infants. The usefulness of several variables for predicting the Hb response to iron was evaluated. We found the following 2 SD cut-off values in iron-replete infants: Hb <105 g/L at 4-6 mo and <100 g/L at 9 mo; ZPP >75 micro mol/mol heme at 4-6 mo and >90 micro mol/mol heme at 9 mo; ferritin <20 micro g/L at 4 mo, <9 micro g/L at 6 mo and <5 micro g/L at 9 mo; and TfR >11 mg/L at 4-9 mo. The Hb response to iron was not a useful definition of IDA at 4 mo of age. Hb, MCV and ZPP at 6 mo as well as growth variables predicted the Hb response at 6-9 mo, but ferritin and TfR at 6 mo did not. We conclude that there is need for a reevaluation of the definitions of ID and IDA in infants. PMID:12468607

  10. Diagnostic criteria and follow-up in neuroendocrine cell hyperplasia of infancy: a case series*

    PubMed Central

    Gomes, Vivianne Calheiros Chaves; Silva, Mara Cristina Coelho; Maia, José Holanda; Daltro, Pedro; Ramos, Simone Gusmão; Brody, Alan S.; Marchiori, Edson

    2013-01-01

    OBJECTIVE: Neuroendocrine cell hyperplasia of infancy (NEHI) is a form of childhood interstitial lung disease characterized by tachypnea, retractions, crackles, and hypoxia. The aim of this study was to report and discuss the clinical, imaging, and histopathological findings in a series of NEHI cases at a tertiary pediatric hospital, with an emphasis on diagnostic criteria and clinical outcomes. METHODS: Between 2003 and 2011, 12 full-term infants were diagnosed with NEHI, based on clinical and tomographic findings. Those infants were followed for 1-91 months. Four infants were biopsied, and the histopathological specimens were stained with bombesin antibody. RESULTS: In this case series, symptoms appeared at birth in 6 infants and by 3 months of age in the remaining 6. In all of the cases, NEHI was associated with acute respiratory infection. The most common initial chest HRCT findings were ground-glass opacities that were in the middle lobe/lingula in 12 patients and in other medullary areas in 10. Air trapping was the second most common finding, being observed in 7 patients. Follow-up HRCT scans (performed in 10 patients) revealed normal results in 1 patient and improvement in 9. The biopsy findings were nonspecific, and the staining was positive for bombesin in all samples. Confirmation of NEHI was primarily based on clinical and tomographic findings. Symptoms improved during the follow-up period (mean, 41 months). A clinical cure was achieved in 4 patients. CONCLUSIONS: In this sample of patients, the diagnosis of NEHI was made on the basis of the clinical and tomographic findings, independent of the lung biopsy results. Most of the patients showed clinical improvement and persistent tomographic changes during the follow-up period, regardless of the initial severity of the disease or type of treatment. PMID:24310630

  11. Update From the 2011 International Schwannomatosis Workshop: From Genetics to Diagnostic Criteria

    PubMed Central

    Plotkin, Scott R.; Blakeley, Jaishri O.; Evans, D. Gareth; Hanemann, C. Oliver; Hulsebos, Theo J.M.; Hunter-Schaedle, Kim; Kalpana, Ganjam V.; Korf, Bruce; Messiaen, Ludwine; Papi, Laura; Ratner, Nancy; Sherman, Larry S.; Smith, Miriam J.; Stemmer-Rachamimov, Anat O.; Vitte, Jeremie; Giovannini, Marco

    2014-01-01

    Schwannomatosis is the third major form of neurofibromatosis and is characterized by the development of multiple schwannomas in the absence of bilateral vestibular schwannomas. The 2011 Schwannomatosis Update was organized by the Children’s Tumor Foundation (www.ctf.org) and held in Los Angeles, CA, from June 5–8, 2011. This article summarizes the highlights presented at the Conference and represents the “state-of-the-field” in 2011. Genetic studies indicate that constitutional mutations in the SMARCB1 tumor suppressor gene occur in 40–50% of familial cases and in 8–10% of sporadic cases of schwannomatosis. Tumorigenesis is thought to occur through a four-hit, three-step model, beginning with a germline mutation in SMARCB1 (hit 1), followed by loss of a portion of chromosome 22 that contains the second SMARCB1 allele and one NF2 allele (hits 2 and 3), followed by mutation of the remaining wild-type NF2 allele (hit 4). Insights from research on HIV and pediatric rhabdoid tumors have shed light on potential molecular pathways that are dysregulated in schwannomatosis-related schwannomas. Mouse models of schwannomatosis have been developed and promise to further expand our understanding of tumorigenesis and the tumor microenvironment. Clinical reports have described the occurrence of intracranial meningiomas in schwannomatosis patients and in families with germline SMARCB1 mutations. The authors propose updated diagnostic criteria to incorporate new clinical and genetic findings since 2005. In the next 5 years, the authors expect that advances in basic research in the pathogenesis of schwannomatosis will lead toward clinical investigations of potential drug therapies. PMID:23401320

  12. Changing Malaria Epidemiology and Diagnostic Criteria for Plasmodium falciparum Clinical Malaria

    PubMed Central

    Roucher, Clémentine; Rogier, Christophe; Dieye-Ba, Fambaye; Sokhna, Cheikh; Tall, Adama; Trape, Jean-François

    2012-01-01

    Background In tropical Africa, where malaria is highly endemic, low grade infections are asymptomatic and the diagnosis of clinical malaria is usually based on parasite density. Here we investigate how changes in malaria control and endemicity modify diagnostic criteria of Plasmodium falciparum attacks. Methods and Findings Parasitological and clinical data from the population of Dielmo, Senegal, monitored during 20 years, are analyzed in a random-effect logistic regression model to investigate the relationship between the level of parasitemia and risk of fever. Between 1990 and 2010, P. falciparum prevalence in asymptomatic persons declined from 85% to 1% in children 0–3 years and from 34% to 2% in adults ≥50 years. Thresholds levels of parasitemia for attributing fever episodes to malaria decreased by steps in relation to control policies. Using baseline threshold during following periods underestimated P. falciparum attacks by 9.8–20.2% in children and 18.9–40.2% in adults. Considering all fever episodes associated with malaria parasites as clinical attacks overestimated P. falciparum attacks by 42.2–68.5% in children and 45.9–211.7% in adults. Conclusions Malaria control modifies in all age-groups the threshold levels of parasitemia to be used for the assessment of malaria morbidity and to guide therapeutic decisions. Even under declining levels of malaria endemicity, the parasite density method must remain the reference method for distinguishing malaria from other causes of fever and assessing trends in the burden of malaria. PMID:23029433

  13. “Missed” Mild Cognitive Impairment: High False-Negative Error Rate Based on Conventional Diagnostic Criteria

    PubMed Central

    Edmonds, Emily C.; Delano-Wood, Lisa; Jak, Amy J.; Galasko, Douglas R.; Salmon, David P.; Bondi, Mark W.

    2016-01-01

    Mild cognitive impairment (MCI) is typically diagnosed using subjective complaints, screening measures, clinical judgment, and a single memory score. Our prior work has shown that this method is highly susceptible to false-positive diagnostic errors. We examined whether the criteria also lead to “false-negative” errors by diagnostically reclassifying 520 participants using novel actuarial neuropsychological criteria. Results revealed a false-negative error rate of 7.1%. Participants’ neuropsychological performance, cerebrospinal fluid biomarkers, and rate of decline provided evidence that an MCI diagnosis is warranted. The impact of “missed” cases of MCI has direct relevance to clinical practice, research studies, and clinical trials of prodromal Alzheimer's disease. PMID:27031477

  14. OBSESSIVE–COMPULSIVE DISORDER: A REVIEW OF THE DIAGNOSTIC CRITERIA AND POSSIBLE SUBTYPES AND DIMENSIONAL SPECIFIERS FOR DSM-V

    PubMed Central

    Leckman, James F.; Denys, Damiaan; Simpson, H. Blair; Mataix-Cols, David; Hollander, Eric; Saxena, Sanjaya; Miguel, Euripedes C.; Rauch, Scott L.; Goodman, Wayne K.; Phillips, Katharine A.; Stein, Dan J.

    2014-01-01

    Background Since the publication of the DSM-IV in 1994, research on obsessive–compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. Methods The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. Results This review presents a number of options and preliminary recommendations to be considered for DSM-V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions(criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered “time-consuming” for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a “general medical condition”; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to “poor insight,” and adding “tic-related OCD”); and (7) highlighting in the DSM-V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). Conclusions A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM-V process progresses. PMID:20217853

  15. Consequences of the Diagnostic Criteria Proposed for the ICD-11 on the Prevalence of PTSD in Children and Adolescents.

    PubMed

    Sachser, Cedric; Goldbeck, Lutz

    2016-04-01

    In 2013, a working group of the World Health Organization (WHO) proposed a reformulation of the posttraumatic stress disorder (PTSD) diagnostic criteria for the upcoming 11(th) edition of the International Classification of Diseases (ICD-11; Maercker, Brewin, Bryant, Cloitre, van Ommeren, et al., 2013). This study investigated the consequences of the proposed ICD-11 PTSD symptom reduction on the prevalence of PTSD in children and adolescents. Prevalence rates of PTSD in a clinical sample of 159 traumatized children and adolescents were compared applying criteria according to the 4(th) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994), the ICD-10 (WHO, 1992), and the ICD-11. The prevalence rate was 76.1% using DSM-IV, 88.1% using ICD-10, and 61.0% using ICD-11. The use of the criteria proposed for ICD-11 resulted in 27.1% less positive cases compared with ICD-10 and 15.1% less positive cases compared with DSM-IV. Our results showed that in a clinical sample of children and adolescents the prevalence of PTSD was significantly affected by the use of different diagnostic systems. This will constitute a major challenge for research and practice because, depending on the algorithm used, different groups of patients will be included in studies and different groups of individuals will be able to access medical care and therapy. PMID:26915520

  16. Pulmonary fungal infections in patients with acute myeloid leukaemia: is it the time to revise the radiological diagnostic criteria?

    PubMed

    Maccioni, Francesca; Vetere, Simone; De Felice, Carlo; Al Ansari, Najwa; Micozzi, Alessandra; Gentile, Giuseppe; Foà, Robin; Girmenia, Corrado

    2016-06-01

    The definition of pulmonary fungal infections (PFI) according to the EORTC-MSG criteria may lack diagnostic sensitivity due to the possible presentation of PFI with different radiological pictures. We evaluated the hypothesis to apply less restrictive radiological criteria to define PFI in patients with acute myeloid leukaemia (AML) submitted to chemotherapy. Overall, 73 consecutive episodes of pulmonary infiltrates associated to positive serum galactomannan test or fungal isolation or galactomannan detection from respiratory specimens were considered. CT scans acquired at the onset of symptoms (time-0) and within 4 weeks (time-1) were analysed to identify specific (group A) or aspecific radiological signs (group B). Pulmonary infiltrates fulfilled the EORTC-MSG criteria in 49 patients (group A), whereas in 24 patients (group B) they did not reach the criteria due to aspecific CT findings at time-0. Eleven of 21 (52.4%) patients of the group B evaluable for the evolution of the radiological findings fulfilled EORTC-MSG criteria at time-1. All the analysed clinical and mycological characteristics, response to antifungal therapy and survival were comparable in the two groups. Our study seems to confirm the possibility to extend the radiological suspicion of PFI to less restrictive chest CT findings when supported by microbiological criteria in high-risk haematological patients. PMID:26865204

  17. Using the Revised Diagnostic Criteria for Frontotemporal Dementia in India: Evidence of an Advanced and Florid Disease

    PubMed Central

    Ghosh, Amitabha; Dutt, Aparna; Ghosh, Madhura; Bhargava, Pallavi; Rao, Sulakshana

    2013-01-01

    Background The International Consortium (FTDC) that revised the diagnostic criteria for behavioural variant frontotemporal dementia (bvFTD) did not have an Asian representation. Whether the revised criteria are equally useful in the early detection of Asian bvFTD patients therefore remains largely unexplored. Earlier studies have indicated differences in clinical manifestations in Indian and other Asian bvFTD patients when compared to western groups. There is an urgent need for clarification, given the projected exponential rise in dementia in these countries and the imminent clinical trials on bvFTD. Objective To assess how Indian bvFTD patients fulfil the FTDC criteria, hypothesizing that our patients might present differently early in the illness. Method In a hospital-based retrospective observational study, we assessed 48 probable bvFTD patients, diagnosed according to the FTDC criteria, for the speed with which these criteria were fulfilled, the frequency of individual symptoms and their order of appearance during the illness. Results Most of our patients presented with moderate to severe dementia, in spite of having relatively short onset to diagnosis times. Patients on average took 1.4 years from onset to meet the FTDC criteria, with 90% of them presenting with four or more symptoms at diagnosis. Disinhibition was the commonest symptom and the first symptom in most patients. Conclusion With most patients presenting with advanced and florid disease, the FTDC criteria have little additional impact in early identification of bvFTD in India. Modifying the criteria further could allow detection of Indian patients early enough for their inclusion in future clinical trials. PMID:23596513

  18. Proposed changes to the American Psychiatric Association diagnostic criteria for autism spectrum disorder: implications for young children and their families.

    PubMed

    Grant, Roy; Nozyce, Molly

    2013-05-01

    The American Psychiatric Association has revised the diagnostic criteria for their DSM-5 manual. Important changes have been made to the diagnosis of the current (DSM-IV) category of Pervasive Developmental Disorders. This category includes Autistic Disorder (autism), Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). The DSM-5 deletes Asperger's Disorder and PDD-NOS as diagnostic entities. This change may have unintended consequences, including the possibility that the new diagnostic framework will adversely affect access to developmental interventions under Individuals with Disabilities Education Act (IDEA) programs, Early Intervention (for birth to 2 years olds) and preschool special education (for 3 and 4 years olds). Changing the current diagnosis of PDD-NOS to a "Social Communication Disorder" focused on language pragmatics in the DSM-5 may restrict eligibility for IDEA programs and limit the scope of services for affected children. Young children who meet current criteria for PDD-NOS require more intensive and multi-disciplinary services than would be available with a communication domain diagnosis and possible service authorization limited to speech-language therapy. Intensive behavioral interventions, inclusive group setting placements, and family support services are typically more available for children with an autism spectrum disorder than with diagnoses reflecting speech-language delay. The diagnostic distinction reflective of the higher language and social functioning between Asperger's Disorder and autism is also undermined by eliminating the former as a categorical diagnosis and subsuming it under autism. This change may adversely affect treatment planning and misinform parents about prognosis for children who meet current criteria for Asperger's Disorder. PMID:23456348

  19. Reliability, Validity, and Classification Accuracy of the DSM-5 Diagnostic Criteria for Gambling Disorder and Comparison to DSM-IV.

    PubMed

    Stinchfield, Randy; McCready, John; Turner, Nigel E; Jimenez-Murcia, Susana; Petry, Nancy M; Grant, Jon; Welte, John; Chapman, Heather; Winters, Ken C

    2016-09-01

    The DSM-5 was published in 2013 and it included two substantive revisions for gambling disorder (GD). These changes are the reduction in the threshold from five to four criteria and elimination of the illegal activities criterion. The purpose of this study was to twofold. First, to assess the reliability, validity and classification accuracy of the DSM-5 diagnostic criteria for GD. Second, to compare the DSM-5-DSM-IV on reliability, validity, and classification accuracy, including an examination of the effect of the elimination of the illegal acts criterion on diagnostic accuracy. To compare DSM-5 and DSM-IV, eight datasets from three different countries (Canada, USA, and Spain; total N = 3247) were used. All datasets were based on similar research methods. Participants were recruited from outpatient gambling treatment services to represent the group with a GD and from the community to represent the group without a GD. All participants were administered a standardized measure of diagnostic criteria. The DSM-5 yielded satisfactory reliability, validity and classification accuracy. In comparing the DSM-5 to the DSM-IV, most comparisons of reliability, validity and classification accuracy showed more similarities than differences. There was evidence of modest improvements in classification accuracy for DSM-5 over DSM-IV, particularly in reduction of false negative errors. This reduction in false negative errors was largely a function of lowering the cut score from five to four and this revision is an improvement over DSM-IV. From a statistical standpoint, eliminating the illegal acts criterion did not make a significant impact on diagnostic accuracy. From a clinical standpoint, illegal acts can still be addressed in the context of the DSM-5 criterion of lying to others. PMID:26408026

  20. What is in a name? Comparing diagnostic criteria for chronic fatigue syndrome with or without fibromyalgia.

    PubMed

    Meeus, Mira; Ickmans, Kelly; Struyf, Filip; Kos, Daphne; Lambrecht, Luc; Willekens, Barbara; Cras, Patrick; Nijs, Jo

    2016-01-01

    The current study had two objectives. (1) to compare objective and self-report measures in patients with chronic fatigue syndrome (CFS) according to the 1994 Center for Disease Control (CDC) criteria, patients with multiple sclerosis (MS), and healthy controls, and (2) to contrast CFS patients who only fulfill CDC criteria to those who also fulfill the criteria for myalgic encephalomyelitis (ME), the 2003 Canadian criteria for ME/CFS, or the comorbid diagnosis of fibromyalgia (FM). One hundred six participants (48 CFS patients diagnosed following the 1994 CDC criteria, 19 MS patients, and 39 healthy controls) completed questionnaires assessing symptom severity, quality of life, daily functioning, and psychological factors. Objective measures consisted of activity monitoring, evaluation of maximal voluntary contraction and muscle recovery, and cognitive performance. CFS patients were screened whether they also fulfilled ME criteria, the Canadian criteria, and the diagnosis of FM. CFS patients scored higher on symptom severity, lower on quality of life, and higher on depression and kinesiophobia and worse on MVC, muscle recovery, and cognitive performance compared to the MS patients and the healthy subjects. Daily activity levels were also lower compared to healthy subjects. Only one difference was found between those fulfilling the ME criteria and those who did not regarding the degree of kinesiophobia (lower in ME), while comorbidity for FM significantly increased the symptom burden. CFS patients report more severe symptoms and are more disabled compared to MS patients and healthy controls. Based on the present study, fulfillment of the ME or Canadian criteria did not seem to give a clinically different picture, whereas a diagnosis of comorbid FM selected symptomatically worse and more disabled patients. PMID:25308475

  1. Resurvey of symptomatics of the Jaipur district population and suggestion for alternative diagnostic criteria of asthma for epidemiological surveys

    PubMed Central

    Gupta, Prahlad Rai; Bansal, Ankit; Singh, Anupam

    2016-01-01

    Introduction: The prevalence of asthma in Jaipur district of Rajasthan was reported as 0.96% in an earlier survey. It was far below the national average of 2.38%. It was reasoned then that this could be due to under diagnosis of asthma in the Jaipur population. Material and Methods: A resurvey of the symptomatics, not diagnosed as asthma at time of the original survey was, therefore, undertaken. The resurvey data were analysed and those who now fulfilled the twin criteria for diagnosis of asthma, as used in the original survey, were diagnosed as having asthma. The original data of these newly diagnosed asthma patients were reanalyzed in search for an alternative diagnostic criterion. Results: Of the 382 symptomatics, 344 (90%) could be resurveyed and of them, 85 now fulfilled the twin diagnostic criteria for asthma. The reanalysis of the original survey data of these patients revealed that presence of shortness of breath (SOB) had the highest sensitivity, the presence of allergic symptoms in self or the family had the highest specificity and the presence of wheezing had the highest odds ratio (OR) for diagnosing asthma. Further, the OR for diagnosing asthma increased further and was highest with the presence of SOB and 2 additional symptoms. With the use of the “symptom criteria” for diagnosis of asthma i.e. the presence of SOB with 2 additional symptoms, it would have been possible to diagnose majority of the missed cases at the time of the original survey itself. Conclusions: Based on this study data it can be concluded that (a) the twin criteria for diagnosing asthma as used in earlier surveys led to under diagnosis of asthma and (b) the use of symptom criteria alone effectively checks the problem of under diagnosis of asthma. The symptom criteria are being suggested as an alternative method for use in future epidemiological surveys on asthma. PMID:26933304

  2. Are the revised diagnostic criteria for Alzheimer’s disease useful in low- and middle-income countries?

    PubMed Central

    Cece, YANG; Shifu, XIAO

    2015-01-01

    Summary Alzheimer’s Disease (AD) is a leading cause of disease burden among elderly individuals that is increasingly important in middle-income countries like China where improvements in overall health (which increase longevity) and other factors are leading to a rapidly aging population. The diagnostic criteria for AD have recently been revised to reflect advances in the understanding of the condition over the past three decades. Different international organizations have proposed algorithms for diagnosing AD that subdivide the AD spectrum into overlapping stages and, in some cases, require the concurrent presence of memory impairment and specific biomarkers. There are, however, several substantial limitations to these revised criteria: highly trained clinicians are needed to make the fine discriminations between the stages; the role of the proposed biomarkers in the onset and course of AD remain uncertain; and assessment of these biomarkers requires the use of expensive, high-tech equipment by well-trained technicians. These problems limit the clinical utility of these diagnostic criteria, particularly in low-resource settings where the clinicians responsible for identifying and treating individuals with AD have limited training and where the equipment needed to identify the biomarkers are either non-existent or in short supply. PMID:26120262

  3. Steps to standardization and validation of hippocampal volumetry as a biomarker in clinical trials and diagnostic criteria for Alzheimer’s disease

    PubMed Central

    Jack, Clifford R; Barkhof, Frederik; Bernstein, Matt A; Cantillon, Marc; Cole, Patricia E; DeCarli, Charles; Dubois, Bruno; Duchesne, Simon; Fox, Nick C; Frisoni, Giovanni B; Hampel, Harald; Hill, Derek LG; Johnson, Keith; Mangin, Jean-François; Scheltens, Philip; Schwarz, Adam J; Sperling, Reisa; Suhy, Joyce; Thompson, Paul M; Weiner, Michael; Foster, Norman L

    2012-01-01

    Background The promise of Alzheimer’s disease (AD) biomarkers has led to their incorporation in new diagnostic criteria and in therapeutic trials; however, significant barriers exist to widespread use. Chief among these is the lack of internationally accepted standards for quantitative metrics. Hippocampal volumetry is the most widely studied quantitative magnetic resonance imaging (MRI) measure in AD and thus represents the most rational target for an initial effort at standardization. Methods and Results The authors of this position paper propose a path toward this goal. The steps include: 1) Establish and empower an oversight board to manage and assess the effort, 2) Adopt the standardized definition of anatomic hippocampal boundaries on MRI arising from the EADC-ADNI hippocampal harmonization effort as a Reference Standard, 3) Establish a scientifically appropriate, publicly available Reference Standard Dataset based on manual delineation of the hippocampus in an appropriate sample of subjects (ADNI), and 4) Define minimum technical and prognostic performance metrics for validation of new measurement techniques using the Reference Standard Dataset as a benchmark. Conclusions Although manual delineation of the hippocampus is the best available reference standard, practical application of hippocampal volumetry will require automated methods. Our intent is to establish a mechanism for credentialing automated software applications to achieve internationally recognized accuracy and prognostic performance standards that lead to the systematic evaluation and then widespread acceptance and use of hippocampal volumetry. The standardization and assay validation process outlined for hippocampal volumetry is envisioned as a template that could be applied to other imaging biomarkers. PMID:21784356

  4. 38 CFR 4.100 - Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Ratings The Cardiovascular System § 4.100 Application of the evaluation criteria for diagnostic codes 7000... medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability....

  5. 38 CFR 4.100 - Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Ratings The Cardiovascular System § 4.100 Application of the evaluation criteria for diagnostic codes 7000... medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability....

  6. 38 CFR 4.100 - Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Ratings The Cardiovascular System § 4.100 Application of the evaluation criteria for diagnostic codes 7000... medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability....

  7. 38 CFR 4.100 - Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Ratings The Cardiovascular System § 4.100 Application of the evaluation criteria for diagnostic codes 7000... medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability....

  8. Structural acceptance criteria for the evaulation of existing double-shell waste storage tanks located at the Hanford site, Richland, Washington

    SciTech Connect

    Julyk, L.J.; Day, A.D.; Dyrness, A.D.; Moore, C.J.; Peterson, W.S.; Scott, M.A.; Shrivastava, H.P.; Sholman, J.S.; Watts, T.N.

    1995-09-01

    The structural acceptance criteria contained herein for the evaluation of existing underground double-shell waste storage tanks located at the Hanford Site is part of the Life Management/Aging Management Program of the Tank Waste Remediation System. The purpose of the overall life management program is to ensure that confinement of the waste is maintained over the required service life of the tanks. Characterization of the present condition of the tanks, understanding and characterization of potential degradation mechanisms, and development of tank structural acceptance criteria based on previous service and projected use are prerequisites to assessing tank integrity, to projecting the length of tank service, and to developing and applying prudent fixes or repairs. The criteria provided herein summarize the requirements for the analysis and structural qualification of the existing double-shell tanks for continued operation. Code reconciliation issues and material degradation under aging conditions are addressed. Although the criteria were developed for double-shell tanks, many of the provisions are equally applicable to single-shell tanks. However, the criteria do not apply to the evaluation of tank appurtenances and buried piping.

  9. Development of Diagnostic Criteria for Serious Non-AIDS Events in HIV Clinical Trials

    PubMed Central

    Lifson, Alan R.; Belloso, Waldo H.; Davey, Richard T.; Duprez, Daniel; Gatell, Jose M.; Hoy, Jennifer F.; Krum, Eric A.; Nelson, Ray; Pedersen, Court; Perez, George; Price, Richard W.; Prineas, Ronald J.; Rhame, Frank S.; Sampson, James H.; Worley, John

    2011-01-01

    Purpose Serious non-AIDS (SNA) diseases are important causes of morbidity and mortality in the HAART era. We describe development of standard criteria for 12 SNA events for Endpoint Review Committee (ERC) use in START, a multicenter international HIV clinical trial. Methods SNA definitions were developed based upon the following: (1) criteria from a previous trial (SMART), (2) review of published literature, (3) an iterative consultation and review process with the ERC and other content experts, and (4) evaluation of draft SNA criteria using retrospectively collected reports in another trial (ESPRIT). Results Final criteria are presented for acute myocardial infarction, congestive heart failure, coronary artery disease requiring drug treatment, coronary revascularization, decompensated liver disease, deep vein thrombosis, diabetes mellitus, end-stage renal disease, non-AIDS cancer, peripheral arterial disease, pulmonary embolism, and stroke. Of 563 potential SNA events reported in ESPRIT and reviewed by an ERC, 72% met “confirmed” and 13% “probable” criteria. Twenty-eight percent of cases initially reviewed by the ERC required follow-up discussion (adjudication) before a final decision was reached. Conclusion HIV clinical trials that include SNA diseases as clinical outcomes should have standardized SNA definitions to optimize event reporting and validation and should have review by an experienced ERC with opportunities for adjudication. PMID:20974576

  10. Major Salivary Gland Ultrasonography in the Diagnosis of Sjögren's Syndrome: A Place in the Diagnostic Criteria?

    PubMed

    Jonsson, Malin V; Baldini, Chiara

    2016-08-01

    Major salivary gland (SG) ultrasonography (US) represents a noninvasive, nonirradiating imaging modality for evaluation of the major SGs in the diagnosis and follow-up of primary and secondary Sjögren syndrome. Structural changes can be visualized as hyperechogenic and hypoechogenic areas, inhomogeneity, and altered echogenicity in general. The reliability of SG-US is poorly investigated, and the definition of US abnormalities varies in previously published studies. Recent studies have shown correlations between SG-US findings and focus score in the minor SGs; however further studies are needed to validate a US criterion in updated classification/diagnostic criteria. PMID:27431351

  11. [Diagnostic criteria of ultrasonographic methods of the study of cerebral venous circulatory failure in initial manifestations of cerebrovascular disorders].

    PubMed

    Eninia, G I; Egere, D A; Robule, V Kh

    1990-01-01

    Altogether 94 patients with initial manifestations of brain blood supply failure (IMBBSF) consequent on vegetative vascular dystonia and atherosclerosis of the cerebral vessels were examined. Clinical, echopulsographic and dopplerographic examinations demonstrated that 54 patients had cerebral venous discirculation. The main diagnostic criteria for cerebral venous discirculation in patients with IMBBSF lie in an increase of the configuration of the diastolic part of the echoPG of the cerebral arteries, possibility of recording echoPG of the cerebral veins, a rise of the linear velocity of the blood flow in the jugular veins under head-down test during dopplerography. PMID:2175094

  12. Selecting the Acceptance Criteria of Medicines in the Reimbursement List of Public Health Insurance of Iran, Using the “Borda” Method: a Pilot Study

    PubMed Central

    Viyanchi, Amir; Rasekh, Hamid Reza; Rajabzadeh Ghatari, Ali; SafiKhani, Hamid Reza

    2015-01-01

    Decision-making for medicines to be accepted in Iran’s public health insurance reimbursement list is a complex process and involves factors, which should be considered in applying a coverage for medicine costs. These processes and factors are not wholly assessed, while assessment of these factors is an essential need for getting a transparent and evidence-based approach toward medicine reimbursement in Iran. This paper aims to show an evidence-based approach toward medicine selection criteria to inform the medical reimbursement decision makers in Iranian health insurance organizations. To explore an adaptable decision-making framework while incorporating a method called “Borda” in medicine reimbursement assessment, we used the help of an expert group including decision makers and clinical researchers who are also policy makers to appraise the five chief criteria that have three sub criteria (Precision, Interpretability, and Cost). Also software “Math-lab”7, “SPSS” 17 and Excel 2007 were used in this study. “Borda” estimates the amount of perceived values from different criteria and creates a range from one to five while providing a comprehensive measurement of a large spectrum of criteria. Participants reported that the framework provided an efficient approach to systematic consideration in a pragmatic format consisting of many parts to guide decision-makings, including criteria and value (a model with the core of Borda) and evidences (medicine reimbursement based on criteria). The most important criterion for medicine acceptance in health insurance companies, in Iran, is the "life-threatening" factor and "evidence quality" is accounted as the fifth important factor. This pilot study showed the usefulness of incorporating Borda in medicine reimbursement decisions to support a transparent and systematic appraisal of health insurance companies' deeds. Further research is needed to advance Borda-based approaches that are effective on health insurance

  13. Selecting the Acceptance Criteria of Medicines in the Reimbursement List of Public Health Insurance of Iran, Using the "Borda" Method: a Pilot Study.

