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Sample records for acr appropriateness criteria

  1. ACR Appropriateness Criteria Myelopathy.

    PubMed

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

    2016-01-01

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

  2. ACR appropriateness criteria jaundice.

    PubMed

    Lalani, Tasneem; Couto, Corey A; Rosen, Max P; Baker, Mark E; Blake, Michael A; Cash, Brooks D; Fidler, Jeff L; Greene, Frederick L; Hindman, Nicole M; Katz, Douglas S; Kaur, Harmeet; Miller, Frank H; Qayyum, Aliya; Small, William C; Sudakoff, Gary S; Yaghmai, Vahid; Yarmish, Gail M; Yee, Judy

    2013-06-01

    A fundamental consideration in the workup of a jaundiced patient is the pretest probability of mechanical obstruction. Ultrasound is the first-line modality to exclude biliary tract obstruction. When mechanical obstruction is present, additional imaging with CT or MRI can clarify etiology, define level of obstruction, stage disease, and guide intervention. When mechanical obstruction is absent, additional imaging can evaluate liver parenchyma for fat and iron deposition and help direct biopsy in cases where underlying parenchymal disease or mass is found. Imaging techniques are reviewed for the following clinical scenarios: (1) the patient with painful jaundice, (2) the patient with painless jaundice, and (3) the patient with a nonmechanical cause for jaundice. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  3. ACR Appropriateness Criteria Crohn Disease.

    PubMed

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

    2015-10-01

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

  4. ACR Appropriateness Criteria on Resectable Rectal Cancer

    SciTech Connect

    Suh, W. Warren; Konski, Andre A.; Mohiuddin, Mohammed; Poggi, Matthew M.; Regine, William F.; Cosman, Bard C.; Saltz, Leonard; Johnstone, Peter A.S.

    2008-04-01

    The American College of Radiology (ACR) Appropriateness Criteria on Resectable Rectal Cancer was updated by the Expert Panel on Radiation Oncology-Rectal/Anal Cancer, based on a literature review completed in 2007.

  5. ACR Appropriateness Criteria colorectal cancer screening.

    PubMed

    Yee, Judy; Kim, David H; Rosen, Max P; Lalani, Tasneem; Carucci, Laura R; Cash, Brooks D; Feig, Barry W; Fowler, Kathryn J; Katz, Douglas S; Smith, Martin P; Yaghmai, Vahid

    2014-06-01

    Colorectal cancer is the third leading cause of cancer deaths in the United States. Most colorectal cancers can be prevented by detecting and removing the precursor adenomatous polyp. Individual risk factors for the development of colorectal cancer will influence the particular choice of screening tool. CT colonography (CTC) is the primary imaging test for colorectal cancer screening in average-risk individuals, whereas the double-contrast barium enema (DCBE) is now considered to be a test that may be appropriate, particularly in settings where CTC is unavailable. Single-contrast barium enema has a lower performance profile and is indicated for screening only when CTC and DCBE are not available. CTC is also the preferred test for colon evaluation following an incomplete colonoscopy. Imaging tests including CTC and DCBE are not indicated for colorectal cancer screening in high-risk patients with polyposis syndromes or inflammatory bowel disease. This paper presents the updated colorectal cancer imaging test ratings and is the result of evidence-based consensus by the ACR Appropriateness Criteria Expert Panel on Gastrointestinal Imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  6. ACR Appropriateness Criteria®-Anal Cancer.

    PubMed

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

    2014-01-01

    The management of anal cancer is driven by randomized and nonrandomized clinical trials. However, trials may present conflicting conclusions. Furthermore, different clinical situations may not be addressed in certain trials because of eligibility inclusion criteria. Although prospective studies point to the use of definitive 5-fluorouracil and mitomycin C-based chemoradiation as a standard, some areas remain that are not well defined. In particular, management of very early stage disease, radiation dose, and the use of intensity-modulated radiation therapy remain unaddressed by phase III studies. The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  7. ACR appropriateness criteria right upper quadrant pain.

    PubMed

    Yarmish, Gail M; Smith, Martin P; Rosen, Max P; Baker, Mark E; Blake, Michael A; Cash, Brooks D; Hindman, Nicole M; Kamel, Ihab R; Kaur, Harmeet; Nelson, Rendon C; Piorkowski, Robert J; Qayyum, Aliya; Tulchinsky, Mark

    2014-03-01

    Acute right upper quadrant pain is a common presenting symptom in patients with acute cholecystitis. When acute cholecystitis is suspected in patients with right upper quadrant pain, in most clinical scenarios, the initial imaging modality of choice is ultrasound. Although cholescintigraphy has been shown to have slightly higher sensitivity and specificity for diagnosis, ultrasound is preferred as the initial study for a variety of reasons, including greater availability, shorter examination time, lack of ionizing radiation, morphologic evaluation, confirmation of the presence or absence of gallstones, evaluation of bile ducts, and identification or exclusion of alternative diagnoses. CT or MRI may be helpful in equivocal cases and may identify complications of acute cholecystitis. When ultrasound findings are inconclusive, MRI is the preferred imaging test in pregnant patients who present with right upper quadrant pain. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  8. ACR Appropriateness Criteria Breast Cancer Screening.

    PubMed

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

    2016-11-01

    Mammography is the recommended method for breast cancer screening of women in the general population. However, mammography alone does not perform as well as mammography plus supplemental screening in high-risk women. Therefore, supplemental screening with MRI or ultrasound is recommended in selected high-risk populations. Screening breast MRI is recommended in women at high risk for breast cancer on the basis of family history or genetic predisposition. Ultrasound is an option for those high-risk women who cannot undergo MRI. Recent literature also supports the use of breast MRI in some women of intermediate risk, and ultrasound may be an option for intermediate-risk women with dense breasts. There is insufficient evidence to support the use of other imaging modalities, such as thermography, breast-specific gamma imaging, positron emission mammography, and optical imaging, for breast cancer screening. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  9. ACR Appropriateness Criteria Palpable Breast Masses.

    PubMed

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

    2016-11-01

    A palpable breast mass is one of the most common presenting features of breast carcinoma. However, the clinical features are frequently nonspecific. Imaging performed before biopsy is helpful in characterizing the nature of the mass. For women with clinically detected breast masses, the vast majority will require evaluation with ultrasound. Diagnostic mammography is the initial imaging modality of choice for women aged ≥ 40 years; ultrasound is typically necessary unless a definitively benign mass is identified as the etiology of the clinical finding. For evaluating women aged <30 years and women who are pregnant or lactating, ultrasound is used for initial evaluation. For women aged 30 to 39 years, either ultrasound or diagnostic mammography may be used for initial evaluation. MRI is rarely indicated to evaluate a clinically detected finding. Biopsy is indicated for masses with suspicious features. Short-term follow-up is a reasonable alternative to biopsy for solid masses with probably benign features suggesting fibroadenoma. Correlation between imaging and the clinical finding is essential. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. ACR Appropriateness Criteria® acute pancreatitis.

    PubMed

    Baker, Mark E; Nelson, Rendon C; Rosen, Max P; Blake, Michael A; Cash, Brooks D; Hindman, Nicole M; Kamel, Ihab R; Kaur, Harmeet; Piorkowski, Robert J; Qayyum, Aliya; Yarmish, Gail M

    2014-12-01

    The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The Atlanta Classification by the Acute Pancreatitis Classification Working Group recently modified the terminology for the clinical course and the morphologic changes identified on imaging, primarily contrast- enhanced multidetector computed tomography (MDCT). The two distinct clinical courses of the disease are classified as (1) early phase, which lasts approximately 1 week, and (2) late phase, which starts after the first week and can last for months after the initial episode. The two, primary, morphologic changes are acute, interstitial edematous and necrotizing pancreatitis. Timing of imaging, primarily MDCT, is based on the clinical phases and is, therefore, important for these imaging guidelines. Ultrasound's role is to detect gallstones after the first episode. MDCT plays a primary role in the management of acutely ill patients, only after a minimum of 48-72 hours and generally after one week. MR plays a supplementary role to MDCT. Follow-up MDCT guides management and therapy: percutaneous aspiration of fluid collections and/or placement of large caliber catheters in infected necrosis.

  11. ACR appropriateness criteria radiologic management of infected fluid collections.

    PubMed

    Lorenz, Jonathan M; Al-Refaie, Waddah B; Cash, Brooks D; Gaba, Ron C; Gervais, Debra A; Gipson, Matthew G; Kolbeck, Kenneth J; Kouri, Brian E; Marshalleck, Francis E; Nair, Ajit V; Ray, Charles E; Hohenwalter, Eric J

    2015-08-01

    The best management of infected fluid collections depends on a careful assessment of clinical and anatomic factors as well as an up-to-date review of the published literature, to be able to select from a host of multidisciplinary treatment options. This article reviews conservative, radiologic, endoscopic, and surgical options and their best application to infected fluid collections as determined by the ACR Appropriateness Criteria Expert Panel on Interventional Radiology. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application, by the panel, of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

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

    PubMed

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

    2016-01-01

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

  13. ACR appropriateness criteria: Permanent source brachytherapy for prostate cancer.

    PubMed

    Davis, Brian J; Taira, Al V; Nguyen, Paul L; Assimos, Dean G; D'Amico, Anthony V; Gottschalk, Alexander R; Gustafson, Gary S; Keole, Sameer R; Liauw, Stanley L; Lloyd, Shane; McLaughlin, Patrick W; Movsas, Benjamin; Prestidge, Bradley R; Showalter, Timothy N; Vapiwala, Neha

    To provide updated American College of Radiology (ACR) appropriateness criteria for transrectal ultrasound-guided transperineal interstitial permanent source brachytherapy. The ACR appropriateness criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Permanent prostate brachytherapy (PPB) is a treatment option for appropriately selected patients with localized prostate cancer with low to very high risk disease. PPB monotherapy remains an appropriate and effective curative treatment for low-risk prostate cancer patients demonstrating excellent long-term cancer control and acceptable morbidity. PPB monotherapy can be considered for select intermediate-risk patients with multiparametric MRI useful in evaluation of such patients. High-risk patients treated with PPB should receive supplemental external beam radiotherapy (EBRT) along with androgen deprivation. Similarly, patients with involved pelvic lymph nodes may also be considered for such combined treatment but reported long-term outcomes are limited. Computed tomography-based postimplant dosimetry completed within 60 days of PPB is essential for quality assurance. PPB may be considered for treatment of local recurrence after EBRT but is associated with an increased risk of toxicity. Updated appropriateness criteria for patient evaluation, selection, treatment, and postimplant dosimetry are given. These criteria are intended to be advisory only with the final responsibility for patient care residing with the treating

  14. ACR Appropriateness Criteria Clinically Suspected Pulmonary Arteriovenous Malformation.

    PubMed

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

    2016-07-01

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

  15. ACR appropriateness criteria acute hip pain-suspected fracture.

    PubMed

    Ward, Robert J; Weissman, Barbara N; Kransdorf, Mark J; Adler, Ronald; Appel, Marc; Bancroft, Laura W; Bernard, Stephanie A; Bruno, Michael A; Fries, Ian Blair; Morrison, William B; Mosher, Timothy J; Roberts, Catherine C; Scharf, Stephen C; Tuite, Michael J; Zoga, Adam C

    2014-02-01

    Substantial cost, morbidity, and mortality are associated with acute proximal femoral fracture and may be reduced through an optimized diagnostic imaging workup. Radiography represents the primary diagnostic test of choice for the evaluation of acute hip pain. In middle aged and elderly patients with negative radiographs, the evidence indicates MRI to be the next diagnostic imaging study to exclude a proximal femoral fracture. CT, because of its relative decreased sensitivity, is only indicated in patients with MRI contraindications. Bone densitometry (DXA) should be obtained in patients with fragility fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  16. ACR Appropriateness Criteria(®) Stage I Breast Carcinoma.

    PubMed

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

    2016-11-01

    Stage I breast carcinoma is classified when an invasive breast carcinoma is ≤2 cm in diameter (T1), with no regional (axillary) lymph node metastases (N0) and no distant metastases (M0). The most common sites for metastases from breast cancer are the skeleton, lung, liver, and brain. In general, women and health care professionals prefer intensive screening and surveillance after a diagnosis of breast cancer. Screening protocols include conventional imaging such as chest radiography, bone scan, ultrasound of the liver, and MRI of brain. It is uncertain whether PET/CT will serve as a replacement for current imaging technologies. However, there are no survival or quality-of-life differences for women who undergo intensive screening and surveillance after a diagnosis of stage I breast carcinoma compared with those who do not. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  17. ACR Appropriateness Criteria Assessment of Fetal Well-Being.

    PubMed

    Simpson, Lynn; Khati, Nadia J; Deshmukh, Sandeep P; Dudiak, Kika M; Harisinghani, Mukesh G; Henrichsen, Tara L; Meyer, Benjamin J; Nyberg, David A; Poder, Liina; Shipp, Thomas D; Zelop, Carolyn M; Glanc, Phyllis

    2016-12-01

    Although there is limited evidence that antepartum testing decreases the risk for fetal death in low-risk pregnancies, women with high-risk factors for stillbirth should undergo antenatal fetal surveillance. The strongest evidence supporting antepartum testing pertains to pregnancies complicated by intrauterine fetal growth restriction secondary to uteroplacental insufficiency. The main ultrasound-based modalities to determine fetal health are the biophysical profile, modified biophysical profile, and duplex Doppler velocimetry. In patients at risk for cardiovascular compromise, fetal echocardiography may also be indicated to ensure fetal well-being. Although no single antenatal test has been shown to be superior, all have high negative predictive values. Weekly or twice-weekly fetal testing has become the standard practice in high-risk pregnancies. The timing for the initiation of assessments of fetal well-being should be tailored on the basis of the risk for stillbirth and the likelihood of survival with intervention. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  18. ACR Appropriateness Criteria Low Back Pain.

    PubMed

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

    2016-09-01

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

  19. ACR Appropriateness Criteria pretreatment staging of colorectal cancer.

    PubMed

    Dewhurst, Catherine; Rosen, Max P; Blake, Michael A; Baker, Mark E; Cash, Brooks D; Fidler, Jeff L; Greene, Frederick L; Hindman, Nicole M; Jones, Bronwyn; Katz, Douglas S; Lalani, Tasneem; Miller, Frank H; Small, William C; Sudakoff, Gary S; Tulchinsky, Mark; Yaghmai, Vahid; Yee, Judy

    2012-11-01

    Because virtually all patients with colonic cancer will undergo some form of surgical therapy, the role of preoperative imaging is directed at determining the presence or absence of synchronous carcinomas or adenomas and local or distant metastases. In contrast, preoperative staging for rectal carcinoma has significant therapeutic implications and will direct the use of radiation therapy, surgical excision, or chemotherapy. CT of the chest, abdomen, and pelvis is recommended for the initial evaluation for the preoperative assessment of patients with colorectal carcinoma. Although the overall accuracy of CT varies directly with the stage of colorectal carcinoma, CT can accurately assess the presence of metastatic disease. MRI using endorectal coils can accurately assess the depth of bowel wall penetration of rectal carcinomas. Phased-array coils provide additional information about lymph node involvement. Adding diffusion-weighted imaging to conventional MRI yields better diagnostic accuracy than conventional MRI alone. Transrectal ultrasound can distinguish layers within the rectal wall and provides accurate assessment of the depth of tumor penetration and perirectal spread, and PET and PET/CT have been shown to alter therapy in almost one-third of patients with advanced primary rectal cancer. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  20. ACR Appropriateness Criteria®  Resectable Rectal Cancer

    PubMed Central

    2012-01-01

    The management of resectable rectal cancer continues to be guided by clinical trials and advances in technique. Although surgical advances including total mesorectal excision continue to decrease rates of local recurrence, the management of locally advanced disease (T3-T4 or N+) benefits from a multimodality approach including neoadjuvant concomitant chemotherapy and radiation. Circumferential resection margin, which can be determined preoperatively via MRI, is prognostic. Toxicity associated with radiation therapy is decreased by placing the patient in the prone position on a belly board, however for patients who cannot tolerate prone positioning, IMRT decreases the volume of normal tissue irradiated. The use of IMRT requires knowledge of the patterns of spreads and anatomy. Clinical trials demonstrate high variability in target delineation without specific guidance demonstrating the need for peer review and the use of a consensus atlas. Concomitant with radiation, fluorouracil based chemotherapy remains the standard, and although toxicity is decreased with continuous infusion fluorouracil, oral capecitabine is non-inferior to the continuous infusion regimen. Additional chemotherapeutic agents, including oxaliplatin, continue to be investigated, however currently should only be utilized on clinical trials as increased toxicity and no definitive benefit has been demonstrated in clinical trials. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment

  1. ACR Appropriateness Criteria(®) Chylothorax Treatment Planning.

    PubMed

    Majdalany, Bill S; Murrey, Douglas A; Kapoor, Baljendra S; Cain, Thomas R; Ganguli, Suvranu; Kent, Michael S; Maldonado, Fabien; McBride, Joseph J; Minocha, Jeet; Reis, Stephen P; Lorenz, Jonathan M; Kalva, Sanjeeva P

    2017-05-01

    Chylothorax is an uncommon but serious medical condition, which arises when intestinal lymphatic fluid leaks into the pleural space. Treatment strategies depend on the daily output and underlying etiology, which may be due to direct injury to lymphatic vessels or a nontraumatic disorder. Chest radiographs confirm the presence of pleural fluid and lateralize the process. In the setting of direct injury, lymphangiography can often be both diagnostic and facilitate a minimally invasive attempt at therapy. CT and MRI in this setting may be appropriate for cases when lymphangiography is not diagnostic. When the etiology is nontraumatic or unknown, CT or MRI can narrow the differential diagnosis, and lymphangiography is useful if a minimally invasive approach to treatment is desired. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  2. ACR Appropriateness Criteria® Resectable Pancreatic Cancer.

    PubMed

    Jones, William E; Suh, W Waren; Abdel-Wahab, May; Abrams, Ross A; Azad, Nilofer; Das, Prajnan; Dragovic, Jadranka; Goodman, Karyn A; Jabbour, Salma K; Konski, Andre A; Koong, Albert C; Kumar, Rachit; Lee, Percy; Pawlik, Timothy M; Small, William; Herman, Joseph M

    2017-04-01

    Management of resectable pancreatic adenocarcinoma continues to present a challenge due to a paucity of high-quality randomized studies. Administration of adjuvant chemotherapy is widely accepted due to the high risk of systemic spread associated with pancreatic adenocarcinoma, but the role of radiation therapy is less clear. This paper reviews literature associated with resectable pancreatic cancer to include prognostic factors to aid in the selection of patients appropriate for adjuvant therapies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

  3. ACR Appropriateness Criteria®—Recurrent Rectal Cancer

    PubMed Central

    Suh, W. Warren; Herman, Joseph M.; Blackstock, A. William; Hong, Theodore S.; Poggi, Matthew M.; Rodriguez-Bigas, Miguel; Small, William; Thomas, Charles R.; Zook, Jennifer

    2012-01-01

    ABSTRACT The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions. These Criteria are reviewed every 2 years by a multidisciplinary expert panel. The development and review of these guidelines includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Local recurrence of rectal cancer can result in devastating symptoms for patients, including intractable pain and discharge. Prior treatment can limit subsequent treatment options. Preoperative 5-FU based chemoradiotherapy is the treatment of choice for patients with a local recurrence who did not receive adjuvant therapy after initial resection or who might have received chemotherapy alone. Chemoradiotherapy followed by evaluation for surgery is the preferred treatment for patients who have undergone previous radiotherapy after surgery. The inclusion of surgery has resulted in the best outcomes in a majority of studies. Palliative chemoradiotherapy is appropriate for patients who have received previous radiotherapy whose recurrent disease is considered inoperable. Radiotherapy can be delivered on a standard or hyperfractionated treatment schedule. Newer systemic treatments have improved response rates and given physicians more options for treating patients in this difficult situation. The use of induction chemotherapy prior to radiotherapy is an evolving treatment option. Specialized treatment modalities should be used at institutions with experience in these techniques and preferably in patients enrolled in clinical trials. PMID:22574231

  4. ACR Appropriateness Criteria(®) Suspected Liver Metastases.

    PubMed

    Kaur, Harmeet; Hindman, Nicole M; Al-Refaie, Waddah B; Arif-Tiwari, Hina; Cash, Brooks D; Chernyak, Victoria; Farrell, James; Grajo, Joseph R; Horowitz, Jeanne M; McNamara, Michelle M; Noto, Richard B; Qayyum, Aliya; Lalani, Tasneem; Kamel, Ihab R

    2017-05-01

    Liver metastases are the most common malignant liver tumors. The accurate and early detection and characterization of liver lesions is the key to successful treatment strategies. Increasingly, surgical resection in combination with chemotherapy is effective in significantly improving survival if all metastases are successfully resected. MRI and multiphase CT are the primary imaging modalities in the assessment of liver metastasis, with the relative preference toward multiphase CT or MRI depending upon the clinical setting (ie, surveillance or presurgical planning). The optimization of imaging parameters is a vital factor in the success of either modality. PET/CT, intraoperative ultrasound are used to supplement CT and MRI. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  5. ACR Appropriateness Criteria(®) Radiologic Management of Mesenteric Ischemia.