    PubMed

    Viyanchi, Amir; Rasekh, Hamid Reza; Rajabzadeh Ghatari, Ali; SafiKhani, Hamid Reza

    2015-01-01

    Decision-making for medicines to be accepted in Iran's public health insurance reimbursement list is a complex process and involves factors, which should be considered in applying a coverage for medicine costs. These processes and factors are not wholly assessed, while assessment of these factors is an essential need for getting a transparent and evidence-based approach toward medicine reimbursement in Iran. This paper aims to show an evidence-based approach toward medicine selection criteria to inform the medical reimbursement decision makers in Iranian health insurance organizations. To explore an adaptable decision-making framework while incorporating a method called "Borda" in medicine reimbursement assessment, we used the help of an expert group including decision makers and clinical researchers who are also policy makers to appraise the five chief criteria that have three sub criteria (Precision, Interpretability, and Cost). Also software "Math-lab"7, "SPSS" 17 and Excel 2007 were used in this study. "Borda" estimates the amount of perceived values from different criteria and creates a range from one to five while providing a comprehensive measurement of a large spectrum of criteria. Participants reported that the framework provided an efficient approach to systematic consideration in a pragmatic format consisting of many parts to guide decision-makings, including criteria and value (a model with the core of Borda) and evidences (medicine reimbursement based on criteria). The most important criterion for medicine acceptance in health insurance companies, in Iran, is the "life-threatening" factor and "evidence quality" is accounted as the fifth important factor. This pilot study showed the usefulness of incorporating Borda in medicine reimbursement decisions to support a transparent and systematic appraisal of health insurance companies' deeds. Further research is needed to advance Borda-based approaches that are effective on health insurance decision making

  14. Evaluation of different diagnostic criteria of diseases manifesting the oral cavity - A review. Part-1.

    PubMed

    Shivhare, Peeyush; Gupta, Ashish; Yadav, Monu; Konidena, Arvinda; Shankarnarayan, Lata

    2016-01-01

    There are many disorders affecting the oral cavity, which can cause difficulty in diagnosis for an oral physician. A criterion is defined as 'a principle or standard by which something may be judged or decided'. Several criteria have been given by different authors or committee, which further aids in diagnosis of certain disease. This article encompasses a collection and analysis of all the criteria of diseases affecting the oral cavity, which will be beneficial for an oral physician in their routine clinics. PMID:27195212

  15. Diagnostic Efficiency of DSM-IV Criteria for Borderline Personality Disorder: An Evaluation in Hispanic Men and Women with Substance Use Disorders

    ERIC Educational Resources Information Center

    Grilo, Carlos M.; Becker, Daniel F.; Anez, Luis Miguel; McGlashan, Thomas H.

    2004-01-01

    This study examined diagnostic efficiency of Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), criteria for borderline personality disorder (BPD). One hundred thirty monolingual Hispanic adults (90 men, 40 women) at an outpatient psychiatric and substance abuse clinic were assessed with the Spanish-Language Version of…

  16. Performance deterioration due to acceptance testing and flight loads; JT90 jet engine diagnostic program

    NASA Technical Reports Server (NTRS)

    Olsson, W. J.

    1982-01-01

    The results of a flight loads test of the JT9D-7 engine are presented. The goals of this test program were to: measure aerodynamic and inertia loads on the engine during flight, explore the effects of airplane gross weight and typical maneuvers on these flight loads, simultaneously measure the changes in engine running clearances and performance resulting from the maneuvers, make refinements of engine performance deterioration prediction models based on analytical results of the tests, and make recommendations to improve propulsion system performance retention. The test program included a typical production airplane acceptance test plus additional flights and maneuvers to encompass the range of flight loads in revenue service. The test results indicated that aerodynamic loads, primarily at take-off, were the major cause of rub-indicated that aerodynamic loads, primarily at take-off, were the major cause of rub-induced deterioration in the cold sectin of the engine. Differential thermal expansion between rotating and static parts plus aerodynamic loads combined to cause blade-to-seal rubs in the turbine.

  17. Social Skills Deficits as Primary Learning Disabilities: A Note on Problems with the ICLD Diagnostic Criteria.

    ERIC Educational Resources Information Center

    Forness, Steven R.; Kavale, Kenneth A.

    1991-01-01

    The Interagency Committee on Learning Disabilities' definition of learning disabilities implies that the presence of social skills deficits alone suffices for diagnosis, even in the absence of academic difficulties. Overlaps between this criterion and eligibility criteria for emotional disturbance are discussed along with implications for…

  18. Comparing Diagnostic Outcomes of Autism Spectrum Disorder Using "DSM-IV-TR" and "DSM-5" Criteria

    ERIC Educational Resources Information Center

    Harstad, Elizabeth B.; Fogler, Jason; Sideridis, Georgios; Weas, Sarah; Mauras, Carrie; Barbaresi, William J.

    2015-01-01

    Controversy exists regarding the "DSM-5" criteria for ASD. This study tested the psychometric properties of the "DSM-5" model and determined how well it performed across different gender, IQ, and "DSM-IV-TR" sub-type, using clinically collected data on 227 subjects (median age = 3.95 years, majority had IQ > 70).…

  19. The validity of the diagnostic criteria used in chronic exertional compartment syndrome: a systematic review.

    PubMed

    Roberts, A; Franklyn-Miller, A

    2012-10-01

    Chronic exertional compartment syndrome (CECS) of the lower limb is part of a group of overuse lower limb injuries with common presenting features. It is commonly diagnosed by the measurement of raised intramuscular pressures in the lower limb. The pathophysiology of the condition is poorly understood, and the criteria used to make the diagnosis are based on small sample sizes of symptomatic patients. We carried out a systematic review to compare intramuscular pressures in the anterior compartment of healthy subjects with commonly used criteria for CECS. Thirty-eight studies were included. With the exception of relaxation pressure, the current criteria for diagnosing CECS, considered to be the gold standard, overlap the range found in normal healthy subjects. Several studies reported mean pressures that would prompt a positive diagnosis for CECS, despite none of the subjects reporting any symptoms. The intramuscular pressure at all time points has also shown to vary in relation to a number of other factors other than the presence of CECS. Taken together, these data have major implications on the ability to use these published criteria for diagnosis and question the underlying pathophysiology. Clinicians are recommended to use protocol-specific upper confidence limits to guide the diagnosis following a failed conservative management. PMID:22092446

  20. Comparison of the Minnesota Percepto-Diagnostic Test and Bender-Gestalt: Relationship with Achievement Criteria.

    ERIC Educational Resources Information Center

    Fuller, Gerald B.; Wallbrown, Fred H.

    1983-01-01

    Compared the Bender Gestalt (BD) and Minnesota Percepto-Diagnostic Test (MPD) in predicting academic achievement for younger children (N=69). Results suggested that the MPD is more sensitive than the Bender in identifying visual-motor perception areas of achievement performance problems. (LLL)

  1. Atypical phenotypes associated with pathogenic CHD7 variants and a proposal for broadening CHARGE syndrome clinical diagnostic criteria.

    PubMed

    Hale, Caitlin L; Niederriter, Adrienne N; Green, Glenn E; Martin, Donna M

    2016-02-01

    CHARGE syndrome (Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary anomalies, and Ear malformations, including deafness and vestibular disorders) is a genetic condition characterized by a specific and recognizable pattern of features. Heterozygous pathogenic variants in the chromodomain helicase DNA-binding protein 7 (CHD7) are the major cause of CHARGE syndrome, and have been identified in 70-90% of individuals fulfilling clinical diagnostic criteria. Since 2004, when CHD7 was discovered as the causative gene for CHARGE syndrome, the phenotypic spectrum associated with pathogenic CHD7 variants has expanded. Predicted pathogenic CHD7 variants have been identified in individuals with isolated features of CHARGE including autism and hypogonadotropic hypogonadism. Here, we present genotype and phenotype data from a cohort of 28 patients who were considered for a diagnosis of CHARGE syndrome, including one patient with atypical presentations and a pathogenic CHD7 variant. We also summarize published literature on pathogenic CHD7 variant positive individuals who have atypical clinical presentations. Lastly, we propose a revision to current clinical diagnostic criteria, including broadening of the major features associated with CHARGE syndrome and addition of pathogenic CHD7 variant status as a major criterion. PMID:26590800

  2. The inclusion of child pornography in the DSM-5 diagnostic criteria for pedophilia: conceptual and practical problems.

    PubMed

    First, Michael B

    2011-01-01

    The proposal to add use of child pornography to Criterion B of pedophilia is in direct conflict with the newly proposed distinction between paraphilia and paraphilic disorder, muddying rather than clarifying the diagnostic definition of pedophilia. The proposal to distinguish paraphilic disorder from paraphilia derives from the fact that the diagnostic criteria for the paraphilias have two components: Criterion A, defining the presence of a paraphilic erotic interest, and Criterion B, requiring clinically significant distress, impairment, or acting out the paraphilia with a nonconsenting person. Meeting Criteria A and B is necessary for a diagnosis of paraphilic disorder; meeting only Criterion A indicates a paraphilia. Use of pornography is better placed within Criterion A, perhaps as an example of a behavioral manifestation of pedophilia. If the Sexual and Gender Identity Disorders Work Group's true intent was to add a third prong to Criterion B, then the criterion must be modified to restrict it to the use of illegal forms of pornography (i.e., visual depictions of real children), excluding written or aural forms or virtual images. PMID:21653274

  3. 40 CFR 86.610-98 - Compliance with acceptable quality level and passing and failing criteria for Selective...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Light-Duty Vehicles, Light-Duty Trucks, and Heavy-Duty Vehicles § 86.610-98 Compliance with acceptable... when the decision is made on the last vehicle required to make a decision under paragraph (c) of...

  4. 40 CFR 86.610-98 - Compliance with acceptable quality level and passing and failing criteria for Selective...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Light-Duty Vehicles, Light-Duty Trucks, and Heavy-Duty Vehicles § 86.610-98 Compliance with acceptable... when the decision is made on the last vehicle required to make a decision under paragraph (c) of...

  5. New diagnostic criteria for alcohol use disorders and novel treatment approaches – 2014 update

    PubMed Central

    Tyburski, Ernest M.; Sokolowski, Andrzej; Samochowiec, Jerzy

    2014-01-01

    The study is aimed at presenting new diagnostic and therapeutic proposals for patients with alcohol use disorders. The revised ICD-11 which is currently being updated is coming closer to American standards in disease classification. The latest update of the American DSM-5 has been a notable step forward as it integrates alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder. Recent developments in research into diagnostic tools have brought changes in the approach to therapy. According to most international guidelines, the form of treatment should be customised to the individual patient, with consideration given to his/her mental and physical condition, personality and natural setting. A significant change is the recommendation of a harm reduction strategy as a useful alternative to total abstinence in alcohol dependence treatment for some patients. PMID:25624858

  6. Investigator feedback about the 2005 NIH diagnostic and scoring criteria for chronic GVHD.

    PubMed

    Inamoto, Y; Jagasia, M; Wood, W A; Pidala, J; Palmer, J; Khera, N; Weisdorf, D; Carpenter, P A; Flowers, M E D; Jacobsohn, D; Martin, P J; Lee, S J; Pavletic, S Z

    2014-04-01

    The 2005 National Institutes of Health (NIH) consensus criteria for chronic GVHD have set standards for reporting. Many questions, however, have arisen regarding their implementation and utilization. To identify perceived areas of controversy, we conducted an international survey on diagnosis and scoring of chronic GVHD. Agreement was observed for 50-83% of the 72 questions in 7 topic areas. There was agreement on the need for modifying criteria in six situations: two or more distinctive manifestations should be enough to diagnose chronic GVHD; symptoms that are not due to chronic GVHD should be scored differently; active disease and fixed deficits should be distinguished; a minimum threshold body surface area of hidebound skin involvement should be required for a skin score of 3; asymptomatic oral lichenoid changes should be considered a score 1; and lung biopsy should be unnecessary to diagnose chronic GVHD in a patient with bronchiolitis obliterans as the only manifestation. The survey also identified 26 points of controversy. Whenever possible, studies should be conducted to confirm the appropriateness of any revisions. In cases where data are not available, clarification of the NIH recommendations by consensus is necessary. This survey should inform future research in the field and revisions of the current consensus criteria. PMID:24464142

  7. Evolving "Diagnostic" Criteria for Axial Spondyloarthritis in the Context of Anterior Uveitis.

    PubMed

    Rosenbaum, James T

    2016-08-01

    Anterior uveitis is far more common than intermediate, posterior or panuveitis. About 50% of patients with acute anterior uveitis are HLA B27+. Those who are HLA B27+ are highly likely to have associated back, joint, or tendon disease. The majority of patients with acute anterior uveitis and inflammatory low back pain are suffering from axial spondyloarthritis and radiographic evidence for abnormal sacroiliac joints is not required to make this diagnosis. Received 12 October 2015; revised 31 January 2016; accepted 16 February 2016; published online 12 April 2016. PMID:27070270

  8. [The clinical impairment of children with Attention Deficit Hyperactivity Disorder: problematic of diagnostic criteria].

    PubMed

    Skounti, M; Bitzaraki, A

    2011-01-01

    One important consideration in the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), as set forth in the criterion D of DSM-IV, is the assessment of clinically significant impairment in social and academic functioning. Despite the avowed importance in the assessment of ADHD, there is little guidance in DSM-IV in defining impairment. Rating scales assessing impairment are few in number and rarely used in clinical practice. Overlooking impairment in diagnostic approaches has strong clinical implications, leading to false positive or false negative diagnoses. The relation between impairment and symptoms remains currently undefined and a controversial field in the ADHD literature, as many children can display the full range of ADHD symptoms without necessarily displaying significant impairment in their functioning. The relation between symptoms and impairment is more obvious in older children, where domains of impairment are more expanded. This finding suggests that symptoms and impairment are related, but yet there are distinct domains that should be measured independently to confirm the presence of ADHD. In conclusion, an operational definition of impairment, valid measures and diagnostic decision rules for incorporating impairment into the assessment of ADHD is warranted. Additional research is also needed to determine whether the age of onset of symptoms (before the age of seven) is different or should be separated from the age of onset of impairment. PMID:21888188

  9. Cocaine use disorder prevalence: From current DSM-IV to proposed DSM-5 diagnostic criteria with both a two and three severity level classification system.

    PubMed

    Proctor, Steven L; Kopak, Albert M; Hoffmann, Norman G

    2014-06-01

    This article presents a secondary analysis from a study investigating the compatibility of the current DSM-IV and previously proposed DSM-5 cocaine use disorder (CUD) criteria (S. L. Proctor, A. M. Kopak, & N. G. Hoffmann, 2012, Compatibility of current DSM-IV and proposed DSM-5 diagnostic criteria for cocaine use disorders. Addictive Behaviors, 37, 722-728). The current analyses examined the compatibility of the current DSM-IV and two sets of proposed DSM-5 diagnostic criteria for CUDs among adult male inmates (N = 6,871) recently admitted to the Minnesota Department of Corrections state prison system from 2000-2003. Initially proposed DSM-5 criteria (DSM-5.0) featured only two diagnostic designations (i.e., moderate and severe). A subsequent revision (DSM-5.1) included the addition of a mild designation and required a greater number of positive findings for the severe designation. A computer-prompted structured diagnostic interview was administered to all inmates as part of routine clinical assessments. The past 12-month prevalence of DSM-IV CUDs was 12.70% (Abuse, 3.78%, Dependence, 8.92%), while 10.98% met past 12-month DSM-5.1 criteria for a CUD (Mild [MiCUD], 1.72%; Moderate [MCUD], 1.12%; and Severe [SCUD], 8.14%). The vast majority of those with no diagnosis (99.6%) continued to have no diagnosis, and most of those with a dependence diagnosis (91.2%) met SCUD criteria of the proposed DSM-5.1. Most of the variation in DSM-5.1 diagnostic classifications was accounted for by those with a current abuse diagnosis. DSM-5.0 MCUD cases were most affected when DSM-5.1 criteria were applied. The proposed diagnostic changes might translate to reduced access to treatment for those individuals evincing symptoms consistent with DSM-IV cocaine abuse. PMID:23915368

  10. A FRAMEWORK TO DEVELOP FLAW ACCEPTANCE CRITERIA FOR STRUCTURAL INTEGRITY ASSESSMENT OF MULTIPURPOSE CANISTERS FOR EXTENDED STORAGE OF USED NUCLEAR FUEL

    SciTech Connect

    Lam, P.; Sindelar, R.; Duncan, A.; Adams, T.

    2014-04-07

    A multipurpose canister (MPC) made of austenitic stainless steel is loaded with used nuclear fuel assemblies and is part of the transfer cask system to move the fuel from the spent fuel pool to prepare for storage, and is part of the storage cask system for on-site dry storage. This weld-sealed canister is also expected to be part of the transportation package following storage. The canister may be subject to service-induced degradation especially if exposed to aggressive environments during possible very long-term storage period if the permanent repository is yet to be identified and readied. Stress corrosion cracking may be initiated on the canister surface in the welds or in the heat affected zone because the construction of MPC does not require heat treatment for stress relief. An acceptance criteria methodology is being developed for flaw disposition should the crack-like defects be detected by periodic Inservice Inspection. The external loading cases include thermal accident scenarios and cask drop conditions with the contribution from the welding residual stresses. The determination of acceptable flaw size is based on the procedure to evaluate flaw stability provided by American Petroleum Institute (API) 579 Fitness-for-Service (Second Edition). The material mechanical and fracture properties for base and weld metals and the stress analysis results are obtained from the open literature such as NUREG-1864. Subcritical crack growth from stress corrosion cracking (SCC), and its impact on inspection intervals and acceptance criteria, is not addressed.

  11. Rational approximations of effectiveness factor and general diagnostic criteria for heat and mass transport limitations

    SciTech Connect

    Gonzo, E.E.; Gottifredi, J.C.

    1983-01-01

    Many efforts have been made to predict the effect of diffusion on the observed rate of reaction and its role in modifying the activity and selectivity of porous catalysts. The discussion of rational approximation predicts the effect of diffusional phenomena on the overall rate of reaction under a great variety of circumstances and shows how some part of the theoretical development can be used to deduce two general criteria to establish the conditions where diffusional phenomena can be safely neglected. The reviewed approximations give accurate results with minimal computational effort as long as multiplicity is absent. The expression is given that accurately predicts effectiveness factor values under isothermal conditions provided the apparent reaction order is greater than 0.5. Expressions have been previously reported that are applicable under nonisothermal conditions. The review of the 54 references was devoted to the single reaction case because not much work has been done on complex reaction systems. (BLM)

  12. Fetal thrombotic vasculopathy: significance in liveborn children using proposed society for pediatric pathology diagnostic criteria.

    PubMed

    Chisholm, Karen M; Heerema-McKenney, Amy

    2015-02-01

    Fetal thrombotic vasculopathy (FTV) is a recently described placental diagnosis associated with adverse perinatal outcomes. The Society for Pediatric Pathology proposed criteria for grading; however, no study has evaluated the proposed thresholds or established standards for large-vessel lesions. Using the Society for Pediatric Pathology criteria of 2 or more foci of 15 or more avascular villi or villous stromal-vascular karyorrhexis to represent severe FTV, this study examines the outcomes of liveborn infants with placentas demonstrating severe or nonsevere distal villous FTV (DV-FTV) and large-vessel FTV (LV-FTV). Control placentas over the same 3-year period were selected with minimal findings. Electronic medical records were queried for birth data, infant laboratory values, morbidities, and neurological development. The 139 cases included 102 with DV-FTV and 94 with LV-FTV. Compared with 111 controls, the 52 severe DV-FTV cases were significantly associated with delivery for fetal indications and small placental weight. The children with severe DV-FTV were more likely to be born small for gestational age, have intracranial hemorrhage, coagulopathy, neurological impairment, growth retardation, and evidence of systemic thrombosis/vasculopathy. Compared with controls, the 67 cases with severe LV-FTV were associated with maternal preeclampsia, delivery for fetal indications, small placental weight, umbilical cord abnormalities, and small size per gestational age. The 45 cases of DV-FTV or LV-FTV not classified as severe had similar characteristics as those without any FTV. In conclusion, severe FTV does appear associated with neurological injury, whereas those with nonsevere lesions have similar rates of morbidities as controls. PMID:25321333

  13. Sensory features as diagnostic criteria for autism: sensory features in autism.

    PubMed

    Grapel, Jordan N; Cicchetti, Domenic V; Volkmar, Fred R

    2015-03-01

    In this study, we examined the frequency of sensory-related issues as reported by parents in a large sample of school-age adolescents and adults with autism/autism spectrum disorder (ASD) [1] as compared to a group of individuals receiving similar clinical evaluations for developmental/behavioral difficulties but whose final diagnoses were not on the autism spectrum. In no comparison were the features examined predictive of autism or autism spectrum in comparison to the non-ASD sample. Only failure to respond to noises had sensitivity above .75 in the comparison of the broader autism spectrum group, but specificity was poor. While sensory issues are relatively common in autism/ASD, they are also frequent in other disorders. These results question the rationale for including sensory items as a diagnostic criterion for autism. PMID:25745375

  14. Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis.

    PubMed

    Molina-Infante, Javier; Bredenoord, Albert J; Cheng, Edaire; Dellon, Evan S; Furuta, Glenn T; Gupta, Sandeep K; Hirano, Ikuo; Katzka, David A; Moawad, Fouad J; Rothenberg, Marc E; Schoepfer, Alain; Spechler, Stuart J; Wen, Ting; Straumann, Alex; Lucendo, Alfredo J

    2016-03-01

    Consensus diagnostic recommendations to distinguish GORD from eosinophilic oesophagitis (EoE) by response to a trial of proton pump inhibitors (PPIs) unexpectedly uncovered an entity called 'PPI-responsive oesophageal eosinophilia' (PPI-REE). PPI-REE refers to patients with clinical and histological features of EoE that remit with PPI treatment. Recent and evolving evidence, mostly from adults, shows that patients with PPI-REE and patients with EoE at baseline are clinically, endoscopically and histologically indistinguishable and have a significant overlap in terms of features of Th2 immune-mediated inflammation and gene expression. Furthermore, PPI therapy restores oesophageal mucosal integrity, reduces Th2 inflammation and reverses the abnormal gene expression signature in patients with PPI-REE, similar to the effects of topical steroids in patients with EoE. Additionally, recent series have reported that patients with EoE responsive to diet/topical steroids may also achieve remission on PPI therapy. This mounting evidence supports the concept that PPI-REE represents a continuum of the same immunological mechanisms that underlie EoE. Accordingly, it seems counterintuitive to differentiate PPI-REE from EoE based on a differential response to PPI therapy when their phenotypic, molecular, mechanistic and therapeutic features cannot be reliably distinguished. For patients with symptoms and histological features of EoE, it is reasonable to consider PPI therapy not as a diagnostic test, but as a therapeutic agent. Due to its safety profile, ease of administration and high response rates (up to 50%), PPI can be considered a first-line treatment before diet and topical steroids. The reasons why some patients with EoE respond to PPI, while others do not, remain to be elucidated. PMID:26685124

  15. Quality of laboratory studies assessing effects of Bt-proteins on non-target organisms: minimal criteria for acceptability.

    PubMed

    De Schrijver, Adinda; Devos, Yann; De Clercq, Patrick; Gathmann, Achim; Romeis, Jörg

    2016-08-01

    The potential risks that genetically modified plants may pose to non-target organisms and the ecosystem services they contribute to are assessed as part of pre-market risk assessments. This paper reviews the early tier studies testing the hypothesis whether exposure to plant-produced Cry34/35Ab1 proteins as a result of cultivation of maize 59122 is harmful to valued non-target organisms, in particular Arthropoda and Annelida. The available studies were assessed for their scientific quality by considering a set of criteria determining their relevance and reliability. As a case-study, this exercise revealed that when not all quality criteria are met, weighing the robustness of the study and its relevance for risk assessment is not obvious. Applying a worst-case expected environmental concentration of bioactive toxins equivalent to that present in the transgenic crop, confirming exposure of the test species to the test substance, and the use of a negative control were identified as minimum criteria to be met to guarantee sufficiently reliable data. This exercise stresses the importance of conducting studies meeting certain quality standards as this minimises the probability of erroneous or inconclusive results and increases confidence in the results and adds certainty to the conclusions drawn. PMID:26980555

  16. Chronic lead poisoning in steers eating silage contaminated with lead shot - diagnostic criteria

    SciTech Connect

    Rice, D.A.; McLoughlin, M.F.; Blanchflower, W.J.; Thompson, T.R.

    1987-10-01

    Lead ingestion is one of the most common causes of poisoning in cattle. Toxicity results most commonly from the consumption of a single high dose of lead although cumulative toxicity resulting from the ingestion of small doses over a prolonged time also occurs. The sources of lead most commonly involved in disease outbreaks are paint, batteries, felt, linoleum and oil. It has traditionally been held that ingested metallic lead does not present a major toxicity risk to cattle because of its low solubility in the rumen and reticulum. More recent evidence suggests that lead shot, if present in silage, can induce toxicity when such silage is eaten by cattle. This communication describes a poisoning outbreak in steers eating lead shot contaminated grass silage. It presents and discusses the limitations of the criteria used for arriving at a diagnosis, including the use of whole blood amino levulinic acid dehydratase (ALAD) concentrations in fresh whole blood and after reactivation with dithiothreitol. Three are differences of opinion, in the literature, regarding the response of erythrocyte ALAD to ingested lead in the bovine. Consequently the results of a small lead feeding trial are also reported here. These results demonstrate a large ALAD response to lead ingestion and justify the use of this test in the confirmation of field cases of lead poisoning in cattle such as the one reported here.

  17. Post craniotomy extra-ventricular drain (EVD) associated nosocomial meningitis: CSF diagnostic criteria.

    PubMed

    Muñoz-Gómez, Sigridh; Wirkowski, Elizabeth; Cunha, Burke A

    2015-01-01

    Because external ventricular drains (EVDs) provide access to cerebrospinal fluid (CSF), there is potential for EVD associated acute bacterial meningitis (EVD-AM). Post-craniotomy, in patients with EVDs, one or more CSF abnormalities are commonly present making the diagnosis of EVD-AM problematic. EVD-AM was defined as elevated CSF lactic acid (>6 nmol/L), plus CSF marked pleocytosis (>50 WBCs/mm(3)), plus a positive Gram stain (same morphology as CSF isolate), plus a positive CSF culture of neuropathogen (same morphology as Gram stained organism). We reviewed 22 adults with EVDs to determine if our four CSF parameters combined accurately identified EVD-AM. No single or combination of <4 CSF parameters correctly diagnosed or ruled out EVD-AM. Combined our four CSF parameters clearly differentiated EVD-AM from one case of pseudomeningitis due to E. cloacae. We conclude that our four CSF criteria combined are useful in diagnosing EVD-AM in adults. PMID:25659927

  18. Should DSM-V include dimensional diagnostic criteria for alcohol use disorders?

    PubMed

    Helzer, John E; Bucholz, Kathleen K; Bierut, Laura Jean; Regier, Darrel A; Schuckit, Marc A; Guth, Sarah E

    2006-02-01

    This program calls attention to the upcoming timetable for the revision of the Diagnostic and Statistical Manual (DSM)-IV and the publication of DSM-V. It is vitally important for Research Society of Alcoholism members to be aware of the current discussions of the important scientific questions related to the next DSM revision and to use the opportunity for input. The title of the symposium highlights 1 key question, i.e., whether the DSM definitions should remain strictly categorical as in the past or whether a dimensional component should be included in this revision. Two substantive and 1 conceptual paper are included in this portion of the symposium. The fourth and final presentation detailing the revision timetable and the opportunities for input is by Dr. Darrel Regier. Dr. Regier is the director of American Psychiatric Institute for Research and Education the research and education branch of the American Psychiatric Association and the organization within the APA that will oversee the DSM revision. The discussion is by Marc Schuckit, who was chair of the Substance Use disorders (SUD) Committee for DSM-IV and cochair of the international group of experts reviewing the SUD definitions for DSM-V. PMID:16441279

  19. Diagnostic criteria for cutaneous injuries in child abuse: classification, findings, and interpretation.

    PubMed

    Tsokos, Michael

    2015-06-01

    Physical abuse of children has many manifestations. Depending on the type of force involved, specific injury patterns are produced on the body of the child, the morphology and localization of which are forensically relevant in terms of diagnostic classification as child abuse. Typical patterned bruising includes, for example, tramline bruises resulting from blows with oblong, stick-like objects. In addition to rounded or one-sided horseshoe-shaped bite injuries, injuries of different ages, clustered injuries (e.g., three or more individual injuries in the same body region), and thermal injuries are typical results of abuse. Abusive scalds are usually characterized by a symmetrical impression and localization with sharp delineation of the scald wound edges, in contrast to accidental scalding injuries with radiating splash patterns ending in tapered points. The coloration of a hematoma can help indicate the time when the injury occurred. Lack of a coherent and comprehensible explanation for accidental injury constitutes grounds for suspecting abuse. Suspicions should be raised in cases of a delayed visit to a doctor, waiting for an unusually long period before summoning emergency medical help for serious injuries to a child, and when differing versions of a purported accident are provided. Documentation of the findings is highly relevant in later reviews of the diagnosis, for instance, when new relevant facts and investigative results come to light in subsequent criminal proceedings. PMID:25772121

  20. Diagnostic value of paraclinical tests in multiple sclerosis: relative sensitivities and specificities for reclassification according to the Poser committee criteria.

    PubMed Central

    Beer, S; Rösler, K M; Hess, C W

    1995-01-01

    The yield of paraclinical tests was evaluated in a prospective study of 189 consecutive patients referred for suspected multiple sclerosis (142 patients with multiple sclerosis, 47 non-multiple sclerosis patients on discharge). Patients were first classified according to the Poser criteria by the clinical findings. Subsequently, the results of paraclinical tests (cranial MRI, visually evoked potentials (VEPs), somatosensory evoked potentials by tibial nerve stimulation (SSEPs), motor evoked potentials (MEPs), and analysis of CSF for oligoclonal banding and IgG-index (CSF)) were taken into account. The percentage of reclassified patients (reclassification sensitivity, RS) was always lower than the percentage of abnormal results (diagnostic sensitivity, DS), and the divergence of RS v DS differed between the tests (60% v 84% in MRI, 31% v 77% in CSF, 29% v 37% in VEPs, 20% v 68% in MEPs, and 12% v 46% in SSEPs respectively). False reclassifications of non-multiple sclerosis patients to multiple sclerosis would have occurred with all tests (MRI: six of 47 patients, (reclassification specificity 88%); CSF: one (98%); VEPs: two (96%); MEPs: two (96%); SSEPs: four (91%); P < 0.05). Although MRI had superior diagnostic capacity, 57 of the 142 patients with multiple sclerosis were not reclassified by the MRI result, 12 of whom were reclassified by CSF and 18 by one of the evoked potential (EP) studies. Of the 98 patients not reclassified by CSF, 53 were reclassified by MRI and 39 by EPs. The results suggest that for the evaluation of paraclinical tests in suspected multiple sclerosis, comparison of diagnostic sensitivities is inappropriate. In general, a cranial MRI contributes most to the diagnosis; however, due to its comparatively low specificity and its considerable number of negative results, EP or CSF studies are often useful to establish the diagnosis of multiple sclerosis. PMID:7629529

  1. Diagnostic Criteria for the Characterization of Electrode Reactions with Chemically Coupled Reactions Preceding the Electron Transfer by Cyclic Square Wave Voltammetry.

    PubMed

    Helfrick, John C; Mann, Megan A; Bottomley, Lawrence A

    2016-08-18

    Theory for cyclic square wave voltammetry of electrode reactions with chemical reactions preceding the electron transfer is presented. Theoretical voltammograms were calculated following systematic variation of empirical parameters to assess their impact on the shape of the voltammogram. From the trends obtained, diagnostic criteria for this mechanism were deduced. When properly applied, these criteria will enable non-experts in voltammetry to assign the electrode reaction mechanism and accurately measure reaction kinetics. PMID:27443581

  2. Development of acceptance criteria for batches of silane primer for external tank thermal protection system bonding applications

    NASA Technical Reports Server (NTRS)

    Mikes, F.

    1985-01-01

    Fourier transform infrared spectroscopy is currently the best technique for observing hydrolytic changes in DC 1200 silane the primers caused by moisture in the atmosphere. To further prove that FTIR can be used as a criterion test for acceptance of silane primer lots, intensities of the FTIR OH- band are being compared with primer adhesive bond strength using a mechanical test suggested by NASA. Results of tests for shear strength and Oh-absorption are tabulated and compared with FTIR absorption intensities in the OH-region.

  3. Multiple system atrophy presenting as parkinsonism: clinical features and diagnostic criteria.

    PubMed Central

    Albanese, A; Colosimo, C; Bentivoglio, A R; Fenici, R; Melillo, G; Colosimo, C; Tonali, P

    1995-01-01

    To evaluate the possibility that parkinsonian signs may be the only presenting feature of multiple system atrophy (MSA), parkinsonian patients were studied who had no atypical clinical signs and had no symptoms of autonomic dysfunction, but who reported that they had not experienced the anticipated good response to dopaminergic treatment. These stringent criteria identified 20 patients from a series of 298 consecutive parkinsonian outpatients. The following clinical pointers were analysed: (a) rate of disease progression; (b) symmetry of parkinsonian symptoms and signs; (c) occurrence of resting tremor during the first three years from onset. In addition, all patients underwent (d) acute and chronic challenge with dopaminergic drugs; (e) cardiovascular reflex autonomic function tests; (f) high field MRI. Rapid progression of disease was seen in 45% of patients, onset was symmetric in 25%, tremor was absent at onset in 70%, response to dopaminergic drug challenges was inadequate in 40%, abnormal cardiovascular reflexes occurred in 50%, and some abnormal MRI finding occurred in 35% of cases. Each of these features was equally weighted by giving to each patient a 0 to 6 point score corresponding to the number of abnormal findings. Fifteen patients scoring higher than 1 were considered at risk for having MSA: five of them were classified as clinically possible (score 2), six as clinically probable (score 3-4), and four patients were classified as clinically definite multiple system atrophy (score 5). The six pointers considered were variably combined in each patient, none of them being universally abnormal in patients with high scores. The patients were followed up for a mean 2.1 (SEM 0.65) years. All but one of the 10 patients prospectively classified as probable or definite MSA developed unequivocal clinical signs of fully symptomatic MSA. A receiver operator characteristic cure was plotted for the prospective score based on follow up diagnosis. The best compromise

  4. Data Quality Objectives and Criteria for Basic Information, Acceptable Uncertainty, and Quality-Assurance and Quality-Control Documentation

    USGS Publications Warehouse

    Granato, Gregory E.; Bank, Fred G.; Cazenas, Patricia A.

    1998-01-01

    The Federal Highway Administration and State transportation agencies have the responsibility of determining and minimizing the effects of highway runoff on water quality; therefore, they have been conducting an extensive program of water-quality monitoring and research during the last 25 years. The objectives and monitoring goals of highway runoff studies have been diverse, because the highway community must address many different questions about the characteristics and impacts of highway runoff. The Federal Highway Administration must establish that available data and procedures that are used to assess and predict pollutant loadings and impacts from highway stormwater runoff are valid, current, and technically supportable. This report examines criteria for evaluating water-quality data and resultant interpretations. The criteria used to determine if data are valid (useful for intended purposes), current, and technically supportable are derived from published materials from the Federal Highway Administration, the U.S. Environmental Protection Agency, the Intergovernmental Task Force on Monitoring Water Quality, the U.S. Geological Survey and from technical experts throughout the U.S. Geological Survey. Water-quality data that are documented to be meaningful, representative, complete, precise, accurate, comparable, and admissible as legal evidence will meet the scientific, engineering, and regulatory needs of highway agencies. Documentation of basic information, such as compatible monitoring objectives and program design features; metadata (when, where, and how data were collected as well as who collected and analyzed the data); ancillary information (explanatory variables and study-site characteristics); and legal requirements are needed to evaluate data. Documentation of sufficient quality-assurance and quality-control information to establish the quality and uncertainty in the data and interpretations also are needed to determine the comparability and utility of

  5. Establishment of design criteria for acceptable failure modes and fail safe considerations for the space shuttle structural system

    NASA Technical Reports Server (NTRS)

    Westrup, R. W.

    1972-01-01

    Investigations of fatigue life, and safe-life and fail-safe design concepts as applied to space shuttle structure are summarized. The results are evaluated to select recommended structural design criteria to provide assurance that premature failure due to propagation of undetected crack-like defects will not occur during shuttle operational service. The space shuttle booster, GDC configuration B-9U, is selected as the reference vehicle. Structural elements used as basis of detail analyses include wing spar caps, vertical stabilizer skins, crew compartment skin, orbiter support frame, and propellant tank shell structure. Fatigue life analyses of structural elements are performed to define potential problem areas and establish upper limits of operating stresses. Flaw growth analyses are summarized in parametric form over a range of initial flaw types and sizes, operating stresses and service life requirements. Service life of 100 to 500 missions is considered.

  6. Examining the Application of the DC-IA-A Diagnostic Criteria for Internet Addiction Disorder in At-Risk College Students.

    PubMed

    Hsu, Wen-Yu; Chang, Shan-Mei; Chiu, Nan-Ying; Lin, Sunny S J; Tseng, Yin-Hsing

    2015-01-01

    Internet addiction disorder is a relatively new condition, and the criteria for its diagnosis have been developed only over the last several years. The criteria for Internet addiction remain controversial. We strive to further elucidate the clinical validity of the diagnostic criteria for Internet addiction. To test items of the diagnostic criteria for Internet addiction among adolescents, we conducted a clinical interview study of college students based on longitudinal data on their risky use of the Internet. Forty-one high-risk cases were selected from a 3-year 5-time point longitudinal survey of 716 college freshmen. We examined disputes relevant to symptoms and impairment in the DC-IA-A (Diagnostic Criteria for Internet Addiction among Taiwanese Adolescents). Of the 41 cases, 21 were diagnosed with Internet addiction via a psychiatric interview. In the Internet addiction disorder group, 23.8% of cases had a diagnosis of depression, whereas only 15.0% of the cases in the non-Internet addiction group had a diagnosis of depression. Two major criteria (A8 and A3) had low incidences in these high-risk college students and thus did not help provide a differential diagnosis between the groups. We suggest that A8, 'excessive effort spent on activities necessary to obtain access to the Internet', should be omitted, and that A3, 'tolerance: a marked increase in the duration of Internet use needed to achieve satisfaction', should be modified. A1 and A9 should be discussed regarding their role in the diagnosis of Internet addiction disorder. Additional well-designed studies examining the diagnostic criteria and the relationship between factors are needed. PMID:26609702

  7. Meta-Review of CSF Core Biomarkers in Alzheimer’s Disease: The State-of-the-Art after the New Revised Diagnostic Criteria

    PubMed Central

    Ferreira, Daniel; Perestelo-Pérez, Lilisbeth; Westman, Eric; Wahlund, Lars-Olof; Sarría, Antonio; Serrano-Aguilar, Pedro

    2014-01-01

    Background: Current research criteria for Alzheimer’s disease (AD) include cerebrospinal fluid (CSF) biomarkers into the diagnostic algorithm. However, spreading their use to the clinical routine is still questionable. Objective: To provide an updated, systematic and critical review on the diagnostic utility of the CSF core biomarkers for AD. Data sources: MEDLINE, PreMedline, EMBASE, PsycInfo, CINAHL, Cochrane Library, and CRD. Eligibility criteria: (1a) Systematic reviews with meta-analysis; (1b) Primary studies published after the new revised diagnostic criteria; (2) Evaluation of the diagnostic performance of at least one CSF core biomarker. Results: The diagnostic performance of CSF biomarkers is generally satisfactory. They are optimal for discriminating AD patients from healthy controls. Their combination may also be suitable for mild cognitive impairment (MCI) prognosis. However, CSF biomarkers fail to distinguish AD from other forms of dementia. Limitations: (1) Use of clinical diagnosis as standard instead of pathological postmortem confirmation; (2) variability of methodological aspects; (3) insufficiently long follow-up periods in MCI studies; and (4) lower diagnostic accuracy in primary care compared with memory clinics. Conclusion: Additional work needs to be done to validate the application of CSF core biomarkers as they are proposed in the new revised diagnostic criteria. The use of CSF core biomarkers in clinical routine is more likely if these limitations are overcome. Early diagnosis is going to be of utmost importance when effective pharmacological treatment will be available and the CSF core biomarkers can also be implemented in clinical trials for drug development. PMID:24715863

  8. Developmentally-Sensitive Diagnostic Criteria for Mental Health Disorders in Early Childhood: DSM-IV, RDC-PA, and the revised DC: 0-3

    PubMed Central

    Egger, Helen L.; Emde, Robert N.

    2011-01-01

    As the infant mental health field has turned its focus to the presentation, course and treatment of clinically significant mental health disorders, the need for reliable and valid criteria for identifying and assessing mental health symptoms and disorders in early childhood has become urgent. In this paper, we offer a critical perspective on diagnostic classification of mental health disorders in young children. We place the issue of early childhood diagnosis within the context of classification of psychopathology at other ages and describe, in some detail, diagnostic classifications that have been developed specifically for young children included DC:0-3, a diagnostic classification for mental health symptoms and disorders in infant, toddlers, and preschoolers. We will briefly outline the role of diagnostic classification in clinical assessment and treatment planning. Lastly, we will review the limitations of current approaches to the diagnostic classification of mental health disorders in young children. PMID:21142337

  9. PIK3CA-Related Overgrowth Spectrum (PROS): Diagnostic and Testing Eligibility Criteria, Differential Diagnosis, and Evaluation

    PubMed Central

    Keppler-Noreuil, Kim M.; Rios, Jonathan J.; Parker, Victoria E.R.; Semple, Robert K.; Lindhurst, Marjorie J.; Sapp, Julie C.; Alomari, Ahmad; Ezaki, Marybeth; Dobyns, William; Biesecker, Leslie G.

    2015-01-01

    Somatic activating mutations in the phosphatidylinositol-3-kinase/AKT/mTOR pathway underlie heterogeneous segmental overgrowth phenotypes. Because of the extreme differences among patients, we sought to characterize the phenotypic spectrum associated with different genotypes and mutation burdens, including a better understanding of associated complications and natural history. Historically, the clinical diagnoses in patients with PIK3CA activating mutations have included Fibroadipose hyperplasia or Overgrowth (FAO), Hemihyperplasia Multiple Lipomatosis (HHML), Congenital Lipomatous Overgrowth, Vascular Malformations, Epidermal Nevi, Scoliosis/Skeletal and Spinal (CLOVES) syndrome, macrodactyly, Fibroadipose Infiltrating Lipomatosis, and the related megalencephaly syndromes, Megalencephaly-Capillary Malformation (MCAP or M-CM) and Dysplastic Megalencephaly (DMEG). A workshop was convened at the National Institutes of Health (NIH) to discuss and develop a consensus document regarding diagnosis and treatment of patients with PIK3CA-associated somatic overgrowth disorders. Participants in the workshop included a group of researchers from several institutions who have been studying these disorders and have published their findings, as well as representatives from patient-advocacy and support groups. The umbrella term of “PIK3CA-Related Overgrowth Spectrum (PROS)” was agreed upon to encompass both the known and emerging clinical entities associated with somatic PIK3CA mutations including, macrodactyly, FAO, HHML, CLOVES, and related megalencephaly conditions. Key clinical diagnostic features and criteria for testing were proposed, and testing approaches summarized. Preliminary recommendations for a uniform approach to assessment of overgrowth and molecular diagnostic testing were determined. Future areas to address include the surgical management of overgrowth tissue and vascular anomalies, the optimal approach to thrombosis risk, and the testing of potential

  10. Assessment of Generalized Anxiety Disorder Diagnostic Criteria in the National Comorbidity Survey and Virginia Adult Twin Study of Psychiatric and Substance Use Disorders

    ERIC Educational Resources Information Center

    Kubarych, Thomas S.; Aggen, Steven H.; Hettema, John M.; Kendler, Kenneth S.; Neale, Michael C.

    2008-01-01

    The authors investigated measurement properties of the "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition," generalized anxiety disorder (GAD) criteria in the National Comorbidity Survey and the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD). The two studies used different widely used…

  11. 38 CFR 4.100 - Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Application of the evaluation criteria for diagnostic codes 7000-7007, 7011, and 7015-7020. 4.100 Section 4.100 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Cardiovascular System §...

  12. ESTABLISHING DIAGNOSTIC CRITERIA FOR SCID, LEAKY SCID, AND OMENN SYNDROME: THE PRIMARY IMMUNE DEFICIENCY TREATMENT CONSORTIUM EXPERIENCE

    PubMed Central

    Shearer, William T.; Dunn, Elizabeth; Notarangelo, Luigi D.; Dvorak, Christopher C.; Puck, Jennifer M.; Logan, Brent R.; Griffith, Linda M.; Kohn, Donald B.; O’Reilly, Richard J.; Fleisher, Thomas A.; Pai, Sung-Yun; Martinez, Caridad A.; Buckley, Rebecca H.; Cowan, Morton J.

    2014-01-01

    Background The approach to the diagnosis of Severe Combined Immunodeficiency Disease (SCID) and related disorders varies among institutions and countries. Objectives The Primary Immune Deficiency Treatment Consortium (PIDTC) attempted to develop a uniform set of criteria for diagnosing SCID and related disorders, and has evaluated the results as part of a retrospective study of SCID in North America. Methods Clinical records from 2000 through 2009 at 27 centers in North America were collected on 332 children treated with hematopoietic cell transplant (HCT), enzyme replacement therapy (ERT) or gene therapy (GT) for SCID and related disorders. Eligibility for inclusion in the study and classification into disease groups were established by set criteria and applied by an expert review group. Result Two hundred eighty-five (86%) of the patients were determined to be eligible and 47 (14%) were not eligible. Of the 285 eligible patients, 84% were classified as typical SCID; 13% were classified as leaky SCID, Omenn syndrome, or reticular dysgenesis; and 3% had a history of enzyme replacement or gene therapy. Detection of a genotype predicting a SCID phenotype was accepted for eligibility. Reasons for non-eligibility were failure to demonstrate either impaired lymphocyte proliferation or maternal T cell engraftment. Overall (n = 332) rates of testing were: proliferation to PHA 77%, maternal engraftment 35%, and genotype 79% (mutation identified in 62%). Conclusion Lack of complete laboratory evaluation of patients prior to HCT presents a significant barrier to definitive diagnosis of SCID and related disorders and prevented inclusion of individuals in our observational HCT study. This lesson is critical for patient care as well as the design of future, prospective treatment studies for such children, since a well-defined and consistent study population is important for precision in outcomes analysis. PMID:24290292

  13. Genetic predisposition to peripheral nerve neoplasia: Diagnostic criteria and pathogenesis of neurofibromatoses, Carney complex, and related syndromes

    PubMed Central

    Rodriguez, Fausto J.; Stratakis, Constantine A.; Evans, D Gareth

    2013-01-01

    Neoplasms of the peripheral nerve sheath represent essential clinical manifestations of the syndromes known as the neurofibromatoses. Although involvement of multiple organ systems, including skin, central nervous system and skeleton, may also be conspicuous, peripheral nerve neoplasia is often the most important and frequent cause of morbidity in these patients. Clinical characteristics of neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2) have been extensively described and studied during the last century, and the identification of mutations in the NF1 and NF2 genes by contemporary molecular techniques have created a separate multidisciplinary field in genetic medicine. In schwannomatosis, the most recent addition to the neurofibromatosis group, peripheral nervous system involvement is the exclusive (or almost exclusive) clinical manifestation. Although the majority of cases of schwannomatosis are sporadic, approximately a third occur in families and a subset of these has recently been associated with germline mutations in the tumor suppressor gene SMARCB1/INI1. Other curious syndromes that involve the peripheral nervous system are associated with predominant endocrine manifestations, and include Carney Complex and MEN2b, secondary to inactivating mutations in the PRKAR1A gene in a subset, and activating mutations in RET respectively. In this review, we provide a concise update on the diagnostic criteria, pathology and molecular pathogenesis of these enigmatic syndromes in relation to peripheral nerve sheath neoplasia. PMID:22210082

  14. Genetic predisposition to peripheral nerve neoplasia: diagnostic criteria and pathogenesis of neurofibromatoses, Carney complex, and related syndromes.

    PubMed

    Rodriguez, Fausto J; Stratakis, Constantine A; Evans, D Gareth

    2012-03-01

    Neoplasms of the peripheral nerve sheath represent essential clinical manifestations of the syndromes known as the neurofibromatoses. Although involvement of multiple organ systems, including skin, central nervous system, and skeleton, may also be conspicuous, peripheral nerve neoplasia is often the most important and frequent cause of morbidity in these patients. Clinical characteristics of neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2) have been extensively described and studied during the last century, and the identification of mutations in the NF1 and NF2 genes by contemporary molecular techniques have created a separate multidisciplinary field in genetic medicine. In schwannomatosis, the most recent addition to the neurofibromatosis group, peripheral nervous system involvement is the exclusive (or almost exclusive) clinical manifestation. Although the majority of cases of schwannomatosis are sporadic, approximately one-third occur in families and a subset of these has recently been associated with germline mutations in the tumor suppressor gene SMARCB1/INI1. Other curious syndromes that involve the peripheral nervous system are associated with predominant endocrine manifestations, and include Carney complex and MEN2b, secondary to inactivating mutations in the PRKAR1A gene in a subset, and activating mutations in RET, respectively. In this review, we provide a concise update on the diagnostic criteria, pathology and molecular pathogenesis of these enigmatic syndromes in relation to peripheral nerve sheath neoplasia. PMID:22210082

  15. Redefining dermatomyositis: a description of new diagnostic criteria that differentiate pure dermatomyositis from overlap myositis with dermatomyositis features.

    PubMed

    Troyanov, Yves; Targoff, Ira N; Payette, Marie-Pier; Raynauld, Jean-Pierre; Chartier, Suzanne; Goulet, Jean-Richard; Bourré-Tessier, Josiane; Rich, Eric; Grodzicky, Tamara; Fritzler, Marvin J; Joyal, France; Koenig, Martial; Senécal, Jean-Luc

    2014-11-01

    cutaneous score and chronicity. Concurrent heliotrope rash and Gottron papules (positive predictive value [PPV] 91%), as well as the V-sign and/or shawl sign (PPV 100%), were diagnostic of pure DM. Anti-Mi-2, anti-MJ, and anti-p155 autoantibodies were present in 50% of pure DM patients and were restricted to this subset (PPV 100%). Cancer was present in 21% of pure DM patients. The 15-year survival was excellent (92%).In contrast, in patients with OMDM, the first manifestation was proximal muscle weakness or other skeletal muscle-related complaints. The DM rash appeared at diagnosis or at follow-up, was associated with a low cutaneous extent score and was transient. Adermatopathic DM, which was absent in pure DM, was highly predictive (PPV 100%) of OMDM. Overlap autoantibodies (including anti-Jo-1, anti-PL-7, anti-PM-Scl, anti-U1RNP, and/or anti-U5-RNP) were found in 70% of OMDM patients. OMDM was not associated with cancer, but the 15-year survival was significantly decreased (65%).Perifascicular atrophy occurred as commonly in OMDM (n = 6/20, 30%) as in pure DM (n = 4/24, 17%) patients. These 6 OMDM patients had adermatopathic DM at myositis diagnosis, and only 1 of them developed a DM rash at follow-up, emphasizing the lack of specificity of perifascicular atrophy for pure DM.In conclusion, using the modified Bohan and Peter classification of AIM allowed identification of OMDM, a new clinical subset of OM. Furthermore, identification of OMDM allowed recognition of pure DM as a new entity that was distinct from OMDM or from OM without DM features. However, the absolute specificity of a DM rash and perifascicular muscle atrophy for the diagnosis of pure DM was lost. The distinctive clinical manifestations and autoantibody profiles presented are proposed as diagnostic criteria to differentiate pure DM from OMDM. PMID:25500701

  16. Cleaning level acceptance criteria and a high pressure liquid chromatography procedure for the assay of Meclizine Hydrochloride residue in swabs collected from pharmaceutical manufacturing equipment surfaces.

    PubMed

    Mirza, T; Lunn, M J; Keeley, F J; George, R C; Bodenmiller, J R

    1999-04-01

    A method using pharmacologically based and visual limit of detection criteria to determine the acceptable residue level for Meclizine Hydrochloride (MH) on pharmaceutical manufacturing equipment surfaces after cleaning is described. A formula was used in order to determine the pharmacologically safe cleaning level for MH. This level was termed as specific residual cleaning Level (SRCL) and calculated to be 50 microg 100 cm(-2). The visual limit of detection (VLOD) was determined by spiking different levels of MH on stainless steel plates and having the plates examined by a group of observers. The lowest level that could be visually detected by the majority of the observers, 62.5 microg 100 cm(-2), was considered as the VLOD for MH. The lower of the SRCL and VLOD values, i.e. 50 microg 100 cm(-2), was therefore chosen as the cleaning acceptance criterion. A sensitive reversed-phase HPLC method was developed and validated for the assay of MH in swabs used to test equipment surfaces. Using this method, the mean recoveries of MH from spiked swabs and '180-Grit' stainless steel plates were 87.0 and 89.5% with relative standard deviations (RSD) of +/- 3.3 and +/- 2.4%, respectively. The method was successfully applied to the assay of actual swab samples collected from the equipment surfaces. The stability of MH on stainless steel plates, on cleaning swabs and in the extraction solution was investigated. PMID:10698538

  17. Neuroimaging in the Differential Diagnosis of Primary Progressive Aphasia – Illustrative Case Series in the Light of New Diagnostic Criteria

    PubMed Central

    Sitek, Emilia J.; Narożańska, Ewa; Brockhuis, Bogna; Muraszko-Klaudel, Anna; Lass, Piotr; Harciarek, Michał; Sławek, Jarosław

    2014-01-01

    Summary Background Primary progressive aphasia (PPA) is a progressive language disorder associated with atrophy of the dominant language hemisphere, typically left. Current PPA criteria divide PPA into three variants: non-fluent (nfvPPA), semantic (svPPA) and logopenic (lvPPA). The classification of PPA into one of the three variants may be performed at 3 levels: I) clinical, II) imaging-supported, III) definite pathologic diagnosis. This paper aimed at assessing the feasibility of the imaging-supported diagnostics of PPA variants in the Polish clinical setting with access to magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) examinations. Case Report We present the clinical and neuroimaging data on 6 patients (4 women, 2 men) clinically diagnosed with PPA (3 with nfvPPA and 3 with lvPPA) in whom MRI and SPECT were performed in order to determine if imaging-supported diagnosis could be established in those cases. In 4 individuals (2 with nfvPPA and 2 with lvPPA) clinical diagnosis was supported by neuroimaging (SPECT, albeit not MRI), thus level II of PPA diagnosis could be established in those cases. MRI results were either inconsistent with the clinical diagnosis (Patients 1 and 2) or a mixed pattern of atrophy was observed (Patients 3–6). Conclusions Imaging-supported diagnosis of PPA variant is more feasible with quantitative analysis of SPECT images than with purely qualitative visual analysis of MRI. Hypoperfusion abnormalities evidenced by SPECT are more variant-specific than patterns of atrophy. PMID:25343001

  18. Refined diagnostic criteria and classification of mast cell leukemia (MCL) and myelomastocytic leukemia (MML): a consensus proposal.

    PubMed

    Valent, P; Sotlar, K; Sperr, W R; Escribano, L; Yavuz, S; Reiter, A; George, T I; Kluin-Nelemans, H C; Hermine, O; Butterfield, J H; Hägglund, H; Ustun, C; Hornick, J L; Triggiani, M; Radia, D; Akin, C; Hartmann, K; Gotlib, J; Schwartz, L B; Verstovsek, S; Orfao, A; Metcalfe, D D; Arock, M; Horny, H-P

    2014-09-01

    Mast cell leukemia (MCL), the leukemic manifestation of systemic mastocytosis (SM), is characterized by leukemic expansion of immature mast cells (MCs) in the bone marrow (BM) and other internal organs; and a poor prognosis. In a subset of patients, circulating MCs are detectable. A major differential diagnosis to MCL is myelomastocytic leukemia (MML). Although criteria for both MCL and MML have been published, several questions remain concerning terminologies and subvariants. To discuss open issues, the EU/US-consensus group and the European Competence Network on Mastocytosis (ECNM) launched a series of meetings and workshops in 2011-2013. Resulting discussions and outcomes are provided in this article. The group recommends that MML be recognized as a distinct condition defined by mastocytic differentiation in advanced myeloid neoplasms without evidence of SM. The group also proposes that MCL be divided into acute MCL and chronic MCL, based on the presence or absence of C-Findings. In addition, a primary (de novo) form of MCL should be separated from secondary MCL that typically develops in the presence of a known antecedent MC neoplasm, usually aggressive SM (ASM) or MC sarcoma. For MCL, an imminent prephase is also proposed. This prephase represents ASM with rapid progression and 5%-19% MCs in BM smears, which is generally accepted to be of prognostic significance. We recommend that this condition be termed ASM in transformation to MCL (ASM-t). The refined classification of MCL fits within and extends the current WHO classification; and should improve prognostication and patient selection in practice as well as in clinical trials. PMID:24675021

  19. Refined diagnostic criteria and classification of mast cell leukemia (MCL) and myelomastocytic leukemia (MML): a consensus proposal

    PubMed Central

    Valent, P.; Sotlar, K.; Sperr, W. R.; Escribano, L.; Yavuz, S.; Reiter, A.; George, T. I.; Kluin-Nelemans, H. C.; Hermine, O.; Butterfield, J. H.; Hägglund, H.; Ustun, C.; Hornick, J. L.; Triggiani, M.; Radia, D.; Akin, C.; Hartmann, K.; Gotlib, J.; Schwartz, L. B.; Verstovsek, S.; Orfao, A.; Metcalfe, D. D.; Arock, M.; Horny, H.-P.

    2014-01-01

    Mast cell leukemia (MCL), the leukemic manifestation of systemic mastocytosis (SM), is characterized by leukemic expansion of immature mast cells (MCs) in the bone marrow (BM) and other internal organs; and a poor prognosis. In a subset of patients, circulating MCs are detectable. A major differential diagnosis to MCL is myelomastocytic leukemia (MML). Although criteria for both MCL and MML have been published, several questions remain concerning terminologies and subvariants. To discuss open issues, the EU/US-consensus group and the European Competence Network on Mastocytosis (ECNM) launched a series of meetings and workshops in 2011–2013. Resulting discussions and outcomes are provided in this article. The group recommends that MML be recognized as a distinct condition defined by mastocytic differentiation in advanced myeloid neoplasms without evidence of SM. The group also proposes that MCL be divided into acute MCL and chronic MCL, based on the presence or absence of C-Findings. In addition, a primary (de novo) form of MCL should be separated from secondary MCL that typically develops in the presence of a known antecedent MC neoplasm, usually aggressive SM (ASM) or MC sarcoma. For MCL, an imminent prephase is also proposed. This prephase represents ASM with rapid progression and 5%–19% MCs in BM smears, which is generally accepted to be of prognostic significance. We recommend that this condition be termed ASM in transformation to MCL (ASM-t). The refined classification of MCL fits within and extends the current WHO classification; and should improve prognostication and patient selection in practice as well as in clinical trials. PMID:24675021

  20. An Update on Neurofibromatosis Type 1: Not Just Café-au-Lait Spots, Freckling, and Neurofibromas. An Update. Part I. Dermatological Clinical Criteria Diagnostic of the Disease.