    PubMed

    Fidelman, Nicholas; AbuRahma, Ali F; Cash, Brooks D; Kapoor, Baljendra S; Knuttinen, M-Grace; Minocha, Jeet; Rochon, Paul J; Shaw, Colette M; Ray, Charles E; Lorenz, Jonathan M

    2017-05-01

    Mesenteric vascular insufficiency is a serious medical condition that may lead to bowel infarction, morbidity, and mortality that may approach 50%. Recommended therapy for acute mesenteric ischemia includes aspiration embolectomy, transcatheter thrombolysis, and angioplasty with or without stenting for the treatment of underlying arterial stenosis. Nonocclusive mesenteric ischemia may respond to transarterial infusion of vasodilators such as nitroglycerin, papaverine, glucagon, and prostaglandin E1. Recommended therapy for chronic mesenteric ischemia includes angioplasty with or without stent placement and, if an endovascular approach is not possible, surgical bypass or endarterectomy. The diagnosis of median arcuate ligament syndrome is controversial, but surgical release may be appropriate depending on the clinical situation. Venous mesenteric ischemia may respond to systemic anticoagulation alone. Transhepatic or transjugular superior mesenteric vein catheterization and thrombolytic infusion can be offered depending on the severity of symptoms, condition of the patient, and response to systemic anticoagulation. Adjunct transjugular intrahepatic portosystemic shunt creation can be considered for outflow improvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College

  6. ACR Appropriateness Criteria: follow-up of Hodgkin's lymphoma.

    PubMed

    Ng, Andrea; Constine, Louis S; Advani, Ranjan; Das, Prajnan; Flowers, Christopher; Friedberg, Jonathan; Hodgson, David C; Schwartz, Cindy L; Wilder, Richard B; Wilson, Lynn D; Yunes, Michael J

    2010-01-01

    In the follow-up of Hodgkin's lymphoma patients, the focus in the first 5 years is to detect recurrence, while after 5 years, the focus is on limiting and detecting late effects of treatment. In the first 5 years post-treatment, routine history and physical and computed tomography (CT) imaging (more frequent in the first 2 years) are generally appropriate. However, there are limited data to support the role of positron emission tomography scanning as routine follow-up. Beyond 5 years post-treatment, annual history and physical is appropriate, although there is no longer a role for routine imaging for recurrences. Women irradiated to the chest area at a young age (<35) would benefit from annual mammogram screening given the increased breast cancer risk. Magnetic resonance imaging can be considered, although there is a lack of data supporting its role in this population. Low-dose chest CT for lung cancer screening in patients with history of mediastinal irradiation and/or alkylating chemotherapy exposures and a smoking history can be considered, although data on its utility is lacking. Cardiac screening with echocardiogram and exercise tolerance tests in patients with history of mediastinal irradiation and/or adriamycin exposure may be appropriate, although the optimal screening interval would depend on mediastinal dose, adriamycin dose, presence of other cardiac risk factors and findings at the baseline screening. Patients at risk for cardiac disease due to treatment exposure would also benefit from lipid screening every 1-3 years. Copyright 2010 American College of Radiology. Published by Mosby, Inc. All rights reserved.

  7. Low back pain in the emergency department-are the ACR Appropriateness Criteria being followed?

    PubMed

    Rao, Sishir; Rao, Sevith; Harvey, H Benjamin; Avery, Laura; Saini, Sanjay; Prabhakar, Anand M

    2015-04-01

    To assess the prevalence of appropriate imaging among emergency department (ED) patients with low back pain. Our level-1 ED records were retrospectively searched for patients with a chief compliant of "low back pain" from January to April 2013. Of 624 patients, 100 were randomly selected and analyzed for their demographics, presentation, imaging, treatment, and outcomes. The study indication for imaging was compared with the ACR Appropriateness Criteria, and the indication was deemed appropriate if it received a rating of ≥5. The mean age of the study population was 48 years (50% women, 50% men). The majority presented with acute or acute on chronic low back pain (94 patients), and half had a precipitating event (50 patients). A total of 28 (28%) patients underwent imaging in the ED; 24 (24%) had outpatient imaging; 54 (54%) had neither ED nor outpatient imaging. In all, 96% (27 of 28) of patients imaged in the ED, and 96% (23 of 24) imaged as outpatients, were appropriately imaged. Of patients who did not undergo imaging, 96% (52 of 54) were appropriately not imaged. A total of 76 patients (76%) had follow-up after discharge: of these, 42 (55%) had resolution or return of pain to baseline with conservative management; 18 (24%) had improvement with intervention (epidural steroid injection or kyphoplasty); 8 (10%) improved with surgery; and 8 had persistent pain (11%). The majority of patients presenting to the ED with low back pain did not undergo imaging. The vast majority of those who underwent imaging were appropriately imaged, based on the ACR Appropriateness Criteria. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  8. ACR Appropriateness Criteria® acute respiratory illness in immunocompromised patients.

    PubMed

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

    2015-05-01

    The respiratory system is often affected by complications of immunodeficiency, typically manifesting clinically as acute respiratory illness. Ongoing literature reviews regarding the appropriateness of imaging in these patients are critical, as advanced medical therapies including stem cell transplantation, chemotherapy, and immunosuppressive therapies for autoimmune disease continue to keep the population of immunosuppressed patients in our health care system high. This ACR Appropriateness Criteria topic describes clinical scenarios of acute respiratory illness in immunocompromised patients with cough, dyspnea, chest pain, and fever, in those with negative, equivocal, or nonspecific findings on chest radiography, in those with multiple, diffuse, or confluent opacities on chest radiography, and in those in whom noninfectious disease is suspected. The use of chest radiography, chest computed tomography, transthoracic needle biopsy, and nuclear medicine imaging is discussed in the context of these clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or is not definitive, expert opinion may be used to recommend imaging or treatment.

  9. ACR appropriateness criteria(®) nasal cavity and paranasal sinus cancers.

    PubMed

    Siddiqui, Farzan; Smith, Richard V; Yom, Sue S; Beitler, Jonathan J; Busse, Paul M; Cooper, Jay S; Hanna, Ehab Y; Jones, Christopher U; Koyfman, Shlomo A; Quon, Harry; Ridge, John A; Saba, Nabil F; Worden, Francis; Yao, Min; Salama, Joseph K

    2017-03-01

    The American College of Radiology (ACR) Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Here, we present the Appropriateness Criteria for cancers arising in the nasal cavity and paranasal sinuses (maxillary, sphenoid, and ethmoid sinuses). This includes clinical presentation, prognostic factors, principles of management, and treatment outcomes. Controversies regarding management of cervical lymph nodes are discussed. Rare and unusual nasal cavity cancers, such as esthesioneuroblastoma and sinonasal undifferentiated carcinomas, are included. © 2016 American College of Radiology. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 39: 407-418, 2017.

  10. Evaluation of resident familiarity and utilization of the ACR musculoskeletal study appropriateness criteria in the context of medical decision support.

    PubMed

    Logie, Chikaodili Iloanusi; Smith, Stacy E; Nagy, Paul

    2010-02-01

    The American College of Radiology (ACR) Appropriateness Criteria was compiled as a set of evidence-based guidelines to aid both radiologists and referring physicians in making efficient use of imaging resources. In our study, only 60% of residents knew how to obtain a copy of the ACR Appropriateness Criteria, and 90% were unaware of its contents. The overall mean score in a Medical Decision Support Competency Quiz was less than 60%. We propose that there is a clear need for the formal implementation of the ACR Appropriateness Criteria within our radiology training programs. Residents should be better familiarized with its contents so as to improve medical decision support to clinicians, technologists, and radiologists alike. Copyright 2010 AUR. Published by Elsevier Inc. All rights reserved.

  11. ACR Appropriateness Criteria® on nonpalpable mammographic findings (excluding calcifications).

    PubMed

    Newell, Mary S; Birdwell, Robyn L; D'Orsi, Carl J; Bassett, Lawrence W; Mahoney, Mary C; Bailey, Lisa; Berg, Wendie A; Harvey, Jennifer A; Herman, Cheryl R; Kaplan, Stuart S; Liberman, Laura; Mendelson, Ellen B; Parikh, Jay R; Rabinovitch, Rachel; Rosen, Eric L; Sutherland, M Linda

    2010-12-01

    Screening mammography can detect breast cancer before it becomes clinically apparent. However, the screening process identifies many false-positive findings for each cancer eventually confirmed. Additional tools are available to help differentiate spurious findings from real ones and to help determine when tissue sampling is required, when short-term follow-up will suffice, or whether the finding can be dismissed as benign. These tools include additional diagnostic mammographic views, breast ultrasound, breast MRI, and, when histologic evaluation is required, percutaneous biopsy. The imaging evaluation of a finding detected at screening mammography proceeds most efficiently, cost-effectively, and with minimization of radiation dose when approached in an evidence-based manner. The appropriateness of the above-referenced tools is presented here as they apply to a variety of findings often encountered on screening mammography; an algorithmic approach to workup of these potential scenarios is also included. The recommendations put forth represent a compilation of evidence-based data and expert opinion of the ACR Appropriateness Criteria(®) Expert Panel on Breast Imaging. Copyright © 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  12. ACR Appropriateness Criteria(®) acute nonspecific chest pain-low probability of coronary artery disease.

    PubMed

    Hoffmann, Udo; Venkatesh, Vikram; White, Richard D; Woodard, Pamela K; Carr, J Jeffrey; Dorbala, Sharmila; Earls, James P; Jacobs, Jill E; Mammen, Leena; Martin, Edward T; Ryan, Thomas; White, Charles S

    2012-10-01

    This document outlines the usefulness of available diagnostic imaging for patients without known coronary artery disease and at low probability for having coronary artery disease who do not present with classic signs, symptoms, or electrocardiographic abnormalities indicating acute coronary syndrome but rather with nonspecific chest pain leading to a differential diagnosis, including pulmonary, gastrointestinal, or musculoskeletal pathologies. A number of imaging modalities are available to evaluate the broad spectrum of possible pathologies in these patients, such as chest radiography, multidetector CT, MRI, ventilation-perfusion scans, cardiac perfusion scintigraphy, transesophageal and transthoracic echocardiography, PET, spine and rib radiography, barium esophageal and upper gastrointestinal studies, and abdominal ultrasound. It is considered appropriate to start the assessment of these patients with a low-cost, low-risk diagnostic test such as a chest x-ray. Contrast-enhanced gated cardiac and ungated thoracic multidetector CT as well as transthoracic echocardiography are also usually considered as appropriate in the evaluation of these patients as a second step if necessary. A number of rest and stress single-photon emission CT myocardial perfusion imaging, ventilation-perfusion scanning, aortic and chest MR angiographic, and more specific x-ray and abdominal examinations may be appropriate as a third layer of testing, whereas MRI of the heart or coronary arteries and invasive testing such as transesophageal echocardiography or selective coronary angiography are not considered appropriate in these patients. Given the low risk of these patients, it is mandated to minimize radiation exposure as much as possible using advanced and appropriate testing protocols. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review

  13. ACR Appropriateness Criteria(®) Imaging of Possible Tuberculosis.

    PubMed

    Ravenel, James G; Chung, Jonathan H; Ackman, Jeanne B; de Groot, Patricia M; Johnson, Geoffrey B; Jokerst, Clinton; Maldonado, Fabien; McComb, Barbara L; Steiner, Robert M; Mohammed, Tan-Lucien

    2017-05-01

    Pulmonary tuberculosis remains a major cause of disease worldwide and an important public health hazard in the United States. The imaging evaluation depends to a large degree on clinical symptoms and whether active disease is suspected or a subject is at high risk for developing active disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. ACR Appropriateness Criteria® management of locoregionally advanced squamous cell carcinoma of the vulva.

    PubMed

    Kidd, Elizabeth; Moore, David; Varia, Mahesh A; Gaffney, David K; Elshaikh, Mohamed A; Erickson, Beth; Jhingran, Anuja; Lee, Larissa J; Mayr, Nina A; Puthawala, Ajmel A; Rao, Gautam G; Small, William; Wahl, Andrew O; Wolfson, Aaron H; Yashar, Catheryn M; Yuh, William; Cardenes, Higinia Rosa

    2013-08-01

    Locoregionally advanced vulvar cancer (LRAVC) is a rare disease that presents many challenging medical decisions. An expert panel was convened to reach consensus on the most appropriate pretreatment assessment and therapeutic interventions in LRAVC patients. The American College of Radiology Appropriateness Criteria are evidenced-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journal and the application of a well-established consensus methodology (modified Delphi) to rate appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to formulate recommendations. Three clinical variants were developed to address common scenarios in the management of LRAVC. Group members reached consensus on the appropriateness of specific evaluation and treatment approaches, with numerical ratings and descriptive commentary. In combining available medical literature and expert opinion, this manuscript may serve as an aid for other practitioners in the appropriate management of patients with LRAVC.

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

    PubMed

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

    2016-08-01

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

  16. ACR Appropriateness Criteria(®) Pretreatment Staging of Colorectal Cancer.

    PubMed

    Fowler, Kathryn J; Kaur, Harmeet; Cash, Brooks D; Feig, Barry W; Gage, Kenneth L; Garcia, Evelyn M; Hara, Amy K; Herman, Joseph M; Kim, David H; Lambert, Drew L; Levy, Angela D; Peterson, Christine M; Scheirey, Christopher D; Small, William; Smith, Martin P; Lalani, Tasneem; Carucci, Laura R

    2017-05-01

    Colorectal cancers are common tumors in the United States and appropriate imaging is essential to direct appropriate care. Staging and treatment differs between tumors arising in the colon versus the rectum. Local staging for colon cancer is less integral to directing therapy given radical resection is often standard. Surgical options for rectal carcinoma are more varied and rely on accurate assessment of the sphincter, circumferential resection margins, and peritoneal reflection. These important anatomic landmarks are best appreciated on high-resolution imaging with transrectal ultrasound or MRI. When metastatic disease is suspected, imaging modalities that provide a global view of the body, such as CT with contrast or PET/CT may be indicated. Rectal cancer often metastasizes to the liver and so MRI of the liver with and without contrast provides accurate staging for liver metastases. This article focuses on local and distant staging and reviews the appropriateness of different imaging for both variants. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  17. ACR Appropriateness Criteria(®) Nonvariceal Upper Gastrointestinal Bleeding.

    PubMed

    Singh-Bhinder, Nimarta; Kim, David H; Holly, Brian P; Johnson, Pamela T; Hanley, Michael; Carucci, Laura R; Cash, Brooks D; Chandra, Ankur; Gage, Kenneth L; Lambert, Drew L; Levy, Angela D; Oliva, Isabel B; Peterson, Christine M; Strax, Richard; Rybicki, Frank J; Dill, Karin E

    2017-05-01

    Upper gastrointestinal bleeding (UGIB) remains a significant cause of morbidity and mortality with mortality rates as high as 14%. This document addresses the indications for imaging UGIB that is nonvariceal and unrelated to portal hypertension. The four variants are derived with respect to upper endoscopy. For the first three, it is presumed that upper endoscopy has been performed, with three potential initial outcomes: endoscopy reveals arterial bleeding source, endoscopy confirms UGIB without a clear source, and negative endoscopy. The fourth variant, "postsurgical and traumatic causes of UGIB; endoscopy contraindicated" is considered separately because upper endoscopy is not performed. When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable with angiography as a diagnostic next step. If endoscopy demonstrates a bleed but the endoscopist cannot identify the bleeding source, angiography or CTA can be typically performed and both are considered appropriate. In the event of an obscure UGIB, angiography and CTA have been shown to be equivalent in identifying the bleeding source; CT enterography may be an alternative to CTA to find an intermittent bleeding source. In the postoperative or traumatic setting when endoscopy is contraindicated, primary angiography, CTA, and CT with intravenous contrast are considered appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to

  18. ACR Appropriateness Criteria® Hodgkin Lymphoma-Favorable Prognosis Stage I and II.

    PubMed

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

    2016-12-01

    This topic addresses the treatment of newly diagnosed patients with favorable prognosis stage I and II Hodgkin lymphoma. In most cases, combined modality therapy (chemotherapy followed by involved site radiation therapy) constitutes the current standard of care. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. By combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the appropriate use of combined modality therapy for favorable prognosis stage I and II Hodgkin lymphoma. Increasing information about the late effects of treatment has led to attempts to decrease toxicity by using less chemotherapy (decreased duration and/or intensity or different agents) and less radiation therapy (reduced volume and/or dose) while maintaining excellent efficacy.

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

    PubMed

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

    2016-08-01

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

  20. ACR Appropriateness Criteria® Right Lower Quadrant Pain--Suspected Appendicitis.

    PubMed

    Smith, Martin P; Katz, Douglas S; Lalani, Tasneem; Carucci, Laura R; Cash, Brooks D; Kim, David H; Piorkowski, Robert J; Small, William C; Spottswood, Stephanie E; Tulchinsky, Mark; Yaghmai, Vahid; Yee, Judy; Rosen, Max P

    2015-06-01

    The most common cause of acute right lower quadrant (RLQ) pain requiring surgery is acute appendicitis (AA). This narrative's focus is on imaging procedures in the diagnosis of AA, with consideration of other diseases causing RLQ pain. In general, Computed Tomography (CT) is the most accurate imaging study for evaluating suspected AA and alternative etiologies of RLQ pain. Data favor intravenous contrast use for CT, but the need for enteric contrast when intravenous contrast is used is not strongly favored. Radiation exposure concerns from CT have led to increased investigation in minimizing CT radiation dose while maintaining diagnostic accuracy and in using algorithms with ultrasound as a first imaging examination followed by CT in inconclusive cases. In children, ultrasound is the preferred initial examination, as it is nearly as accurate as CT for the diagnosis of AA in this population and without ionizing radiation exposure. In pregnant women, ultrasound is preferred initially with MRI as a second imaging examination in inconclusive cases, which is the majority.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

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

    PubMed

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

    2015-12-01

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

  2. ACR Appropriateness Criteria® Metastatic Epidural Spinal Cord Compression and Recurrent Spinal Metastasis.

    PubMed

    Lo, Simon Shek-Man; Ryu, Samuel; Chang, Eric L; Galanopoulos, Nicholas; Jones, Joshua; Kim, Edward Y; Kubicky, Charlotte D; Lee, Charles P; Rose, Peter S; Sahgal, Arjun; Sloan, Andrew E; Teh, Bin S; Traughber, Bryan J; Van Poznak, Catherine; Vassil, Andrew D

    2015-07-01

    Metastatic epidural spinal cord compression (MESCC) is an oncologic emergency and if left untreated, permanent paralysis will ensue. The treatment of MESCC is governed by disease, patient, and treatment factors. Patient's preferences and goals of care are to be weighed into the treatment plan. Ideally, a patient with MESCC is evaluated by an interdisciplinary team promptly to determine the urgency of the clinical scenario. Treatment recommendations must take into consideration the risk-benefit profiles of surgical intervention and radiotherapy for the particular individual's circumstance, including neurologic status, performance status, extent of epidural disease, stability of the spine, extra-spinal disease status, and life expectancy. In patients with high spinal instability neoplastic score (SINS) or retropulsion of bone fragments in the spinal canal, surgical intervention should be strongly considered. The rate of development of motor deficits from spinal cord compression may be a prognostic factor for ultimate functional outcome, and should be taken into account when a treatment recommendation is made. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

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

    SciTech Connect

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

    2011-08-01

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

  4. ACR Appropriateness Criteria® pulsatile abdominal mass, suspected abdominal aortic aneurysm.

    PubMed

    Desjardins, Benoit; Dill, Karin E; Flamm, Scott D; Francois, Christopher J; Gerhard-Herman, Marie D; Kalva, Sanjeeva P; Mansour, M Ashraf; Mohler, Emile R; Oliva, Isabel B; Schenker, Matthew P; Weiss, Clifford; Rybicki, Frank J

    2013-01-01

    Clinical palpation of a pulsating abdominal mass alerts the clinician to the presence of a possible abdominal aortic aneurysm (AAA). Generally an arterial aneurysm is defined as a localized arterial dilatation ≥50% greater than the normal diameter. Imaging studies are important in diagnosing the cause of a pulsatile abdominal mass and, if an AAA is found, in determining its size and involvement of abdominal branches. Ultrasound (US) is the initial imaging modality of choice when a pulsatile abdominal mass is present. Noncontrast computed tomography (CT) may be substituted in patients for whom US is not suitable. When aneurysms have reached the size threshold for intervention or are clinically symptomatic, contrast-enhanced multidetector CT angiography (CTA) is the best diagnostic and preintervention planning study, accurately delineating the location, size, and extent of aneurysm and the involvement of branch vessels. Magnetic resonance angiography (MRA) may be substituted if CT cannot be performed. Catheter arteriography has some utility in patients with significant contraindications to both CTA and MRA. The American College of Radiology Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  5. ACR Appropriateness Criteria® external-beam radiation therapy treatment planning for clinically localized prostate cancer.