    PubMed

    Hernández-Martín, A; Duat-Rodríguez, A

    2016-01-01

    Neurofibromatosis type 1 (NF1) is the most common neurocutaneous syndrome and probably the one best known to dermatologists, who are generally the first physicians to suspect its diagnosis. Although the genetic locus of NF1 was identified on chromosome 17 in 1987, diagnosis of the disease is still mainly based on clinical observations and the diagnostic criteria of the National Institute of Health, dating from 1988. Cutaneous manifestations are particularly important because café-au-lait spots, freckling on flexural areas, and cutaneous neurofibromas comprise 3 of the 7 clinical diagnostic criteria. However, café-au-lait spots and freckling can also be present in other diseases. These manifestations are therefore not pathognomonic and are insufficient for definitive diagnosis in the early years of life. NF1 is a multisystemic disease associated with a predisposition to cancer. A multidisciplinary follow-up is necessary and dermatologists play an important role. PMID:26979265

  1. Opioid-use disorder among patients on long-term opioid therapy: impact of final DSM-5 diagnostic criteria on prevalence and correlates

    PubMed Central

    Boscarino, Joseph A; Hoffman, Stuart N; Han, John J

    2015-01-01

    Aims Previously, we estimated the prevalence and risk factors for prescription opioid-use disorder among outpatients on opioid therapy using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and DSM-4 criteria. However, at the time, the DSM-5 criteria were not finalized. In the current study, we analyzed these data using the final DSM-5 criteria and compared these results. Methods Using electronic records from a large US health care system, we identified outpatients receiving five or more prescription orders for opioid therapy in the past 12 months for noncancer pain (mean prescription orders =10.72; standard deviation =4.96). In 2008, we completed diagnostic interviews with 705 of these patients using the DSM-4 criteria. In the current study, we reassessed these results using the final DSM-5 criteria. Results The lifetime prevalence of DSM-5 opioid-use disorders using the final DSM-5 criteria was 58.7% for no or few symptoms (<2), 28.1% for mild symptoms (2–3), 9.7% for moderate symptoms (4–5), and 3.5% for severe symptoms (six or more). Thus, the lifetime prevalence of “any” prescription opioid-use disorder in this cohort was 41.3% (95% confidence interval [CI] =37.6–45.0). A comparison to the DSM-4 criteria indicated that the majority of patients with lifetime DSM-4 opioid dependence were now classified as having mild opioid-use disorder, based on the DSM-5 criteria (53.6%; 95% CI =44.1–62.8). In ordinal logistic regression predicting no/few, mild, moderate, and severe opioid-use disorder, the best predictors were age <65 years, current pain impairment, trouble sleeping, suicidal thoughts, anxiety disorders, illicit drug use, and history of substance abuse treatment. Conclusion Given the final DSM-5 criteria, including the elimination of tolerance and withdrawal, inclusion of craving and abuse symptoms, and introduction of a new graded severity classification, the prevalence of opioid-use disorders has changed, while many of the DSM-4

  2. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†

    PubMed Central

    Schiffman, Eric; Ohrbach, Richard; Truelove, Edmond; Look, John; Anderson, Gary; Goulet, Jean-Paul; List, Thomas; Svensson, Peter; Gonzalez, Yoly; Lobbezoo, Frank; Michelotti, Ambra; Brooks, Sharon L.; Ceusters, Werner; Drangsholt, Mark; Ettlin, Dominik; Gaul, Charly; Goldberg, Louis J.; Haythornthwaite, Jennifer A.; Hollender, Lars; Jensen, Rigmor; John, Mike T.; De Laat, Antoon; de Leeuw, Reny; Maixner, William; van der Meulen, Marylee; Murray, Greg M.; Nixdorf, Donald R.; Palla, Sandro; Petersson, Arne; Pionchon, Paul; Smith, Barry; Visscher, Corine M.; Zakrzewska, Joanna; Dworkin, Samuel F.

    2015-01-01

    Aims The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project—the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings. Results The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0

  3. Classification of neuropathic pain in cancer patients: A Delphi expert survey report and EAPC/IASP proposal of an algorithm for diagnostic criteria.

    PubMed

    Brunelli, Cinzia; Bennett, Michael I; Kaasa, Stein; Fainsinger, Robin; Sjøgren, Per; Mercadante, Sebastiano; Løhre, Erik T; Caraceni, Augusto

    2014-12-01

    Neuropathic pain (NP) in cancer patients lacks standards for diagnosis. This study is aimed at reaching consensus on the application of the International Association for the Study of Pain (IASP) special interest group for neuropathic pain (NeuPSIG) criteria to the diagnosis of NP in cancer patients and on the relevance of patient-reported outcome (PRO) descriptors for the screening of NP in this population. An international group of 42 experts was invited to participate in a consensus process through a modified 2-round Internet-based Delphi survey. Relevant topics investigated were: peculiarities of NP in patients with cancer, IASP NeuPSIG diagnostic criteria adaptation and assessment, and standardized PRO assessment for NP screening. Median consensus scores (MED) and interquartile ranges (IQR) were calculated to measure expert consensus after both rounds. Twenty-nine experts answered, and good agreement was found on the statement "the pathophysiology of NP due to cancer can be different from non-cancer NP" (MED=9, IQR=2). Satisfactory consensus was reached for the first 3 NeuPSIG criteria (pain distribution, history, and sensory findings; MEDs⩾8, IQRs⩽3), but not for the fourth one (diagnostic test/imaging; MED=6, IQR=3). Agreement was also reached on clinical examination by soft brush or pin stimulation (MEDs⩾7 and IQRs⩽3) and on the use of PRO descriptors for NP screening (MED=8, IQR=3). Based on the study results, a clinical algorithm for NP diagnostic criteria in cancer patients with pain was proposed. Clinical research on PRO in the screening phase and on the application of the algorithm will be needed to examine their effectiveness in classifying NP in cancer patients. PMID:25284070

  4. Comparison of Glucose Tolerance Categories in the Korean Population According to World Health Organization and American Diabetes Association Diagnostic Criteria

    PubMed Central

    Park, Kyong Soo; Park, Young Joo; Kim, Sun Wook; Shin, Chan Soo; Park, Do Joon; Koh, Jae Joon; Kim, Seong Yeon; Kim, No Keyong; Lee, Hong Kyu

    2000-01-01

    Objectives To compare the prevalence and metabolic profiles of glucose tolerance categories according to World Health Organization(WHO) and 1997 American Diabetes Association (ADA) fasting criteria for the diagnosis of diabetes mellitus and impaired glucose metabolism in the Korean population. Methods 2251 subjects without previous history of diabetes, who participated in the Yonchon diabetes epidemiology survey in 1993, were classified according to both criteria. The prevalence of glucose tolerance categories and the agreement across all categories of glucose tolerance were calculated. Metabolic characteristics of different glucose tolerance categories were compared. Results The prevalence of diabetes and impaired fasting glucose (IFG) according to ADA fasting criteria was similar to those of diabetes and impaired glucose tolerance (IGT) according to WHO criteria, respectively. However, 35.5 % of the subjects who were diagnosed as diabetes by WHO criteria were reclassified as either IFG or normal fasting glucose (NFG), and 38.5 % of diabetic patients according to ADA fasting criteria were IGT or normal glucose tolerance (NGT) by WHO criteria. Only 31.3 % of IGT subjects remained as IFG and 62.1 % were reclassified as NFG. Similarly, 69.4 % of IFG subjects were NGT by WHO criteria. The agreement between the two criteria was poor (K =0.31). Discordant diabetes groups had higher WHR, systolic and diastolic blood pressure, cholesterol and triglyceride levels than concordant non-diabetes group. Non-diabetes(WHO)/diabetes(ADA) group had higher WHR than diabetes (WHO)/non-diabetes (ADA) group. There were no differences in other metabolic characteristics between the two discordant diabetes groups. IGT/NFG and NGT/IFG group showed higher BMI, WHR, systolic and diastolic blood pressure, cholesterol and triglyceride levels than NGT/NFG group. Metabolic characteristics of IGT/NFG group were not different from those of NGT/IFG group except IGT/NFG subjects were older than NGT

  5. A trans-diagnostic review of anxiety disorder comorbidity and the impact of multiple exclusion criteria on studying clinical outcomes in anxiety disorders

    PubMed Central

    Goldstein-Piekarski, A N; Williams, L M; Humphreys, K

    2016-01-01

    Anxiety disorders are highly comorbid with each other and with other serious mental disorders. As our field progresses, we have the opportunity to pursue treatment study designs that consider these comorbidities. In this perspective review, we first characterized the prevalence of multiple anxiety disorder comorbidity by reanalyzing national survey data, then conducted an English-language PubMed search of studies analyzing the impact of exclusion criteria on treatment outcome data. In the prevalence data, 60% of people with an anxiety disorder had one or more additional anxiety or depression diagnosis. Because our commonly applied exclusion criteria focus on a single diagnosis and do not consider a multiple comorbidity profile, the impact of the criteria may be to exclude up to 92% of anxiety disorder treatment seekers. Moreover, the findings do not suggest a consistent relationship between the number of exclusion criteria and the effect size of treatment outcomes. Thus, future studies might consider a more trans-diagnostic rationale for determining exclusion criteria, one that is generalizable to real-world settings in which multiple diagnoses commonly co-occur. The findings also encourage a more systematic reporting of rationales for the choice of—and the implications of—each exclusion criterion. PMID:27351601

  6. A trans-diagnostic review of anxiety disorder comorbidity and the impact of multiple exclusion criteria on studying clinical outcomes in anxiety disorders.

    PubMed

    Goldstein-Piekarski, A N; Williams, L M; Humphreys, K

    2016-01-01

    Anxiety disorders are highly comorbid with each other and with other serious mental disorders. As our field progresses, we have the opportunity to pursue treatment study designs that consider these comorbidities. In this perspective review, we first characterized the prevalence of multiple anxiety disorder comorbidity by reanalyzing national survey data, then conducted an English-language PubMed search of studies analyzing the impact of exclusion criteria on treatment outcome data. In the prevalence data, 60% of people with an anxiety disorder had one or more additional anxiety or depression diagnosis. Because our commonly applied exclusion criteria focus on a single diagnosis and do not consider a multiple comorbidity profile, the impact of the criteria may be to exclude up to 92% of anxiety disorder treatment seekers. Moreover, the findings do not suggest a consistent relationship between the number of exclusion criteria and the effect size of treatment outcomes. Thus, future studies might consider a more trans-diagnostic rationale for determining exclusion criteria, one that is generalizable to real-world settings in which multiple diagnoses commonly co-occur. The findings also encourage a more systematic reporting of rationales for the choice of-and the implications of-each exclusion criterion. PMID:27351601

  7. Diagnostic value of Light's criteria and albumin gradient in classifying the pathophysiology of pleural effusion formation in cats.

    PubMed

    Zoia, Andrea; Drigo, Michele

    2016-08-01

    The primary aim of this study was to assess whether human Light's criteria with the cut-off values previously published for cats are useful and superior to the traditional veterinary classification in diagnosing pathophysiology of fluid formation in cats with pleural effusion. The secondary aim was to assess if the albumin gradient (ALBg) is a reliable criterion for differentiating exudates from transudates in patients with pleural effusion thought to be transudative by clinical criteria but identified as exudative by Light's criteria. Nineteen client-owned cats with pleural effusion were studied. The aetiology of the pleural effusion was used to establish the pathophysiology of its formation. Parameters measured or calculated undergoing statistical analysis included Light's criteria, total protein and total nucleated cell count in the pleural effusions, and the ALBg. Based on the pathophysiology of fluid formation there were seven transudates caused by increased hydrostatic pressure and 12 exudates. There was a significant difference in the accuracy of the Light's criteria in correctly classifying origin of the pleural fluid formation compared with the traditional veterinary classification (84% vs 53%). ALBg values were significantly different between transudates and exudates. One of the three transudates misclassified as exudates by Light's criteria was correctly identified as a transudate by the ALBg. In conclusion, pleural effusion should be classified as either a transudate or an exudate using Light's criteria. In cats with pleural effusion thought to be transudative by clinical criteria, but identified as exudative by Light's criteria, the ALBg may further help in correctly differentiating exudates from transudates. PMID:26116619

  8. Early experiences on the feasibility, acceptability, and use of malaria rapid diagnostic tests at peripheral health centres in Uganda-insights into some barriers and facilitators

    PubMed Central

    2012-01-01

    Background While feasibility of new health technologies in well-resourced healthcare settings is extensively documented, it is largely unknown in low-resourced settings. Uganda's decision to deploy and scale up malaria rapid diagnostic tests (mRDTs) in public health facilities and at the community level provides a useful entry point for documenting field experience, acceptance, and predictive variables for technology acceptance and use. These findings are important in informing implementation of new health technologies, plans, and budgets in low-resourced national disease control programmes. Methods A cross-sectional qualitative descriptive study at 21 health centres in Uganda was undertaken in 2007 to elucidate the barriers and facilitators in the introduction of mRDTs as a new diagnostic technology at lower-level health facilities. Pre-tested interview questionnaires were administered through pre-structured patient exit interviews and semi-structured health worker interviews to gain an understanding of the response to this implementation. A conceptual framework on technology acceptance and use was adapted for this study and used to prepare the questionnaires. Thematic analysis was used to generate themes from the data. Results A total of 52 of 57 health workers (92%) reported a belief that a positive mRDT result was true, although only 41 of 57 (64%) believed that treatment with anti-malarials was justified for every positive mRDT case. Of the same health workers, only 49% believed that a negative mRDT result was truly negative. Factors linked to these findings were related to mRDT acceptance and use, including the design and characteristics of the device, availability and quality of mRDT ancillary supplies, health worker capacity to investigate febrile cases testing negative with the device and provide appropriate treatment, availability of effective malaria treatments, reliability of the health commodity supply chain, existing national policy recommendations

  9. Pathogen inactivation of whole blood and red cell components: an overview of concept, design, developments, criteria of acceptability and storage lesion.

    PubMed

    Seghatchian, Jerard; Putter, Jeffrey S

    2013-10-01

    Multilayer preventative strategies have been instituted to enhance transfusion safety for patients in need of critical blood components. Presently blood safety is at its highest levels, with the implementation of precautionary/preventative measures against vCJD, bacterial and viral contamination of the blood supply. The implementation of these strategies together with advances in automation and computerization led to significant improvements in standardisation for transfusion practices. These include validation, verification, adherence to GLP and GMP and other regulatory requirements. In most European countries, universal prestorage leukodepletion is routine practice. In France proactive pathogen inactivation treatments [PITs] have been implemented emphasizing patient safety. This at least conceptually reduces the risk of transfusing viable WBCs, emerging bacteria and viruses, all with potential transfusion complications. In the UK, prion removal filters for red cell products are used selectively for special groups of patients. Some research establishments are exploring the potential impact of pathogen inactivation of whole blood or red cell components, using the new generation of S-303 PIT and the prion removal filters in combination. It needs to be determined whether such a combined strategy, applied synergistically, enhances red cell transfusion safety without compromising the overall criteria of acceptability. It is necessary to critically examine the impact of a new generation of PIT technologies, which may exacerbate the red cell storage lesion and cause the development of undesirable antibodies in the recipient. The development of innovative laboratory tools is vital to study impacts of these measures on the quality of stored blood and their clinical outcome. The ultimate aim of red cell transfusion is to provide oxygen enriched red blood cells to the microcirculations and tissues. Definitive studies are needed to establish the potential unforeseen negative

  10. Interstitial cystitis/painful bladder syndrome: the influence of modern diagnostic criteria on epidemiology and on Internet search activity by the public

    PubMed Central

    Gnanappiragasam, Sanjith; Thornhill, John A.

    2015-01-01

    Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic debilitating condition that is characterised by suprapubic pain and urinary symptoms such as urgency, nocturia and urinary frequency. The prevalence of the condition is increasing due to more inclusive diagnostic criteria. Herein, we review the evolving epidemiology of IC/PBS and investigate health seeking behaviour for the condition through Internet search activity. Study selection was performed in accordance with PRISMA. In addition, global search trends for the terms ‘Interstitial Cystitis’ and ‘Painful Bladder Syndrome’ from 2005 to 2015 were also evaluated using the ‘Google Trends’ search application. The mean search activity per month was recorded and mean activity at annual intervals calculated. Regional search activity by country and city was also measured. Prevalence rates for IC/PBS vary according to diagnostic criteria and range from 2% to 17.3% among the general population. Increased prevalence is associated with female gender and females with one first-degree relative affected. There has been an increase in global mean search activity for IC/PBS on an annual basis since 2005. The greatest increase in search activity was in USA, Canada, United Kingdom, Australia, Ireland and India respectively. The top five cities for search activity for IC/PBS were in the USA. As diagnostic criteria for IC/PBS continues to become more inclusive it is likely that the prevalence will continue to increase. This is particularly true for the USA and Canada as these regions have demonstrated the greatest increase in Internet search activity for IC/ PBS. PMID:26816850

  11. Interstitial cystitis/painful bladder syndrome: the influence of modern diagnostic criteria on epidemiology and on Internet search activity by the public.

    PubMed

    Davis, Niall F; Gnanappiragasam, Sanjith; Thornhill, John A

    2015-10-01

    Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic debilitating condition that is characterised by suprapubic pain and urinary symptoms such as urgency, nocturia and urinary frequency. The prevalence of the condition is increasing due to more inclusive diagnostic criteria. Herein, we review the evolving epidemiology of IC/PBS and investigate health seeking behaviour for the condition through Internet search activity. Study selection was performed in accordance with PRISMA. In addition, global search trends for the terms 'Interstitial Cystitis' and 'Painful Bladder Syndrome' from 2005 to 2015 were also evaluated using the 'Google Trends' search application. The mean search activity per month was recorded and mean activity at annual intervals calculated. Regional search activity by country and city was also measured. Prevalence rates for IC/PBS vary according to diagnostic criteria and range from 2% to 17.3% among the general population. Increased prevalence is associated with female gender and females with one first-degree relative affected. There has been an increase in global mean search activity for IC/PBS on an annual basis since 2005. The greatest increase in search activity was in USA, Canada, United Kingdom, Australia, Ireland and India respectively. The top five cities for search activity for IC/PBS were in the USA. As diagnostic criteria for IC/PBS continues to become more inclusive it is likely that the prevalence will continue to increase. This is particularly true for the USA and Canada as these regions have demonstrated the greatest increase in Internet search activity for IC/ PBS. PMID:26816850

  12. Diagnostics of Sacroiliitis According to ASAS Criteria: A Comparative Evaluation of Conventional Radiographs and MRI in Patients with a Clinical Suspicion of Spondyloarthropathy. Preliminary Results

    PubMed Central

    Sudoł-Szopińska, Iwona; Kwiatkowska, Brygida; Włodkowska-Korytkowska, Monika; Matuszewska, Genowefa; Grochowska, Elżbieta

    2015-01-01

    Summary Background The objective of this study was a comparative evaluation of radiography and MRI in the diagnostics of sacroiliitis in patients with a clinical diagnosis of spondyloartropathy, according to the current ASAS criteria. Material/Methods Sacroiliac joints radiograms and MRI were conducted in 101 consecutive patients, aged 19–71 yrs (mean age: 40.6 yrs). The patients were referred by a senior rheumatologist, with symptoms of the chronic back pain. The sacroiliac joints were assessed on AP radiograms of the pelvis according to the modified New York criteria for ankylosing spondylitis. MRI was performed to look for active and chronic inflammatory lesions. Results Of 14 patients with radiographic sacroiliitis according to modified New York criteria, only 50% had sacroiliitis on MRI. The sensitivity and specificity of conventional radiography were 22% and 94% and of MRI were 71% and 90%. Cohen’s kappa coefficient was κ=0.0187, agreement of radiograms and MRI was 58%. Among 86 patients displaying no sacroiliitis on radiograms, MRI showed sacroiliitis in 34 patients (39.5%). Positive predictive value was 0.429, negative predictive value was 0.605. Conclusions MRI allowed to diagnose sacroiliitis in 39,5 % of patients in preradiographic stage. MRI ruled out the presence of active inflammatory lesions in 60.4% of patients with sacroiliitis on radiograms according to modified New York criteria. PMID:26082819

  13. Posttraumatic stress disorder according to DSM-5 and DSM-IV diagnostic criteria: a comparison in a sample of Congolese ex-combatants

    PubMed Central

    Schaal, Susanne; Koebach, Anke; Hinkel, Harald; Elbert, Thomas

    2015-01-01

    Background Compared to DSM-IV, the criteria for diagnosing posttraumatic stress disorder (PTSD) have been modified in DSM-5. Objective The first aim of this study was to examine how these modifications impact rates of PTSD in a sample of Congolese ex-combatants. The second goal of this study was to investigate whether PTSD symptoms were associated with perpetrator-related acts or victim-related traumatic events. Method Ninety-five male ex-combatants in the eastern Democratic Republic of Congo were interviewed. Both the DSM-IV and the DSM-5 PTSD symptom criteria were assessed. Results The DSM-5 symptom criteria yielded a PTSD rate of 50% (n=47), whereas the DSM-IV symptom criteria were met by 44% (n=42). If the DSM-5 would be set as the current “gold standard,” then DSM-IV would have produced more false negatives (8%) than false positives (3%). A minority of participants (19%, n=18) indicated an event during which they were involved as a perpetrator as their most stressful event. Results of a regression analysis (R 2=0.40) showed that, after accounting for the number of types of traumatic events, perpetrated violent acts were not associated with the symptom severity of PTSD. Conclusions The findings demonstrate that more diagnostic cases were produced with the DSM-5 diagnostic rules than were dropped resulting in an increase in PTSD rates compared to the DSM-IV system. The missing association between PTSD symptoms and perpetrated violent acts might be explained by a potential fascinating and excited perception of these acts. PMID:25720994

  14. [Criteria for the diagnosis of corticobasal degeneration].

    PubMed

    Shimohata, Takayoshi; Aiba, Ikuko; Nishizawa, Masatoyo

    2015-04-01

    Corticobasal degeneration (CBD) is a distinct neurodegenerative disorder characterized by widespread neuronal and glial accumulation of abnormally phosphorylated tau protein. Patients with CBD often present with corticobasal syndrome (CBS) showing impairment of the motor system, cognition, or both. Several studies demonstrate that they may also present with progressive supranuclear palsy syndrome (PSPS), aphasia, Alzheimer disease-like dementia, or behavioral changes, suggesting that CBS is merely one of the presenting phenotypes of CBD. Accurate diagnosis is important for future clinical trials using drugs aimed at modifying the underlying tau pathology. Although previous CBD diagnostic criteria reflected only CBS, Armstrong et al. proposed new diagnostic criteria for CBD in 2013 (Armstrong's criteria). The new criteria include 4 CBD phenotypes, including CBS, frontal behavioral-spatial syndrome (FBS), nonfluent/agrammatic variant of primary progressive aphasia (naPPA), and PSPS. These phenotypes were combined to create 2 sets of criteria: specific clinical research criteria for probable CBD (cr-CBD) and broader criteria for possible CBD that are more inclusive but have a higher probability of detecting other tau-based pathologies (p-CBD). However, two recent studies revealed that the sensitivity and specificity of these criteria were insufficient. Further refinement of the criteria is needed via biomarker research with prospective study designs. (Received August 19, 2014; Accepted December 26, 2014: Published April 1, 2015). PMID:25846600

  15. Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

    PubMed Central

    2014-01-01

    The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations of CTE from 202 published cases. The clinical features include impairments in mood (for example, depression and hopelessness), behavior (for example, explosivity and violence), cognition (for example, impaired memory, executive functioning, attention, and dementia), and, less commonly, motor functioning (for example, parkinsonism, ataxia, and dysarthria). We present proposed research criteria for traumatic encephalopathy syndrome (TES) which consist of four variants or subtypes (TES behavioral/mood variant, TES cognitive variant, TES mixed variant, and TES dementia) as well as classifications of ‘probable CTE’ and ‘possible CTE’. These proposed criteria are expected to be modified and updated as new research findings become available. They are not meant to be used for a clinical diagnosis. Rather, they should be viewed as research criteria that can be employed in studies of the underlying causes, risk factors, differential diagnosis, prevention, and treatment of CTE and related disorders. PMID:25580160

  16. Craniofacial configuration and postcranial development of a hydrocephalic child (ca. 2500 B.C.-500 A.D.): with a review of cases and comment on diagnostic criteria.

    PubMed

    Richards, G D; Anton, S C

    1991-06-01

    Hydrocephalus is a severe disorder of the central nervous system characterized by absorption blockage of the cerebral spinal fluid (CSF). The archaeological record of the condition ranges in time from 10,000 B.C. to 1670 A.D. and consists of 30 possible cases worldwide. A review of this material reveals that diagnostic criteria which fully delineate the condition have not been established. Previously, no attempt has been made to differentiate the two major categories of hydrocephalus and their subgroupings, or to identify other conditions which might result in similar morphologies. A partial child's skeleton from the Middle Period (ca. 2500 B.C. to 500 A.D.) of Central California Prehistory is described in light of an extensive clinical literature. Examination of this individual reveals a unique craniofacial configuration and malformed postcrania. Bony criteria for a differential diagnosis of hydrocephalus are established and applied to this individual. Based on these criteria, the individual is diagnosed as having a chronic form of noncommunicating hydrocephalus. Blockage of the CSF pathway most likely occurred in the aqueduct of Sylvius with a partial occlusion of the foramen of Monro or a frontal cyst. In addition, femoral development is suggestive of partial paralysis. PMID:1882981

  17. Design criteria of the bolometer diagnostic for steady-state operation of the W7-X stellarator.

    PubMed

    Zhang, D; Burhenn, R; Koenig, R; Giannone, L; Grodzki, P A; Klein, B; Grosser, K; Baldzuhn, J; Ewert, K; Erckmann, V; Hirsch, M; Laqua, H P; Oosterbeek, J W

    2010-10-01

    A bolometric diagnostic system with features necessary for steady-state operation in the superconducting stellarator W7-X was designed. During a pulse length of 1800 s with an ECRH (electron cyclotron resonance heating) power of 10 MW, the components suffer not only from a large thermal load but also from stray radiation of the nonabsorbed isotropic microwaves. This paper gives an overview of the technical problems encountered during the design work and the solutions to individual problems to meet the special requirements in W7-X, e.g., component thermal protection, detector offset thermal drift suppression, as well as a microwave shielding technique. PMID:21033996

  18. [Semantic dementia: reflexions of a French working group for diagnostic criteria and constitution of a patient cohort].

    PubMed

    Moreaud, O; Belliard, S; Snowden, J; Auriacombe, S; Basaglia-Pappas, S; Bernard, F; Bon, L; Boutantin, J; Boutoleau-Bretonnière, C; Charnallet, A; Coutant, E; David, D; Deramecourt, V; Gaestel, Y; Garnier, S; Guichart, E; Hahn-Barma, V; Lebail, B; Lebrun-Givois, C; Lamy, E; Le Carret, N; Lemesle, B; Memin, A; Parienté, J; Pasquier, F; Renou, P; Rouaud, O; Sarazin, M; Thomas-Antérion, C; Vercelletto, M; Virat-Brassaud, M-E

    2008-04-01

    Semantic dementia (SD) is a syndrome of progressive loss of semantic knowledge for objects and people. International criteria propose that SD be included in the frontotemporal lobar degeneration syndromes, with progressive non-fluent aphasia and frontotemporal dementia (FTD). However, several related syndromes have been defined that clinically and conceptually share both similarities and differences with SD: fluent progressive aphasia, progressive prosopagnosia, temporal variant of FTD. In order to establish a French consensus for the diagnosis and modalities of evaluation and follow-up of SD, a working group, composed of neurologists, neuropsychologists and speech-therapists, was established by the Groupe de réflexion sur les évaluations cognitives (GRECO). New criteria were elaborated, based on clinical, neuropsychological, and imaging data. They define typical and atypical forms of SD. A diagnosis of typical SD relies on an isolated and progressive loss of semantic knowledge, attested by a deficit of word comprehension and a deficit of objects and/or people identification, with imaging showing temporal atrophy and/or hypometabolism. SD is atypical if the deficit of semantic knowledge is present only within a single modality (verbal versus visual), or if non-semantic deficits (mild and not present at onset) and/or neurological signs, are associated with the semantic loss. PMID:18439926

  19. Changing Diagnostic and Treatment Criteria for Chronic Illness: A Critical Consideration of their Impact on Low-Income Hispanic Patients

    PubMed Central

    Hunt, Linda M.; Kreiner, Meta; Rodriguez-Mejia, Fredy

    2015-01-01

    Low-income Hispanics are often identified as especially at risk for common chronic conditions like diabetes, and targeted for aggressive screening and treatment. Anthropologists and other social scientists have extensively explored barriers and facilitators to chronic illnesses management in minority populations, but have not yet considered the impact of recently lowered diagnostic and treatment thresholds on such groups. In this paper, we critically review recent changes in diabetes, hypertension and high cholesterol diagnostic and treatment standards which have dramatically increased the number of people being treated for these conditions. Drawing on an ethnographic study of chronic illness management in two Hispanic-serving clinics in the Midwest, we examine how these new standards are being applied, and consider the resulting health care challenges these Hispanic patients face. Our analysis leads us to question the value of promoting narrowly defined treatment goals, particularly when patients lack reliable access to the health care resources these goals require. While improving the health of low-income Hispanics is a worthwhile goal, it is important to consider whether these efforts may be promoting over-diagnosis and over-treatment, drawing them into an expensive chronic patient role with uncertain benefit. PMID:25797962

  20. Operationalizing diagnostic criteria for Alzheimer’s disease and other age-related cognitive impairment—Part 2*

    PubMed Central

    Seshadri, Sudha; Beiser, Alexa; Au, Rhoda; Wolf, Philip A.; Evans, Denis A.; Wilson, Robert S.; Petersen, Ronald C.; Knopman, David S.; Rocca, Walter A.; Kawas, Claudia H.; Corrada, Maria M.; Plassman, Brenda L.; Langa, Kenneth M.; Chui, Helena C.

    2011-01-01

    This article focuses on the effects of operational differences in case ascertainment on estimates of prevalence and incidence of cognitive impairment/dementia of the Alzheimer type. Experience and insights are discussed by investigators from the Framingham Heart Study, the East Boston Senior Health Project, the Chicago Health and Aging Project, the Mayo Clinic Study of Aging, the Baltimore Longitudinal Study of Aging, and the Aging, Demographics, and Memory Study. There is a general consensus that the single most important factor regulating prevalence estimates of Alzheimer’s disease (AD) is the severity of cognitive impairment used for case ascertainment. Studies that require a level of cognitive impairment in which persons are unable to provide self-care will have much lower estimates than studies aimed at identifying persons in the earliest stages of AD. There is limited autopsy data from the above-mentioned epidemiologic studies to address accuracy in the diagnosis of etiologic subtype, namely the specification of AD alone or in combination with other types of pathology. However, other community-based cohort studies show that many persons with mild cognitive impairment (MCI) meet pathologic criteria for AD, and a large minority of persons without dementia or MCI also meets pathologic criteria for AD, thereby suggesting that the number of persons who would benefit from an effective secondary prevention intervention is probably higher than the highest published prevalence estimates. Improved accuracy in the clinical diagnosis of AD is anticipated with the addition of molecular and structural biomarkers in the next generation of epidemiologic studies. PMID:21255742

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

    PubMed

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

    2013-01-01

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

  2. Bisphosphonate-related osteonecrosis of jaw (BRONJ): diagnostic criteria and possible pathogenic mechanisms of an unexpected anti-angiogenic side effect

    PubMed Central

    2013-01-01

    Recently, bisphosphonates (BPs) have been widely used in medical practice as anti-resorptive agents owing to their anti-osteoclatic action. In addition, these compounds are also used for their analgesic action and their potential anti-tumour effect. Patients treated with BPs may subsequently develop osteonecrosis of the jaw or maxillary bone after minor local trauma including dental work, recently labelled as bisphosphonate osteonecrosis of jaw (BRONJ). However, the etiopathogenic mechanisms of this pathological condition are poorly understood. Although, several pathways have been proposed for BRONJ occurrence, no single model can explain all morphological changes observed at the macro- and microscopic level. Recent research suggests that BPs may promote an anti-angiogenic effect which contributes directly to the clinical features associated with BRONJ. Remarkably, the anti-angiogenic effect promoting BRONJ might be in keeping with the anti-neoplastic action of BPs. The current review, presents clinical diagnostic criteria. In addition, based on our own experience we describe the histopathological criteria for diagnosis of BRONJ and the possible pathways which may lead to this frustrating pathological condition. PMID:23316704

  3. Plasma cell leukemia: consensus statement on diagnostic requirements, response criteria and treatment recommendations by the International Myeloma Working Group.

    PubMed

    Fernández de Larrea, C; Kyle, R A; Durie, B G M; Ludwig, H; Usmani, S; Vesole, D H; Hajek, R; San Miguel, J F; Sezer, O; Sonneveld, P; Kumar, S K; Mahindra, A; Comenzo, R; Palumbo, A; Mazumber, A; Anderson, K C; Richardson, P G; Badros, A Z; Caers, J; Cavo, M; LeLeu, X; Dimopoulos, M A; Chim, C S; Schots, R; Noeul, A; Fantl, D; Mellqvist, U-H; Landgren, O; Chanan-Khan, A; Moreau, P; Fonseca, R; Merlini, G; Lahuerta, J J; Bladé, J; Orlowski, R Z; Shah, J J

    2013-04-01

    Plasma cell leukemia (PCL) is a rare and aggressive variant of myeloma characterized by the presence of circulating plasma cells. It is classified as either primary PCL occurring at diagnosis or as secondary PCL in patients with relapsed/refractory myeloma. Primary PCL is a distinct clinic-pathological entity with different cytogenetic and molecular findings. The clinical course is aggressive with short remissions and survival duration. The diagnosis is based upon the percentage (≥ 20%) and absolute number (≥ 2 × 10(9)/l) of plasma cells in the peripheral blood. It is proposed that the thresholds for diagnosis be re-examined and consensus recommendations are made for diagnosis, as well as, response and progression criteria. Induction therapy needs to begin promptly and have high clinical activity leading to rapid disease control in an effort to minimize the risk of early death. Intensive chemotherapy regimens and bortezomib-based regimens are recommended followed by high-dose therapy with autologous stem cell transplantation if feasible. Allogeneic transplantation can be considered in younger patients. Prospective multicenter studies are required to provide revised definitions and better understanding of the pathogenesis of PCL. PMID:23288300

  4. Developmentally Sensitive Diagnostic Criteria for Mental Health Disorders in Early Childhood: The Diagnostic and Statistical Manual of Mental Disorders-IV, the Research Diagnostic Criteria-Preschool Age, and the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood-Revised

    ERIC Educational Resources Information Center

    Egger, Helen L.; Emde, Robert N.

    2011-01-01

    As the infant mental health field has turned its focus to the presentation, course, and treatment of clinically significant mental health disorders, the need for reliable and valid criteria for identifying and assessing mental health symptoms and disorders in early childhood has become urgent. In this article we offer a critical perspective on…

  5. Comparison of diagnostic accuracy, time dependency, and prognostic impact of abnormal Q waves, combined electrocardiographic criteria, and ST segment abnormalities in right ventricular infarction.

    PubMed Central

    Zehender, M; Kasper, W; Kauder, E; Schönthaler, M; Olschewski, M; Just, H

    1994-01-01

    OBJECTIVE--To determine the diagnostic and prognostic impact of abnormal Q waves in comparison to or in combination with ST segment abnormalities in the right precordial and inferior leads as indicators of right ventricular infarction during the acute phase of inferior myocardial infarction. DESIGN--Prospective study of a consecutive series of 200 patients with acute inferior myocardial infarction with and without right ventricular infarction. SETTING--Department of internal medicine, university clinic. RESULTS--Right ventricular infarction was diagnosed in 106 (57%) out of 187 patients from the results of coronary angiography, technetium pyrophosphate scanning, and measurement of haemodynamic variables or at necropsy, or both. In the acute phase of inferior infarction ST segment elevation > or = 0.1 mV in any of the right precordial leads V4-6R was the most reliable criterion for right ventricular infarction (sensitivity, 89%; specificity, 83%). Abnormal Q waves in the right precordial leads, the most specific criterion (91%) for right ventricular infarction, were superior to ST segment elevation in patients admitted > 12 hours after the onset of symptoms. Both ST segment elevation in leads V4-6R (increase in in hospital mortality, 6.2-times; P < 0.001; major complications, 2.3-times; P < 0.01) and abnormal Q waves (2.3-times, P < 0.05; 1.8-times, P < 0.05) on admission were highly predictive of a worse outcome during the in hospital period. In the presence of inferior myocardial infarction previously proposed combined electrocardiographic criteria were not better diagnostically or prognostically than ST segment abnormalities and abnormal Q waves alone. CONCLUSIONS--During the first 24 hours of inferior myocardial infarction ST segment elevation and abnormal Q waves derived from the right precordial leads are complementary rather than competitive criteria for reliably diagnosing right ventricular infarction, both indicating a worse in hospital course for the

  6. The Risk of Epithelial Ovarian Cancer of Women With Endometriosis May be Varied Greatly if Diagnostic Criteria Are Different

    PubMed Central

    Lee, Wen-Ling; Chang, Wen-Hsun; Wang, Kuan-Chin; Guo, Chao-Yu; Chou, Yiing-Jeng; Huang, Nicole; Huang, Hsin-Yi; Yen, Ming-Shyen; Wang, Peng-Hui

    2015-01-01

    Abstract This article aims to test the hypothesis that the risk of epithelial ovarian cancer (EOC) in women with endometriosis might be changed by enrolling different population. A nationwide 14-year historic cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan and the Registry for Catastrophic Illness Patients was conducted. A total of 239,385 women aged between 20 and 51 years, with at least 1 gynecologic visit after 2000, were analyzed. Cases included women with a diagnosed endometriosis, which was established along a spectrum from at least 1 medical record of endometriosis (recalled endometriosis) to tissue-proved ovarian endometriosis (n = X). Controls included women without any diagnosis of endometriosis (n = 239,385 – X). We used Cox regression, and computed hazard ratios (HRs) with 95% confidence intervals (95% CI) to determine the risk of EOC in patients. The EOC incidence rates (IRs, per 10,000 person-years) of women with endometriosis ranged from 1.90 in women with recalled endometriosis to 18.70 in women with tissue-proved ovarian endometrioma, compared with those women without any diagnosis of endometriosis (0.77–0.89), contributing to crude HRs ranging from 2.59 (95% CI, 2.09–3.21; P < 0.001) to 24.04 (95% CI, 17.48–33.05; P < 0.001). After adjustment for pelvic inflammatory disease, infertility, Charlson co-morbidity index, and age, adjusted HRs were ranged from the lowest of 1.90 (95% CI, 1.51–2.37; P < 0.001) in recalled endometriosis to the highest of 18.57 (95% CI, 13.37–25.79; P < 0.001) in tissue-proved ovarian endometrioma, which was inversely related to the prevalence rate of endometriosis (from the highest of 30.80% in recalled endometriosis to the lowest of 1.54% in tissue-proved ovarian endometrioma). The risk of EOC in women with endometriosis varied greatly by different criteria used. Women with endometriosis might have a more apparently higher risk than those reported

  7. Associations between pre-diabetes, by three different diagnostic criteria, and incident CVD differ in South Asians and Europeans

    PubMed Central

    Eastwood, Sophie V; Tillin, Therese; Sattar, Naveed; Forouhi, Nita G; Hughes, Alun D; Chaturvedi, Nish

    2016-01-01

    Objective We examined longitudinal associations between pre-diabetes and cardiovascular disease (CVD) (coronary heart disease (CHD) and stroke) in Europeans and South Asians. Research design and methods UK cohort study of 1,336 Europeans and 1,139 South Asians, aged 40-69 years at baseline (1988-91). Assessment included blood pressure, blood tests, anthropometry and questionnaires. Pre-diabetes was determined by OGTT or HbA1c, using either International Expert Committee (IEC, HbA1c 6.0-6.5% (42-48 mmol/mol)) or American Diabetes Association (ADA, HbA1c 5.7-6.5% (39-48 mmol/mol)) cut-points. Incident CHD and stroke were established at 20 years from death certification, hospital admission, primary care record review and participant report. Results Compared to normoglycaemic individuals, IEC-defined pre-diabetes was related to both CHD and CVD risk in Europeans but not South Asians (sub-hazards ratio[95% CI]: CHD;1.68[1.19,2.37] vs. 0.99[0.74,1.33], ethnicity interaction p=0.008, CVD; 1.49[1.08,2.07] vs. 1.03[0.79,1.36], ethnicity interaction p=0.04). Conversely, IEC-defined pre-diabetes was associated with stroke risk in South Asians but not Europeans (1.75 [1.04,2.93] vs. 0.85[0.45,1.64], ethnicity interaction p=0.11). Risks were adjusted for age, sex, smoking, total/HDL-cholesterol ratio, waist/hip ratio, systolic blood pressure and anti-hypertensive use. . Associations were weaker for OGTT or ADA-defined pre-diabetes. Conversion from pre-diabetes to diabetes was greater in South Asians, but accounting for time to conversion did not account for these ethnic differences. Conclusions Associations between pre-diabetes and CVD differed by pre-diabetes diagnostic criterion, type of CVD and ethnicity, with associations being present for overall CVD in Europeans but not South Asians. Substantiation of these findings and investigation of potential explanations are required. PMID:26486189

  8. Bridging Fieldwork and Remote Sensing Data: Pilot Study of Diagnostic Criteria for Icelandic Volcanoes to Optimize Analysis of Volcanic Landforms

    NASA Astrophysics Data System (ADS)

    Pedersen, G.

    2011-12-01

    In order to assess the capabilities of remote sensing (RS) data for geomorphological mapping of volcanoes, a correlation of the diagnostic characteristics between field- and RS- data has been carried out for a variety of Icelandic volcanic landforms, such as lava flows, shields, tuyas and hyaloclastite ridges. Identification of fundemental morphologic characteristics, identification of information constraints of different types of RS data and an evaluation of the spatial and temporal resolution control on geomorphic information is necessary to establish a general mapping procedure of volcanoes. This includes a field to pixel- evaluation of spatial information as well as the analysis of temporal changes on multispectral data and its impact on image segmentation. Introduction The current plethora of RS data allows varied thematic and quantitative characterization of the Earth's surface, but requires great computational efficiency and formalization with respect to information extraction. Today human visual geomorphic analysis and interpretation is more sofisticated than computational analysis, but has obvious drawbacks such as the risk of subjectivity, reproducibility and time consumption. This pilot study focuses on constraining what geomorphic information is available from different types of RS data and how it effectively can be incorporated into image segmentation. Study area Reykjanæs Peninsula host a variety of easily accessible volcanic edifices allowing frequent field visits, which is important for spatial and temporal ground verification. Moreover, Reykjavik Peninsula is among the youngest and most pristine parts of Iceland and the only region in Iceland to have been completely mapped in 1:100,000. Data and methodology A variety of RS data is available for the Reykjanes Peninsula ranging from SPOT, MODIS, Landsat and aerial photographs covering the visible, near-, short-, mid- and long wavelengths. These have spatial resolutions from 15 cm per pixel to 1000 m

  9. [Permanent essential defacement--remarks on the possibilities of verification of the accepted criteria in medico-legal certification in criminal and civil law proceedings].

    PubMed

    Chowaniec, Czesław; Nowak, Agnieszka; Jabłoński, Christian; Neniczka, Stanisława

    2007-01-01

    Despite the fact that some criteria of medico-legal certification in criminal and civil proceedings have been established, there are still some topics which are controversial and thus require modification. This is also true of the notion of "permanent essential defacement". In the opinion of the authors, changes in social conventions that are occurring nowadays, as well as a highly diversified, subjective perception of esthetic values indicate the need for discussing a possible modification of the presently obligatory criteria. Apart from the assessment of posttraumatic changes, an important problem is posed by defining the notion of "a part of the body customarily open to the view ". Additionally, the authors bring up for discussion the issue of experts taking into consideration the age and sex of the victims while assessing damages. A separate problem lies in difficulties in assessing the degree of detriment to health because of defacement due to the fact that official tables for evaluating permanent or long-term detriment to health do not include relevant information. PMID:17571513

  10. Criteria for the development and use of the methodology for environmentally-acceptable fossil energy site evaluation and selection. Volume 2. Final report

    SciTech Connect

    Eckstein, L.; Northrop, G.; Scott, R.

    1980-02-01

    This report serves as a companion document to the report, Volume 1: Environmentally-Acceptable Fossil Energy Site Evaluation and Selection: Methodology and Users Guide, in which a methodology was developed which allows the siting of fossil fuel conversion facilities in areas with the least environmental impact. The methodology, known as SELECS (Site Evaluation for Energy Conversion Systems) does not replace a site specific environmental assessment, or an environmental impact statement (EIS), but does enhance the value of an EIS by thinning down the number of options to a manageable level, by doing this in an objective, open and selective manner, and by providing preliminary assessment and procedures which can be utilized during the research and writing of the actual impact statement.

  11. Standard format and content acceptance criteria for the Material Control and Accounting (MC and A) Reform Amendment: 10 CFR Part 74, Subpart E. Revision 1

    SciTech Connect

    1995-04-01

    In 1987 the NRC revised the material control and accounting requirements for NRC licensees authorized to possess and use a formula quantity (i.e., 5 formula kilograms or more) of strategic special nuclear material. Those revisions issued as 10 CFR 74.51-59 require timely monitoring of in-process inventory and discrete items to detect anomalies potentially indicative of material losses. Timely detection and enhanced loss localization capabilities are beneficial to alarm resolution and also for material recovery in the event of an actual loss. NUREG-1280 was issued in 1987 to present criteria that could be used by applicants, licensees, and NRC license reviewers in the initial preparation and subsequent review of fundamental nuclear material control (FNMC) plans submitted in response to the Reform Amendment. This document is also intended for both licensees and license reviewers with respect to FNMC plan revisions. General performance objectives, system capabilities, process monitoring, item monitoring, alarm resolution, quality assurance, and accounting are addressed. This revision to NUREG-1280 is an expansion of the initial edition, which clarifies and expands upon several topics and addresses issues identified under Reform Amendment implementation experience.

  12. Perspective: Towards environmentally acceptable criteria for downstream fish passage through mini hydro and irrigation infrastructure in the Lower Mekong River Basin

    SciTech Connect

    Baumgartner, Lee J.; Deng, Zhiqun; Thorncraft, Garry; Boys, Craig A.; Brown, Richard S.; Singhanouvong, Douangkham; Phonekhampeng, Oudom

    2014-02-26

    Tropical rivers have high annual discharges optimal for hydropower and irrigation development. The Mekong River is one of the largest tropical river systems, supporting a unique mega-diverse fish community. Fish are an important commodity in the Mekong, contributing a large proportion of calcium, protein, and essential nutrients to the diet of the local people and providing a critical source of income for rural households. Many of these fish migrate not only upstream and downstream within main-channel habitats but also laterally into highly productive floodplain habitat to both feed and spawn. Most work to date has focused on providing for upstream fish passage, but downstream movement is an equally important process to protect. Expansion of hydropower and irrigation weirs can disrupt downstream migrations and it is important to ensure that passage through regulators or mini hydro systems is not harmful or fatal. Many new infrastructure projects (<6 m head) are proposed for the thousands of tributary streams throughout the Lower Mekong Basin and it is important that designs incorporate the best available science to protect downstream migrants. Recent advances in technology have provided new techniques which could be applied to Mekong fish species to obtain design criteria that can facilitate safe downstream passage. Obtaining and applying this knowledge to new infrastructure projects is essential in order to produce outcomes that are more favorable to local ecosystems and fisheries.

  13. Restless legs syndrome (Willis-Ekbom disease) and growing pains: are they the same thing? A side-by-side comparison of the diagnostic criteria for both and recommendations for future research.

    PubMed

    Walters, Arthur S; Gabelia, David; Frauscher, Birgit

    2013-12-01

    There has been no previous side-by-side comparison of the diagnostic criteria for restless legs syndrome (RLS) (Willis-Ekbom disease) and growing pains. In our review, we explore this comparison emphasizing overlaps and disconnects, summarize recent literature exploring the relationship between the 2 entities, and make suggestions for future research. There is considerable overlap in the diagnostic criteria for childhood RLS and growing pains. The literature also indicates that RLS and growing pains more commonly occur together than one would expect based on chance alone, and the family histories of RLS and growing pains often are overlapping. Leg rubbing to obtain relief from leg discomfort is common to both disorders, though walking to obtain relief seems unique to RLS. Childhood RLS also has been reported to be painful in up to 45% of cases. The development of standard diagnostic criteria is necessary to move forward in the field of growing pains research. A quantitative and validated rating scale for growing pains severity already exists. Because of the clinical and genetic similarity between RLS and growing pains, studies that parallel those previously performed in RLS patients are recommended for growing pains patients. For example, a genome wide association study in growing pains patients of all possible genes with particular attention to those identified as related to RLS and a therapeutic trial of medications known to be effective in RLS would be welcome. Abnormalities in vitamin D metabolism also may be common to both disorders. PMID:24157095

  14. Pathogenesis and diagnostic criteria for rickets and osteomalacia - proposal by an expert panel supported by Ministry of Health, Labour and Welfare, Japan, The Japanese Society for Bone and Mineral Research and The Japan Endocrine Society.

    PubMed

    Fukumoto, Seiji; Ozono, Keiichi; Michigami, Toshimi; Minagawa, Masanori; Okazaki, Ryo; Sugimoto, Toshitsugu; Takeuchi, Yasuhiro; Matsumoto, Toshio

    2015-01-01

    Rickets and osteomalacia are diseases characterized by impaired mineralization of bone matrix. Recent investigations revealed that the causes for rickets and osteomalacia are quite variable. While these diseases can severely impair the quality of life of the affected patients, rickets and osteomalacia can be completely cured or at least respond to treatment when properly diagnosed and treated according to the specific causes. On the other hand, there are no standard criteria to diagnose rickets or osteomalacia nationally and internationally. Therefore, we summarize the definition and pathogenesis of rickets and osteomalacia, and propose the diagnostic criteria and a flowchart for the differential diagnosis of various causes for these diseases. We hope that these criteria and flowchart are clinically useful for the proper diagnosis and management of patients with these diseases. PMID:26156530

  15. Pathogenesis and diagnostic criteria for rickets and osteomalacia--proposal by an expert panel supported by the Ministry of Health, Labour and Welfare, Japan, the Japanese Society for Bone and Mineral Research, and the Japan Endocrine Society.

    PubMed

    Fukumoto, Seiji; Ozono, Keiichi; Michigami, Toshimi; Minagawa, Masanori; Okazaki, Ryo; Sugimoto, Toshitsugu; Takeuchi, Yasuhiro; Matsumoto, Toshio

    2015-09-01

    Rickets and osteomalacia are diseases characterized by impaired mineralization of bone matrix. Recent investigations have revealed that the causes of rickets and osteomalacia are quite variable. Although these diseases can severely impair the quality of life of affected patients, rickets and osteomalacia can be completely cured or at least respond to treatment when properly diagnosed and treated according to the specific causes. On the other hand, there are no standard criteria to diagnose rickets or osteomalacia nationally and internationally. Therefore, we summarize the definition and pathogenesis of rickets and osteomalacia, and propose diagnostic criteria and a flowchart for the differential diagnosis of various causes of these diseases. We hope that these criteria and the flowchart are clinically useful for the proper diagnosis and management of these diseases. PMID:26197863

  16. Assessment of the European classification criteria for Sjögren's syndrome in a series of clinically defined cases: results of a prospective multicentre study. The European Study Group on Diagnostic Criteria for Sjögren's Syndrome.

    PubMed Central

    Vitali, C; Bombardieri, S; Moutsopoulos, H M; Coll, J; Gerli, R; Hatron, P Y; Kater, L; Konttinen, Y T; Manthorpe, R; Meyer, O; Mosca, M; Ostuni, P; Pellerito, R A; Pennec, Y; Porter, S R; Richards, A; Sauvezie, B; Schiødt, M; Sciuto, M; Shoenfeld, Y; Skopouli, F N; Smolen, J S; Soromenho, F; Tishler, M; Wattiaux, M J

    1996-01-01

    OBJECTIVE: To assess the recently proposed preliminary criteria for the classification of Sjögren's syndrome (SS) in a multicentre European study of a new series of clinically defined cases. METHODS: The criteria included six items: I = ocular symptoms; II = oral symptoms; III = evidence of keratoconjunctivitis sicca; IV = focal sialoadenitis by minor salivary gland biopsy; V = instrumental evidence of salivary gland involvement; VI = presence of autoantibodies. Each centre was asked to provide five patients with primary SS, five with secondary SS, five with connective tissue diseases (CTD) but without SS, and five controls (patients with ocular or oral features that may simulate SS). The preliminary six item classification criteria set was applied to both the SS patients and the non-SS controls, and the performance of the criteria in terms of sensitivity and specificity was tested. RESULTS: The criteria set was tested on a total of 278 cases (157 SS patients and 121 non-SS controls) collected from 16 centres in 10 countries. At least four of the six items in the criteria set (limiting item VI to the presence of Ro(SS-A) or La(SS-B) antibodies) were present in 79 of 81 patients initially classified as having primary SS (sensitivity 97.5%), but in only seven of 121 non-SS controls (specificity 94.2%). When the presence of item I or II plus any two of items III-V of the criteria set was considered as indicative of secondary SS, 97.3% (71 of 73) of the patients initially defined as having this disorder and 91.8% (45 of 49) of the control patients with CTD without SS were correctly classified. CONCLUSION: This prospective study confirmed the high validity and reliability of the classification criteria for SS recently proposed by the European Community Study Group. PMID:8712861

  17. Bayesian risk-based acceptance criteria

    SciTech Connect

    Martz, H.F.; Abramson, L.R.; Johnson, J.W.

    1996-04-01

    Mechanistic (or deterministic) analysis is traditionally performed in the process of designing a new nuclear reactor or reactor core and also as part of the safety analysis of existing reactors or reload cores. Mechanistic accident analysis is characterized by the specification of an initial operating condition, an initiating event, and subsequent system faults. These subsequent faults are often chosen, through such mechanisms as the worst single failure criterion, so as to maximize the consequences of the accident. Thus, the behavior of all reactor system hardware is prescribed before this analysis begins. Mechanistic analysis then attempts to predict the dynamic response of the system and usually involves detailed reactor physics and thermal-hydraulic predictions of the system behavior, including such parameters as power distributions in the reactor core, coolant temperatures and flow rates, and fuel clad temperature distributions. The objective of this analysis has typically been to establish and verify reactor operating limits and technical specifications, so that severe core damage (SCD) is prevented for a wide variety of reactor accidents.

  18. Update on diagnosis of acute rheumatic fever: 2015 Jones criteria

    PubMed Central

    Eroğlu, Ayşe Güler

    2016-01-01

    In the final Jones criteria, different diagnostic criteria were established for the diagnosis of acute rheumatic fever for low risk and moderate-high risk populations. Turkey was found to be compatible with moderate-high risk populations as a result of regional screenings performed in terms of acute rheumatic fever and rheumatic heart disease. The changes in the diagnostic criteria for low-risk populations include subclinical carditis found on echocardiogram as a major criterion in addition to carditis found clinically and a body temperature of 38.5°C and above as a minor criterion. In moderate-high risk populations including Turkey, subclinical carditis found on echocardiogram in addition to clinical carditis is used as a major criterion as a new amendment. In addition, aseptic monoarthritis and polyarthralgia are used as major criteria in addition to migratory arthritis and monoarhtralgia is used as a minor criterion among joint findings. However, differentiation of subclinical carditis from physiological valve regurgitation found in healthy individuals and exclusion of other diseases involving joints when aseptic monoarthritis and polyarthralgia are used as major criteria are very important. In addition, a body temperature of 38°C and above and an erythrocyte sedimentation rate of 30 mm/h and above have been accepted as minor criteria. The diagnostic criteria for the first attack have not been changed; three minor findings have been accepted in presence of previous sterptococcal infection in addition to the old cirteria for recurrent attacks. In the final Jones criteria, it has been recommended that patients who do not fully meet the diagnostic criteria of acute rheumatic fever should be treated as acute rheumatic fever if another diagnosis is not considered and should be followed up with benzathine penicilin prophylaxis for 12 months. It has been decided that these patients be evaluated 12 months later and a decision for continuation or discontinuation of

  19. Update on diagnosis of acute rheumatic fever: 2015 Jones criteria.

    PubMed

    Eroğlu, Ayşe Güler

    2016-03-01

    In the final Jones criteria, different diagnostic criteria were established for the diagnosis of acute rheumatic fever for low risk and moderate-high risk populations. Turkey was found to be compatible with moderate-high risk populations as a result of regional screenings performed in terms of acute rheumatic fever and rheumatic heart disease. The changes in the diagnostic criteria for low-risk populations include subclinical carditis found on echocardiogram as a major criterion in addition to carditis found clinically and a body temperature of 38.5°C and above as a minor criterion. In moderate-high risk populations including Turkey, subclinical carditis found on echocardiogram in addition to clinical carditis is used as a major criterion as a new amendment. In addition, aseptic monoarthritis and polyarthralgia are used as major criteria in addition to migratory arthritis and monoarhtralgia is used as a minor criterion among joint findings. However, differentiation of subclinical carditis from physiological valve regurgitation found in healthy individuals and exclusion of other diseases involving joints when aseptic monoarthritis and polyarthralgia are used as major criteria are very important. In addition, a body temperature of 38°C and above and an erythrocyte sedimentation rate of 30 mm/h and above have been accepted as minor criteria. The diagnostic criteria for the first attack have not been changed; three minor findings have been accepted in presence of previous sterptococcal infection in addition to the old cirteria for recurrent attacks. In the final Jones criteria, it has been recommended that patients who do not fully meet the diagnostic criteria of acute rheumatic fever should be treated as acute rheumatic fever if another diagnosis is not considered and should be followed up with benzathine penicilin prophylaxis for 12 months. It has been decided that these patients be evaluated 12 months later and a decision for continuation or discontinuation of

  20. An overview on CALR and CSF3R mutations and a proposal for revision of WHO diagnostic criteria for myeloproliferative neoplasms.

    PubMed

    Tefferi, A; Thiele, J; Vannucchi, A M; Barbui, T

    2014-07-01

    Disease-specific mutations facilitate diagnostic precision and drug target discovery. In myeloproliferative neoplasms (MPN), this is best exemplified by the chronic myeloid leukemia-associated BCR-ABL1. No other mutation in MPN has thus far shown a similar degree of diagnostic accuracy or therapeutic relevance. However, JAK2 and KIT mutations are detected in more than 90% of patients with polycythemia vera and systemic mastocytosis, respectively, and are therefore used as highly sensitive clonal markers in these diseases. JAK2 and MPL mutations also occur in essential thrombocythemia (ET) and primary myelofibrosis (PMF), but their diagnostic value is limited by suboptimal sensitivity and specificity. The molecular diagnostic gap in JAK2/MPL-unmutated ET/PMF is now partially addressed by the recent discovery of calreticulin (CALR) mutations in the majority of such cases. However, bone marrow morphology remains the central diagnostic platform and is essential for distinguishing ET from prefibrotic PMF and diagnosing patients those do not express JAK2, MPL or CALR (triple-negative). The year 2013 was also marked by the description of CSF3R mutations in the majority of patients with chronic neutrophilic leukemia (CNL). Herein, we argue for the inclusion of CALR and CSF3R mutations in the World Health Organization classification system for ET/PMF and CNL, respectively. PMID:24441292

  1. DIAGNOSTIC EVALUATIONS OF REGION 4 WASTEWATER TREATMENT FACILITIES: AUGUST 2007 – SEPTEMBER 2008

    EPA Science Inventory

    Diagnostic Evaluations (DEs) are conducted by the Region 4 Science and Ecosystem Support Division (SESD) at the request of the Region 4 Water Management Division or Region 4 States and focus on two key areas: 1) facility design criteria are compared to accepted design parameters ...

  2. Diagnosing attention-deficit hyperactivity disorder (ADHD) in children involved with child protection services: are current diagnostic guidelines acceptable for vulnerable populations?

    PubMed

    Klein, B; Damiani-Taraba, G; Koster, A; Campbell, J; Scholz, C

    2015-03-01

    Children involved with child protection services (CPS) are diagnosed and treated for attention-deficit hyperactivity disorder (ADHD) at higher rates than the general population. Children with maltreatment histories are much more likely to have other factors contributing to behavioural and attentional regulation difficulties that may overlap with or mimic ADHD-like symptoms, including language and learning problems, post-traumatic stress disorder, attachment difficulties, mood disorders and anxiety disorders. A higher number of children in the child welfare system are diagnosed with ADHD and provided with psychotropic medications under a group care setting compared with family-based, foster care and kinship care settings. However, children's behavioural trajectories change over time while in care. A reassessment in the approach to ADHD-like symptoms in children exposed to confirmed (or suspected) maltreatment (e.g. neglect, abuse) is required. Diagnosis should be conducted within a multidisciplinary team and practice guidelines regarding ADHD diagnostic and management practices for children in CPS care are warranted both in the USA and in Canada. Increased education for caregivers, teachers and child welfare staff on the effects of maltreatment and often perplexing relationship with ADHD-like symptoms and co-morbid disorders is also necessary. Increased partnerships are needed to ensure the mental well-being of children with child protection involvement. PMID:24942100

  3. Criteria for Developing Criteria Sets.

    ERIC Educational Resources Information Center

    Martin, James L.

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

  4. Comprehensive molecular analysis demonstrates type V collagen mutations in over 90% of patients with classic EDS and allows to refine diagnostic criteria.