    PubMed

    Abdel-Wahab, May; Mahmoud, Omar; Merrick, Gregory; Hsu, I-Chow Joe; Arterbery, V Elayne; Ciezki, Jay P; Frank, Steven J; Mohler, James Lloyd; Moran, Brian J; Rosenthal, Seth A; Rossi, Carl J; Yamada, Yoshiya

    2012-04-01

    Image-based radiation treatment planning and localization have contributed to better targeting of the prostate and sparing of normal tissues. Guidelines are needed to address radiation dose delivery, including patient setup and immobilization, target volume definition, treatment planning, treatment delivery methods, and target localization. Guidelines for external-beam radiation treatment planning have been updated and are presented here. The use of appropriate doses, simulation techniques, and verification of field setup are essential for the accurate delivery of radiation therapy. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

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

    SciTech Connect

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

    2010-11-15

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

  7. Validation of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis: slight improvement over the 1987 ACR criteria.

    PubMed

    Britsemmer, Karin; Ursum, Jennie; Gerritsen, Martijn; van Tuyl, L H; van Tuyl, Lilian; van Schaardenburg, Dirkjan

    2011-08-01

    Recently, an American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) collaboration developed new classification criteria for rheumatoid arthritis (RA). To evaluate the diagnostic and discriminative ability of these new criteria compared with the 1987 ACR criteria and the Visser decision rule. 455 patients with early arthritis were studied. The diagnostic performance of the criteria was evaluated using methotrexate treatment within 1 year, expert opinion RA and erosive disease as 'gold standards'. Erosive disease was defined as a 0-3 year change in radiographic score of ≥5. The discriminative ability of the three criteria sets (2010 ACR/EULAR, 1987 ACR criteria and Visser algorithm) was similar with areas under the curve of 0.71-0.78 ('gold standard' methotrexate), 0.74-0.80 (gold standard expert opinion RA) and 0.63-0.67 (gold standard erosive disease after 3 years). The sensitivity of the 2010 ACR/EULAR criteria was highest with 0.85 (gold standard methotrexate). 86% of patients with RA and 51% of 'non-RA' patients according to the new criteria used methotrexate. The 2010 ACR/EULAR criteria were slightly more sensitive, but otherwise performed similarly to the older criteria. A high percentage of 'non-RA' patients used methotrexate, the gold standard for RA. The ability of the new criteria to identify patients with erosive disease was low, possibly owing to the effect of intensive treatment.

  8. Comparison of ACR 1987 and ACR/EULAR 2010 criteria for predicting a 10-year diagnosis of rheumatoid arthritis.

    PubMed

    Cornec, Divi; Varache, Sophie; Morvan, Johanne; Devauchelle-Pensec, Valérie; Berthelot, Jean-Marie; Le Henaff-Bourhis, Catherine; Hoang, Sylvie; Martin, Antoine; Chalès, Gérard; Jousse-Joulin, Sandrine; Saraux, Alain

    2012-12-01

    To compare the diagnostic accuracy of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) and 1987 ACR criteria for rheumatoid arthritis (RA) in a cohort of patients with recent-onset arthritis followed-up for 10 years. One hundred and sixty-four patients with recent-onset arthritis of less than 1 year's duration were included prospectively between 1995 and 1997. The diagnosis of RA was defined as having a diagnosis of RA made by the office-based rheumatologist 10 years after enrolment. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the criteria sets at baseline. At baseline, 60 of the 164 patients had alternative diagnoses better explaining the arthritis and 13 had erosions typical for RA; of the 91 remaining patients, 33 had at least 6 ACR/EULAR points (indicating definite RA), and 58 had fewer than 6 points. The ACR/EULAR criteria had a quite similar sensitivity than the 1987 ACR criteria (33/57 [57.9%] for ACR/EULAR criteria vs 34/57 [59.6%] for the 1987 ACR criteria), but higher specificity, PPV, and NPV (95/107 [88.8%], 34/46 [73.9%], and 95/118 [80.5%], respectively) than the 1987 ACR criteria (80/107 [74.8%], 33/63 [52.4%], and 80/104 [76.9%], respectively). ACR/EULAR criteria performed substantially better than ACR 1987 criteria for predicting a diagnosis of RA after 10 years. Much of the improvement was ascribable to the use of exclusion criteria. BULLET POINTS: (1) The ACR/EULAR criteria had the same sensitivity, but higher specificity, PPV, and NPV than the 1987 ACR criteria; (2) Much of the improvement was ascribable to the use of exclusion criteria. Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  9. Do the 2010 ACR/EULAR or ACR 1987 classification criteria predict erosive disease in early arthritis?

    PubMed

    Mäkinen, Heidi; Kaarela, Kalevi; Huhtala, Heini; Hannonen, Pekka J; Korpela, Markku; Sokka, Tuulikki

    2013-05-01

    The new 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis (RA) aim at earlier diagnosis of RA compared to the 1987 ACR criteria. To evaluate the ability of the 2010 ACR/EULAR and the 1987 ACR classification criteria to predict radiographic progression after 10 years of follow-up. All early arthritis patients referred to Central Hospital in Jyväskylä from 1997 to 1999 (cases with peripheral joint synovitis, other specific diseases excluded) were included in this 10-year follow-up study. Radiographs of hands and feet were analysed according to Larsen on a scale of 0-100. At 10 years, 58% of the patients had an erosive disease (defined as Larsen ≥2 in at least one joint). The discriminative power of the 2010 ACR/EULAR and the 1987 ACR criteria (erosive disease at 10 years) were comparable, with area under the curve 0.72 (95% CI 0.65 to 0.79) (2010 ACR/EULAR criteria) and 0.65 (95% CI 0.58 to 0.72) (1987 ACR criteria). The respective sensitivities and specificities were 0.87 and 0.70, and 0.44 and 0.47. At 10 years, median (IQR) Larsen score was 6 (0, 15) among patients who had fulfilled both sets of criteria, 2 (0, 8) in those who met the 2010 ACR/EULAR and did not meet the ACR 1987 criteria, 0 (0, 5) in those who met ACR 1987 criteria but did not meet 2010 ACR/EULAR criteria, and 0 (0, 2) among patients who did not fulfil either of the criteria. The percentage of patients with erosions was 69%, 64%, 32% and 26%, respectively. The ability of the 2010 ACR/EULAR and 1987 ACR classification criteria to identify erosive disease in early arthritis is low. The discriminative power of the 2010 ACR/EULAR criteria of erosiveness in 10 years is slightly better than that of the 1987 ACR criteria.

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

    PubMed Central

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

    2015-01-01

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

  11. Do radiologists use the American College of Radiology Musculoskeletal Appropriateness Criteria?

    PubMed

    Tigges, S; Sutherland, D; Manaster, B J

    2000-08-01

    The objective of this study was to determine the proportion of radiologists in three different radiology organizations who report using the American College of Radiology (ACR) musculoskeletal appropriateness criteria. Radiologists from the Society of Skeletal Radiology, Georgia Radiological Society, and Utah Radiological Society were surveyed regarding their use of the ACR musculoskeletal appropriateness criteria. The surveys were carried out during 1998 and data were collected using written survey forms, telephone, and fax. The overall survey response rate was 298 (64%) of 465. Overall, 30% of respondents reported using the musculoskeletal appropriateness criteria. The proportion of respondents who used the musculoskeletal criteria was not different across the three organizations or for private practice compared with academic radiologists. The proportion of radiologists who report using the ACR musculoskeletal radiology appropriateness criteria is low. This result is consistent with other reports in the literature that show little impact on the practice of physicians after the distribution of written practice guidelines.

  12. Performance of the new ACR/EULAR classification criteria for systemic sclerosis in clinical practice.

    PubMed

    Jordan, Suzana; Maurer, Britta; Toniolo, Martin; Michel, Beat; Distler, Oliver

    2015-08-01

    The preliminary classification criteria for SSc lack sensitivity for mild/early SSc patients, therefore, the new ACR/EULAR classification criteria for SSc were developed. The objective of this study was to evaluate the performance of the new classification criteria for SSc in clinical practice in a cohort of mild/early patients. Consecutive patients with a clinical diagnosis of SSc, based on expert opinion, were prospectively recruited and assessed according to the EULAR Scleroderma Trials and Research group (EUSTAR) and very early diagnosis of SSc (VEDOSS) recommendations. In some patients, missing values were retrieved retrospectively from the patient's records. Patients were grouped into established SSc (fulfilling the old ACR criteria) and mild/early SSc (not fulfilling the old ACR criteria). The new ACR/EULAR criteria were applied to all patients. Of the 304 patients available for the final analysis, 162/304 (53.3%) had established SSc and 142/304 (46.7%) had mild/early SSc. All 162 established SSc patients fulfilled the new ACR/EULAR classification criteria. The remaining 142 patients had mild/early SSc. Eighty of these 142 patients (56.3%) fulfilled the new ACR/EULAR classification criteria. Patients with mild/early SSc not fulfilling the new classification criteria were most often suffering from RP, had SSc-characteristic autoantibodies and had an SSc pattern on nailfold capillaroscopy. Taken together, the sensitivity of the new ACR/EULAR classification criteria for the overall cohort was 242/304 (79.6%) compared with 162/304 (53.3%) for the ACR criteria. In this cohort with a focus on mild/early SSc, the new ACR/EULAR classification criteria showed higher sensitivity and classified more patients as definite SSc patients than the ACR criteria. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. Understanding appropriate use criteria in nuclear medicine.

    PubMed

    Farrell, Mary Beth; Cerqueira, Manuel D

    2012-06-01

    There has been a significant increase in cardiac radionuclide imaging over the past decade, leading to a corresponding increase in scrutiny from Federal and private health plans questioning the necessity of these tests. In response to efforts by third-party payers to limit all types of cardiovascular imaging studies, the American College of Cardiology Foundation, in conjunction with other professional societies, developed appropriate use criteria. The goal of this article is to explain how the criteria were created and define the 3 categories of indications: appropriate, inappropriate, and uncertain. Tips for using appropriate use criteria and tables, including a definition of several key terms technologists should be familiar with, will be provided. In addition, reimbursement, benchmark data, and practical considerations for implementation will be discussed. Finally, several tools to aid in calculating appropriateness are suggested. With a basic understanding, the appropriate use criteria are relatively easy to apply. It is important for facilities to begin to voluntarily incorporate them into their practice and document levels of appropriateness now as payers are developing 2 trends that are not favorable for nuclear cardiology: preauthorization and denial of payment for inappropriate studies.

  14. Validation of the ACR/EULAR classification criteria for systemic sclerosis in patients with early scleroderma.

    PubMed

    Araújo, Farley Carvalho; Camargo, Cíntia Zumstein; Kayser, Cristiane

    2017-08-17

    The aim of this study was to validate the 2013 ACR/EULAR classification criteria for systemic sclerosis (SSc) in patients with SSc, including patients with early SSc. Fifty-six consecutive patients with early SSc (2001 LeRoy and Medsger criteria), 122 patients with established SSc (1980 ACR classification criteria), and 141 patients with SSc-like disorders were included in this cross-sectional study. The diagnostic performance of the 2013 ACR/EULAR criteria was compared with the 1980 ACR criteria in several subsets of patients. The performance of individual variables was also obtained. Receiver operating characteristic (ROC) curves and optimal cut-off values were computed. The sensitivity and specificity in the whole cohort of 178 SSc patients were 77.6 and 98.5%, respectively, using the 2013 ACR/EULAR criteria and 68.5 and 100%, respectively, using the 1980 ACR criteria. Twenty-eight percent of the patients with early SSc met the 2013 ACR/EULAR criteria. Among the patients with early SSc, 53% of those who had Raynaud's phenomenon, abnormal capillaroscopy and positive SSc-related antibodies met the 2013 ACR/EULAR criteria. The area under the ROC curve was 0.975 (95% confidence interval 0.962-0.987). The best cut-off value for the total score was ≥8 (sensitivity 82%; specificity 97.9%). The individual variables with the highest specificity values were proximal skin thickening, sclerodactyly (specificity 100%), telangiectasia and SSc-related antibodies (specificity 98.6%). Raynaud's phenomenon had the best sensitivity (99.4%) but had low specificity (4.2%). In conclusion, the 2013 ACR/EULAR classification criteria showed high accuracy and increased sensitivity in the classification of patients with early SSc.

  15. Assessment of 2012 EULAR/ACR new classification criteria for polymyalgia rheumatica in Japanese patients diagnosed using Bird's criteria.

    PubMed

    Matsui, Kiyoshi; Maruoka, Momo; Yoshikawa, Takahiro; Hashimoto, Naoaki; Nogami, Mika; Sekiguchi, Masahiro; Azuma, Naoto; Kitano, Masayasu; Tsunoda, Shinichiro; Sano, Hajime

    2017-03-06

    The 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for polymyalgia rheumatica (PMR) were published in 2012. The present study aimed to assess the 2012 EULAR/ACR classification criteria for PMR in Japanese patients diagnosed with PMR using Bird's criteria. The study included 75 patients diagnosed using Bird's criteria. The patients were divided into fulfilled and not-fulfilled groups according to whether they met the 2012 EULAR/ACR classification criteria for PMR. The factors in the new criteria were morning stiffness duration > 45 min, hip pain or limited range of motion, absence of rheumatoid factor or anti-citrullinated protein antibody, and absence of other joint involvement. Thirty-two of the patients diagnosed with PMR using Bird's criteria met the new EULAR/ACR classification criteria, while the remaining 43 patients did not meet the new criteria. Among the factors, only morning stiffness duration > 45 min was an independent predictive factor. A morning stiffness duration > 45 min is the only independent predictive factor for differentiating patients diagnosed according to the new 2012 EULAR/ACR classification criteria for PMR. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  16. [Comparison of ACR/EULAR remission criterion of rheumatoid arthritis published in 2011 year with the other common remission criteria].

    PubMed

    Lu, Xiao-yan; Li, Chun; Zhao, Jin-xia; Li, Zhan-guo

    2013-04-18

    To evaluate and compare the advantage and utility of the 2011 ACR/EULAR criterion and the other remission criteria of rheumatoid arthritis. The questionnaires for RA patients were used for the study. The remission rate and residual disease activity of RA patients were compared according to four criteria of remission, including 2011 ACR/EULAR remission criterion, DAS28, CDAI and ACR. Among the 310 cases, 254 effective questionnaires were obtained. The remission rates of ACR, CDAI,ACR/EULAR and DAS28 were 15.4%, 23.2%,25.2%,38.2%, respectively.ACR criteria is the most stringent criteria, the remission rate of ACR was significantly lower than the other three criteria (P<0.05). There was no residual disease activity of ACR criteria. DAS28 criteria is the laxest criteria,the remission rate and residual disease activity of DAS28 was significantly higher than the other three criteria (P<0.05).There was no difference between CDAI and ACR/EULAR, which were more suitable for clinical practice. Among the four criteria, ACR criteria is the most stringent criteria, DAS28 criteria is the laxest criteria, The CDAI and ACR/EULAR criteria were more suitable for clinical practice.

  17. Applying the ACR/EULAR Systemic Sclerosis Classification Criteria to the Spanish Scleroderma Registry Cohort.

    PubMed

    Sáez-Comet, Luis; Simeón-Aznar, Carmen Pilar; Pérez-Conesa, Mercedes; Vallejo-Rodríguez, Carmen; Tolosa-Vilella, Carles; Iniesta-Arandia, Nerea; Colunga-Argüelles, Dolores; Egurbide-Arberas, Maria Victoria; Ortego-Centeno, Norberto; Vargas-Hitos, José Antonio; Freire-Dapena, Mayka; Rubio-Rivas, Manuel; Ríos-Blanco, Juan José; Trapiella-Martínez, Luis; Fonollosa-Pla, Vicent

    2015-12-01

    To compare American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for systemic sclerosis (SSc) with previous American Rheumatology Association (ARA) criteria. This was a cross-sectional multicenter study comparing sensitivity of both criteria in the cutaneous subsets in the Spanish scleroderma registry (RESCLE) cohort. In 1222 patients with SSc, the most prevalent items were Raynaud phenomenon (95%), skin thickening (91%), and abnormal capillaroscopy (89%). ARA criteria classified as SSc 63.5% of all patients, and 63%, 100%, 11.2%, and 0% in the limited, diffuse, sine, and pre-SSc subsets, respectively. ACR/EULAR criteria classified 87.5% of all patients and 98.5%, 100%, 41.8%, and 15.9% in the same subsets, respectively. ACR/EULAR criteria are more sensitive than ARA criteria, especially in limited, sine, and pre-SSc subsets.

  18. Prevalence of Systemic Sclerosis in Primary Biliary Cholangitis Using the New ACR/EULAR Classification Criteria.

    PubMed

    Zheng, Boyang; Vincent, Catherine; Fritzler, Marvin J; Senécal, Jean-Luc; Koenig, Martial; Joyal, France

    2017-01-01

    Systemic sclerosis (SSc) is a well-established disease associated with primary biliary cholangitis (PBC). However, the original 1980 American College of Rheumatology (ACR) criteria have poor sensitivity, especially for the detection of earlier SSc in previous studies. The objective was to evaluate the prevalence of SSc in patients with PBC using more sensitive 2001 LeRoy and Medsger criteria and the 2013 ACR/European League Against Rheumatism (EULAR) classification criteria. The secondary objective was to evaluate the frequency of individual clinical features. One hundred consecutive patients with PBC without previously diagnosed SSc were recruited between 2005 and 2007 from a tertiary care gastroenterology clinic. All patients underwent a complete clinical examination, determination of SSc-specific antibodies, and a nailfold capillary microscopy. Fulfillment of the 3 different criteria sets was analyzed, along with individual disease features. Of 100 patients with PBC, 1% met the ACR 1980 criteria, 22% met the 2001 LeRoy and Medsger criteria for early SSc, and 17% the 2013 ACR/EULAR criteria. Raynaud phenomenon, SSc-related antibodies, and SSc capillaroscopic patterns were the most prevalent findings, with the highest sensitivities to help guide future screening. Our data show a high prevalence of SSc in patients with PBC with probable underestimation by previous studies using the original ACR criteria. Comorbid SSc should be actively searched for based on newly described criteria to improve detection and increase benefits of earlier treatment.

  19. The concept of incomplete fibromyalgia syndrome: comparison of incomplete fibromyalgia syndrome with fibromyalgia syndrome by 1990 ACR classification criteria and its implications for newer criteria and clinical practice.

    PubMed

    Yunus, Muhammad B; Aldag, Jean C

    2012-03-01

    The 1990 American College of Rheumatology (ACR) classification criteria for fibromyalgia/fibromyalgia syndrome (FMS) has 2 components: (a) widespread pain (WSP) and (b) presence of 11 or more tender points (TP) among possible 18 sites. Some clinic patients fulfill 1 component but not the other. We have considered these patients to have incomplete FMS (IFMS). The purpose of this study was to examine the clinical and psychological differences between IFMS and FMS (by 1990 ACR criteria) because such comparison may be helpful to diagnose patients in the clinic. Six hundred consecutive patients referred to our rheumatology clinic with a diagnosis of FMS were examined by a standard protocol to determine whether they fulfilled the 1990 criteria for FMS. Both IFMS and FMS groups were compared in demographic, clinical, and psychological variables using appropriate statistical methods. One hundred twelve (18.7%) patients did not satisfy the 1990 ACR criteria and were classified as IFMS. Symptoms in IFMS and FMS were similar, generally with less frequent and less severe symptoms in the IFMS group. In IFMS, no significant difference was found among the WSP and TP component subgroups. Both TP and WSP were correlated with important features of FMS. Fulfillment of the ACR 1990 criteria is not necessary for a diagnosis of FMS in the clinic. For diagnosis and management of FMS in the clinical setting, IFMS patients, along with consideration of the total clinical picture, may be considered to have FMS, albeit generally mild.

  20. Diagnostic accuracy of ACR/EULAR 2010 criteria for rheumatoid arthritis in a 2-year cohort.

    PubMed

    Varache, Sophie; Cornec, Divi; Morvan, Johanne; Devauchelle-Pensec, Valérie; Berthelot, Jean-Marie; Le Henaff-Bourhis, Catherine; Hoang, Sylvie; Thorel, Jean-Baptiste; Martin, Antoine; Chalès, Gérard; Nowak, Emmanuel; Jousse-Joulin, Sandrine; Youinou, Pierre; Saraux, Alain

    2011-07-01

    To evaluate the diagnostic accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) and 1987 ACR criteria for rheumatoid arthritis (RA), and the respective role of the algorithm and scoring of the ACR/EULAR. In total, 270 patients with recent-onset arthritis of < 1 year duration were included prospectively between 1995 and 1997 and followed for 2 years. RA was defined as the combination, at completion of followup, of RA diagnosed by an office-based rheumatologist and treatment with a disease-modifying antirheumatic drug or glucocorticoid. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the criteria sets in the overall population, in the subgroup meeting the tree condition for ACR/EULAR scoring, and in the overall population classified according the full tree. At baseline, 111 of the 270 patients had better alternative diagnoses and 16 had erosions typical for RA; of the 143 remaining patients, 52 had more than 6 ACR/EULAR 2010 points (indicating definite RA) and 91 had fewer than 6 points. After 2 years, 11/16 patients with erosions and 40/52 with more than 6 points had RA. 100 of the 270 patients met the reference standard for RA. Sensitivity, specificity, PPV, and NPV of the ACR/EULAR (full tree) were 51/100 (51%), 153/170 (90%), 51/68 (75.4%), and 153/202 (75.7%), respectively. Diagnostic accuracies of the ACR/EULAR score and ACR 1987 criteria were not statistically different. Much of the improvement of the ACR/EULAR criteria was ascribable to the use of exclusion criteria in the algorithm.

  1. Appropriate Use Criteria for Amyloid PET

    PubMed Central

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

    2013-01-01

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

  2. Comparison of the 1987 ACR and 2010 ACR/EULAR classification criteria for rheumatoid arthritis in clinical practice: a prospective cohort study.

    PubMed

    Berglin, E; Dahlqvist, S R

    2013-01-01

    To compare application of the 1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism (EULAR) classification criteria for diagnosing rheumatoid arthritis (RA) in clinical practice. The medical records of patients with early arthritis attending the Rheumatology Department, Umeå University Hospital (n = 1026) were analysed. Patients with synovitis in at least one joint, no diagnosis other than RA being better for explaining the synovitis, and duration of symptoms less than 1 year at first visit, and at least 1 year of follow-up were included consecutively. Fulfilment of the 1987 and 2010 criteria at baseline was evaluated. Sensitivity and specificity for each criterion set, where estimated by using the outcome measures: initiation of methotrexate (MTX) therapy during the first year, and a clinical diagnosis of RA at the 1-year follow-up. Radiographs of hands and feet were evaluated using the Larsen score. The study included 313 patients, of whom 56% fulfilled the 1987 ACR criteria, 74% the 2010 ACR/EULAR criteria, and 53% both sets of criteria at baseline. The sensitivity/specificity for the 1987 and 2010 criteria with MTX within the first year as the outcome measure was 0.68/0.79 and 0.84/0.54, respectively, and with a diagnosis of RA at follow-up 0.72/0.83 and 0.91/0.65, respectively. Older patients (i.e. ≥ 60 years) more often fulfilled the 2010 criteria. Patients who fulfilled the 2010 ACR/EULAR but not the 1987 ACR criteria had a lower Larsen score at inclusion and after 2 years. Compared with the 1987 ACR criteria, the 2010 ACR/EULAR criteria have higher sensitivity but lower specificity, especially in patients aged ≥ 60 years. The 1987 ACR criteria are suggested to predict a more erosive disease.

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

    PubMed

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

    2010-01-01

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

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

    PubMed

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

    2010-11-23

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

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

    PubMed

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

    2010-11-23

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

  6. Level of agreement of the 1987 ACR and 2010 ACR/EULAR rheumatoid arthritis classification criteria: an analysis based on ESPOIR cohort data.

    PubMed

    Fautrel, Bruno; Combe, B; Rincheval, N; Dougados, M

    2012-03-01

    In 2010, new classification criteria for rheumatoid arthritis (RA) were developed. To assess agreement between 1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism (EULAR) criteria and the potential source of discordance, based on ESPOIR cohort data. 813 early arthritis patients were included in ESPOIR between 2002 and 2005. Between-criteria agreement was based on the κ coefficient. Discordance was explored by logistic regression. Data for 811 patients were available, with their main characteristics as follows: women 77%, swollen joint count 7.2, tender joint count 8.4, disease activity score in 28 joints 5.2, rheumatoid factor 46%, anticitrullinated protein antibody (ACPA) 39%, structural damage 22%. At baseline, 579 (71.4%) patients met the 1987 ACR criteria and 641 (79.0%) the 2010 criteria. Agreement at baseline was discordant for 168 patients: 115 satisfied the 2010 criteria and 53 the 1987 criteria. Concordance between the two sets was fair, with a κ coefficient of 0.45 and 0.42 at baseline and year 2, respectively. The main sources of discordance were the number and symmetry of joint involvement, as well as ACPA status. 2010 ACR/EULAR criteria identified more patients with RA than did 1987 criteria. The 2010 criteria failed to identify RA patients with symmetrical seronegative arthritis and limited joint involvement.

  7. Utility of the new rheumatoid arthritis 2010 ACR/EULAR classification criteria in routine clinical care

    PubMed Central

    Kennish, Lauren; Labitigan, Monalyn; Budoff, Sam; Filopoulos, Maria T; McCracken, W Andrew; Swearingen, Christopher J; Yazici, Yusuf

    2012-01-01

    Objectives The new 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for rheumatoid arthritis (RA) have been designed to classify early onset RA, but has not been studied to identify RA in patients with arthritis seen in routine clinical care where correct ‘classification’ of patients, when they are not selected for having RA would be important. Design Prospective, consecutive patients cohort. Setting Outpatient clinic of a university rheumatology centre. Participants A total of 126 patients with joint symptoms were consecutively recruited. Interventions The ACR/EULAR RA criteria were applied, with questions followed by a targeted musculoskeletal exam. The gold standard for the diagnosis of RA was the primary rheumatologist's diagnosis. Primary outcome measure Number of patients with non-RA diagnosis who were classified as having RA by the new classification criteria. Results The sensitivity and specificity of the 2010 criteria in classifying RA were 97% and 55%, respectively, compared with the 1987 RA criteria which were 93% and 76%, respectively. The 2010 criteria as applied to this group of patients had a poorer positive predictive (44% vs 61%) and a similar negative predictive value (98% vs 97%) compared with the 1987 criteria. More specifically, 66.7% of systemic lupus erythematosus patients, 50% of osteoarthritis, 37.5% of psoriatic arthritis and 27.2% of others fulfilled the new criteria and could have been classified as RA. Conclusions In this, we believe, the first study to examine the new 2010 ACR/EULAR RA criteria among consecutive patients seen in routine care, we found the criteria to have low specificity, and therefore incorrectly label those as having RA when, in fact, they may have a different type of inflammatory arthritis. Physicians need to be aware of this when applying the new criteria for classifying their patients for any purpose. PMID:23035013

  8. Classification Criteria for Systemic Sclerosis: An ACR-EULAR Collaborative Initiative

    PubMed Central

    van den Hoogen, Frank; Khanna, Dinesh; Fransen, Jaap; Johnson, Sindhu R.; Baron, Murray; Tyndall, Alan; Matucci-Cerinic, Marco; Naden, Raymond; Riemekasten, Gabriela; Carreira, Patricia; Gabrielli, Armando; Distler, Oliver; van Laar, Jacob M; Valentini, Gabriele; Denton, Christopher P; Kowal-Bielecka, Otylia; Inanc, Murat; Allanore, Yannick; Walker, Ulrich A; Müller-Ladner, Ulf; Vonk, Madelon; Czirjak, Laszlo; Herrick, Ariane; Sierakowski, Stanislav; Veale, Douglas; Chung, Lorinda; Clements, Phillip; Fessler, Barry J; Furst, Dan; Guiducci, Serena; Hsu, Vivian; Mayes, Maureen; Medsger, Thomas A; Merkel, Peter; Silver, Richard; Steen, Virginia; Varga, John; Collier, David; Csuka, Mary Ell; Jimenez, Sergio; Kahaleh, Bashar; Seibold, James R; Simms, Robert; Pope, Janet

    2013-01-01

    Background The 1980 classification criteria for systemic sclerosis (SSc) lack sensitivity in early SSc and limited cutaneous SSc. A joint ACR-EULAR committee was established to develop new classification criteria for SSc. Methods Using consensus methods, 23 candidate items were arranged in a multi-criteria additive point system with a threshold to classify cases as SSc. The classification system was reduced by clustering items, and simplifying weights. The system was tested by: a) determining specificity and sensitivity in SSc cases and controls with scleroderma-like disorders; b) validating against the combined view of a group of experts on a set of cases with or without SSc. Results Skin thickening of the fingers extending proximal to the MCPs is sufficient to be classified as SSc, if that is not present, seven additive items apply with varying weights for each: skin thickening of the fingers, finger tip lesions, telangiectasia, abnormal nailfold capillaries, interstitial lung disease or pulmonary arterial hypertension, Raynaud's phenomenon, and SSc-related autoantibodies. Sensitivity and specificity in the validation sample were 0.91 and 0.92 for the new classification criteria and 0.75 and 0.72 for the 1980 ARA classification criteria. All selected cases were classified in accordance with consensus-based expert opinion. All cases classified as SSc by the 1980 ARA criteria were classified with the new criteria, and several additional cases were now considered to be SSc. Conclusion The ACR-EULAR classification criteria for SSc performed better than the 1980 ARA Criteria for SSc and should allow for more patients to be classified correctly as SSc. PMID:24122180

  9. The new 2010 ACR/EULAR criteria as predictor of clinical and radiographic response in patients with early arthritis.

    PubMed

    Mueller, R B; Schiff, M; Kaegi, T; Finckh, A; Haile, S R; Schulze-Koops, H; von Kempis, J

    2015-01-01

    New American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for the classification of rheumatoid arthritis (RA) have recently been proposed. The aim of this cohort study was to examine whether fulfilling these 2010 ACR/EULAR criteria at the first visit has an impact on the clinical course and on the radiographic progression of the disease. For this observational cohort study, we included patients from the Swiss RA registry SCQM with early RA or undifferentiated arthritis (UA, disease duration ≤1 year), as defined by the treating rheumatologist, who had not received any previous disease modifying anti-rheumatic drugs (DMARDs). Patients were categorized into two groups depending on whether or not they fulfilled the 2010 ACR/EULAR criteria (≥6 points vs <6 points) at the first visit. The primary outcome measures were the evolution of the DAS 28 and of radiographic erosions as measured by the Ratingen score over time. Of the 592 patients fulfilling the inclusion criteria, 352 satisfied the 2010 ACR/EULAR criteria at baseline, whereas 240 were not classifiable as definite RA. The ACR/EULAR criteria scores correlated with disease activity at disease onset (R (2) = 0.31). DMARD treatment was subsequently initiated in all patients, mostly with methotrexate (MTX). There were no significant differences in the therapeutic strategies between patients fulfilling or not fulfilling the classification criteria. Six months after inclusion, patients fulfilling the ACR/EULAR criteria developed a 39.1 % reduction of DAS 28 scores, as compared to a 33.6 % reduction in patients not fulfilling the ACR/EULAR criteria (p = 0.0002), independently of their respective treatment strategy. Importantly, the DAS 28 scores were higher in those patients fulfilling the ACR/EULAR criteria (ACR/EULAR positive patients) throughout the observation, as compared to patients not fulfilling those (ACR/EULAR negative patients). Average radiographic progression

  10. Comparison of performance of the 2016 ACR-EULAR classification criteria for primary Sjögren's syndrome with other sets of criteria in Japanese patients.

    PubMed

    Tsuboi, Hiroto; Hagiwara, Shinya; Asashima, Hiromitsu; Takahashi, Hiroyuki; Hirota, Tomoya; Noma, Hisashi; Umehara, Hisanori; Kawakami, Atsushi; Nakamura, Hideki; Sano, Hajime; Tsubota, Kazuo; Ogawa, Yoko; Takamura, Etsuko; Saito, Ichiro; Inoue, Hiroko; Nakamura, Seiji; Moriyama, Masafumi; Takeuchi, Tsutomu; Tanaka, Yoshiya; Hirata, Shintaro; Mimori, Tsuneyo; Matsumoto, Isao; Sumida, Takayuki

    2017-03-22

    To compare the performance of the new 2016 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria for primary Sjögren's syndrome (SS) with 1999 revised Japanese Ministry of Health criteria for diagnosis of SS (JPN), 2002 American-European Consensus Group classification criteria for SS (AECG) and 2012 ACR classification criteria for SS (ACR) in Japanese patients. The study subjects were 499 patients with primary SS (pSS) or suspected pSS who were followed up in June 2012 at 10 hospitals in Japan. All patients had been assessed for all four criteria of JPN (pathology, oral, ocular, anti-SS-A/SS-B antibodies). The clinical diagnosis by the physician in charge was set as the 'gold standard'. pSS was diagnosed in 302 patients and ruled out in 197 patients by the physician in charge. The sensitivity of the ACR-EULAR criteria in the diagnosis of pSS (95.4%) was higher than those of the JPN, AECG and ACR (82.1%, 89.4% and 79.1%, respectively), while the specificity of the ACR-EULAR (72.1%) was lower than those of the three sets (90.9%, 84.3% and 84.8%, respectively). The differences of sensitivities and specificities between the ACR-EULAR and other three sets of criteria were statistically significant (p<0.001). Eight out of 302 patients with pSS and 11 cases out of 197 non-pSS cases satisfied only the ACR-EULAR criteria, compared with none of the other three sets. The ACR-EULAR criteria had significantly higher sensitivity and lower specificity in diagnosis of pSS, compared with the currently available three sets of criteria. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

    PubMed Central

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

    2012-01-01

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

  12. An Internet-based ontology editor for medical appropriateness criteria.

    PubMed

    Kahn, C E

    1998-04-01

    Appropriateness criteria and practice guidelines seek to promote the cost-effectiveness use of medical interventions, and can be most useful when integrated with computer-based patient records and order-entry systems. Building an abstract model (ontology) of appropriateness criteria can require considerable effort among investigators at geographically dispersed institutions. To facilitate the construction and maintenance of ontologies for clinical appropriateness criteria, the author developed an Internet-based system for viewing and editing the knowledge model. The system, called NEON (Network-based Editor for ONtologies), uses the World Wide Web as a platform-independent user interface. NEON allows users to edit the indexing terms and the semantic network that form the ontology for a set of appropriateness criteria. Ontologies built using the system can be imported and exported using an open, internationally standardized format based on the Standard Generalized Markup Language (SGML).

  13. Arthroscopic synovectomy of the knee in rheumatoid arthritis defined by the 2010 ACR/EULAR criteria.

    PubMed

    Triolo, Pierfranco; Rossi, Roberto; Rosso, Federica; Blonna, Davide; Castoldi, Filippo; Bonasia, Davide Edoardo

    2016-10-01

    The aims of this study were: (1) to evaluate the mid-term results and survivorship of arthroscopic synovectomy (AS) of the knee in rheumatoid arthritis (RA) defined with the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria; and (2) to identify prognostic factors. Patients matching the 2010 ACR/EULAR criteria, with symptomatic knee synovitis for at least six months, treated with arthroscopic synovectomy of the knee at a minimum of three year followup were included. Pre-operative evaluation included Larsen, HAQ, DAS28, and Laurin scores. Post-operatively, Laurin, WOMAC, and patient satisfaction scores were evaluated. Different variables were investigated to find associations with the outcomes. Kaplan-Meier survival analysis was performed. Sixty-four patients met the inclusion criteria. Seven patients (9.6%) were lost to followup, leaving 57 patients (66 knees) for the present study. The average followup was 96.3months (SD 41). The pre-operative Laurin score was 3.91 points (SD 1.3) and significantly (P<0.001) improved after surgery (mean 8.2, SD 2). The post-operative average WOMAC score was 73.9 points (SD 45.9). Eighteen knees (27.3%) underwent revision procedures at an average of 48.6 months (SD 39.8). Joint degeneration (Larsen grade III) and range of movement (ROM) reduction (>10%) were identified as negative prognostic factors. Kaplan-Meier survivorship with total knee replacement as endpoint was: 78% at one year, 28% at four years, and six percent at 10 years. Although AS of the knee has still a role as a salvage procedure in the treatment of RA synovitis with initial joint degeneration (less than Larsen grade III) and good ROM, high revision rates and limited survivorship are reported. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Remission of Rheumatoid Arthritis in Clinical Practice: Application of the ACR/EULAR 2011 Remission Criteria

    PubMed Central

    Shahouri, Shadi H.; Michaud, Kaleb; Mikuls, Ted R.; Caplan, Liron; Shaver, Timothy S.; Anderson, James D.; Weidensaul, David N.; Busch, Ruth E.; Wang, Shirley; Wolfe, Frederick

    2011-01-01

    Purpose To describe use of the ACR/EULAR (AE) rheumatoid arthritis (RA) remission criteria in clinical practice. Methods We examined remission in the US Veterans Affairs RA (VARA) registry of 1,341 patients (91% men) with 9,700 visits and a community rheumatology practice (ARCK) of 1,168 patients (28% men) with 6,362 visits. We studied cross-sectional and cumulative probabilities, agreement among various remission criteria, and aspects of reliability using Boolean definitions and CDAI and SDAI methods proposed by AE. Results By AE definition for community practice (swollen and tender joints ≤1, patient global ≤1), cross-sectional remission was 7.5% (6.4, 8.7) for ARCK and 8.9% (7.9, 9.9) for VARA. Cumulative or remission at any observation was 18.0% (ARCK) and 24.4% (VARA) over a mean of 2.2 years. Addition of ESR or CRP to criteria reduced remission to 5.0-6.2%, and use of CDAI/SDAI increased proportions to 6.9-10.1%. 1.8%-4.6% of patients met remission criteria at ≥2 visits. Agreement between criteria definitions was good by Kappa and Jaccard measures. Among patients in remission, the probability of a remission lasting 2 years was 6.0%-14.1%. Among all patients the probability of a remission lasting 2 years was <3%. Remission and examination results varied substantially among physicians by multilevel analyses. Conclusion Cross-sectional remission occurs at 5.0%-10.1%, with cumulative remission 2-3 times greater. Long-term remissions are rare. Problems with reliability and agreement limit criteria usefulness in the individual patient. However, the criteria can be an effective method for measuring clinical status and treatment effect in groups of patients in the community. PMID:21739423

  15. Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy

    PubMed Central

    de Oliveira, Anderson; Rezende, Maria Fernanda; Corrêa, Renato; Mousinho, Rodrigo; Azevedo, Jader Cunha; Miranda, Sandra Marina; Oliveira, Aline Ribeiro; Gutterres, Ricardo Fraga; Mesquita, Evandro Tinoco; Mesquita, Cláudio Tinoco

    2014-01-01

    Background Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. Objective To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both. Methods We included records of 383 patients that underwent MPS, November 2008 up to February 2009. Demographic characteristics, patient's origin, coronary risk factors, time of medical graduation and appropriateness criteria of medical applications were studied. The criteria were evaluated by two independent physicians and, in doubtful cases, defined by a medical expert in MPS. Results Mean age was 65 ± 12 years. Of the 367 records reviewed, 236 (64.3%) studies were performed in men and 75 (20.4%) were internee. To ACC 2005, 255 (69.5%) were considered appropriate indication and 13 (3.5%) inappropriate. With ACC 2009, 249 (67.8%) were considered appropriate indications and 13 (5.2%) inappropriate. Conclusions We observed a high rate of adequacy of medical indications for MPS. Compared to the 2005 version, 2009 did not change the results. PMID:25252163

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

    PubMed Central

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

    2006-01-01

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

  17. Application of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis in Korean patients with undifferentiated arthritis.