    PubMed

    Symoens, Sofie; Syx, Delfien; Malfait, Fransiska; Callewaert, Bert; De Backer, Julie; Vanakker, Olivier; Coucke, Paul; De Paepe, Anne

    2012-10-01

    Type V collagen mutations are associated with classic Ehlers-Danlos Syndrome (EDS), but it is unknown for which proportion they account and to what extent other genes are involved. We analyzed COL5A1 and COL5A2 in 126 patients with a diagnosis or suspicion of classic EDS. In 93 patients, a type V collagen defect was found, of which 73 were COL5A1 mutations, 13 were COL5A2 mutations and seven were COL5A1 null-alleles with mutation unknown. The majority of the 73 COL5A1 mutations generated a COL5A1 null-allele, whereas one-third were structural mutations, scattered throughout COL5A1. All COL5A2 mutations were structural mutations. Reduced availability of type V collagen appeared to be the major disease-causing mechanism, besides other intra- and extracellular contributing factors. All type V collagen defects were identified within a group of 102 patients fulfilling all major clinical Villefranche criteria, that is, skin hyperextensibility, dystrophic scarring and joint hypermobility. No COL5A1/COL5A2 mutation was detected in 24 patients who displayed skin and joint hyperextensibility but lacked dystrophic scarring. Overall, over 90% of patients fulfilling all major Villefranche criteria for classic EDS were shown to harbor a type V collagen defect, which indicates that this is the major--if not only--cause of classic EDS. PMID:22696272

  5. Michelin tire baby syndrome: a review of the literature and a proposal for diagnostic criteria with adoption of the name circumferential skin folds syndrome.

    PubMed

    Rothman, Ilene L

    2014-01-01

    The term Michelin tire baby (MTB), named for the cartoon mascot of the Michelin Tire Company, has been used to describe babies with multiple symmetric circumferential rings of folded skin. In those reported with this phenotype who had skin biopsies, pathology has shown nevus lipomatosis, smooth muscle hamartoma, degenerative collagen, and scarring. Others did not undergo biopsy or had normal skin. Many individuals with the MTB phenotype have had a variety of other congenital anomalies. I review the literature on MTB and the history of the designation Michelin tire baby Syndrome (MTBS). Because the term MTBS has been poorly defined or not defined at all, I propose strict criteria for diagnosis. In doing so, it is recommended that the syndrome be renamed to avoid further confusion. PMID:25424205

  6. Performance Criteria: Concrete, Volume 1.

    ERIC Educational Resources Information Center

    Hallenbeck, Roger F.; And Others

    The State University Construction Fund provides guidance and direction to professionals participating in its program by issuing performance criteria that set forth owner or user requirements. This document provides guidelines in the form of performance criteria, testing procedures, and instructions to achieve an acceptable level of performance in…

  7. Letter to the Editor: Diagnostic Criteria in Urological Diseases do not Always Match with Findings by Extended Culture Techniques and Metagenomic Sequencing of 16S rDNA

    PubMed Central

    Smelov, Vitaly; Naber, Kurt; Bjerklund Johansen, Truls E.

    2016-01-01

    Some diseases of the urinary tract are defined by the presence of microorganisms while others are defined by their absence. The underlying idea has always been that urine from healthy subjects is sterile and a negative urine culture has usually been taken as discriminative for an infection to be absent. Several disorders with symptoms that resemble infections are regarded as separate entities based on the exclusion of bacterial growth such as overactive neurogenic bladder and pelvic pain syndromes. During the recent years two paradigmata related to the role of bacteria in urological disease classification have changed completely. Firstly, bacteriuria does not necessarily mean an infection, and secondly, if extended sets of culture media for identification of fastidious and anaerobic bacteria or culture-independent metagenomic sequencing (MGS) is applied, a broad range of even non-culturable bacteria has been detected in the ”sterile” bladder urine in healthy individuals. The aim of this editorial is to initiate a discussion to redefine the criteria for urinary tract infections and non-infectious urological disorders with similar symptoms. Clinical studies, in which extended sets of culture media and MGS are integrated, are needed to clarify the pathogenesis of urological disorders where bacteria may play a role. The pure detection of bacteria in the urine does not by itself prove an infectious etiology of a specific disorder. It is important to avoid that results of new technologies lead to unnecessary antibiotic consumption with unwanted collateral damage and adverse events. PMID:27006726

  8. The Risk of Epithelial Ovarian Cancer of Women With Endometriosis May be Varied Greatly if Diagnostic Criteria Are Different: A Nationwide Population-Based Cohort Study.

    PubMed

    Lee, Wen-Ling; Chang, Wen-Hsun; Wang, Kuan-Chin; Guo, Chao-Yu; Chou, Yiing-Jeng; Huang, Nicole; Huang, Hsin-Yi; Yen, Ming-Shyen; Wang, Peng-Hui

    2015-09-01

    This article aims to test the hypothesis that the risk of epithelial ovarian cancer (EOC) in women with endometriosis might be changed by enrolling different population. A nationwide 14-year historic cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan and the Registry for Catastrophic Illness Patients was conducted. A total of 239,385 women aged between 20 and 51 years, with at least 1 gynecologic visit after 2000, were analyzed. Cases included women with a diagnosed endometriosis, which was established along a spectrum from at least 1 medical record of endometriosis (recalled endometriosis) to tissue-proved ovarian endometriosis (n = X). Controls included women without any diagnosis of endometriosis (n = 239,385 - X). We used Cox regression, and computed hazard ratios (HRs) with 95% confidence intervals (95% CI) to determine the risk of EOC in patients. The EOC incidence rates (IRs, per 10,000 person-years) of women with endometriosis ranged from 1.90 in women with recalled endometriosis to 18.70 in women with tissue-proved ovarian endometrioma, compared with those women without any diagnosis of endometriosis (0.77-0.89), contributing to crude HRs ranging from 2.59 (95% CI, 2.09-3.21; P < 0.001) to 24.04 (95% CI, 17.48-33.05; P < 0.001). After adjustment for pelvic inflammatory disease, infertility, Charlson co-morbidity index, and age, adjusted HRs were ranged from the lowest of 1.90 (95% CI, 1.51-2.37; P < 0.001) in recalled endometriosis to the highest of 18.57 (95% CI, 13.37-25.79; P < 0.001) in tissue-proved ovarian endometrioma, which was inversely related to the prevalence rate of endometriosis (from the highest of 30.80% in recalled endometriosis to the lowest of 1.54% in tissue-proved ovarian endometrioma). The risk of EOC in women with endometriosis varied greatly by different criteria used. Women with endometriosis might have a more apparently higher risk than those reported by systematic review and meta-analysis. PMID

  9. Monitoring Reading Behavior: Criteria for Performance.

    ERIC Educational Resources Information Center

    Powell, William R.

    Effective use of the informal reading inventory (IRI) depends upon the criteria used in determining the functional reading levels and more specifically the word recognition criteria employed in describing acceptable limits of oral reading behavior. The author of this paper looks at the diverse sets of criteria commonly used, the problems…

  10. Lung donor selection criteria

    PubMed Central

    Chaney, John; Suzuki, Yoshikazu; Cantu, Edward

    2014-01-01

    The criteria that define acceptable physiologic and social parameters for lung donation have remained constant since their empiric determination in the 1980s. These criteria include a donor age between 25-40, a arterial partial pressure of oxygen (PaO2)/FiO2 ratio greater than 350, no smoking history, a clear chest X-ray, clean bronchoscopy, and a minimal ischemic time. Due to the paucity of organ donors, and the increasing number of patients requiring lung transplant, finding a donor that meets all of these criteria is quite rare. As such, many transplants have been performed where the donor does not meet these stringent criteria. Over the last decade, numerous reports have been published examining the effects of individual acceptance criteria on lung transplant survival and graft function. These studies suggest that there is little impact of the historical criteria on either short or long term outcomes. For age, donors should be within 18 to 64 years old. Gender may relay benefit to all female recipients especially in male to female transplants, although results are mixed in these studies. Race matched donor/recipients have improved outcomes and African American donors convey worse prognosis. Smoking donors may decrease recipient survival post transplant, but provide a life saving opportunity for recipients that may otherwise remain on the transplant waiting list. No specific gram stain or bronchoscopic findings are reflected in recipient outcomes. Chest radiographs are a poor indicator of lung donor function and should not adversely affect organ usage aside for concerns over malignancy. Ischemic time greater than six hours has no documented adverse effects on recipient mortality and should not limit donor retrieval distances. Brain dead donors and deceased donors have equivalent prognosis. Initial PaO2/FiO2 ratios less than 300 should not dissuade donor organ usage, although recruitment techniques should be implemented with intent to transplant. PMID:25132970

  11. Lung donor selection criteria.

    PubMed

    Chaney, John; Suzuki, Yoshikazu; Cantu, Edward; van Berkel, Victor

    2014-08-01

    The criteria that define acceptable physiologic and social parameters for lung donation have remained constant since their empiric determination in the 1980s. These criteria include a donor age between 25-40, a arterial partial pressure of oxygen (PaO2)/FiO2 ratio greater than 350, no smoking history, a clear chest X-ray, clean bronchoscopy, and a minimal ischemic time. Due to the paucity of organ donors, and the increasing number of patients requiring lung transplant, finding a donor that meets all of these criteria is quite rare. As such, many transplants have been performed where the donor does not meet these stringent criteria. Over the last decade, numerous reports have been published examining the effects of individual acceptance criteria on lung transplant survival and graft function. These studies suggest that there is little impact of the historical criteria on either short or long term outcomes. For age, donors should be within 18 to 64 years old. Gender may relay benefit to all female recipients especially in male to female transplants, although results are mixed in these studies. Race matched donor/recipients have improved outcomes and African American donors convey worse prognosis. Smoking donors may decrease recipient survival post transplant, but provide a life saving opportunity for recipients that may otherwise remain on the transplant waiting list. No specific gram stain or bronchoscopic findings are reflected in recipient outcomes. Chest radiographs are a poor indicator of lung donor function and should not adversely affect organ usage aside for concerns over malignancy. Ischemic time greater than six hours has no documented adverse effects on recipient mortality and should not limit donor retrieval distances. Brain dead donors and deceased donors have equivalent prognosis. Initial PaO2/FiO2 ratios less than 300 should not dissuade donor organ usage, although recruitment techniques should be implemented with intent to transplant. PMID:25132970

  12. Perspectives on the revised Ghent criteria for the diagnosis of Marfan syndrome

    PubMed Central

    von Kodolitsch, Yskert; De Backer, Julie; Schüler, Helke; Bannas, Peter; Behzadi, Cyrus; Bernhardt, Alexander M; Hillebrand, Mathias; Fuisting, Bettina; Sheikhzadeh, Sara; Rybczynski, Meike; Kölbel, Tilo; Püschel, Klaus; Blankenberg, Stefan; Robinson, Peter N

    2015-01-01

    Three international nosologies have been proposed for the diagnosis of Marfan syndrome (MFS): the Berlin nosology in 1988; the Ghent nosology in 1996 (Ghent-1); and the revised Ghent nosology in 2010 (Ghent-2). We reviewed the literature and discussed the challenges and concepts of diagnosing MFS in adults. Ghent-1 proposed more stringent clinical criteria, which led to the confirmation of MFS in only 32%–53% of patients formerly diagnosed with MFS according to the Berlin nosology. Conversely, both the Ghent-1 and Ghent-2 nosologies diagnosed MFS, and both yielded similar frequencies of MFS in persons with a causative FBN1 mutation (90% for Ghent-1 versus 92% for Ghent-2) and in persons not having a causative FBN1 mutation (15% versus 13%). Quality criteria for diagnostic methods include objectivity, reliability, and validity. However, the nosology-based diagnosis of MFS lacks a diagnostic reference standard and, hence, quality criteria such as sensitivity, specificity, or accuracy cannot be assessed. Medical utility of diagnosis implies congruency with the historical criteria of MFS, as well as with information about the etiology, pathogenesis, diagnostic triggers, prognostic triggers, and potential complications of MFS. In addition, social and psychological utilities of diagnostic criteria include acceptance by patients, patient organizations, clinicians and scientists, practicability, costs, and the reduction of anxiety. Since the utility of a diagnosis or exclusion of MFS is context-dependent, prioritization of utilities is a strategic decision in the process of nosology development. Screening tests for MFS should be used to identify persons with MFS. To confirm the diagnosis of MFS, Ghent-1 and Ghent-2 perform similarly, but Ghent-2 is easier to use. To maximize the utility of the diagnostic criteria of MFS, a fair and transparent process of nosology development is essential. PMID:26124674

  13. Comparison of Diagnostic Methods for Asperger Syndrome

    ERIC Educational Resources Information Center

    Kopra, Kristiina; von Wendt, Lennart; Nieminen-von Wendt, Taina; Paavonen, E. Julia

    2008-01-01

    Several different diagnostic sets of criteria exist for Asperger syndrome (AS), but there is no agreement on a gold standard. The aim of this study was to compare four diagnostic sets of criteria for AS: the ICD-10, the DSM-IV, the Gillberg & Gillberg, and the Szatmari criteria. The series consists of 36 children who had been referred to two…

  14. Acceptance and Avoidance Processes at Different Levels of Psychological Recovery from Enduring Mental Illness

    PubMed Central

    Siqueira, Vinicius R.; Oades, Lindsay G.

    2015-01-01

    Objective. This study examined the use of psychological acceptance and experiential avoidance, two key concepts of Acceptance and Commitment Therapy (ACT), in the psychological recovery process of people with enduring mental illness. Method. Sixty-seven participants were recruited from the metropolitan, regional, and rural areas of New South Wales, Australia. They all presented some form of chronic mental illness (at least 12 months) as reflected in DSM-IV Axis I diagnostic criteria. The Acceptance and Action Questionnaire (AAQ-19) was used to measure the presence of psychological acceptance and experiential avoidance; the Recovery Assessment Scale (RAS) was used to examine the levels of psychological recovery; and the Scales of Psychological Well-Being was used to observe if there are benefits in utilizing psychological acceptance and experiential avoidance in the recovery process. Results. An analysis of objectively quantifiable measures found no clear correlation between the use of psychological acceptance and recovery in mental illness as measured by the RAS. The data, however, showed a relationship between psychological acceptance and some components of recovery, thereby demonstrating its possible value in the recovery process. Conclusion. The major contribution of this research was the emerging correlation that was observed between psychological acceptance and positive levels of psychological well-being among individuals with mental illness. PMID:26576412

  15. Sensitivity and Specificity of Polysomnographic Criteria for Defining Insomnia

    PubMed Central

    Edinger, Jack D.; Ulmer, Christi S.; Means, Melanie K.

    2013-01-01

    Study Objectives: In recent years, polysomnography-based eligibility criteria have been increasingly used to identify candidates for insomnia research, and this has been particularly true of studies evaluating pharmacologic therapy for primary insomnia. However, the sensitivity and specificity of PSG for identifying individuals with insomnia is unknown, and there is no consensus on the criteria sets which should be used for participant selection. In the current study, an archival data set was used to test the sensitivity and specificity of PSG measures for identifying individuals with primary insomnia in both home and lab settings. We then evaluated the sensitivity and specificity of the eligibility criteria employed in a number of recent insomnia trials for identifying primary insomnia sufferers in our sample. Design: Archival data analysis. Settings: Study participants' homes and a clinical sleep laboratory. Participants: Adults: 76 with primary insomnia and 78 non-complaining normal sleepers. Measurements and Results: ROC and cross-tabs analyses were used to evaluate the sensitivity and specificity of PSG-derived total sleep time, latency to persistent sleep, wake after sleep onset, and sleep efficiency for discriminating adults with primary insomnia from normal sleepers. None of the individual criteria accurately discriminated PI from normal sleepers, and none of the criteria sets used in recent trials demonstrated acceptable sensitivity and specificity for identifying primary insomnia. Conclusions: The use of quantitative PSG-based selection criteria in insomnia research may exclude many who meet current diagnostic criteria for an insomnia disorder. Citation: Edinger JD; Ulmer CS; Means MK. Sensitivity and specificity of polysomnographic criteria for defining insomnia. J Clin Sleep Med 2013;9(5):481-491. PMID:23674940

  16. Acceptance speech.

    PubMed

    Carpenter, M

    1994-01-01

    In Bangladesh, the assistant administrator of USAID gave an acceptance speech at an awards ceremony on the occasion of the 25th anniversary of oral rehydration solution (ORS). The ceremony celebrated the key role of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in the discovery of ORS. Its research activities over the last 25 years have brought ORS to every village in the world, preventing more than a million deaths each year. ORS is the most important medical advance of the 20th century. It is affordable and client-oriented, a true appropriate technology. USAID has provided more than US$ 40 million to ICDDR,B for diarrheal disease and measles research, urban and rural applied family planning and maternal and child health research, and vaccine development. ICDDR,B began as the relatively small Cholera Research Laboratory and has grown into an acclaimed international center for health, family planning, and population research. It leads the world in diarrheal disease research. ICDDR,B is the leading center for applied health research in South Asia. It trains public health specialists from around the world. The government of Bangladesh and the international donor community have actively joined in support of ICDDR,B. The government applies the results of ICDDR,B research to its programs to improve the health and well-being of Bangladeshis. ICDDR,B now also studies acute respiratory diseases and measles. Population and health comprise 1 of USAID's 4 strategic priorities, the others being economic growth, environment, and democracy, USAID promotes people's participation in these 4 areas and in the design and implementation of development projects. USAID is committed to the use and improvement of ORS and to complementary strategies that further reduce diarrhea-related deaths. Continued collaboration with a strong user perspective and integrated services will lead to sustainable development. PMID:12345470

  17. Acceptance speech.

    PubMed

    Yusuf, C K

    1994-01-01

    I am proud and honored to accept this award on behalf of the Government of Bangladesh, and the millions of Bangladeshi children saved by oral rehydration solution. The Government of Bangladesh is grateful for this recognition of its commitment to international health and population research and cost-effective health care for all. The Government of Bangladesh has already made remarkable strides forward in the health and population sector, and this was recognized in UNICEF's 1993 "State of the World's Children". The national contraceptive prevalence rate, at 40%, is higher than that of many developed countries. It is appropriate that Bangladesh, where ORS was discovered, has the largest ORS production capacity in the world. It was remarkable that after the devastating cyclone in 1991, the country was able to produce enough ORS to meet the needs and remain self-sufficient. Similarly, Bangladesh has one of the most effective, flexible and efficient control of diarrheal disease and epidemic response program in the world. Through the country, doctors have been trained in diarrheal disease management, and stores of ORS are maintained ready for any outbreak. Despite grim predictions after the 1991 cyclone and the 1993 floods, relatively few people died from diarrheal disease. This is indicative of the strength of the national program. I want to take this opportunity to acknowledge the contribution of ICDDR, B and the important role it plays in supporting the Government's efforts in the health and population sector. The partnership between the Government of Bangladesh and ICDDR, B has already borne great fruit, and I hope and believe that it will continue to do so for many years in the future. Thank you. PMID:12345479

  18. [Sporadic amyotrophic lateral sclerosis. Diagnostic criteria].

    PubMed

    Godoy, J M; de Oliveira, M A; de Moraes Neto, J B; Balassiano, S L; Montagna, N; Pinto, J R; Skacel, M

    1993-06-01

    The authors report two cases of amyotrophic lateral sclerosis (ALS) misdiagnosis (a craniocervical junction disorder, and a cervical spinal cord ependymoma). They review some causes of ALS-like syndrome and propose a protocol to be adopted for the study of all patients who present clinical abnormalities suggesting ALS. PMID:8274087

  19. Hashimoto thyroiditis: clinical and diagnostic criteria.

    PubMed

    Caturegli, P; De Remigis, A; Rose, N R

    2014-01-01

    Hashimoto thyroiditis (HT), now considered the most common autoimmune disease, was described over a century ago as a pronounced lymphoid goiter affecting predominantly women. In addition to this classic form, several other clinico-pathologic entities are now included under the term HT: fibrous variant, IgG4-related variant, juvenile form, Hashitoxicosis, and painless thyroiditis (sporadic or post-partum). All forms are characterized pathologically by the infiltration of hematopoietic mononuclear cells, mainly lymphocytes, in the interstitium among the thyroid follicles, although specific features can be recognized in each variant. Thyroid cells undergo atrophy or transform into a bolder type of follicular cell rich in mitochondria called Hürthle cell. Most HT forms ultimately evolve into hypothyroidism, although at presentation patients can be euthyroid or even hyperthyroid. The diagnosis of HT relies on the demonstration of circulating antibodies to thyroid antigens (mainly thyroperoxidase and thyroglobulin) and reduced echogenicity on thyroid sonogram in a patient with proper clinical features. The treatment remains symptomatic and based on the administration of synthetic thyroid hormones to correct the hypothyroidism as needed. Surgery is performed when the goiter is large enough to cause significant compression of the surrounding cervical structures, or when some areas of the thyroid gland mimic the features of a nodule whose cytology cannot be ascertained as benign. HT remains a complex and ever expanding disease of unknown pathogenesis that awaits prevention or novel forms of treatment. PMID:24434360

  20. von Willebrand disease in a pediatric-based population--comparison of type 1 diagnostic criteria and use of the PFA-100 and a von Willebrand factor/collagen-binding assay.

    PubMed

    Dean, J A; Blanchette, V S; Carcao, M D; Stain, A M; Sparling, C R; Siekmann, J; Turecek, P L; Lillicrap, D; Rand, M L

    2000-09-01

    Definitive diagnosis of type 1 von Willebrand Disease (VWD) remains a problem. Provisional consensus guidelines for the diagnosis of definite and possible type 1 VWD were prepared by the Scientific Subcommittee on von Willebrand factor (VWF) of the Scientific and Standardization Committee (SSC) of the International Society on Thrombosis and Haemostasis (ISTH) during the 1996 annual meeting for the specific purpose of further evaluation in retrospective and prospective studies by a Working Party on Diagnostic Criteria (1996 Annual Report of the SSC/ISTH Subcommittee on VWF). In the first phase of this study, we compared 2 definitions of type 1 VWD. each with 3 criteria: significant bleeding history, laboratory investigations, and family history. Using the ISTH consensus guidelines for type 1 VWD definition, significantly fewer patients were diagnosed with definite type 1 disease as compared to our "in house" Hospital for Sick Children (HSC) criteria (4 vs. 31). While we recognize that the provisional ISTH consensus guidelines were not intended for clinical use, we believe that the results of our studies are of interest and will assist in any future refinements to the ISTH guidelines. In the second phase of this study, we investigated the utility of 2 new tests, a laboratory screening test and a functional test, for VWD in our well characterized, pediatric-based population. The Platelet Function Analyzer (PFA-100) provides an in vitro measure of primary hemostasis under conditions of high shear, using disposable cartridges containing collagen and either epinephrine or ADP. All tested subjects with types 2 or 3 VWD had prolonged PFA-100 closure times (CTs) with both cartridge types (n = 17) and prolonged bleeding times (n = 14). In subjects with definite type 1 VWD, 20/24 (83%) had prolonged CTs with the collagen/ADP cartridge (19/24 (79%) with collagen/epinephrine), compared with 7/26 (27%) with prolonged bleeding times. In subjects with definite types 1, 2, or 3 VWD

  1. The European Community Study Group on diagnostic criteria for Sjögren's syndrome. Sensitivity and specificity of tests for ocular and oral involvement in Sjögren's syndrome.

    PubMed Central

    Vitali, C; Moutsopoulos, H M; Bombardieri, S

    1994-01-01

    AIM--To establish a definitive set of diagnostic criteria in a multicentre European study a selected number of oral and ocular tests were performed on a large number of patients with Sjögrens Syndrome (SS) and controls. The diagnostic accuracy of each test for patients with primary and secondary SS and for controls at different ages, was studied. METHODS--Each centre received a clinical chart describing the series of tests to be conducted. The tests included: questionnaires for dry eye and dry mouth symptoms, Schirmer's-I-test (ScT), tear fluid lactoferrin level (TFLL), break-up time (BUT) and rose Bengal score (RBS) for the eye evaluation; unstimulated and stimulated whole saliva collection (UWSC and SWSC), salivary gland scintigraphy (SGS), parotid sialography (PS) and minor salivary gland biopsy (MSGB) for oral involvement. RESULTS--Data from 22 centres and 11 countries was collected on a total of 447 patients with SS (246 with primary SS and 201 with secondary SS) and 246 controls (of whom 113 had a connective tissue disease without SS). Among the ocular symptoms, the feeling of dry eye and 'sand in the eye' were the ones most commonly recorded in patients with SS. Similarly, the feeling of dry mouth, appearing either spontaneously or when the patient was eating or breathing, was the most frequent subjective oral symptom. Among the ocular tests, ScT showed the best balance between sensitivity and specificity (76.9% and 72.4% respectively), while RBS was the most specific test (81.7%). ScT and RBS gave also sufficiently concordant results. TFLL and BUT gave considerably less reliable results, which were not concordant with each other or with the other ocular tests. The quantitative lacrimal tests ScT and TFLL produced significantly different results in elderly controls, while RBS did not. Abnormal results for all of the ocular tests were less marked and less frequent in patients with secondary SS than in those with primary SS. The oral tests (except SWSC) were

  2. Searching the perfect ultrasonic classification in assessing carotid artery stenosis: comparison and remarks upon the existing ultrasound criteria.

    PubMed

    Mozzini, Chiara; Roscia, Giuseppe; Casadei, Alder; Cominacini, Luciano

    2016-01-01

    Doppler ultrasound scanning is the first line investigation for quantifying the internal carotid artery stenosis. Nevertheless, the lack of internationally accepted ultrasound criteria for describing the degree of stenosis has contributed to the different and confusing measurements ranges. The use of two different angiographic methods, the North American Symptomatic Carotid Endoarterectomy Study and the European Carotid Surgery Trial was probably the major initial source of confusion in deriving valid and reliable duplex ultrasound criteria worldwide. The consensus proposed in 2003 by the Society of Radiologists in Ultrasound has been a great attempt to create a conformity document, establishing grey scale and Doppler criteria in considering the different degrees of stenosis. According to this attempt, in 2010, the multi-parametric Deutsche Gesellschaft für Ultraschall in der Medizin ultrasound criteria have been proposed with a precise differentiation between main and additional criteria and depicted a different peak systolic velocity (PSV) threshold. In 2012, these criteria have been implemented, focusing on the multi-parametric approach, re-defining the PSV values and clearly introducing the concept of PSV average. Despite these attempts, a wide range of practice patterns still exists, with consistent disparities in patients' care. This paper collects these previous experiences and summarizes their strengths and weaknesses, to give a contribution in the carotid artery stenosis grading standardization using ultrasonic methods. Carotid ultrasound as the only diagnostic tool for the selection of patients for carotid surgery or stenting will be possible only with internationally accepted criteria. PMID:27298648

  3. Crew Transportation Technical Standards and Design Evaluation Criteria

    NASA Technical Reports Server (NTRS)

    Lueders, Kathryn L.; Thomas, Rayelle E. (Compiler)

    2015-01-01

    Crew Transportation Technical Standards and Design Evaluation Criteria contains descriptions of technical, safety, and crew health medical processes and specifications, and the criteria which will be used to evaluate the acceptability of the Commercial Providers' proposed processes and specifications.

  4. Design criteria for maglev structures

    SciTech Connect

    Sandberg, H.R.; Williams, J.R.

    1997-05-01

    Maglev systems represent an entirely new concept in transportation. They will not operate on nor share the right-of-way with any other system. It is important, therefore, that the guideways be designed and constructed so as to be economical, constructable, durable, adaptable, reliable, and readily maintained. Comparisons should be made with the current transportation systems, especially highways and railroads. Since most of the guideway will be elevated, the comparison should be with the bridges. The object of the comparisons should be to avoid the shortcomings of the other systems while building on their strengths. This paper develops in some detail design and construction criteria that will ensure a good, long-lived performance of the maglev guideway. The importance of beauty should have a low priority in comparison to the other design criteria. Clean, simple details meeting other criteria will ensure an acceptable appearance. These criteria were used in evaluating the four maglev concepts developed for the National Maglev Initiative.

  5. A Prospective comparison of new Japanese criteria for disseminated intravascular coagulation: new Japanese criteria versus ISTH criteria.

    PubMed

    Hayakawa, Mineji; Gando, Satoshi; Hoshino, Hirokatsu

    2007-04-01

    In Japan, early diagnosis and early treatment of disseminated intravascular coagulation (DIC) based on the old Japanese criteria have greatly improved the outcomes of DIC patients with hematopoietic malignancy. However, the prognoses of critically ill patients with DIC have remained poor. To overcome this situation, new Japanese DIC criteria for critically ill patients were established in 2002. The new Japanese DIC criteria adopted a concept of coagulopathy associated with systemic inflammatory response syndrome. In the present study, we prospectively investigated the relationships between the new criteria and organ failure, prognosis, and other sets of DIC criteria. This study included 74 patients whose platelet counts were below 150 x 10(9)/L. Daily DIC scores and sequential organ failure assessment scores were recorded from days 0 to 4 once the patient was included in the study. The new Japanese DIC criteria diagnosed DIC earlier than both the non-overt DIC and the old Japanese criteria did (P = .0005). The new Japanese criteria diagnosed more DIC patients prior to the establishment of multiple organ failure than the other sets (P = .023). The new Japanese criteria tended also to predict prognoses more efficiently than the other two sets. In conclusion, the diagnostic sensitivity of the new Japanese criteria was as high as that of the non-overt DIC criteria. Furthermore, the new Japanese criteria provided the earliest detection and most accurate outcome prediction of DIC among the DIC criteria sets. PMID:17456627

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

    PubMed

    Yazici, Hasan; Yazici, Yusuf

    2014-01-01

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

  7. 49 CFR 173.57 - Acceptance criteria for new explosives.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... (Test Method D-3 in appendix D to this part), a non-gelatin dynamite loses more than 3 percent by weight of the liquid explosive or a gelatin dynamite loses more than 10 percent by weight of the...

  8. 49 CFR 173.57 - Acceptance criteria for new explosives.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... must be subjected to the Drop Weight Impact Sensitivity Test (Test Method 3(a)(i)), the Friction Sensitivity Test (Test Method 3(b)(iii)), the Thermal Stability Test (Test Method 3(c)) at 75 °C (167 °F) and... tested in the Drop Weight Impact Sensitivity Test apparatus for liquids; (2) For a solid, failure to...

  9. 49 CFR 173.57 - Acceptance criteria for new explosives.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... must be subjected to the Drop Weight Impact Sensitivity Test (Test Method 3(a)(i)), the Friction Sensitivity Test (Test Method 3(b)(iii)), the Thermal Stability Test (Test Method 3(c)) at 75 °C (167 °F) and... tested in the Drop Weight Impact Sensitivity Test apparatus for liquids; (2) For a solid, failure to...

  10. 49 CFR 173.57 - Acceptance criteria for new explosives.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... must be subjected to the Drop Weight Impact Sensitivity Test (Test Method 3(a)(i)), the Friction Sensitivity Test (Test Method 3(b)(iii)), the Thermal Stability Test (Test Method 3(c)) at 75 °C (167 °F) and... tested in the Drop Weight Impact Sensitivity Test apparatus for liquids; (2) For a solid, failure to...

  11. 49 CFR 173.57 - Acceptance criteria for new explosives.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... must be subjected to the Drop Weight Impact Sensitivity Test (Test Method 3(a)(i)), the Friction Sensitivity Test (Test Method 3(b)(iii)), the Thermal Stability Test (Test Method 3(c)) at 75 °C (167 °F) and... tested in the Drop Weight Impact Sensitivity Test apparatus for liquids; (2) For a solid, failure to...

  12. 44 CFR 362.3 - Criteria for determining acceptance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... gift of services is offered to the Administrator for the benefit of the National Earthquake Hazards... objectives of the National Earthquake Hazards Reduction Program, as defined in 42 U.S.C. 7702. (b) All...

  13. 44 CFR 362.3 - Criteria for determining acceptance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... gift of services is offered to the Administrator for the benefit of the National Earthquake Hazards... objectives of the National Earthquake Hazards Reduction Program, as defined in 42 U.S.C. 7702. (b) All...

  14. Acceptance criteria for reactor coolant pumps and valves

    SciTech Connect

    Gupta, N.K.; Miller, R.F.; Sindelar, R.L.

    1993-05-01

    Each of the six primary coolant loop systems of the Savannah River Site (SRS) production reactors contains one reactor coolant pump, one PUMP suction side motor operated valve, and other smaller valves. The pumps me double suction, double volute, and radially split type pumps. The valves are different size shutoff and control valves rated from ANSI B16.5 construction class 150 to class 300. The reactor coolant system components, also known as the process water system (PWS), are classified as nuclear Safety Class I components. These components were constructed in the 1950`s in accordance with the then prevailing industry practices. No uniform construction codes were used for design and analysis of these components. However, no pressure boundary failures or bolting failures have ever been recorded throughout their operating history. Over the years, the in-service inspection (ISI) was limited to visual inspection of the pressure boundaries, and surface and volumetric examination of the pressure retaining bolts. Efforts are now underway to implement ISI requirements similar to the ASME Section XI requirements for pumps and valves. This report discusses the new ISI requirements which also call for volumetric examination of the pump casing and valve body welds.

  15. 44 CFR 362.3 - Criteria for determining acceptance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... gift of services is offered to the Administrator for the benefit of the National Earthquake Hazards... objectives of the National Earthquake Hazards Reduction Program, as defined in 42 U.S.C. 7702. (b) All...

  16. 44 CFR 362.3 - Criteria for determining acceptance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... gift of services is offered to the Administrator for the benefit of the National Earthquake Hazards... objectives of the National Earthquake Hazards Reduction Program, as defined in 42 U.S.C. 7702. (b) All...

  17. 44 CFR 362.3 - Criteria for determining acceptance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... gift of services is offered to the Administrator for the benefit of the National Earthquake Hazards... objectives of the National Earthquake Hazards Reduction Program, as defined in 42 U.S.C. 7702. (b) All...

  18. DWPF COAL CARBON WASTE ACCEPTANCE CRITERIA LIMIT EVALUATION

    SciTech Connect

    Lambert, D.; Choi, A.

    2010-06-21

    A paper study was completed to assess the impact on the Defense Waste Processing Facility (DWPF)'s Chemical Processing Cell (CPC) acid addition and melter off-gas flammability control strategy in processing Sludge Batch 10 (SB10) to SB13 with an added Fluidized Bed Steam Reformer (FBSR) stream and two Salt Waste Processing Facility (SWPF) products (Strip Effluent and Actinide Removal Stream). In all of the cases that were modeled, an acid mix using formic acid and nitric acid could be achieved that would produce a predicted Reducing/Oxidizing (REDOX) Ratio of 0.20 Fe{sup +2}/{Sigma}Fe. There was sufficient formic acid in these combinations to reduce both the manganese and mercury present. Reduction of manganese and mercury are both necessary during Sludge Receipt and Adjustment Tank (SRAT) processing, however, other reducing agents such as coal and oxalate are not effective in this reduction. The next phase in this study will be experimental testing with SB10, FBSR, and both SWPF simulants to validate the assumptions in this paper study and determine whether there are any issues in processing these streams simultaneously. The paper study also evaluated a series of abnormal processing conditions to determine whether potential abnormal conditions in FBSR, SWPF or DWPF would produce melter feed that was too oxidizing or too reducing. In most of the cases that were modeled with one parameter at its extreme, an acid mix using formic acid and nitric acid could be achieved that would produce a predicted REDOX of 0.09-0.30 (target 0.20). However, when a run was completed with both high coal and oxalate, with minimum formic acid to reduce mercury and manganese, the final REDOX was predicted to be 0.49 with sludge and FBSR product and 0.47 with sludge, FBSR product and both SWPF products which exceeds the upper REDOX limit.

  19. Cardiometabolic Risk Profiles in Patients With Impaired Fasting Glucose and/or Hemoglobin A1c 5.7% to 6.4%: Evidence for a Gradient According to Diagnostic Criteria: The PREDAPS Study.

    PubMed

    Giráldez-García, Carolina; Sangrós, F Javier; Díaz-Redondo, Alicia; Franch-Nadal, Josep; Serrano, Rosario; Díez, Javier; Buil-Cosiales, Pilar; García-Soidán, F Javier; Artola, Sara; Ezkurra, Patxi; Carrillo, Lourdes; Millaruelo, J Manuel; Seguí, Mateu; Martínez-Candela, Juan; Muñoz, Pedro; Goday, Albert; Regidor, Enrique

    2015-11-01

    It has been suggested that the early detection of individuals with prediabetes can help prevent cardiovascular diseases. The purpose of the current study was to examine the cardiometabolic risk profile in patients with prediabetes according to fasting plasma glucose (FPG) and/or hemoglobin A1c (HbA1c) criteria.Cross-sectional analysis from the 2022 patients in the Cohort study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS Study) was developed. Four glycemic status groups were defined based on American Diabetes Association criteria. Information about cardiovascular risk factors-body mass index, waist circumference, blood pressure, cholesterol, triglycerides, uric acid, gamma-glutamyltransferase, glomerular filtration-and metabolic syndrome components were analyzed. Mean values of clinical and biochemical characteristics and frequencies of metabolic syndrome were estimated adjusting by age, sex, educational level, and family history of diabetes.A linear trend (P < 0.001) was observed in most of the cardiovascular risk factors and in all components of metabolic syndrome. Normoglycemic individuals had the best values, individuals with both criteria of prediabetes had the worst, and individuals with only one-HbA1c or FPG-criterion had an intermediate position. Metabolic syndrome was present in 15.0% (95% confidence interval: 12.6-17.4), 59.5% (54.0-64.9), 62.0% (56.0-68.0), and 76.2% (72.8-79.6) of individuals classified in normoglycemia, isolated HbA1c, isolated FPG, and both criteria groups, respectively.In conclusion, individuals with prediabetes, especially those with both criteria, have worse cardiometabolic risk profile than normoglycemic individuals. These results suggest the need to use both criteria in the clinical practice to identify those individuals with the highest cardiovascular risk, in order to offer them special attention with intensive lifestyle intervention programs. PMID:26554799

  20. Cardiometabolic Risk Profiles in Patients With Impaired Fasting Glucose and/or Hemoglobin A1c 5.7% to 6.4%: Evidence for a Gradient According to Diagnostic Criteria

    PubMed Central

    Giráldez-García, Carolina; Sangrós, F. Javier; Díaz-Redondo, Alicia; Franch-Nadal, Josep; Serrano, Rosario; Díez, Javier; Buil-Cosiales, Pilar; García-Soidán, F. Javier; Artola, Sara; Ezkurra, Patxi; Carrillo, Lourdes; Millaruelo, J. Manuel; Seguí, Mateu; Martínez-Candela, Juan; Muñoz, Pedro; Goday, Albert; Regidor, Enrique

    2015-01-01

    Abstract It has been suggested that the early detection of individuals with prediabetes can help prevent cardiovascular diseases. The purpose of the current study was to examine the cardiometabolic risk profile in patients with prediabetes according to fasting plasma glucose (FPG) and/or hemoglobin A1c (HbA1c) criteria. Cross-sectional analysis from the 2022 patients in the Cohort study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS Study) was developed. Four glycemic status groups were defined based on American Diabetes Association criteria. Information about cardiovascular risk factors–body mass index, waist circumference, blood pressure, cholesterol, triglycerides, uric acid, gamma-glutamyltransferase, glomerular filtration–and metabolic syndrome components were analyzed. Mean values of clinical and biochemical characteristics and frequencies of metabolic syndrome were estimated adjusting by age, sex, educational level, and family history of diabetes. A linear trend (P < 0.001) was observed in most of the cardiovascular risk factors and in all components of metabolic syndrome. Normoglycemic individuals had the best values, individuals with both criteria of prediabetes had the worst, and individuals with only one–HbA1c or FPG–criterion had an intermediate position. Metabolic syndrome was present in 15.0% (95% confidence interval: 12.6–17.4), 59.5% (54.0–64.9), 62.0% (56.0–68.0), and 76.2% (72.8–79.6) of individuals classified in normoglycemia, isolated HbA1c, isolated FPG, and both criteria groups, respectively. In conclusion, individuals with prediabetes, especially those with both criteria, have worse cardiometabolic risk profile than normoglycemic individuals. These results suggest the need to use both criteria in the clinical practice to identify those individuals with the highest cardiovascular risk, in order to offer them special attention with intensive lifestyle intervention programs. PMID:26554799

  1. W-087 Acceptance test procedure. Revision 1

    SciTech Connect

    Joshi, A.W.

    1997-06-10

    This Acceptance Test Procedure/Operational Test Procedure (ATP/OTP) has been prepared to demonstrate that the Electrical/Instrumentation and Mechanical systems function as required by project criteria and to verify proper operation of the integrated system including the interlocks.

  2. Chronic pancreatitis: A diagnostic dilemma

    PubMed Central

    Duggan, Sinead N; Ní Chonchubhair, Hazel M; Lawal, Oladapo; O’Connor, Donal B; Conlon, Kevin C

    2016-01-01

    Typical clinical symptoms of chronic pancreatitis are vague and non-specific and therefore diagnostic tests are required, none of which provide absolute diagnostic certainly, especially in the early stages of disease. Recently-published guidelines bring much needed structure to the diagnostic work-up of patients with suspected chronic pancreatitis. In addition, novel diagnostic modalities bring promise for the future. The assessment and diagnosis of pancreatic exocrine insufficiency remains challenging and this review contests the accepted perspective that steatorrhea only occurs with > 90% destruction of the gland. PMID:26900292

  3. Measurable differences between sequential and parallel diagnostic decision processes for determining stroke subtype: a representation of interacting pathologies.

    PubMed

    Helgason, Cathy M; Watkins, Fred A; Jobe, Thomas H

    2002-08-01

    Stroke diagnosis depends on causal subtype. The accepted classification procedure is a succession of diagnostic tests administered in an order based on prior reported frequencies of the subtypes. The first positive test result completely determines diagnosis. An alternative approach tests multiple concomitant diagnostic hypotheses in parallel. This method permits multiple simultaneous pathologies in the patient. These two diagnostic procedures can be compared by novel numeric criteria presented here. Thrombosis, a type of ischemic stroke, results from interaction between endothelium, blood flow and blood components. We tested for ischemic stroke on thirty patients using both methods. For each patient the procedure produced an assessment of severity as an ordered set of three numbers in the interval [0, 1]. We measured the difference in diagnosis between the sequential and parallel diagnostic algorithms. The computations reveal systematic differences: The sequential procedure tends to under-diagnose and excludes any measure of interaction between pathologic elements. PMID:12195691

  4. Cows' milk protein-sensitive enteropathy. Combined clinical and histological criteria for diagnosis.

    PubMed Central

    Iyngkaran, N; Robinson, M J; Prathap, K; Sumithran, E; Yadav, M

    1978-01-01

    Cows' milk protein enteropathy is recognised as a significant cause of persistent diarrhoea and malabsorption in young infants, but there are as yet no generally accepted diagnostic criteria. A combined clinical and histological approach to the diagnosis of cows' milk protein-sensitive enteropathy has been used in 15 patients, and the following set of criteria are proposed. (1) Clinical disease (diarrhoea with or without vomiting) while receiving cows' milk protein. (2) Clinical improvement on a diet free of cows' milk protein. (3) Normal or mildly abnormal histology of jejunal mucosa when taken 6-8 weeks after symptoms subside. (4) Histological relapse, with or without clinical relapse, after re-exposure to cows' milk protein. Images Fig. 1 Fig. 2 PMID:564668

  5. Integrated diagnostics

    NASA Technical Reports Server (NTRS)

    Hunthausen, Roger J.

    1988-01-01

    Recently completed projects in which advanced diagnostic concepts were explored and/or demonstrated are summarized. The projects begin with the design of integrated diagnostics for the Army's new gas turbine engines, and advance to the application of integrated diagnostics to other aircraft subsystems. Finally, a recent project is discussed which ties together subsystem fault monitoring and diagnostics with a more complete picture of flight domain knowledge.

  6. Evaluating Dependence Criteria for Caffeine.

    PubMed

    Striley, Catherine L W; Griffiths, Roland R; Cottler, Linda B

    2011-12-01

    Background: Although caffeine is the most widely used mood-altering drug in the world, few studies have operationalized and characterized Diagnostic and Statistical Manual IV (DSM-IV) substance dependence criteria applied to caffeine. Methods: As a part of a nosological study of substance use disorders funded by the National Institute on Drug Abuse, we assessed caffeine use and dependence symptoms among high school and college students, drug treatment patients, and pain clinic patients who reported caffeine use in the last 7 days and also reported use of alcohol, nicotine, or illicit drugs within the past year (n=167). Results: Thirty-five percent met the criteria for dependence when all seven of the adopted DSM dependence criteria were used. Rates of endorsement of several of the most applicable diagnostic criteria were as follows: 26% withdrawal, 23% desire to cut down or control use, and 44% continued use despite harm. In addition, 34% endorsed craving, 26% said they needed caffeine to function, and 10% indicated that they talked to a physician or counselor about problems experienced with caffeine. There was a trend towards increased caffeine dependence among those dependent on nicotine or alcohol. Within a subgroup that had used caffeine, alcohol, and nicotine in the past year, 28% fulfilled criteria for caffeine dependence compared to 50% for alcohol and 80% for nicotine. Conclusion: The present study adds to a growing literature suggesting the reliability, validity, and clinical utility of the caffeine dependence diagnosis. Recognition of caffeine dependence in the DSM-V may be clinically useful. PMID:24761264

  7. Identifying Prolonged Grief Reactions in Children: Dimensional and Diagnostic Approaches

    PubMed Central

    Melhem, Nadine M.; Porta, Giovanna; Payne, Monica Walker; Brent, David A.

    2013-01-01

    Objective Children with prolonged grief reactions (PGR) have been found to be at increased risk for depression and functional impairment. Identifying and diagnosing PGR in children is challenging, as there are no available dimensional measures with established thresholds and no diagnostic criteria in the DSM-IV. We examine thresholds for the Inventory for Complicated Grief–Revised for Children (ICG-RC) and compare this dimensional approach to the proposed DSM-5 criteria for Persistent Complex Bereavement-Related Disorder. We also identify a screening tool for PGR. Method Parentally bereaved children, 8–17 years of age, were assessed at 9, 21, and 33 months after parental death. Receiver Operator Characteristics were used to establish the “best threshold” that would identify children with PGR and evaluate the proposed DSM-5 criteria cross-sectionally and longitudinally. Results A score of 68 or higher on the ICG-RC was found to have high sensitivity (0.942) and specificity (0.965) in differentiating cases with PGR from noncases at 9 months. We also identify a 6-item screening tool that consists of longing and yearning for the deceased, inability to accept the death, shock, disbelief, loneliness, and a changed world view. The proposed DSM-5 criteria only correctly identified 20% to 41.7% of cases with PGR at different timepoints. Conclusions For the identification of youth at risk for PGR, the dimensional approach outperformed the proposed categorical diagnostic criteria. We propose a brief screening scale that, if validated, can help clinicians identify bereaved children at risk for PGR, and guide the development of prevention and intervention strategies. PMID:23702449

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

    PubMed Central

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

    2012-01-01

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

  9. Impact of the American Diabetes Association diagnosis criteria on high-risk Spanish population. IGT Research Group. Impaired glucose tolerance.

    PubMed

    Costa, B; Franch, J; Martín, F; Morató, J; Donado, A; Basora, J; Daniel, J

    1999-10-01

    To research into the impact of the new American Diabetes Association (ADA) diagnostic criteria on high risk Spanish population, two cross-sectional studies involving seven primary health care centers in Catalonia (Spain) were revised. Individuals aged > 40 years with any major risk factor for diabetes were screened according to the World Health Organization (WHO) rules using a 75 g oral glucose tolerance test to measure fasting plasma glucose (FPG) and 2 h plasma glucose. The changes on diabetes prevalence and on epidemiological characteristics were evaluated applying the ADA criteria on the basis of FPG alone. A total of 970 individuals, 453 males (46.7%), mean age 59 years and mean body mass index (BMI) 30.6 kg/m2 were screened. Among the 459 diabetic subjects according to either the WHO or the ADA criteria, 314 (68.4%) were classified as having diabetes with respect to both sets of criteria (WHO and ADA). The overlap between impaired glucose tolerance (WHO) and impaired fasting glucose (ADA) diagnoses was 20.7%. Using the ADA criteria results in a decrease of the prevalence of diabetes by 1.5% (95% confidence interval (CI) = -2.2 to -0.8%). No changes in the diabetic phenotype (age, sex and BMI) were found. Impaired fasting glucose prevalence was 18.4% (95% CI = 16-21%). Overall concordance in terms of crude and weighted kappa-value was only acceptable (kappa = 0.51 and kappa = 0.61, respectively). To apply the new ADA diagnostic criteria on high risk Spanish population evidenced a decrease on diabetes prevalence. Nevertheless, the change of criteria undervalued the risk of postprandial hyperglycaemia related to impaired glucose tolerance. PMID:10580619

  10. Preliminary Criteria for Global Flares in Childhood-Onset Systemic Lupus Erythematosus

    PubMed Central

    Brunner, Hermine I.; Mina, Rina; Pilkington, Clarissa; Beresford, Michael W.; Reiff, Andreas; Levy, Deborah M.; Tucker, Lori B.; Eberhard, B. Anne; Ravelli, Angelo; Schanberg, Laura E.; Saad-Magalhaes, Claudia; Higgins, Gloria C.; Onel, Karen; Singer, Nora G.; von Scheven, Emily; Itert, Lukasz; Klein-Gitelman, Marisa S.; Punaro, Marilynn; Ying, Jun; Giannini, Edward H.

    2011-01-01

    Objectives To develop widely acceptable preliminary criteria of global flare for childhood-onset SLE (cSLE). Methods Pediatric rheumatologists (n=138) rated a total of 358 unique patient profiles (PP) with information about the cSLE flare descriptors (cSLE-FD) from two consecutive visits: patient global assessment of well-being, physician global assessment of disease activity (MD-global), health-related quality of life, anti-dsDNA antibodies, disease activity index score, protein/creatinine (P/C) ratio, complement levels and ESR. Based on 2996 rater responses about the course of cSLE (baseline vs. follow-up) the accuracy (sensitivity, specificity, area under the receiver operating characteristic curve) of candidate flare criteria was assessed. An international consensus conference was held to rank these candidate flare criteria as per the ACR-recommendations for the development and validation of criteria sets. Results The highest ranked candidate criteria considered absolute changes (Δ) of the SLEDAI or BILAG, MD-global, P/C ratio, and ESR; Flare scores can be calculated [0.5 × ΔSLEDAI + 0.45 × ΔP/C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR], where values ≥ 1.04 are reflective of a flare. Similarly, BILAG-based flare scores [0.4 × ΔBILAG + 0.65 × ΔP/C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR] of ≥ 1.15 were diagnostic of a flare. Flare scores increase with flare severity. Conclusions Consensus has been reached on preliminary criteria for global flares in cSLE. Further validation studies are needed to confirm the usefulness of the cSLE flare criteria in research and for clinical care. PMID:21618452

  11. ATLAS ACCEPTANCE TEST

    SciTech Connect

    J.C. COCHRANE; J.V. PARKER; ET AL

    2001-06-01

    The acceptance test program for Atlas, a 23 MJ pulsed power facility for use in the Los Alamos High Energy Density Hydrodynamics program, has been completed. Completion of this program officially releases Atlas from the construction phase and readies it for experiments. Details of the acceptance test program results and of machine capabilities for experiments will be presented.

  12. Fine-needle aspiration cytology of soft tissue lesions: diagnostic challenges.

    PubMed

    Domanski, Henryk A

    2007-12-01

    Clinical and radiographic data provide important information in the evaluation of soft tissue lesions/neoplasms. Morphologic tissue and cytologic examination is considered to be a necessary part of the diagnostic work-up. The standard procedure for obtaining tumor tissue for morphologic evaluation has been incisional (open) or core needle biopsy. An increasing use of minimally invasive diagnostic procedures has resulted in better acceptance of fine-needle aspiration cytology (FNAC) in the diagnosis of soft tissue lesions. This article discusses challenges in FNAC of soft tissue lesions based on the experience at a multidisciplinary referral sarcoma center. Obtaining sufficient specimens from deeply seated small and necrotic/cystic lesions is technically a potential pitfall and misdiagnosis of cells from reactive zones surrounding the tumor as well as the correct evaluation of spindle cell lesions, rare soft tissue neoplasms, and "new entities" lacking reproducible cytological criteria are other important challenges in FNAC of soft tissues. The successful cytological evaluation of soft tissue lesions requires the application of strict, reproducible morphological criteria in the context of the clinical findings as well as ancillary techniques. The minimal criteria for diagnostic intervention in various clinical settings and the relative advantages and disadvantages of FNAC must be understood. FNAC of soft tissue lesions is facilitated when limited to specialized orthopedic-oncologic centers with a well-integrated multidisciplinary team and experience in the evaluation and therapy of soft tissue lesions. PMID:18008345

  13. IHE material qualification tests description and criteria

    SciTech Connect

    Slape, R J

    1984-06-01

    This report describes the qualification tests presently being used at Pantex Plant, Lawrence Livermore National Laboratory, and Los Alamos National Laboratory that are required by the Department of Energy prior to the approval for an explosive as an Insensitive High Explosive (IHE) material. The acceptance criteria of each test for IHE qualification is also discussed. 5 references, 10 figures.

  14. Acceptance Probability (P a) Analysis for Process Validation Lifecycle Stages.

    PubMed

    Alsmeyer, Daniel; Pazhayattil, Ajay; Chen, Shu; Munaretto, Francesco; Hye, Maksuda; Sanghvi, Pradeep

    2016-04-01

    This paper introduces an innovative statistical approach towards understanding how variation impacts the acceptance criteria of quality attributes. Because of more complex stage-wise acceptance criteria, traditional process capability measures are inadequate for general application in the pharmaceutical industry. The probability of acceptance concept provides a clear measure, derived from specific acceptance criteria for each quality attribute. In line with the 2011 FDA Guidance, this approach systematically evaluates data and scientifically establishes evidence that a process is capable of consistently delivering quality product. The probability of acceptance provides a direct and readily understandable indication of product risk. As with traditional capability indices, the acceptance probability approach assumes that underlying data distributions are normal. The computational solutions for dosage uniformity and dissolution acceptance criteria are readily applicable. For dosage uniformity, the expected AV range may be determined using the s lo and s hi values along with the worst case estimates of the mean. This approach permits a risk-based assessment of future batch performance of the critical quality attributes. The concept is also readily applicable to sterile/non sterile liquid dose products. Quality attributes such as deliverable volume and assay per spray have stage-wise acceptance that can be converted into an acceptance probability. Accepted statistical guidelines indicate processes with C pk > 1.33 as performing well within statistical control and those with C pk < 1.0 as "incapable" (1). A C pk > 1.33 is associated with a centered process that will statistically produce less than 63 defective units per million. This is equivalent to an acceptance probability of >99.99%. PMID:26024723

  15. The Prevalence of Metabolic Syndrome Using Three Different Diagnostic Criteria among Low Earning Nomadic Kazakhs in the Far Northwest of China: New Cut-Off Points of Waist Circumference to Diagnose MetS and Its Implications

    PubMed Central

    Guo, Heng; Liu, Jiaming; Zhang, Jingyu; Ma, Rulin; Ding, Yusong; Zhang, Mei; He, Jia; Xu, Shangzhi; Li, Shugang; Yan, Yizhong; Mu, Lati; Rui, Dongsheng; Niu, Qiang; Guo, Shuxia

    2016-01-01

    Background Although the epidemic of metabolic syndrome (MetS) has aroused wide public concern, most studies on MetS tend to examine urban and high income settings, and few studies cover nomadic areas and low earning populations. This research aims to investigate the prevalence of MetS and explore the cut-off point of waist circumference in a nomadic minority typical of low income populations in the remote northwest region of China. Methods A cross-sectional study was performed in a representative sample of 3900 Kazakh adults aged 18–84 years from 2009–2010. Three widely used criteria (ATP III\\IDF\\JIS) were employed to estimate the prevalence of MetS in Kazakhs to compare them with other populations. Receiver operator characteristic (ROC) curve analysis was used to explore the optimal cut-off values of waist circumference. Results The age-adjusted prevalence of MetS was 13.8%, 20.9%, and 24.8% based on the ATP III, IDF, and JIS criteria, respectively. The prevalence of MetS was higher in women and increased with age. Except for reduced HDL-cholesterol, the risk of other components of MetS increased with waist circumference enlargement. The cut-off point of waist circumference in screening at least two other components of MetS was 88 cm in men (Sensitivity = 61.1%, Specificity = 62.1%, ROC Curve Distance = 0.54) and 83 cm in women (Sensitivity = 60.0%, Specificity = 59.6%, ROC Curve Distance = 0.57). Conclusion The prevalence of MetS in Kazakhs is higher than the national level of China and falls in between the Euro-American and Asia levels, as their cut-off points of waist circumference differ from that recommended for Chinese. We suggest a cost-effective strategy to screen for MetS and prevent cardiovascular disease using new cut-off points of waist circumference in low earning nomadic Kazakhs. PMID:26901035

  16. Negotiable Acceptability: Reflections on the Interactions between Language Professionals in Europe and NNS Scientists Wishing to Publish in English

    ERIC Educational Resources Information Center

    Burrough-Boenisch, Joy

    2006-01-01

    Prior to submitting a paper to a science journal, many European scientists employ language professionals to check that the English is acceptable. What influences these language professionals' criteria of acceptability? How do they interact with the authors for whom they work? And how do journals' criteria of acceptability affect their work? In…

  17. [Diagnostic criteria for Menière's disease. Consensus document of the Bárány Society, the Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society].

    PubMed

    Lopez-Escamez, José A; Carey, John; Chung, Won-Ho; Goebel, Joel A; Magnusson, Måns; Mandalà, Marco; Newman-Toker, David E; Strupp, Michael; Suzuki, Mamoru; Trabalzini, Franco; Bisdorff, Alexandre

    2016-01-01

    This paper presents diagnostic criteria for Menière's disease jointly formulated by the Classification Committee of the Bárány Society, The Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society. The classification includes 2 categories: definite Menière's disease and probable Menière's disease. The diagnosis of definite Menière's disease is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low-to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing, tinnitus and/or fullness) in the affected ear. Duration of vertigo episodes is limited to a period between 20 min and 12h. Probable Menière's disease is a broader concept defined by episodic vestibular symptoms (vertigo or dizziness) associated with fluctuating aural symptoms occurring in a period from 20 min to 24h. PMID:26277738

  18. Nutrient Criteria Research

    EPA Science Inventory

    EPA has developed methodologies for deriving nutrient criteria, default criteria for the variety of waters and eco-regions found in the U.S., and a strategy for implementing the criteria including guidance on the use and development of biocriteria. Whereas preliminary research ha...

  19. Acceptance, values, and probability.

    PubMed

    Steel, Daniel

    2015-10-01

    This essay makes a case for regarding personal probabilities used in Bayesian analyses of confirmation as objects of acceptance and rejection. That in turn entails that personal probabilities are subject to the argument from inductive risk, which aims to show non-epistemic values can legitimately influence scientific decisions about which hypotheses to accept. In a Bayesian context, the argument from inductive risk suggests that value judgments can influence decisions about which probability models to accept for likelihoods and priors. As a consequence, if the argument from inductive risk is sound, then non-epistemic values can affect not only the level of evidence deemed necessary to accept a hypothesis but also degrees of confirmation themselves. PMID:26386533

  20. Newbery Medal Acceptance.

    ERIC Educational Resources Information Center

    Freedman, Russell

    1988-01-01

    Presents the Newbery Medal acceptance speech of Russell Freedman, writer of children's nonfiction. Discusses the place of nonfiction in the world of children's literature, the evolution of children's biographies, and the author's work on "Lincoln." (ARH)

  1. Newbery Medal Acceptance.

    ERIC Educational Resources Information Center

    Cleary, Beverly

    1984-01-01

    Reprints the text of Ms. Cleary's Newbery medal acceptance speech in which she gives personal history concerning her development as a writer and her response to the letters she receives from children. (CRH)

  2. Caldecott Medal Acceptance.

    ERIC Educational Resources Information Center

    Provensen, Alice; Provensen, Martin

    1984-01-01

    Reprints the text of the Provensens' Caldecott medal acceptance speech in which they describe their early interest in libraries and literature, the collaborative aspect of their work, and their current interest in aviation. (CRH)

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

    PubMed

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

    2012-05-29

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

  4. Proposed Evaluation Criteria for Screening Programs for the Elderly.

    ERIC Educational Resources Information Center

    Rogers, John; And Others

    1986-01-01

    Contends that generally accepted criteria for screening asymptomatic individuals are not appropriate for the elderly due to the prevalence of symptoms and chronic problems in the elderly and the importance of tertiary prevention. Proposes evaluation criteria that reflect the goals of screening elderly individuals. (Author/ABB)

  5. Nuclear safety criteria and specifications for space nuclear reactors

    SciTech Connect

    Not Available

    1982-08-01

    The purpose of this document is to define safety criteria which must be met to implement US safety policy for space fission reactors. These criteria provide the bases for decisions on the acceptability of specific mission and reactor design proposals. (JDH)

  6. Diagnostic Imaging

    MedlinePlus

    Diagnostic imaging lets doctors look inside your body for clues about a medical condition. A variety of machines and ... and activities inside your body. The type of imaging your doctor uses depends on your symptoms and ...