    PubMed

    Jung, S J; Kang, Y; Ha, Y J; Lee, K H; Lee, S W; Lee, S-K; Park, Y-B

    2012-05-01

    The aim of this study was to determine how many patients with undifferentiated arthritis (UA) are classified as patients with rheumatoid arthritis (RA) by the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for RA. The 2010 ACR/EULAR criteria for RA were applied to 102 patients with UA. UA is defined as an inflammatory arthritis that does not meet any criteria for a definitive diagnosis. We analysed discrepancy in the classification between previous criteria and the 2010 criteria by identifying patients who were categorized as those with RA. The mean age of the patients was 46.8 ± 14.3 years. Rheumatoid factor (RF) was positive in 36 patients (35.2%), and 30 patients (29.5%) were positive for anti-cyclic citrullinated peptide antibody (anti-CCP). The 2010 ACR/EULAR criteria classified 33 patients (32.4%) as having RA, and 31 of them (93.9%) had the involvement of 1-3 small joints. All patients were seropositive, and 25 of them (75.8%) had high positive RF or anti-CCP. Seropositivity and small joint involvement was significantly different between patients who were classified with RA and those who were not (p < 0.001). Using the 2010 ACR/EULAR criteria, 32.4% of patients with UA were classified as having RA, and all were seropositive. Most of the UA patients with high positive RF or anti-CCP could be classified as having RA when we applied the 2010 ACR/EULAR criteria.

  18. Application of the 2013 ACR/EULAR classification criteria for systemic sclerosis to patients with Raynaud's phenomenon.

    PubMed

    Park, Jin-Su; Park, Min-Chan; Song, Jason Jungsik; Park, Yong-Beom; Lee, Soo-Kon; Lee, Sang-Won

    2015-03-22

    We investigated how many patients, who presented with Raynaud's phenomenon (RP) and who had not been classified as systemic sclerosis (SSc), would be reclassified as SSc, if the 2013 American College of Rheumatology (ACR)/the European League Against Rheumatism (EULAR) classification criteria were used. We also analyzed the predictive values of the reclassification as SSc in those patients. We consecutively enrolled 64 patients with RP and 60 patients with SSc. We applied the new classification criteria to them, reclassified them, and compared variables between those who were newly classified as SSc and those who were not or previously classified as SSc. Seventeen of 64 patients (26.5%), who presented with RP, but did not fulfill the 1980 ACR classification criteria, were newly classified as SSc by the 2013 ACR/EULAR classification criteria. The newly classified patients as SSc showed increased frequencies of sclerodactyly, digital tip ulcer, telangiectasia, abnormal nailfold capillaries and the presence of anti-centromere antibody, compared to those not and telangiectasia and anti-centromere antibody, compared to the previously classified patients. For the reclassification as SSc, the variables with independent predictive value were sclerodactyly (odds ratio (OR) 60.025), telangiectasia (OR 13.353) and the presence of anti-centromere antibody (OR 11.168). Overall, 26.5% of the patients, who presented with RP, but who did not fulfill the 1980 ACR classification criteria, were newly classified as SSc according to the 2013 ACR/EULAR classification criteria. Sclerodactyly, telangiectasia, and the presence of anti-centromere antibody had independent predictive value for reclassifying patients with RP as SSc.

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2011-11-01

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

  1. Performance of the new 2012 EULAR/ACR classification criteria for polymyalgia rheumatica: comparison with the previous criteria in a single-centre study.

    PubMed

    Macchioni, Pierluigi; Boiardi, Luigi; Catanoso, Mariagrazia; Pazzola, Giulia; Salvarani, Carlo

    2014-06-01

    To compare the performance of published classification/diagnostic criteria for polymyalgia rheumatica (PMR), including the new 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria, in a single-centre study. We studied all consecutive patients with new-onset PMR seen in our centre over 6 years, whose diagnosis was confirmed during a prospective 12-month follow-up period. Subjects were classified by each of the seven different criteria. Sensitivity and specificity were compared. Control population consisted of all consecutive patients aged ≥50 years seen in a 4-year period in our early arthritis clinic who had a 12-month confirmation of a diagnosis of rheumatoid arthritis (RA) or other inflammatory articular diseases. Data were collected from 136 cases and 149 controls, including 94 patients with RA. The most sensitive criteria were the new 2012 EULAR/ACR classification criteria (92.6%). Adding ultrasound (US) specificity increased from 81.5% to 91.3% in total cases and from 79.7% to 89.9% in RA. Bird criteria had a sensitivity of 89.2% but the lowest specificity (40.2% in total cases and 72.5% in RA). Jones and Nobunaga criteria were the most specific criteria (96.7% and 97.8% in total cases and 98.6% and 99.5% in RA) but the less sensitive (63.1% and 58.2%) ones. Overall, discriminatory ability, as reflected by the area under the receiver operating characteristic curve, was better for the 2012 US EULAR/ACR criteria (0.920 in total cases and 0.910 in RA). The new EULAR/ACR criteria in new-onset PMR patients perform best in discriminating PMR from RA and other inflammatory articular diseases. Ultrasound further increases the specificity of the criteria.

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

    PubMed

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

    2016-03-30

    The high prevalence of coronary heart disease and dramatic growth of cardiac interventions in India motivate an evaluation of the appropriateness of coronary revascularisation procedures in India. Although, appropriate-use criteria (AUC) have been used to analyse the appropriateness of cardiovascular care in the USA, they are yet to be applied to care in India. In our study, we apply AUC to cardiac care in Karnataka, India, compare our results to international applications of AUC, and suggest ways to improve the appropriateness of care in India. Data were collected from the Vajpayee Arogyashree Scheme, a government-sponsored health insurance scheme in Karnataka, India. These data were collected as part of the preauthorisation process for cardiac procedures. The final data included a random sample of 600 patients from 28 hospitals in Karnataka, who obtained coronary artery bypass grafting or percutaneous coronary intervention between 1 October 2014 and 31 December 2014. We obtained our primary baseline results using a random imputation simulation to fill in missing data. Our secondary outcome measure was a best case-worst case scenario where missing data were filled to give the lowest or highest number of appropriate cases. Of the cases, 86.7% (CI 0.837% to 0.892%) were deemed appropriate, 3.65% (CI 0.023% to 0.055%) were inappropriate and 9.63% (CI 0.074% to 0.123%) were uncertain. The vast majority of cardiac revascularisation procedures performed on beneficiaries of a government-sponsored insurance programme in India were found to be appropriate. These results meet or exceed levels of appropriate use of cardiac care in the USA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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

    PubMed Central

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

    2016-01-01

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

  4. Prevalence of Osteoarthritis of Knee Among Elderly Persons in Urban Slums Using American College of Rheumatology (ACR) Criteria.

    PubMed

    Singh, Arvind Kumar; Kalaivani, Mani; Krishnan, Anand; Aggarwal, Praveen Kumar; Gupta, Sanjeev Kumar

    2014-09-01

    The prevalence of osteoarthritis among elderly is high and it majorly affects the quality of life. Knee osteoarthritis is the most common form of osteoarthritis. Timely diagnosis using clinical criteria and effective intervention is of utmost importance. To estimate the prevalence and determinants of osteoarthritis of knee joint among elderly persons residing in an urban slum of Delhi using ACR clinical criteria. We did a community-based cross-sectional study among 496 elderly (>= 60 years) persons residing in urban slum of Delhi, India from December 2009 to February 2010. The American College of Rheumatology (ACR) criteria was used to clinically diagnose osteoarthritis knee. Bivariate analysis using Chi-square test and multivariate analysis was done to identify the determinants. Sensitivity and specificity of individual factors to diagnose osteoarthritis knee was calculated. The prevalence of osteoarthritis was estimated to be 41.1% (95% C.I., 36.7-45.6). Female sex and age >= 70 y were found to be independent risk factor for osteoarthritis knee. Among those having knee pain, presence of crepitus and tenderness were the most sensitive factors whereas bone overgrowth and bone warmth were most specific factors. The prevalence of osteoarthritis knee was high among this elderly population and increased with age. Overall, individual factors of ACR criteria were both sensitive and specific in diagnosing osteoarthritis knee. In resource constrained setting of urban India, it can be an effective tool in clinical diagnosis of osteoarthritis knee.

  5. Appropriateness Criteria for Active Surveillance of Prostate Cancer.

    PubMed

    Cher, Michael L; Dhir, Apoorv; Auffenberg, Gregory B; Linsell, Susan; Gao, Yuqing; Rosenberg, Bradley; Jafri, S Mohammad; Klotz, Laurence; Miller, David C; Ghani, Khurshid R; Bernstein, Steven J; Montie, James E; Lane, Brian R

    2017-01-01

    The adoption of active surveillance varies widely across urological communities, which suggests a need for more consistency in the counseling of patients. To address this need we used the RAND/UCLA Appropriateness Method to develop appropriateness criteria and counseling statements for active surveillance. Panelists were recruited from MUSIC urology practices. Combinations of parameters thought to influence decision making were used to create and score 160 theoretical clinical scenarios for appropriateness of active surveillance. Recent rates of active surveillance among real patients across the state were assessed using the MUSIC registry. Low volume Gleason 6 was deemed highly appropriate for active surveillance whereas high volume Gleason 6 and low volume Gleason 3+4 were deemed appropriate to uncertain. No scenario was deemed inappropriate or highly inappropriate. Prostate specific antigen density, race and life expectancy impacted scores for intermediate and high volume Gleason 6 and low volume Gleason 3+4. The greatest degree of score dispersion (disagreement) occurred in scenarios with long life expectancy, high volume Gleason 6 and low volume Gleason 3+4. Recent rates of active surveillance use among real patients ranged from 0% to 100% at the provider level for low or intermediate biopsy volume Gleason 6, demonstrating a clear opportunity for quality improvement. By virtue of this work urologists have the opportunity to present specific recommendations from the panel to their individual patients. Community-wide efforts aimed at increasing rates of active surveillance and reducing practice and physician level variation in the choice of active surveillance vs treatment are warranted. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. Application of the 2010 ACR/EULAR classification criteria in patients with very early inflammatory arthritis: analysis of sensitivity, specificity and predictive values in the SAVE study cohort

    PubMed Central

    Biliavska, Iuliia; Stamm, Tanja A; Martinez-Avila, Jose; Huizinga, Thomas W J; Landewé, Robert B M; Steiner, Günter; Aletaha, Daniel; Smolen, Josef S; Machold, Klaus P

    2013-01-01

    Objective Performance of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) criteria was analysed in an internationally recruited early arthritis cohort (≤16 weeks symptom duration) enrolled in the ‘Stop-Arthritis-Very-Early’ trial. This sample includes patients with a variety of diseases diagnosed during follow-up. Methods Two endpoints were defined: Investigators’ diagnosis and disease-modifying antirheumatic drug (DMARD) treatment start during the 12-month follow-up. The 2010 criteria were applied to score Patients’ baseline data. Sensitivity, specificity, predictive values and areas under the receiver operating curves of this scoring with respect to both endpoints were calculated and compared to the 1987 criteria. The optimum level of agreement between the endpoints and the 2010 classification score ways estimated by Cohen’s ϰ coefficients. Results 303 patients had 12-months follow-up. Positive predictive values of the 2010 criteria were 0.68 and 0.71 for RA-diagnosis and DMARD-start, respectively. Sensitivity for RA-diagnosis was 0.85, for DMARD-start 0.8, whereas the 1987 criteria’s sensitivities were 0.65 and 0.55. The areas under the receiver operating curves of the 2010 criteria for RA-diagnosis and DMARD-start were 0.83 and 0.78. Analysis of inter-rater-agreement using Cohen’s ϰ demonstrated the highest ϰ values (0.5 for RA-diagnosis and 0.43 for DMARD-start) for the score of 6. Conclusions In this international very early arthritis cohort predictive and discriminative abilities of the 2010 ACR/EULAR classification criteria were satisfactory and substantially superior to the ‘old’ 1987 classification criteria. This easier classification of RA in early stages will allow targeting truly early disease stages with appropriate therapy. PMID:22984174

  7. Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective Multicenter Study.

    PubMed

    Ozen, Gulsen; Inanc, Nevsun; Unal, Ali Ugur; Bas, Seda; Kimyon, Gezmis; Kisacik, Bunyamin; Onat, Ahmet Mesut; Murat, Sadiye; Keskin, Havva; Can, Meryem; Mengi, Alperen; Cakir, Necati; Balkarli, Ayse; Cobankara, Veli; Yilmaz, Neslihan; Yazici, Ayten; Dogru, Atalay; Sahin, Mehmet; Sahin, Ali; Gok, Kevser; Senel, Soner; Pamuk, Omer Nuri; Yilmaz, Sema; Bayindir, Ozun; Aksu, Kenan; Cagatay, Yonca; Akyol, Lutfi; Sayarlioglu, Mehmet; Yildirim-Cetin, Gozde; Yasar-Bilge, Sule; Yagci, Ilker; Aydin, Sibel Zehra; Alibaz-Oner, Fatma; Atagunduz, Pamir; Direskeneli, Haner

    2016-05-01

    To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study. Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated. Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls. The new 2012 EULAR/ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria.

  8. Use of SLICC criteria in a large, diverse lupus registry enables SLE classification of a subset of ACR-designated subjects with incomplete lupus

    PubMed Central

    Aberle, Teresa; Bourn, Rebecka L; Chen, Hua; Roberts, Virginia C; Guthridge, Joel M; Bean, Krista; Robertson, Julie M; Sivils, Kathy L; Rasmussen, Astrid; Liles, Meghan; Merrill, Joan T; Harley, John B; Olsen, Nancy J; Karp, David R; James, Judith A

    2017-01-01

    Objective SLE is traditionally classified using the American College of Rheumatology (ACR) criteria. The Systemic Lupus International Collaborating Clinics (SLICC) recently validated an alternative system. This study examined large cohorts of subjects with SLE and incomplete lupus erythematosus (ILE) to compare the impact of ACR and SLICC criteria. Methods Medical records of subjects in the Lupus Family Registry and Repository were reviewed for documentation of 1997 ACR classification criteria, SLICC classification criteria and medication usage. Autoantibodies were assessed by indirect immunofluorescence (ANA, antidouble-stranded DNA), precipitin (Sm) and ELISA (anticardiolipin). Other relevant autoantibodies were detected by precipitin and with a bead-based multiplex assay. Results Of 3575 subjects classified with SLE under at least one system, 3312 (92.6%) were classified as SLE by both systems (SLEboth), 85 only by ACR criteria (SLEACR-only) and 178 only by SLICC criteria (SLESLICC-only). Of 440 subjects meeting 3 ACR criteria, 33.9% (149/440) were SLESLICC-only, while 66.1% (n=291, designated ILE) did not meet the SLICC classification criteria. Under the SLICC system, the complement criterion and the individual autoantibody criteria enabled SLE classification of SLESLICC-only subjects, while SLEACR-only subjects failed to meet SLICC classification due to the combined acute/subacute cutaneous criterion. The SLICC criteria classified more African-American subjects by the leucopenia/lymphopenia criterion than did ACR criteria. Compared with SLEACR-only subjects, SLESLICC-only subjects exhibited similar numbers of affected organ systems, rates of major organ system involvement (∼30%: pulmonary, cardiovascular, renal, neurological) and medication history. Conclusions The SLICC criteria classify more subjects with SLE than ACR criteria; however, individuals with incomplete lupus still exist under SLICC criteria. Subjects who gain SLE classification through SLICC

  9. The role of bone scintigraphy in the diagnosis of rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria.

    PubMed

    Kim, Ji Young; Cho, Soo-Kyung; Han, Minkyung; Choi, Yun Young; Bae, Sang-Cheol; Sung, Yoon-Kyoung

    2014-02-01

    We aimed to investigate the role of bone scintigraphy (BS) in the diagnosis of rheumatoid arthritis (RA) as a supplement to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. A total of 156 patients who underwent BS with screening laboratory to confirm RA were enrolled. We divided them into two groups according to the presence of arthritis upon the first physical examination, and evaluated the diagnostic validity of BS as an independent (BS only) or assistant diagnostic tool using the 2010 criteria (BS-assisted). Seventy-five patients had active arthritis (Group I), while the remaining 81 patients did not (Group II). Among them, 56 patients in group I and 5 patients in group II were finally classified as RA. In the group I patients who were eligible for application of the 2010 criteria, the sensitivity of the BS only and BS-assisted diagnosis was not superior to that of the 2010 criteria. However, BS-assisted diagnosis showed high positive prediction values in group I patients with 2010 criteria score < 6 and group II patients. Therefore, BS is still helpful to detect RA even after the introduction of the 2010 criteria, especially among patients who do not satisfy the 2010 criteria as well as those who are ineligible for the 2010 criteria due to dubitable arthritis at clinical presentation.

  10. Performance of the 2015 ACR-EULAR classification criteria for gout in a primary care population presenting with monoarthritis.

    PubMed

    Janssens, Hein J E M; Fransen, Jaap; Janssen, Matthijs; Neogi, Tuhina; Schumacher, H Ralph; Jansen, Tim L; Dalbeth, Nicola; Taylor, William J

    2017-08-01

    To test the performance of the 2015 ACR-EULAR gout classification criteria against presence of SF MSU crystals in a primary healthcare population. The criteria were applied to an existing dataset of consecutive patients with monoarthritis presenting to Dutch family physicians; all patients underwent microscopic SF analysis by design. The data had been prospectively collected to develop a diagnostic decision rule for gout in 2010. Diagnostic performance was assessed by calculating area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and constructing calibration plots for the full version of the criteria (including SF analysis results of all patients) and the clinical-only version (not including SF analysis results). Performance of both versions was compared with the 2010 diagnostic rule. Of 381 patients enrolled into the study, 216 (57%) were MSU crystal-positive. The full and clinical-only versions of the criteria had satisfactory area under the receiver operating characteristic curve (0.96 and 0.87, respectively), high specificity (0.98 and 0.84), high PPV (0.98 and 0.84), but lower sensitivity (0.68 and 0.68) and NPV (0.70 and 0.67). Specificity and PPV of both versions were higher compared with 0.71 and 0.89 of the 2010 diagnostic decision rule. The decison rule had the highest sensitivity and NPV (0.99 and 0.97). This study presents the first external validation of the 2015 ACR-EULAR gout classification criteria in a primary healthcare setting. The criteria perform well in this setting in patients presenting with monoarthritis for the purpose of enrolling into gout clinical trials.

  11. EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria.

    PubMed

    van der Heijde, Désirée; van der Helm-van Mil, Annette H M; Aletaha, Daniel; Bingham, Clifton O; Burmester, Gerd R; Dougados, Maxime; Emery, Paul; Felson, David; Knevel, Rachel; Kvien, Tore K; Landewé, Robert B M; Lukas, Cédric; McInnes, Iain; Silman, Alan J; Smolen, Josef S; Stanislawska-Biernat, Ewa; Zink, Angela; Combe, Bernard

    2013-04-01

    The aim of this report was to propose a definition for erosive disease in the context of inflammatory arthritis in light of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) criteria for use in clinical practice and studies. A EULAR task force was formed including 16 rheumatologists and one rheumatology fellow. The process was both evidence based and consensus based, and included, between March 2010 and April 2012, analyses of data from two cohorts, two face-to-face meetings, one online voting and one teleconference. The Leiden Early Arthritis Cohort and the French ESPOIR cohort were used for the evidence-based part. The outcome measures, which were initiation of methotrexate therapy, or any disease-modifying antirheumatic drug therapy within the first year of disease and arthritis persistency over 5 years, were studied with the aim to give the best definition of erosive disease. A decision was made to select a definition with a high specificity and focus on patients who did not otherwise fulfil the 2010 ACR/EULAR RA criteria (<6 points). By a unanimous vote the following definition was selected: erosive disease for use in the 2010 ACR/EULAR RA classification criteria is defined when an erosion (defined as a cortical break) is seen in at least three separate joints at any of the following sites: the proximal interphalangeal, the metacarpophalangeal, the wrist (counted as one joint) and the metatarsophalangeal joints on radiographs of both hands and feet. A highly specific definition for erosive disease has thus been formulated.

  12. 45 CFR 400.81 - Criteria for appropriate employability services and employment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Criteria for appropriate employability services... REFUGEE RESETTLEMENT PROGRAM Requirements for Employability Services and Employment Criteria for Appropriate Employability Services and Employment § 400.81 Criteria for appropriate employability services...

  13. Utilization Management and ACR Select.

    PubMed

    Cooke, Robert

    2015-01-01

    The ACR, published as ACR Select, provides an industry standard for imaging and through its experience with Appropriateness Criteria, is positioned to respond quickly to changing market demands. It has added hundreds of clinically relevant indications to ensure that even common scenarios have coverage. ACR Select is inclusive of numerous other credible content sources and actively receives vetted criteria from other medical specialty societies. ACR Select is well established in the market and available for integration into multiple physician access points. It also has support for the provisions and requirements of PL113-93. Healthcare providers have adopted ACR Select within their physician access points to deliver higher quality imaging services and understand the impact that imaging has on the overall care cycle. This better positions these providers to participate in risk-based contracts based on the value that appropriate imaging delivers. With the passage of PAMA, Congress has set a powerful precedent that has created the opportunity for every healthcare payer to transform the way imaging utilization is managed. Physicians will be required to consult Appropriateness Criteria delivered through CDS when placing orders for HTDI exams for Medicaid patients, and this can easily extend across the entire payer mix. PAMA has passed into public law (PLI113-93) and represents an opportunity for healthcare providers to develop risk based payment models across all imaging services, regardless of the payer of the claim or care setting.

  14. Joint involvement in patients with early polymyalgia rheumatica using high-resolution ultrasound and its contribution to the EULAR/ACR 2012 classification criteria for polymyalgia rheumatica.

    PubMed

    Weigand, Sandra; Ehrenstein, Boris; Fleck, Martin; Hartung, Wolfgang

    2014-04-01

    To assess joint involvement and the contribution of musculoskeletal ultrasound (MSUS) to the novel European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) 2012 classification criteria in patients with polymyalgia rheumatic (PMR). MSUS was performed in 54 consecutive patients with recent-onset PMR. Biceps tenosynovitis of at least 1 shoulder has been observed in 70.4% of patients, and 64.8% had a bilateral biceps tenosynovitis. Subdeltoid bursitis (27.8% unilateral, 5.6% bilateral), glenohumeral synovitis (22.2% unilateral, 9.3% bilateral), and hip involvement (22.2% unilateral, 16.7% bilateral) were observed less frequently. The sensitivities of the classification criteria were 85.2% for EULAR/ACR without MSUS and 81.5% for EULAR/ACR with MSUS. The most common MSUS pathology was a biceps tenosynovitis. However, US findings had no effect on the sensitivity of the novel EULAR/ACR criteria for PMR.

  15. Validity and reliability problems with patient global as a component of the ACR/EULAR remission criteria as used in clinical practice.

    PubMed

    Masri, Karim R; Shaver, Timothy S; Shahouri, Shadi H; Wang, Shirley; Anderson, James D; Busch, Ruth E; Michaud, Kaleb; Mikuls, Ted R; Caplan, Liron; Wolfe, Frederick

    2012-06-01

    To investigate what factors influence patient global health assessment (PtGlobal), and how those factors and the reliability of PtGlobal affect the rate, reliability, and validity of recently published American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria when used in clinical practice. We examined consecutive patients with RA in clinical practice and identified 77 who met ACR/EULAR joint criteria for remission (≤ 1 swollen joint and ≤ 1 tender joint). We evaluated factors associated with a PtGlobal > 1, because a PtGlobal ≤ 1 defined ACR/EULAR remission in this group of patients who had already met ACR/EULAR joint criteria. Of the 77 patients examined, only 17 (22.1%) had PtGlobal ≤ 1 and thus fully satisfied ACR/EULAR criteria. A large proportion of patients not in remission by ACR/EULAR criteria had high PtGlobal related to noninflammatory issues, including low back pain, fatigue, and functional limitations, and a number of patients clustered in the range of PtGlobal > 1 and ≤ 2. However, the minimal detectable difference for PtGlobal was 2.3. In addition, compared with a PtGlobal severity score, a PtGlobal activity score was 3.3% less likely to be abnormal (> 1). Noninflammatory factors contribute to the level of PtGlobal and result in the exclusion of many patients who would otherwise be in "true" remission according to the ACR/EULAR definition. Reliability problems associated with PtGlobal can also result in misclassification, and may explain the observation of low longterm remission rates in RA. As currently constituted, the use of the ACR/EULAR remission criteria in clinical practice appears to be problematic.

  16. Diagnostic performance of the ACR/EULAR 2010 criteria for rheumatoid arthritis and two diagnostic algorithms in an early arthritis clinic (REACH).

    PubMed

    Alves, Celina; Luime, Jolanda Jacoba; van Zeben, Derkjen; Huisman, Anne-Margriet; Weel, Angelique Elisabeth Adriana Maria; Barendregt, Pieternella Johanna; Hazes, Johanna Maria Wilhelmina

    2011-09-01

    An ACR/EULAR task force released new criteria to classify rheumatoid arthritis at an early stage. This study evaluates the diagnostic performance of these criteria and algorithms by van der Helm and Visser in REACH. Patients with symptoms ≤12 months from REACH were used. Algorithms were tested on discrimination, calibration and diagnostic accuracy of proposed cut-points. Two patient sets were defined to test robustness; undifferentiated arthritis (UA) (n=231) and all patients including those without synovitis (n=513). The outcomes evaluated were methotrexate use and persistent disease at 12 months. In UA patients all algorithms had good areas under the curve 0.79, 95% CI 0.73 to 0.83 for the ACR/EULAR criteria, 0.80, 95% CI 0.74 to 0.87 for van der Helm and 0.83, 95% CI 0.77 to 0.88 for Visser. All calibrated well. Sensitivity and specificity were 0.74 and 0.66 for the ACR/EULAR criteria, 0.1 and 1.0 for van der Helm and 0.59 and 0.93 for Visser. Similar results were found in all patients indicating robustness. The ACR/EULAR 2010 criteria showed good diagnostic properties in an early arthritis cohort reflecting daily practice, as did the van der Helm and Visser algorithms. All were robust. To promote uniformity and comparability the ACR/EULAR 2010 criteria should be used in future diagnostic studies.

  17. EpiFibro (Brazilian Fibromyalgia Registry): data on the ACR classification and diagnostic preliminary criteria fulfillment and the follow-up evaluation.

    PubMed

    Martinez, José Eduardo; Paiva, Eduardo S; Rezende, Marcelo C; Heymann, Roberto E; Helfenstein, Milton; Ranzolin, Aline; Provenza, Jose Roberto; Ribeiro, Luiz Severiano; Souza, Eduardo J R; Feldman, Daniel P; Assis, Marcos Renato de

    2016-09-17

    EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study Fibromyalgia patients. Patients were included since 2011 according to the 1990 American College of Rheumatology Classification Criteria for Fibromyalgia (ACR1990). To determine how many patients still fulfill the ACR1990 and the ACR2010 criteria in 2014; to determine the correlation between the impact of FM and to describe data on the follow-up evaluation. This is a cross sectional study in a multicenter cohort of patients. The data was collected between 2013 and 2015. Physician included patients that fulfilled the ACR1990 criteria on the date of entry. The follow-up data were considered only for patients with at least two evaluations. A minimally significant change was considered to be a 30% variation of parameters scores. 810 patients' data were analyzed. Patients presented a mean age of 51.8±11.5 years old. There were 786 female. Most patients met both criteria. There was a greater fulfilling of the ACR2010. There was a moderate correlation between PDS and FIQ. Three hundred fourteen patients with more than one assessment were found, but 88 patients were excluded. Thus, 226 patients with one follow-up monitoring parameter were considered. (FIQ: 222; PDS: 199; both: 195). The mean follow-up time was 9.1±7.5 months (1- 44). Most patients became stable. InEpiFibro, most patients fulfill simultaneously the ACR1990 and ACR2010. A larger number of patients fulfill the ACR2010 at the time of the evaluation. There was a moderate correlation. Most patients remained stable over time. Copyright © 2016. Published by Elsevier Editora Ltda.

  18. EpiFibro (Brazilian Fibromyalgia Registry): data on the ACR classification and diagnostic preliminary criteria fulfillment and the follow-up evaluation.

    PubMed

    Martinez, José Eduardo; Paiva, Eduardo S; Rezende, Marcelo C; Heymann, Roberto E; Helfenstein, Milton; Ranzolin, Aline; Provenza, Jose Roberto; Ribeiro, Luiz Severiano; Souza, Eduardo J R; Feldman, Daniel P; Assis, Marcos Renato de

    EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study Fibromyalgia patients. Patients were included since 2011 according to the 1990 American College of Rheumatology Classification Criteria for Fibromyalgia (ACR1990). To determine how many patients still fulfill the ACR1990 and the ACR2010 criteria in 2014; to determine the correlation between the impact of FM and to describe data on the follow-up evaluation. This is a cross sectional study in a multicenter cohort of patients. The data was collected between 2013 and 2015. Physician included patients that fulfilled the ACR1990 criteria on the date of entry. The follow-up data were considered only for patients with at least two evaluations. A minimally significant change was considered to be a 30% variation of parameters scores. 810 patients' data were analyzed. Patients presented a mean age of 51.8±11.5 years old. There were 786 female. Most patients met both criteria. There was a greater fulfilling of the ACR2010. There was a moderate correlation between Polysymptomatic Distress Scale and Fibromyalgia Impact Questionnaire. Three hundred fourteen patients with more than one assessment were found, but 88 patients were excluded. Thus, 226 patients with one follow-up monitoring parameter were considered (Fibromyalgia Impact Questionnaire: 222; Polysymptomatic Distress Scale: 199; both: 195). The mean follow-up time was 9.1±7.5 months (1-44). Most patients became stable. InEpiFibro, most patients fulfill simultaneously the ACR1990 and ACR2010. A larger number of patients fulfill the ACR2010 at the time of the evaluation. There was a moderate correlation between the Polysymptomatic Distress Scale and the Fibromyalgia Impact Questionnaire. Most patients remained stable over time. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

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

    ERIC Educational Resources Information Center

    Ntuli, Esther; Kyei-Blankson, Lydia

    2011-01-01

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

  20. Developing an Appropriateness Criteria for Knee MRI Using the Rand Appropriateness Method (RAM)-2013.

    PubMed

    Ebrahimipour, Hossein; Mirfeizi, Seyedeh Zahra; Najar, Ali Vafaee; Kachooei, Amir Reza; Ariamanesh, Amir Shahriar; Ganji, Reza; Esmaeeli, Habibollah; Salari, Hedayat; Vejdani, Marjan

    2014-03-01

    Knee pain is one of the most common reasons patients visit their physician. In this regard Magnetic Resonance Imaging (MRI) is the tool of preference for diagnosis. The aim of this study was to determine appropriate guidelines for knee MRI administration using the RAND Appropriateness Method (RAM)-2013. This qualitative study was done in the Mashhad University of Medical Sciences in 2013. The most appropriate approved knee MRI administration clinical guidelines were evaluated using Guidelines Evaluation and Research Appraisal (AGREE). Panel members consisting of six orthopedic and three rheumatologic doctors gave scores ranging from 1 to 9 for each scenario. The indications were grouped as appropriate, equivocal and inappropriate. Data were analyzed by descriptive statistics and SPSS ver. 18 software. Sixty-three scenarios were extracted from the guidelines and then the scenarios were evaluated in 26 indications. Thirty-two (50.79%) cases were considered appropriate, 12 (19.04%) cases uncertain and 19 (30.1%) cases inappropriate. The RAND appropriateness method is helpful in identifying the opinion of stakeholders in health care systems. Moreover, making practical use of clinical guidelines can improve patients' quality of care and prevent unnecessary costs.

  1. Appropriateness criteria of FDG PET/CT in oncology

    PubMed Central

    Agrawal, Archi; Rangarajan, Venkatesh

    2015-01-01

    18Fluorine-2-fluoro-2-Deoxy-d-glucose (18F-FDG) positron emission tomography/computerized tomography (PET/CT) is a well-established functional imaging method widely used in oncology. In this article, we have incorporated the various indications for 18FDG PET/CT in oncology based on available evidence and current guidelines. Growing body of evidence for use of 18FDG PET/CT in select tumors is also discussed. This article attempts to give the reader an overview of the appropriateness of using 18F-FDG PET/CT in various malignancies. PMID:25969632

  2. Performance of the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) criteria for classification of rheumatoid arthritis in an Indian population: An observational study in a single centre.

    PubMed

    Kedar, Mvv Pavan; Acharya, Raviraja V; Prakashini, K

    2016-08-01

    The 1987 American College of Rheumatology (ACR) criteria were criticised for classifying patients only in the late stage. The 2010 ACR/European League against Rheumatism (ACR/EULAR) classification criteria for rheumatoid arthritis (RA) were thus formulated to recognize the early stage of disease with high sensitivity. This pilot study was designed to estimate and compare the sensitivities of the 1987 ACR and 2010 ACR/EULAR classification criteria for RA. In a tertiary care hospital, the medical records of 97 patients diagnosed with RA were reviewed. Case study forms were filled with relevant clinical data and investigation results after reviewing each medical record. The radiographs of hands were also reviewed. To each case, both the 1987 ACR and the 2010 ACR/EULAR criteria were applied and the results of the classification were noted. The sensitivity of the 2010 ACR/EULAR criteria was found to be 79.38 per cent [95% confidence interval (CI) = 71.33-87.43%] and the sensitivity of the 1987 ACR criteria was found to be 63.92 per cent (95% CI = 54.36-73.48%). The difference in the sensitivities was significant (P< 0.01). There was a significant rise in sensitivity of the 2010 ACR/EULAR criteria when patients having anti-cyclic citrullinated peptide (CCP) titres were analysed. The 2010 ACR/EULAR criteria were found to be more sensitive than the 1987 ACR criteria possibly owing to features of the criteria. Anti-CCP titres were found to increase the sensitivity of the 2010 ACR/EULAR criteria.

  3. Performance of the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) criteria for classification of rheumatoid arthritis in an Indian population: An observational study in a single centre

    PubMed Central

    Kedar, M. V. V. Pavan; Acharya, Raviraja V.; Prakashini, K.

    2016-01-01

    Background & objectives: The 1987 American College of Rheumatology (ACR) criteria were criticised for classifying patients only in the late stage. The 2010 ACR/European League against Rheumatism (ACR/EULAR) classification criteria for rheumatoid arthritis (RA) were thus formulated to recognize the early stage of disease with high sensitivity. This pilot study was designed to estimate and compare the sensitivities of the 1987 ACR and 2010 ACR/EULAR classification criteria for RA. Methods: In a tertiary care hospital, the medical records of 97 patients diagnosed with RA were reviewed. Case study forms were filled with relevant clinical data and investigation results after reviewing each medical record. The radiographs of hands were also reviewed. To each case, both the 1987 ACR and the 2010 ACR/EULAR criteria were applied and the results of the classification were noted. Results: The sensitivity of the 2010 ACR/EULAR criteria was found to be 79.38 per cent [95% confidence interval (CI) = 71.33-87.43%] and the sensitivity of the 1987 ACR criteria was found to be 63.92 per cent (95% CI = 54.36-73.48%). The difference in the sensitivities was significant (P< 0.01). There was a significant rise in sensitivity of the 2010 ACR/EULAR criteria when patients having anti-cyclic citrullinated peptide (CCP) titres were analysed. Interpretation & conclusions: The 2010 ACR/EULAR criteria were found to be more sensitive than the 1987 ACR criteria possibly owing to features of the criteria. Anti-CCP titres were found to increase the sensitivity of the 2010 ACR/EULAR criteria. PMID:27934811

  4. Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study.

    PubMed

    Rudmik, Luke; Soler, Zachary M; Hopkins, Claire; Schlosser, Rodney J; Peters, Anju; White, Andrew A; Orlandi, Richard R; Fokkens, Wytske J; Douglas, Richard; Smith, Timothy L

    2016-06-01

    Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of this study was to define appropriateness criteria for ESS during management of adult patients with uncomplicated CRS. The RAND/UCLA appropriateness methodology was performed. An international, multidisciplinary panel of 10 experts in CRS was formed and completed 2 rounds of a modified Delphi ranking process along with a face-to-face meeting. A total of 624 clinical scenarios were ranked, 312 scenarios each for CRS with and CRS without nasal polyps. For adult patients with uncomplicated CRS with nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus a short-course of systemic corticosteroid with a post-treatment total SNOT-22 score ≥ 20. For adult patients with uncomplicated CRS without nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus either a short-course of a broad spectrum/culture-directed systemic antibiotic or the use of a prolonged course of systemic low-dose anti-inflammatory antibiotic with a post-treatment total SNOT-22 score ≥ 20. This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment "option" during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment "option" and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  7. The additional benefit of ultrasonography to 2010 ACR/EULAR classification criteria when diagnosing rheumatoid arthritis in the absence of anti-cyclic citrullinated peptide antibodies.

    PubMed

    Ji, Lanlan; Deng, Xuerong; Geng, Yan; Song, Zhibo; Zhang, Zhuoli

    2017-02-01

    The aim of this study was to assess the benefit of ultrasonography (US) contributing to 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria in diagnosing rheumatoid arthritis (RA), when anti-citrullinated protein (CCP) antibody and radiographic erosions are absent. Ninety-four patients suffering from arthritis of at least one joint in hands, symptom duration of less than 2 years, normal radiographs at baseline, and negative anti-CCP had 22 joint US assessments and were followed prospectively for at least 12 months. Sensitivity and specificity for final RA diagnosis based on 1987 RA criteria were determined for ultrasound variables. Logistic regression models were then fitted to evaluate predictive ability over and above the 2010 ACR/EULAR classification criteria. Twenty-nine of them were classified as RA patients and 65 had alternative diagnoses. There were significantly more joints with synovial hypertrophy, synovitis, and bone erosion detected by US in RA patients. The gray-scale (GS) variables positively correlated with acute phase reactants. The area under curve (AUC) values of GS and power Doppler (PD) were comparable, higher than bone erosion. However, regression analysis demonstrated that only PD involvement of joints, especially wrists, provided independently predictive data, with improved AUC values from 0.738 to 0.872 combined with 2010 ACR/EULAR classification criteria. PD scanning of hand joints, especially wrists, may provide independently assistance to 2010 ACR/EULAR criteria in the early diagnosis of RA in those patients who are negative for anti-CCP antibody.

  8. Continual Maintenance of Remission Defined by the ACR/EULAR Criteria in Daily Practice Leads to Better Functional Outcomes in Patients with Rheumatoid Arthritis.