  7. Acceptance Priority Ranking & Annual Capacity Report

    SciTech Connect

    2004-07-31

    The Nuclear Waste Policy Act of 1982, as amended (the Act), assigns the Federal Government the responsibility for the disposal of spent nuclear fuel and high-level waste. Section 302(a) of the Act authorizes the Secretary to enter into contracts with the owners and generators of commercial spent nuclear fuel and/or high-level waste. The Standard Contract for Disposal of Spent Nuclear Fuel and/or High-Level Radioactive Waste (Standard Contract) established the contractual mechanism for the Department's acceptance and disposal of spent nuclear fuel and high-level waste. It includes the requirements and operational responsibilities of the parties to the Standard Contract in the areas of administrative matters, fees, terms of payment, waste acceptance criteria, and waste acceptance procedures. The Standard Contract provides for the acquisition of title to the spent nuclear fuel and/or high-level waste by the Department, its transportation to Federal facilities, and its subsequent disposal.

  8. Diagnostic radiology

    SciTech Connect

    Leeds, N.E.; Jacobson, H.G.

    1986-10-17

    Developments in the burgeoning field of diagnostic radiology have continued apace. Four areas that represent either subspecialities or technological advances in diagnostic radiology will be considered in this report: ultrasonography, interventional radiology, nuclear radiology, and magnetic resonance. In no sense is the exclusion of other subdisciplines and modalities (eg, pediatric radiology, computed tomography) and indication of their of importance or their failure to include innovative concepts.

  9. Recommendations for ductile and brittle failure design criteria for ductile cast iron spent-fuel shipping containers

    SciTech Connect

    Schwartz, M.W.

    1984-04-01

    This report presents recommendations for establishing design and acceptance criteria for the ductile cast iron to be used for fabricating spent-fuel shipping casks. These recommendations address design criteria for preventing ductile failure, and acceptance criteria for preventing brittle fracture, based upon drop testing a flawed prototype cask.

  10. Takotsubo cardiomyopathy systematic review: Pathophysiologic process, clinical presentation and diagnostic approach to Takotsubo cardiomyopathy.

    PubMed

    Ono, Ryohei; Falcão, L Menezes

    2016-04-15

    Takotsubo cardiomyopathy (TTC) is characterized by transient left ventricular apical ballooning with the absence of coronary occlusion, which typically occurs in older women after emotional or physical stress. The pathophysiology of TTC is not well established, though several possible causes such as catecholamine cardiotoxicity, metabolic disturbance, coronary microvascular impairment and multivessel epicardial coronary artery spasm have been proposed. A number of diagnostic criteria have been suggested in the world and not unified as single, but the most common accepted one is Mayo Clinic proposed criteria. Since the clinical presentation of TTC is usually similar to acute coronary syndrome, differential diagnosis is essential to exclude other diseases and also for its treatment. Imaging modality including echocardiogram, angio CT and cardiac MRI, and lab tests for catecholamine, troponin T, creatine kinase MB and B-type natriuretic peptide can be useful to differentiate TTC from other diseases. Prognosis is generally favorable and in-hospital mortality is from 0% to within 10%. PMID:26896623

  11. DIAGNOSTIC ACCURACY OF PHYSICAL EXAMINATION TESTS OF THE ANKLE/FOOT COMPLEX: A SYSTEMATIC REVIEW

    PubMed Central

    Schwieterman, Braun; Haas, Deniele; Columber, Kirby; Knupp, Darren

    2013-01-01

    Background: Orthopedic special tests of the ankle/foot complex are routinely used during the physical examination process in order to help diagnose ankle/lower leg pathologies. Purpose: The purpose of this systematic review was to investigate the diagnostic accuracy of ankle/lower leg special tests. Methods: A search of the current literature was conducted using PubMed, CINAHL, SPORTDiscus, ProQuest Nursing and Allied Health Sources, Scopus, and Cochrane Library. Studies were eligible if they included the following: 1) a diagnostic clinical test of musculoskeletal pathology in the ankle/foot complex, 2) description of the clinical test or tests, 3) a report of the diagnostic accuracy of the clinical test (e.g. sensitivity and specificity), and 4) an acceptable reference standard for comparison. The quality of included studies was determined by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results: Nine diagnostic accuracy studies met the inclusion criteria for this systematic review; analyzing a total of 16 special tests of the ankle/foot complex. After assessment using the QUADAS-2, only one study had low risk of bias and low concerns regarding applicability. Conclusion: Most ankle/lower leg orthopedic special tests are confirmatory in nature and are best utilized at the end of the physical examination. Most of the studies included in this systematic review demonstrate notable biases, which suggest that results and recommendations in this review should be taken as a guide rather than an outright standard. There is need for future research with more stringent study design criteria so that more accurate diagnostic power of ankle/lower leg special tests can be determined. Level of Evidence: 3a PMID:24175128

  12. A Novel Screening and Diagnostic Tool for Child and Adolescent Psychiatric Disorders for Telepsychiatry

    PubMed Central

    Malhotra, Savita; Chakrabarti, Subho; Shah, Ruchita; Mehta, Anurati; Gupta, Aarzoo; Sharma, Minali

    2015-01-01

    Background: A diagnostic tool designed as part of a telepsychiatry application for diagnosis and management of child and adolescent psychiatric disorders in India was developed considering the paucity of trained child psychiatrists and mental health professionals in India. Materials and Methods: The diagnostic tool consisted of screening and 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) criteria-based diagnostic algorithms for 18 psychiatric disorders seen in childhood and adolescence. Accuracy of diagnoses and feasibility of use of the tool was examined by comparing it with detailed semi-structured clinical evaluations by a qualified psychiatrist with 50 psychiatric patients (children and adolescents). Statistical Analysis: Descriptive analyses and paired t-tests were conducted to compare the mean number of diagnosis generated by the two interviews. Sensitivity, specificity, positive and negative predictive values were computed for the screening and the diagnostic sub-modules of the tool, compared to the clinical diagnoses. Kappa coefficients were computed to assess agreement between the diagnoses generated by the diagnostic sub-module and the clinical diagnoses. Results: The screening sub-module had high sensitivity, high specificity and negative predictive values for all disorders. For the diagnostic sub-module, there was moderate (kappa-0.4–0.6) to substantial agreement (kappa > 0.6) for all the disorders, (except psychosis) and high sensitivity (barring a few disorders) and specificity for almost all the disorders. Positive predictive values were found to be acceptable to high for most disorders, with consistently high negative predictive values. Conclusion: The new tool was found to be comprehensive, reasonably short and feasible. Results showed acceptable level of accuracy in diagnosis generated by the tool. PMID:26424901

  13. Diagnostic Labeling in Juvenile Court: How Do Descriptions of Psychopathy and Conduct Disorder Influence Judges?

    ERIC Educational Resources Information Center

    Murrie, Daniel C.; Boccaccini, Marcus T.; McCoy, Wendy; Cornell, Dewey G.

    2007-01-01

    This study examined the influence of diagnostic criteria and diagnostic labels for psychopathy or conduct disorder on judicial decisions. A national sample of judges (N = 326) rendered hypothetical dispositions based on 1 of 12 mock psychological evaluations. The evaluations varied the presence of 2 sets of diagnostic criteria (antisocial…

  14. Fungal Diagnostics

    PubMed Central

    Kozel, Thomas R.; Wickes, Brian

    2014-01-01

    Early diagnosis of fungal infection is critical to effective treatment. There are many impediments to diagnosis such as a diminishing number of clinical mycologists, cost, time to result, and requirements for sensitivity and specificity. In addition, fungal diagnostics must meet the contrasting needs presented by the increasing diversity of fungi found in association with the use of immunosuppressive agents in countries with high levels of medical care and the need for diagnostics in resource-limited countries where large numbers of opportunistic infections occur in patients with AIDS. Traditional approaches to diagnosis include direct microscopic examination of clinical samples, histopathology, culture, and serology. Emerging technologies include molecular diagnostics and antigen detection in clinical samples. Innovative new technologies that use molecular and immunoassay platforms have the potential to meet the needs of both resource-rich and resource-limited clinical environments. PMID:24692193

  15. Accept or divert?

    PubMed

    Angelucci, P A

    1999-09-01

    Stretching scarce resources is more than a managerial issue. Should you accept the patient to an understaffed ICU or divert him to another facility? The intense "medical utility" controversy focuses on a situation that critical care nurses now face every day. PMID:10614370

  16. Approaches to acceptable risk

    SciTech Connect

    Whipple, C.

    1997-04-30

    Several alternative approaches to address the question {open_quotes}How safe is safe enough?{close_quotes} are reviewed and an attempt is made to apply the reasoning behind these approaches to the issue of acceptability of radiation exposures received in space. The approaches to the issue of the acceptability of technological risk described here are primarily analytical, and are drawn from examples in the management of environmental health risks. These include risk-based approaches, in which specific quantitative risk targets determine the acceptability of an activity, and cost-benefit and decision analysis, which generally focus on the estimation and evaluation of risks, benefits and costs, in a framework that balances these factors against each other. These analytical methods tend by their quantitative nature to emphasize the magnitude of risks, costs and alternatives, and to downplay other factors, especially those that are not easily expressed in quantitative terms, that affect acceptance or rejection of risk. Such other factors include the issues of risk perceptions and how and by whom risk decisions are made.

  17. 1984 Newbery Acceptance Speech.

    ERIC Educational Resources Information Center

    Cleary, Beverly

    1984-01-01

    This acceptance speech for an award honoring "Dear Mr. Henshaw," a book about feelings of a lonely child of divorce intended for eight-, nine-, and ten-year-olds, highlights children's letters to author. Changes in society that affect children, the inception of "Dear Mr. Henshaw," and children's reactions to books are highlighted. (EJS)

  18. Why was Relativity Accepted?

    NASA Astrophysics Data System (ADS)

    Brush, S. G.

    Historians of science have published many studies of the reception of Einstein's special and general theories of relativity. Based on a review of these studies, and my own research on the role of the light-bending prediction in the reception of general relativity, I discuss the role of three kinds of reasons for accepting relativity (1) empirical predictions and explanations; (2) social-psychological factors; and (3) aesthetic-mathematical factors. According to the historical studies, acceptance was a three-stage process. First, a few leading scientists adopted the special theory for aesthetic-mathematical reasons. In the second stage, their enthusiastic advocacy persuaded other scientists to work on the theory and apply it to problems currently of interest in atomic physics. The special theory was accepted by many German physicists by 1910 and had begun to attract some interest in other countries. In the third stage, the confirmation of Einstein's light-bending prediction attracted much public attention and forced all physicists to take the general theory of relativity seriously. In addition to light-bending, the explanation of the advance of Mercury's perihelion was considered strong evidence by theoretical physicists. The American astronomers who conducted successful tests of general relativity became defenders of the theory. There is little evidence that relativity was `socially constructed' but its initial acceptance was facilitated by the prestige and resources of its advocates.

  19. UGV acceptance testing

    NASA Astrophysics Data System (ADS)

    Kramer, Jeffrey A.; Murphy, Robin R.

    2006-05-01

    With over 100 models of unmanned vehicles now available for military and civilian safety, security or rescue applications, it is important to for agencies to establish acceptance testing. However, there appears to be no general guidelines for what constitutes a reasonable acceptance test. This paper describes i) a preliminary method for acceptance testing by a customer of the mechanical and electrical components of an unmanned ground vehicle system, ii) how it has been applied to a man-packable micro-robot, and iii) discusses the value of testing both to ensure that the customer has a workable system and to improve design. The test method automated the operation of the robot to repeatedly exercise all aspects and combinations of components on the robot for 6 hours. The acceptance testing process uncovered many failures consistent with those shown to occur in the field, showing that testing by the user does predict failures. The process also demonstrated that the testing by the manufacturer can provide important design data that can be used to identify, diagnose, and prevent long-term problems. Also, the structured testing environment showed that sensor systems can be used to predict errors and changes in performance, as well as uncovering unmodeled behavior in subsystems.

  20. Diagnostic imaging.

    PubMed

    Morris, Peter; Perkins, Alan

    2012-04-21

    Physical techniques have always had a key role in medicine, and the second half of the 20th century in particular saw a revolution in medical diagnostic techniques with the development of key imaging instruments: x-ray imaging and emission tomography (nuclear imaging and PET), MRI, and ultrasound. These techniques use the full width of the electromagnetic spectrum, from gamma rays to radio waves, and sound. In most cases, the development of a medical imaging device was opportunistic; many scientists in physics laboratories were experimenting with simple x-ray images within the first year of the discovery of such rays, the development of the cyclotron and later nuclear reactors created the opportunity for nuclear medicine, and one of the co-inventors of MRI was initially attempting to develop an alternative to x-ray diffraction for the analysis of crystal structures. What all these techniques have in common is the brilliant insight of a few pioneering physical scientists and engineers who had the tenacity to develop their inventions, followed by a series of technical innovations that enabled the full diagnostic potential of these instruments to be realised. In this report, we focus on the key part played by these scientists and engineers and the new imaging instruments and diagnostic procedures that they developed. By bringing the key developments and applications together we hope to show the true legacy of physics and engineering in diagnostic medicine. PMID:22516558

  1. WATER QUALITY CRITERIA DOCUMENTS

    EPA Science Inventory

    Background

    Water quality standards and criteria are the foundation for a wide range of programs under the Clean Water Act. Specifically, under section 304(a)(1) of the Clean Water Act it requires EPA to develop criteria for water quality that accurately re...

  2. Plutonium storage criteria

    SciTech Connect

    Chung, D.; Ascanio, X.

    1996-05-01

    The Department of Energy has issued a technical standard for long-term (>50 years) storage and will soon issue a criteria document for interim (<20 years) storage of plutonium materials. The long-term technical standard, {open_quotes}Criteria for Safe Storage of Plutonium Metals and Oxides,{close_quotes} addresses the requirements for storing metals and oxides with greater than 50 wt % plutonium. It calls for a standardized package that meets both off-site transportation requirements, as well as remote handling requirements from future storage facilities. The interim criteria document, {open_quotes}Criteria for Interim Safe Storage of Plutonium-Bearing Solid Materials{close_quotes}, addresses requirements for storing materials with less than 50 wt% plutonium. The interim criteria document assumes the materials will be stored on existing sites, and existing facilities and equipment will be used for repackaging to improve the margin of safety.

  3. The potential impact of various diagnostic strategies in cases of chronic pain syndromes associated with lumbar spine degeneration

    PubMed Central

    Bokov, Andrey; Perlmutter, Olga; Aleynik, Alexander; Rasteryaeva, Marina; Mlyavykh, Sergey

    2013-01-01

    Purpose To study the possible effects of various diagnostic strategies and the relative contribution of various structures in order to determine the optimal diagnostic strategy in treating patients with noncompressive pain syndromes. Study design Prospective, nonrandomized cohort study of 83 consecutive patients with noncompressive pain syndromes resistant to repeated courses of conservative treatment. The follow-up period was 18 months. Results Nucleoplasty was effective in cases of discogenic pain; the consequences related to false positive results of the discography were significant. The most specific criterion was 80% pain relief after facet joint blocks, whereas 50% pain relief and any subjective pain relief were not associated with a significant increase in the success rate. A considerable rate of false negative results was associated with 80% pain relief, whereas 50% pain relief after facet joint blocks showed the optimal ratio of sensitivity and specificity. Facet joint pain was detected in 50.6% of cases (95% confidence interval 44.1%–66.3%), discogenic pain in 16.9% cases (95% confidence interval 9.5%–26.7%), and sacroiliac joint pain in 7.2% cases (95% confidence interval 2.7%–15%). It was impossible to differentiate the main source of pain in 25.3% of cases. Conclusion It is rational to adjust the diagnostic algorithm to the probability of detecting a particular pain source and, in doing so, reduce the number of invasive diagnostic measures to evaluate a pain source. False positive results of diagnostic measures can negatively affect the overall efficacy of a particular technology; therefore, all reasons for the failure should be studied in order to reach an unbiased conclusion. In choosing diagnostic criteria, not only should the success rate of a particular technology be taken into consideration but also the rate of false negative results. Acceptable diagnostic criteria should be based on a rational balance of sensitivity and specificity. PMID

  4. Acceptability of human risk.

    PubMed Central

    Kasperson, R E

    1983-01-01

    This paper has three objectives: to explore the nature of the problem implicit in the term "risk acceptability," to examine the possible contributions of scientific information to risk standard-setting, and to argue that societal response is best guided by considerations of process rather than formal methods of analysis. Most technological risks are not accepted but are imposed. There is also little reason to expect consensus among individuals on their tolerance of risk. Moreover, debates about risk levels are often at base debates over the adequacy of the institutions which manage the risks. Scientific information can contribute three broad types of analyses to risk-setting deliberations: contextual analysis, equity assessment, and public preference analysis. More effective risk-setting decisions will involve attention to the process used, particularly in regard to the requirements of procedural justice and democratic responsibility. PMID:6418541

  5. Age and Acceptance of Euthanasia.

    ERIC Educational Resources Information Center

    Ward, Russell A.

    1980-01-01

    Study explores relationship between age (and sex and race) and acceptance of euthanasia. Women and non-Whites were less accepting because of religiosity. Among older people less acceptance was attributable to their lesser education and greater religiosity. Results suggest that quality of life in old age affects acceptability of euthanasia. (Author)

  6. Predictive Validity of DSM-IV and ICD-10 Criteria for ADHD and Hyperkinetic Disorder

    ERIC Educational Resources Information Center

    Lee, Soyoung I.; Schachar, Russell J.; Chen, Shirley X.; Ornstein, Tisha J.; Charach, Alice; Barr, Cathy; Ickowicz, Abel

    2008-01-01

    Background: The goal of this study was to compare the predictive validity of the two main diagnostic schemata for childhood hyperactivity--attention-deficit hyperactivity disorder (ADHD; "Diagnostic and Statistical Manual"-IV) and hyperkinetic disorder (HKD; "International Classification of Diseases"-10th Edition). Methods: Diagnostic criteria for…

  7. UPDATE ON PEC ACTIVITIES INCLUDING NEW EVALUATION CRITERIA, THE APPLICATION COMPLETENESS CHECKLIST, AND STATUS OF THE WEBSITE DEVELOPMENT

    EPA Science Inventory

    US EPA's Pathogen Equivalency Committee (PEC) has updated the evaluation criteria it uses to make recommendations of equivalency (to processes acceptable under 40CFR503) on innovative or alternative sludge pathogen reduction processes. These criteria will be presented along with ...

  8. Fire protection design criteria

    SciTech Connect

    1997-03-01

    This Standard provides supplemental fire protection guidance applicable to the design and construction of DOE facilities and site features (such as water distribution systems) that are also provided for fire protection. It is intended to be used in conjunction with the applicable building code, national Fire Protection Association Codes and Standards, and any other applicable DOE construction criteria. This Standard, along with other delineated criteria, constitutes the basic criteria for satisfying DOE fire and life safety objectives for the design and construction or renovation of DOE facilities.

  9. DOE natural phenomenal hazards design and evaluation criteria

    SciTech Connect

    Murray, R.C.; Nelson, T.A.; Short, S.A.; Kennedy, R.P.; Chander, H.; Hill, J.R.; Kimball, J.K.

    1994-10-01

    It is the policy of the Department of Energy (DOE) to design, construct, and operate DOE facilities so that workers, the general public, and the environment are protected from the impacts of natural phenomena hazards (NPH). Furthermore, DOE has established explicit goals of acceptable risk for NPH performance. As a result, natural phenomena hazard (earthquake, extreme wind, and flood) design and evaluation criteria for DOE facilities have been developed based on target probabilistic performance goals. These criteria include selection of design/evaluation NPH input from probabilistic hazard curves combined with commonly practiced deterministic response evaluation methods and acceptance criteria with controlled levels of conservatism. For earthquake considerations, conservatism is intentionally introduced in specification of material strengths and capacities, in the allowance of limited inelastic behavior, and by a seismic scale factor. Criteria have been developed following a graded approach for several performance goals ranging from that appropriate for normal-use facilities to that appropriate for facilities involving hazardous or critical operations. Performance goals are comprised of qualitative expressions of acceptable behavior and of target quantitative probabilities that acceptable limits of behavior are maintained. The criteria are simple procedures but have a rigorous basis. This paper addresses DOE seismic design and evaluation criteria.

  10. Validation and acceptance of synthetic infrared imagery

    NASA Astrophysics Data System (ADS)

    Smith, Moira I.; Bernhardt, Mark; Angell, Christopher R.; Hickman, Duncan; Whitehead, Philip; Patel, Dilip

    2004-08-01

    This paper describes the use of an image query database (IQ-DB) tool as a means of implementing a validation strategy for synthetic long-wave infrared images of sea clutter. Specifically it was required to determine the validity of the synthetic imagery for use in developing and testing automatic target detection algorithms. The strategy adopted for exploiting synthetic imagery is outlined and the key issues of validation and acceptance are discussed in detail. A wide range of image metrics has been developed to achieve pre-defined validation criteria. A number of these metrics, which include post processing algorithms, are presented. Furthermore, the IQ-DB provides a robust mechanism for configuration management and control of the large volume of data used. The implementation of the IQ-DB is reviewed in terms of its cardinal point specification and its central role in synthetic imagery validation and EOSS progressive acceptance.

  11. Baby-Crying Acceptance

    NASA Astrophysics Data System (ADS)

    Martins, Tiago; de Magalhães, Sérgio Tenreiro

    The baby's crying is his most important mean of communication. The crying monitoring performed by devices that have been developed doesn't ensure the complete safety of the child. It is necessary to join, to these technological resources, means of communicating the results to the responsible, which would involve the digital processing of information available from crying. The survey carried out, enabled to understand the level of adoption, in the continental territory of Portugal, of a technology that will be able to do such a digital processing. It was used the TAM as the theoretical referential. The statistical analysis showed that there is a good probability of acceptance of such a system.

  12. High acceptance recoil polarimeter

    SciTech Connect

    The HARP Collaboration

    1992-12-05

    In order to detect neutrons and protons in the 50 to 600 MeV energy range and measure their polarization, an efficient, low-noise, self-calibrating device is being designed. This detector, known as the High Acceptance Recoil Polarimeter (HARP), is based on the recoil principle of proton detection from np[r arrow]n[prime]p[prime] or pp[r arrow]p[prime]p[prime] scattering (detected particles are underlined) which intrinsically yields polarization information on the incoming particle. HARP will be commissioned to carry out experiments in 1994.

  13. Gender Differences in Developmental Dyscalculia Depend on Diagnostic Criteria

    ERIC Educational Resources Information Center

    Devine, Amy; Soltesz, Fruzsina; Nobes, Alison; Goswami, Usha; Szucs, Denes

    2013-01-01

    Developmental dyscalculia (DD) is a learning difficulty specific to mathematics learning. The prevalence of DD may be equivalent to that of dyslexia, posing an important challenge for effective educational provision. Nevertheless, there is no agreed definition of DD and there are controversies surrounding cutoff decisions, specificity and gender…

  14. [Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-].

    PubMed

    Ozono, Keiichi

    2016-02-01

    Vitamin D deficiency causes rickets or osteomalacia, which is associated with hypomineralization of bone and chondrocytes, and/or hypocalcemia. Accumulating evidence indicates increase in frequency of vitamin D deficiency due to insufficient intake of vitamin D and calcium and decrease in sunshine. It is necessary for clinician to diagnose vitamin D deficiency accurately and treat patients with vitamin D deficiency adequately. For the purpose, clinical guideline or expert opinion on vitamin D deficiency has been reported. PMID:26813501

  15. PANDAS: The Need to Use Definitive Diagnostic Criteria.

    PubMed

    Singer, Harvey S

    2015-01-01

    In Response to: Helm CE, Blackwood RA. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS): Experience at a tertiary referral center. Tremor Other Hyperkinet Mov. 2015; 5. doi: 10.7916/D8348JCX. PMID:26196028

  16. PANDAS: The Need to Use Definitive Diagnostic Criteria

    PubMed Central

    Singer, Harvey S.

    2015-01-01

    In Response to: Helm CE, Blackwood RA. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS): Experience at a tertiary referral center. Tremor Other Hyperkinet Mov. 2015; 5. doi: 10.7916/D8348JCX PMID:26196028

  17. Preclinical Alzheimer's disease: Definition, natural history, and diagnostic criteria.

    PubMed

    Dubois, Bruno; Hampel, Harald; Feldman, Howard H; Scheltens, Philip; Aisen, Paul; Andrieu, Sandrine; Bakardjian, Hovagim; Benali, Habib; Bertram, Lars; Blennow, Kaj; Broich, Karl; Cavedo, Enrica; Crutch, Sebastian; Dartigues, Jean-François; Duyckaerts, Charles; Epelbaum, Stéphane; Frisoni, Giovanni B; Gauthier, Serge; Genthon, Remy; Gouw, Alida A; Habert, Marie-Odile; Holtzman, David M; Kivipelto, Miia; Lista, Simone; Molinuevo, José-Luis; O'Bryant, Sid E; Rabinovici, Gil D; Rowe, Christopher; Salloway, Stephen; Schneider, Lon S; Sperling, Reisa; Teichmann, Marc; Carrillo, Maria C; Cummings, Jeffrey; Jack, Cliff R

    2016-03-01

    During the past decade, a conceptual shift occurred in the field of Alzheimer's disease (AD) considering the disease as a continuum. Thanks to evolving biomarker research and substantial discoveries, it is now possible to identify the disease even at the preclinical stage before the occurrence of the first clinical symptoms. This preclinical stage of AD has become a major research focus as the field postulates that early intervention may offer the best chance of therapeutic success. To date, very little evidence is established on this "silent" stage of the disease. A clarification is needed about the definitions and lexicon, the limits, the natural history, the markers of progression, and the ethical consequence of detecting the disease at this asymptomatic stage. This article is aimed at addressing all the different issues by providing for each of them an updated review of the literature and evidence, with practical recommendations. PMID:27012484

  18. Non-dermatophytic onychomycosis diagnostic criteria: an unresolved question.

    PubMed

    Bombace, Francesca; Iovene, Maria Rosaria; Galdiero, Marilena; Martora, Francesca; Nicoletti, Giovanni Francesco; D'Andrea, Mirella; Della Pepa, Maria Elena; Vitiello, Mariateresa

    2016-09-01

    Non-dermatophytic moulds (NDMs) have been increasingly recognised as causative agents of onychomycosis. The diagnosis of onychomycosis is most often obtained by microscopic observation of nail specimens where fungal elements can be detected and cultured by standard mycological techniques. Direct microscopic examination does not always result positive in NDM onychomycosis; therefore to perform a correct diagnosis, a proper mycological culture is often required. The purpose of our study was to evaluate the role of direct microscopic examination in the NDM onychomycosis diagnosis. The results show that only 57.2% of the specimens from onychomycosis patients could be properly diagnosed showing positivity to both direct microscopic examination and NDMs culture isolation in two or more subsequent inoculations, while 42.8% of analysed specimens with a negative direct microscopic examination, showed NDMs growth after three or more subsequent inoculations. The large proportion of false negatives (more than 42%) could be related to the duration of the infection and/or to the experience and skills of the personnel dedicated to specimen collection. We point out the need for thoroughly evaluating all specimens showing cultural growth in at least three subsequent medium inoculations, whatever the result of the microscopic examination, in order to reduce false-negative rates. This strategy would allow for more accurate diagnosis of this mycosis. PMID:27061613

  19. Diagnostic criteria and differential diagnosis of mild traumatic brain injury.

    PubMed

    De Kruijk, J R; Twijnstra, A; Leffers, P

    2001-02-01

    Brain injury is classified clinically as severe, moderate or mild brain injury characteristics, including admission Glasgow coma score, duration of unconsciousness and post-traumatic amnesia and any focal neurological findings. Most traumatic brain injuries are classified as mild traumatic brain injury (MTBI). Headache, nausea and dizziness are frequent symptoms after MTBI and may continue for weeks to months after the trauma. MTBI may also be complicated by intracranial injuries. Experimental animal models and post-mortem studies have shown axonal damage and dysfunction in MTBI. This damage is mostly localized in the frontal lobes. Serum S-100 and NSE have been reported to be markers for the seventy of brain damage. In the literature, indications for radiodiagnostic evaluation following MTBI have been the subject of debate. Radiographs of the skull are used to exclude skull fractures, but are not useful for an evaluation of brain injury. Computed tomography of the brain seems to be the best way to exclude the development of relevant intracranial lesions. MTBI has a good clinical outcome, although a substantial group of patients develop post-concussional complaints (PCC). There is little information on the effectiveness of various methods suggested for reducing the frequency of PCC. PMID:11260760

  20. Blastic plasmacytoid dendritic cell neoplasm: diagnostic criteria and therapeutical approaches.

    PubMed

    Pagano, Livio; Valentini, Caterina G; Grammatico, Sara; Pulsoni, Alessandro

    2016-07-01

    Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare haematological malignancy derived from the precursors of plamacytoid dendritic cells, with an aggressive clinical course and high frequency of cutaneous and bone marrow involvement. Neoplastic cells express CD4, CD43 (also termed SPN), CD45RA and CD56 (also termed NCAM1), as well as the plasmacytoid dendritic cell-associated antigens CD123 (also termed IL3RA), BDCA-2 (also termed CD303, CLEC4E) TCL1 and CTLA1 (also termed GZMB). The median survival is only a few months as the tumour exhibits a progressive course despite initial response to chemotherapy. The best modality of treatment remains to be defined. Generally, patients receive acute leukaemia-like induction, according to acute myeloid leukaemia (AML)-type or acute lymphoid leukaemia (ALL)-type regimens. The frequent neuromeningeal involvement indicates systematic pre-emptive intrathecal chemotherapy in addition to intensive chemotherapy. Allogeneic haematopoietic stem cell transplantation (HSCT), particularly when performed in first remission, may improve the survival. Preliminary data suggest a potential role for immunomodulatory agents and novel targeted drugs. Herein epidemiology, clinical manifestations, diagnosis and management of BPDCN will be presented. In detail, this review focuses on the therapeutic aspects of BPDCN, proposing a treatment algorithm for the management of the disease, including induction chemotherapy, allogeneic HSCT and intrathecal prophylaxis at different steps of treatment, according to compliance, biological and clinical characteristics of patients. PMID:27264021