    PubMed

    Shidara, Kumi; Nakajima, Ayako; Inoue, Eisuke; Hoshi, Daisuke; Sugimoto, Naoki; Seto, Yohei; Tanaka, Eiichi; Momohara, Shigeki; Taniguchi, Atsuo; Yamanaka, Hisashi

    2017-02-01

    To evaluate longterm functional outcomes in rheumatoid arthritis (RA) based on the number of times that the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) or the 28-joint Disease Activity Score (DAS28) remission criteria were fulfilled. Patients with RA who participated in all 6 data collections in an observational cohort from 2008 to 2010 and who fulfilled the DAS28 remission criteria at baseline were studied. Patients were classified by the number of times they fulfilled the ACR/EULAR [Boolean trial, Boolean practice, Simplified Disease Activity Index (SDAI), or Clinical Disease Activity Index (CDAI)] or DAS28 remission criteria at each collection. The OR for the Japanese version of the Health Assessment Questionnaire (J-HAQ) progression, based on the number of times each set of remission criteria was fulfilled, were calculated by logistic regression. A total of 915 patients were studied. The OR (95% CI) for J-HAQ progression were 0.54 (0.33-0.87), 0.55 (0.33-0.92), 0.48 (0.28-0.82), 0.29 (0.16-0.51), 0.24 (0.13-0.47), and 0.07 (0.03-0.15) for those fulfilling the Boolean trial remission from 1 to 6 times. This tendency was also observed for the other 4 criteria. The OR (95% CI) for J-HAQ progression in patients who achieved remission at all 6 data collections were 0.07 (0.03-0.14) for the Boolean practice, 0.10 (0.05-0.20) for the SDAI, and 0.07 (0.04-0.15) for the CDAI, whereas 0.15 (0.08-0.29) for the DAS28. Continual fulfillment of any remission criteria was strongly effective in preventing patients from progression of functional disability; however, the ACR/EULAR criteria appear to be preferable.

  9. Prevalence and incidence of systemic sclerosis in southern Sweden: population-based data with case ascertainment using the 1980 ARA criteria and the proposed ACR-EULAR classification criteria.

    PubMed

    Andréasson, K; Saxne, T; Bergknut, C; Hesselstrand, R; Englund, M

    2014-10-01

    To estimate the prevalence and incidence of systemic sclerosis (SSc) in southern Sweden. In Skåne, the southernmost region of Sweden (total population 1.2 million), healthcare provided is registered in the Skåne Healthcare Register. We identified all Skåne residents who had received an International Classification of Diseases 10 diagnosis of SSc (M34) or Raynaud's phenomenon (I73.0) between 1998 and 2010. Every single case was ascertained by review of medical records in reference to the 1980 American Rheumatism Association preliminary classification criteria for SSc and the proposed American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria presented at the ACR/Association of Rheumatology Health Professionals Annual Meeting 2012. We calculated the point prevalence by the end of 2010 by linkage with the population register to exclude deceased persons and we also estimated the mean annual cumulative incidence for 2006-2010. Using the 1980 ARA criteria, the adult prevalence and annual incidence of SSc in the Skåne region were 235 and 14 per 1 million inhabitants respectively. Applying the proposed ACR-EULAR criteria, the corresponding figures were 305 and 19 per 1 million inhabitants. A majority (82%) of the prevalent cases had the limited cutaneous SSc subtype. The prevalence and incidence of SSc in southern Sweden, based on the 1980 ARA criteria, are higher than previously reported in northern Europe and do not support the concept of a north-south gradient of SSc occurrence in Europe. Application of the proposed ACR-EULAR classification criteria in this population results in about 30-40% higher estimates of SSc prevalence and incidence compared to the 1980 ARA criteria. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. An algebraic approach to detect logical inconsistencies in medical appropriateness criteria.

    PubMed

    García-Remesal, Miguel; Maojo, Victor; Laita, Luis; Roanes-Lozano, Eugenio; Crespo, José

    2007-01-01

    In this paper, we present a computerized approach to detect inconsistencies in medical knowledge bases. The method has been applied to a set of medical appropriateness criteria developed for the review of coronary artery disease management. One of the main problems associated to medical appropriateness criteria is to detect logical inconsistencies in the criteria set, a process often manually carried out by health services specialists. In our approach, appropriateness criteria are automatically translated to rules containing propositional variables, using three-valued Łukasiewicz's logic augmented with modal operators to manage uncertainty. The method assigns a polynomial to each of the rules, integrity constraints, and facts from the rule-based set. This rule set is then checked for inconsistencies. The problem of determining if a formula is a tautological consequence of a set of formulae is reduced by our method into an ideal membership problem in computer algebra. Finally, the set of medical appropriateness criteria is represented in a flowchart format that can be disseminated and remotely accessed over Internet, and can be prospectively used for patient care and management. The method reported in this paper can be applied to other knowledge bases represented by means of IF-THEN rules.

  11. Appropriate use criteria for transthoracic echocardiography at a tertiary care center.

    PubMed

    Fonseca, Paulo; Sampaio, Francisco; Ribeiro, José; Gonçalves, Helena; Gama, Vasco

    2015-12-01

    The American College of Cardiology and American Society of Echocardiography have developed appropriate use criteria for echocardiography. The objective of this study was to assess the rate of appropriate requests for transthoracic echocardiography at a Portuguese tertiary care center and to identify the factors associated with lower adherence to the appropriate use criteria. All transthoracic echocardiograms (in- and outpatient) performed over a period of one month were analyzed by two independent imaging cardiologists, who matched each request to a specific indication in the appropriate use criteria document. Overall, 799 echocardiograms were included in the analysis. In 97.5% of cases it was possible to determine an indication listed in the criteria, according to which 78.7% of classifiable echocardiograms were appropriate, 15.3% inappropriate and 6.0% of uncertain appropriateness. The most common appropriate indication (111 echocardiograms) was initial evaluation of patients with symptoms or conditions potentially related to cardiac etiology, while the main inappropriate indication (59 echocardiograms) was routine surveillance of ventricular function in patients with known coronary artery disease and no change in clinical status or cardiac exam. The proportion of inappropriate echocardiograms was significantly higher among outpatients than among inpatients (18.8 vs. 4.3%, p<0.05) and among cardiologists compared to other specialties (19.3% vs. 10.9%, p<0.05). The majority of requests for transthoracic echocardiograms at a Portuguese tertiary care center were appropriate. Requests by cardiologists and outpatient referrals presented the highest rates of inappropriateness. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  12. Validation of the 2010-ACR/EULAR -classification criteria using newly EULAR-defined erosion for rheumatoid arthritis on the very early arthritis community-based (VErA) cohort.

    PubMed

    Le Loët, Xavier; Nicolau, Julia; Boumier, Patrick; Daragon, Alain; Mejjad, Othmane; Pouplin, Sophie; Zarnitsky, Charles; Vittecoq, Olivier; Fardellone, Patrice; Ménard, Jean-François

    2015-01-01

    To validate the 2010-ACR/EULAR criteria for rheumatoid arthritis (RA), taking into account the recent EULAR definition of "erosive disease", on the 310 patients comprising the very early arthritis cohort (VErA). 2010-criteria performances were tested by first strictly applying its three items successively: ≥ 1 clinical synovitis/another disease(s)/score ≥ 6/10), then the typical erosion grid without obtaining a score of ≥ 6 to diagnose RA. We tested successively: no erosion (S1), ≥ 1 erosion(s) (S2), EULAR-defined erosive disease (S3). Two gold standards were used: expert diagnosis at six years and EULAR erosive disease at two years. At inclusion, median age was 52 years; median RA duration 4.2 months. 2010-ACR/EULAR criteria, including EULAR-defined erosive disease applied at baseline, classified comparable numbers of patients as the 1987 criteria (P=0.27). Using expert diagnosis at six years, more patients were classified as RA with S2 than 1987-ACR criteria (P<0.04). In contrast, sensitivity and specificity indicated that 2010-ACR/EULAR-S3 criteria performed slightly but not significantly better than 1987-ACR criteria. On ROC curves, a score ≥ 6 correctly classified RA. When EULAR-defined erosion at two years was the gold standard, the 1987-ACR, the 2010-S1, -S2 and -S3 criteria performed comparably. Using the very early community-based, conservatively treated VErA cohort, the strict application of 2010-ACR/EULAR criteria using the new EULAR definition of erosive disease or not performed slightly but not significantly better than the 1987-ACR criteria. Copyright © 2014. Published by Elsevier SAS.

  13. Application of the 2016 EULAR/ACR/PRINTO Classification Criteria for Macrophage Activation Syndrome in Patients with Adult-onset Still Disease.

    PubMed

    Ahn, Sung Soo; Yoo, Byung-Woo; Jung, Seung Min; Lee, Sang-Won; Park, Yong-Beom; Song, Jason Jungsik

    2017-07-01

    To evaluate the clinical significance of the 2016 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR)/Pediatric Rheumatology International Trials Organization (PRINTO) classification criteria for macrophage activation syndrome (MAS) in patients with adult-onset Still disease (AOSD). We performed a retrospective analysis of patients with AOSD with fever who were admitted to Severance Hospital between 2005 and 2016. The patients with AOSD were evaluated for MAS using the 2016 classification criteria for MAS. Clinical features, laboratory findings, and overall survival were analyzed. Logistic regression analysis was used to evaluate the factors associated with in-hospital mortality. Among 64 patients with AOSD, 36 (56.3%) were classified as having MAS. The overall survival rate was significantly lower in patients with MAS than in those without (67% vs 100%, p < 0.001). Multivariate analysis showed that a low erythrocyte sedimentation rate, a low albumin level, an increase in ferritin of over 2 folds, and the development of MAS on admission were significantly associated with mortality in patients with AOSD. The 2016 EULAR/ACR/PRINTO classification criteria for MAS are potentially useful for the identification of patients with AOSD at high risk for a poor outcome. Febrile patients with AOSD should be monitored with the 2016 classification criteria for MAS in the early diagnosis and proper treatment of MAS.

  14. Association with joint damage and physical functioning of nine composite indices and the 2011 ACR/EULAR remission criteria in rheumatoid arthritis.

    PubMed

    Klarenbeek, N B; Koevoets, R; van der Heijde, D M F M; Gerards, A H; Ten Wolde, S; Kerstens, P J S M; Huizinga, T W J; Dijkmans, B A C; Allaart, C F

    2011-10-01

    To compare nine disease activity indices and the new American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) remission criteria in rheumatoid arthritis (RA) and to relate these to physical function and joint damage progression. Five-year data from the BeSt study were used, a randomised clinical trial comparing four treatment strategies in 508 patients with recent-onset RA. Every three months disease activity was assessed with nine indices (Disease Activity Score (DAS), DAS-C reactive proteine (DAS-CRP), Disease Activity Score in 28 joints (DAS-28), DAS28-CRP, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and three DAS versions with adjusted tender joint scores) and categorized into remission, low, moderate and high disease activity (LDA, MDA, HDA). In addition, the recent ACR/EULAR clinical trial and practice remission was assessed 3-monthly with 28 and 68/66 joint counts. For each index, Generalized Estimating Equations analyses were performed to relate disease activity levels and the absence/presence of remission to 3-monthly assessments of physical functioning and annual radiological progression. From the composite indices, CDAI and SDAI were the most stringent definitions of remission and classified more patients as LDA. DAS28 and DAS28-CRP had the highest proportions of remission and MDA and a smaller proportion of LDA. ACR/EULAR remission percentages were comparable to CDAI/SDAI: remission percentages. The variant including CRP and 68/66 joint counts was the most stringent. For all indices, higher levels of disease activity were associated with decreased physical functioning and more radiological damage progression. Despite differences in classification between the indices, no major differences in relation to the two outcomes were observed. The associations of nine composite indices and ACR/EULAR remission criteria with functional status and joint damage progression showed high accordance, whereas

  15. Impact of an enhanced pharmacy discharge service on prescribing appropriateness criteria: a randomised controlled trial.

    PubMed

    Basger, Benjamin J; Moles, Rebekah J; Chen, Timothy F

    2015-12-01

    Older people are at increased risk of drug-related problems (DRPs) caused by inappropriate use or underuse of medications which may be increased during care transitions. To examine the effects of applying a validated prescribing appropriateness criteria-set during medication review in a cohort of older (≥65 years) Australians at the time of discharge from hospital. Private hospital and homes of older patients in Sydney, Australia. Cognitively well English speaking patients aged 65 years or over taking five or more medications were recruited. A prescribing appropriateness criteria-set and SF-36 health-related quality of life health (HRQoL) survey were applied to all patients at discharge. Patients were then randomly assigned to receive either usual care (control, n = 91) or discharge medication counselling and a medication review by a clinical pharmacist (intervention, n = 92). Medication review recommendations were sent to the general practitioners of intervention group patients. All patients were followed up at 3 months post discharge, where the prescribing appropriateness criteria-set was reapplied and HRQoL survey repeated. MAIN OUTCOME MEASURES change in the number of prescribing appropriateness criteria met; change in HRQoL; number and causes of DRPS identified by medication review; intervention patient medication recommendation implementation rates. There was no significant difference in the number of criteria applicable and met in intervention patients, compared to control patients, between follow-up and discharge (0.09 ≤ p ≤ 0.97). While the difference between groups was positive at follow-up for SF-36 scores, the only domain that reached statistical significance was that for vitality (p = 0.04). Eighty-eight intervention patient medication reviews identified 750 causes of DRPs (8.5 ± 2.7 per patient). No causes of DRPs were identified in four patients. Of these causes, 76.4 % (573/750) were identified by application of the prescribing

  16. Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis

    PubMed Central

    2016-01-01

    Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician’s clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen’s kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches. PMID:27822928

  17. Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis.

    PubMed

    Sung, Yoon Kyoung; Cho, Soo Kyung; Kim, Dam; Yoon, Bo Young; Choi, Chan Bum; Cha, Hoon Suk; Choe, Jung Yoon; Chung, Won Tae; Hong, Seung Jae; Jun, Jae Bum; Kang, Young Mo; Kim, Jinseok; Kim, Tae Hwan; Kim, Tae Jong; Koh, Eunmi; Lee, Choong Ki; Lee, Jisoo; Lee, Shin Seok; Lee, Sung Won; Lee, Hye Soon; Lee, Yeon Ah; Park, Sung Hoon; Yoo, Dae Hyun; Yoo, Wan Hee; Bae, Sang Cheol

    2016-12-01

    Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician's clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.

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

    PubMed Central

    2013-01-01

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

  19. Appropriate wastewater treatment systems for developing countries: criteria and indictor assessment in Thailand.

    PubMed

    Singhirunnusorn, W; Stenstrom, M K

    2009-01-01

    This paper presents a comprehensive approach with factors to select appropriate wastewater treatment systems in developing countries in general and Thailand in particular. Instead of focusing merely on the technical dimensions, the study integrates the social, economic, and environmental concerns to develop a set of criteria and indicators (C&I) useful for evaluating appropriate system alternatives. The paper identifies seven elements crucial for technical selection: reliability, simplicity, efficiency, land requirement, affordability, social acceptability, and sustainability. Variables are organized into three hierarchical elements, namely: principles, criteria, and indicators. The study utilizes a mail survey to obtain information from Thai experts-academicians, practitioners, and government officials-to evaluate the C&I list. Responses were received from 33 experts on two multi-criteria analysis inquiries-ranking and rating-to obtain evaluative judgments. Results show that reliability, affordability, and efficiency are among the most important elements, followed by sustainability and social acceptability. Land requirement and simplicity are low in priority with relatively inferior weighting. A number of criteria are then developed to match the contextual environment of each particular condition. A total of 14 criteria are identified which comprised 64 indicators. Unimportant criteria and indicators are discarded after careful consideration, since some of the indicators are local or site specific.

  20. Utility of the AAOS Appropriate Use Criteria (AUC) for Pediatric Supracondylar Humerus Fractures in Clinical Practice.

    PubMed

    Ibrahim, Talal; Hegazy, Abdelsalam; Abulhail, Safa I S; Ghomrawi, Hassan M K

    2017-01-01

    The American Academy of Orthopaedic Surgeons (AAOS) recently developed an Appropriate Use Criteria (AUC) for pediatric supracondylar humerus fractures (PSHF). The AUC is intended to improve quality of care by informing surgeon decision making. The aim of our study was to cross-reference the management of operatively treated PSHF with the AAOS-published AUC. The AUC for PSHF include 220 patient scenarios, based on different combinations of 6 factors. For each patient scenario, 8 treatment options are evaluated as "appropriate," "maybe appropriate," and "rarely appropriate." We retrospectively reviewed the medical charts and radiographs of all operatively treated PSHF at our hospital from January 2013 to December 2014 and determined the appropriateness of the treatment. Over the study period, 94 children (mean age: 5.2 y; 51 male, 43 female) were admitted with PSHF and underwent a surgical procedure (type IIA: 7, type IIB: 14, type III: 70, flexion type: 3). Only 8 of the 220 scenarios were observed in our patient cohort. The most frequent scenario was represented by a type III fracture, palpable distal pulse, no nerve injury, closed soft-tissue envelope, no radius/ulna fracture, and typical swelling. Of the 94 fractures, the AUC was "appropriate" for 84 cases and "maybe appropriate" for 9 cases. There was only 1 case of "rarely appropriate" management. Closed reduction with lateral pinning and immobilization was the most prevalent treatment option (58.5%). The rate of appropriateness was not affected by the operating surgeon. However, the definition of a case as emergent had a significant impact on the rate of appropriateness. Application of the AUC to actual clinical data was relatively simple. The majority of operatively treated PSHF (89.4%) were managed appropriately. With the introduction of electronic medical charts, an AUC application becomes attractive and easy for orthopaedic surgeons to utilize in clinical practice. However, validity studies of the AUC in

  1. The new ACR/EULAR criteria for rheumatoid arthritis can identify patients with same disease activity but less damage by ultrasound.

    PubMed

    Aydın, Sibel Zehra; Castillo-Gallego, Concepcion; Nam, Jackie; Freeston, Jane; Horton, Sarah; Wakefield, Richard J; Emery, Paul

    2017-06-01

    We aimed to compare the ultrasound findings of patients fulfilling the 1987 ACR [OLD-rheumatoid arthritis (RA)] and the new ACR/EULAR (NEW-RA) classification criteria to examine the impact of the new criteria on disease characteristics, particularly disease duration. A total of 2730 hands, wrists, elbows, knees, ankles, and foot joints of 105 consecutive patients with inflammatory arthritis, i.e., 82 patients fulfilling the RA criteria (60 patients, OLD-RA; 22 patients, NEW-RA alone) and 23 patients with undifferentiated arthritis, were scanned using ultrasound. Synovitis, erosions, and power Doppler (PD) findings were scored using a scale of 0-3 and scores form each joint were added up to calculate synovitis, PD and erosion scores for each patient. OLD-RA and NEW-RA patients had similar swollen joint count, tender joint count, acute-phase response, patient global, and disease activity assessment 28 scores. The disease duration was longer in OLD-RA patients [30 (3-179) months] than in NEW-RA patients [16 (0-45) months; p=0.009]. Both the groups had similar synovitis and PD scores, whereas erosion scores were higher in OLD-RA patients than in NEW-RA patients (p=0.009). Patients with undifferentiated arthritis were older than those with RA and had fewer swollen joints than NEW-RA patients [0 (0-4) vs. 2 (0-9); p=0.017]. All other disease activity parameters were similar in both NEW-RA and OLD-RA patients. Both the synovitis (p=0.006) and erosion (p=0.007) scores were lower in patients with undifferentiated arthritis than in OLD-RA patients, despite the scores being similar to those in NEW-RA patients. The new ACR/EULAR RA criteria enabled the classification of patients with similar disease activity (by clinical assessment and ultrasound) but with less damage. A similar disease activity should ensure suitability for an intervention, and a shorter duration and less damage should improve the outcome with patient benefit.

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

    PubMed Central

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

    2016-01-01

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

  3. Appropriate Use Criteria for Echocardiography: Evolving Applications in the Era of Value-Based Healthcare

    PubMed Central

    Singh, Amita

    2017-01-01

    The current climate in healthcare is increasingly emphasizing a value-based approach to diagnostic testing. Cardiac imaging, including echocardiography, has been a primary target of ongoing reforms in healthcare delivery and reimbursement. The Appropriate Use Criteria (AUC) for echocardiography is a physician-derived tool intended to guide utilization in optimal patient care. To date, the AUC have primarily been employed solely as justification for reimbursement, though evolving broader applications to guide clinical decision-making suggest a far more valuable role in the delivery of high-quality and high-value healthcare. PMID:27553788

  4. Application of Appropriate Use Criteria for Initial Transthoracic Echocardiography in an Academic Outpatient Pediatric Cardiology Program.

    PubMed

    Safa, Raya; Aggarwal, Sanjeev; Misra, Amrit; Kobayashi, Daisuke

    2017-08-01

    Transthoracic echocardiography (TTE) is a non-invasive diagnostic modality for children with suspected heart disease. The American College of Cardiology published Appropriate Use Criteria (AUC) for an initial outpatient pediatric TTE in 2014 to promote effective care and improve resource utilization. The objective was to determine the appropriateness of TTE per the published AUC in a single academic pediatric cardiology clinic as a baseline performance quality measure. The echocardiography database was used to identify initial outpatient TTE in children during January-March 2014. TTE indications (appropriate [A], may be appropriate [M], or rarely appropriate [R]) and findings (normal, incidental, or abnormal) were recorded. The effect of AUC and age groups on yield of abnormal TTE findings was analyzed. Of the 2166 screened studies, our study cohort consisted of 247 TTEs. Indications rated A, M, and R were found in 129, 27, and 90, respectively, and 1 was unclassifiable. Majority of TTE (n = 183) were normal, although incidental findings were noted in 32 and abnormal findings in 32 cases. Abnormal findings were noted in 26/129 of A, 2/27 of M, and 4/90 of R. Indications rated A were significantly associated with yield of abnormal TTE findings, adjusted by age group. Infants and adolescents were more likely to have abnormal TTE findings compared to young children. Recently published AUC were validated for initial TTE in the outpatient pediatric cardiology clinic. Appropriateness rated by AUC was highly associated with yield of abnormal TTE findings and worked best in infants and adolescent.

  5. Self-limiting arthritis among patients fulfilling the 2010 ACR/EULAR classification criteria for rheumatoid arthritis in a very early arthritis cohort.

    PubMed

    Norli, Ellen Sauar; Brinkmann, Gina H; Kvien, Tore K; Bjørneboe, Olav; Haugen, Anne J; Nygaard, Halvor; Thunem, Cathrine; Lie, Elisabeth; Mjaavatten, Maria D

    2016-12-01

    To study occurrence of and factors associated with self-limiting arthritis among patients fulfilling the 2010 ACR/EULAR classification criteria for rheumatoid arthritis (RA) (2010 RA criteria) in patients with ≤16 weeks׳ duration of joint swelling. We applied the 2010 RA criteria in 1118 patients included in a 2-year longitudinal cohort. In all, 256 patients fulfilled the 2010 RA criteria at baseline; outcome was defined as either "self-limiting arthritis" (no DMARD use during follow-up, no swollen joints at last assessment, and no final clinical diagnosis of RA) or "persistent disease." The associations between baseline characteristics, including the components of the 2010 RA criteria score, and outcomes were studied. In total, 36 of 256 patients (14.1%) classified as having RA had self-limiting arthritis. These patients differed from patients with persistent disease according to ACPA positivity (11.1% vs. 65.0%, p < 0.001), duration of joint swelling (median = 47.5 vs. 66.0 days, p = 0.002), 2010 RA criteria points (median = 6.0 vs. 7.0, p < 0.001), and ever smoking (52.8% vs. 74.5%, p = 0.01). Having no serology points and no duration points were independent predictors of self-limiting arthritis. The rate of self-limiting arthritis was 2.7% vs. 29.4% among ACPA positive vs. ACPA negative patients (p < 0.001), and 32.5% when duration of joint swelling was <4 weeks vs. 10.6% with longer duration (p < 0.001). Negative ACPA status, short duration of joint swelling and being a never smoker were factors associated with self-limiting arthritis in early arthritis patients classified as having RA at presentation. Our findings contribute to identify patients who potentially do not need DMARDs and who should not be included in early RA clinical drug trials. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Management of full-thickness rotator cuff tears: appropriate use criteria.

    PubMed

    Schmidt, Christopher C; Morrey, Bernard F

    2015-12-01

    The appropriate use criteria (AUC) were developed for full-thickness rotator cuff tears to determine when it is reasonable to recommend nonoperative care, partial repair/débridement, repair, reconstruction, or arthroplasty. The goal of this report was to interpret and summarize the results of the AUC process into clinically relevant terms. Using the results of the AUC methodology, we systematically interpreted the clinical importance attributed to the various patient and pathologic variables. We then assessed the combination of considerations that would justify the various treatment options using "preference tables." A nonoperative program was appropriate if the patient had a positive response to conservative care. However, a repair could be maybe appropriate was also accepted. Rotator cuff repair was appropriate when conservative treatment failed in symptomatic patients. Reconstructive measures were recognized primarily in those with chronic massive tears. Most found arthroplasty maybe appropriate only in healthy patients, pseudoparalysis, and chronic massive tears. Surprisingly, neither factors that decreased healing nor adversely affected outcome had a strong influence on the panel's treatment recommendations. The AUC process accounts for clinical experience and considers individual patient and pathologic characteristics of the condition. Overall, the outcome of this exercise does support the current practice for the management of rotator cuff tears (ie, repair of symptomatic tears). However, the minimal importance given to patient and pathologic considerations, well documented to influence outcome, prompts an ongoing effort to refine this important and clinically relevant process. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Appropriateness of diagnosis of streptococcal pharyngitis among Thai community pharmacists according to the Centor criteria.

    PubMed

    Saengcharoen, Woranuch; Jaisawang, Pornchanok; Udomcharoensab, Palita; Buathong, Kittika; Lerkiatbundit, Sanguan

    2016-10-01

    Background Inappropriate use of antibiotic treatment for pharyngitis by community pharmacists is prevalent in developing countries. Little is known about how the pharmacists identify patients with bacterial pharyngitis. Objective To ascertain the appropriateness of diagnosis of streptococcal pharyngitis among Thai community pharmacists according to the Centor criteria and to identify factors related to antibiotic dispensing. Setting 1040 Thai community pharmacists. Method A cross-sectional survey of community pharmacists was conducted in November 2012 to March 2013. The self-administered questionnaires were mailed to 57 % of community pharmacists in the south of Thailand (n = 1040). The survey included questions on diagnosis of streptococcal pharyngitis, knowledge on pharyngitis, and attitudes and control beliefs regarding antibiotic dispensing. Main outcome measure The appropriateness of diagnosis of streptococcal pharyngitis according to the original and modified Centor criteria and determinants of antibiotic dispensing including demographic characteristics of pharmacists, knowledge on pharyngitis, and attitudes and control beliefs on antibiotic dispensing. Results Approximately 68 % completed the questionnaires (n = 703). Compared to the pharmacists who reported not dispensing antibiotics in the hypothetical case with common cold, those reported dispensing antibiotics were more likely to consider the following conditions-presence of cough, mild sore throat and patients with age >60 years as cues for diagnosis of streptococcal pharyngitis (p < 0.05). The use of fewer scores of the clinical prediction rules for diagnosis was observed in antibiotic dispensers, compared to who did not do so (p < 0.005). Antibiotic dispensing was positively associated with period of dispensing experience (>5 years) [odds ratio (OR) 1.52; 95 % confidence interval (CI) 1.03-2.23], belief that antibiotics could shorten duration of pharyngitis (OR 1.48; 95 % CI 1

  8. In-hospital mortality in febrile lupus patients based on 2016 EULAR/ACR/PRINTO classification criteria for macrophage activation syndrome.

    PubMed

    Ahn, Sung Soo; Yoo, Byung-Woo; Jung, Seung Min; Lee, Sang-Won; Park, Yong-Beom; Song, Jason Jungsik

    2017-10-01

    To evaluate the clinical significance of the 2016 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR)/Pediatric Rheumatology International Trials Organization (PRINTO) classification criteria for macrophage activation syndrome (MAS) in patients with febrile systemic lupus erythematosus (SLE). We performed a retrospective analysis of SLE patients with fever, who were admitted to Severance Hospital between December 2005 and May 2016. Patients were evaluated for MAS using the 2016 classification criteria for MAS. Clinical features and laboratory findings were compared and overall survival rate was analyzed. Forward and backward stepwise logistic regression analysis was used to evaluate the factors associated with in-hospital mortality. Among 157 patients with SLE, 54 (34.3%) were considered to have MAS on admission (n = 42) and during admission (n = 12). For patients who already have MAS on admission, their baseline laboratory findings demonstrated lower CRP, platelets, total protein, albumin, complement C3, fibrinogen and higher AST, ALT, total bilirubin, ferritin, and triglyceride. The overall survival rate was significantly lower in patients with MAS than without MAS (64.8% vs. 97.0%, p < 0.001). Multivariate analysis showed that the presence of MAS was significantly associated with in-hospital mortality in febrile SLE patients (OR = 64.5; 95% CI: 7.6-544.4; p < 0.001). The 2016 classification criteria for MAS is useful to identify febrile SLE patients at high risk for in-hospital mortality. Monitoring febrile SLE patients with the new 2016 classification criteria might aid in the early detection of MAS. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Ultrasound-detectable grey scale synovitis predicts future fulfilment of the 2010 ACR/EULAR RA classification criteria in patients with new-onset undifferentiated arthritis

    PubMed Central

    Horton, Sarah C; Tan, Ai Lyn; Wakefield, Richard J; Freeston, Jane E; Buch, Maya H; Emery, Paul

    2017-01-01

    Objective To determine the clinical outcomes for patients with new-onset undifferentiated arthritis (UA), not fulfilling the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) classification criteria, and the clinical and imaging predictors of disease progression in these patients. Methods A prospective observational study was conducted in treatment-naïve UA patients. Baseline ultrasound involved semiquantitative assessment of grey scale (GS) synovitis and power Doppler activity (PD) at 26 joints. Outcomes were fulfilment of 2010 RA criteria (joint involvement determined clinically) and initiation of methotrexate over 12 months. Cox proportional hazards analysis was used to investigate predictors of outcome. Results Of 60 patients, 13(22%) progressed to RA and 32(53%) ever received methotrexate. Analyses of predictors of outcome were conducted in the subgroup (n=41) of patients with complete baseline data. The presence of GS was associated with progression to RA and methotrexate use: HRs (95% CI) were 1.25(1.07 to 1.45) and 1.16(1.02 to 1.32), respectively, for the number of joints with GS≥ grade 2 after adjustment for swollen joints. PD was not predictive in the low levels at which it was observed. Progression to RA was also associated with fulfilment of the 2010 criteria using ultrasound synovitis for enumerating joint involvement, higher baseline disability and radiographic erosion. Conclusions This is the first report of ultrasound findings in early UA (defined by presence of clinical synovitis and non-fulfilment of 2010 RA criteria). A significant proportion of patients with UA progressed to RA and/or required methotrexate. GS synovitis was predictive of disease progression. PMID:28469936

  10. Ultrasound-detectable grey scale synovitis predicts future fulfilment of the 2010 ACR/EULAR RA classification criteria in patients with new-onset undifferentiated arthritis.

    PubMed

    Horton, Sarah C; Tan, Ai Lyn; Wakefield, Richard J; Freeston, Jane E; Buch, Maya H; Emery, Paul

    2017-01-01

    To determine the clinical outcomes for patients with new-onset undifferentiated arthritis (UA), not fulfilling the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) classification criteria, and the clinical and imaging predictors of disease progression in these patients. A prospective observational study was conducted in treatment-naïve UA patients. Baseline ultrasound involved semiquantitative assessment of grey scale (GS) synovitis and power Doppler activity (PD) at 26 joints. Outcomes were fulfilment of 2010 RA criteria (joint involvement determined clinically) and initiation of methotrexate over 12 months. Cox proportional hazards analysis was used to investigate predictors of outcome. Of 60 patients, 13(22%) progressed to RA and 32(53%) ever received methotrexate. Analyses of predictors of outcome were conducted in the subgroup (n=41) of patients with complete baseline data. The presence of GS was associated with progression to RA and methotrexate use: HRs (95% CI) were 1.25(1.07 to 1.45) and 1.16(1.02 to 1.32), respectively, for the number of joints with GS≥ grade 2 after adjustment for swollen joints. PD was not predictive in the low levels at which it was observed. Progression to RA was also associated with fulfilment of the 2010 criteria using ultrasound synovitis for enumerating joint involvement, higher baseline disability and radiographic erosion. This is the first report of ultrasound findings in early UA (defined by presence of clinical synovitis and non-fulfilment of 2010 RA criteria). A significant proportion of patients with UA progressed to RA and/or required methotrexate. GS synovitis was predictive of disease progression.

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

    PubMed

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

    2016-06-01

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

  12. Clinical utility and prognostic value of appropriateness criteria in stress echocardiography for the evaluation of valvular heart disease.

    PubMed

    Bhattacharyya, Sanjeev; Kamperidis, Vasilis; Shah, Benoy Nalin; Roussin, Isabelle; Chahal, Navtej; Li, Wei; Khattar, Rajdeep; Senior, Roxy

    2013-09-01

    We examined the prognostic value of stress echocardiography appropriateness criteria for evaluation of valvular heart disease in 100 consecutive patients. Of the studies, 49%, 36%, and 15% were classified as appropriate, uncertain, and inappropriate, respectively. Over a median of 12.6 months, 24 events (12 deaths and 12 heart failure admissions) occurred. The 12-month event-free survival was significantly reduced in patients with appropriate or uncertain studies compared with patients with inappropriate studies (p = 0.04 and p = 0.005, respectively). There was no survival difference between patients with an appropriate or uncertain indication (p = 0.1). The only independent predictors of events were a positive stress echocardiogram (hazard ratio: 15.5, p < 0.0001) and left ventricular ejection fraction (hazard ratio: 0.95, p = 0.02). The appropriateness criteria for evaluation of valvular heart disease provide the ability to differentiate between patients at high- (appropriate group) and low- (inappropriate group) risk of cardiac events. Reclassification of the uncertain group may improve the differential value of these criteria.

  13. Appropriateness of applying the response criteria for multiple myeloma to Waldenstrom's macroglobulinemia?

    PubMed

    Bladé, Joan; Montoto, Silvia; Rosiñol, Laura; Montserrat, Emili

    2003-04-01

    Since the presence of an M-component is an essential disease feature in both multiple myeloma (MM) and Waldenstrom's macroglobulinemia (WM), the decrease in the M-protein size applied for response in MM is also a crucial criteria for assessing response in WM. However, WM frequently displays lymphoma-like features that should be included in the response criteria.

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false What criteria will Reclamation apply to determine whether it is appropriate to recommend that a feasibility study be conducted? 404.44 Section 404.44 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR RECLAMATION RURAL WATER SUPPLY...

  15. 45 CFR 400.81 - Criteria for appropriate employability services and employment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Requirements for Employability Services and Employment Criteria for... duration (including any time enrolled in such program in the United States prior to the...

  16. Predictors of response to anti-TNF therapy according to ACR and EULAR criteria in patients with established RA: results from the South Swedish Arthritis Treatment Group Register.

    PubMed

    Kristensen, L E; Kapetanovic, M C; Gülfe, A; Söderlin, M; Saxne, T; Geborek, P

    2008-04-01

    To identify factors predicting response to first TNF blocking treatment course in patients with established RA with a special focus on gender differences. Patients with active RA initiating their first treatment course of TNF-blocking therapy were enrolled. The study period was March 1999 through September 2006. The prospective protocol included information on demographics, clinical characteristics of patients and response measures. Fulfilment of ACR 50-70% improvement and European League Against Rheumatism (EULAR) good response or remission [28-joint disease activity score (DAS28) <2.6] at 3 months were chosen as primary outcome measures. Potential predictors of responses were identified using multivariate binary logistic regression models. In total, 1565 patients were included in the study. Gender did not influence treatment response. Consistently, concomitant methotrexate (MTX) was significantly associated with EULAR remission, EULAR good response, ACR50 response and ACR70 response with odds ratios (ORs) 1.97, 2.13, 2.10 and 1.75, respectively. Concurrent treatment with other DMARDs was also significantly associated with EULAR remission, EULAR good response and ACR50 response (OR: 1.96, 2.24 and 1.94, respectively). Likewise, low HAQ at baseline consistently predicted good clinical outcome. Disease activity at baseline was directly associated with favourable response when measured by ACR50 and ACR70 (OR: 1.59 and 1.60, respectively), whereas DAS28 score at baseline was inversely associated with EULAR remission (OR: 0.78). In this observational study of patients with established RA, gender did not predict response to anti-TNF therapy, whereas treatment with concomitant DMARDs, especially MTX and low disability were associated with good response. Choice of outcome measures may influence the predictive value of baseline features.

  17. 45 CFR 400.81 - Criteria for appropriate employability services and employment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Requirements for Employability Services and Employment Criteria for... basis. Any claim of adverse effect on physical or mental health must be based on adequate medical...

  18. Detecting Appropriate Trajectories of Growth in Latent Growth Models: The Performance of Information-Based Criteria

    ERIC Educational Resources Information Center

    Whittaker, Tiffany A.; Khojasteh, Jam

    2017-01-01

    Latent growth modeling (LGM) is a popular and flexible technique that may be used when data are collected across several different measurement occasions. Modeling the appropriate growth trajectory has important implications with respect to the accurate interpretation of parameter estimates of interest in a latent growth model that may impact…

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

    ERIC Educational Resources Information Center

    Ihmeideh, Fathi Mahmoud

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Ihmeideh, Fathi Mahmoud

    2015-01-01

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

  1. Hirsutism and oligomenorrhea are appropriate screening criteria for polycystic ovary syndrome in adolescents.

    PubMed

    Villarroel, Claudio; López, Patricia; Merino, Paulina M; Iñiguez, Germán; Sir-Petermann, Teresa; Codner, Ethel

    2015-01-01

    We evaluated the association of hirsutism and oligomenorrhea (persistent menstrual cycles > 45 days) as screening criteria for the detection of biochemical hyperandrogenism (BH) and polycystic ovaries (PCOM) during adolescence and determined which androgens, granulosa cell hormone, ultrasonographic parameters have the best association with polycystic ovary syndrome (PCOS). Hirsute girls with oligomenorrhea (N = 26 Hirs/Oligo group) and non-hirsute girls with regular cycles (N = 63, C group) were studied. Prevalence of BH and PCOM, diagnostic performance of androgens and ultrasound parameters for PCOS diagnosis were analyzed. BH and PCOM prevalence were higher in the Hirs/Oligo girls than in the C girls (76.9% versus 25.5%; 92.3% versus 33.3%, respectively; p < 0.0001). A complete PCOS phenotype (Hirs/Oligo with BH and PCOM) was observed in 73.1% of the Hirs/Oligo group. The presence of both BH and PCOM was observed in 7.9% of the C group. The parameters with the best diagnostic performance were free androgen index ≥6.1, testosterone ≥2.4 nmol/L, follicle number ≥12 and ovarian volume ≥10 ml anti-Müllerian hormone (AMH) exhibited a low diagnostic accuracy. Hirsutism and persistent menstrual cycle over 45 days are highly associated with BH and PCOM suggesting that the presences of both criteria are necessary for the diagnosis of PCOS during adolescence.

  2. Application of appropriate use criteria to cardiac stress testing in the hospital setting: limitations of the criteria and areas for improved practice.

    PubMed

    Gertz, Zachary M; O'Donnell, William; Raina, Amresh; Litwack, Andrew J; Balderston, Jessica R; Goldberg, Lee R

    2015-01-01

    Imaging cardiac stress test use has risen significantly, leading to the development of appropriate use criteria. Prior studies have suggested the rate of inappropriate testing is 13% to 14%, but inappropriate testing in hospitalized patients has not been well studied. Appropriate use of stress testing in hospitalized patients is not comparable to the ambulatory setting. We studied 459 consecutive patients referred for imaging stress tests (nuclear imaging or stress echocardiography) at a single institution over a 6-month period. Appropriate use was determined by research cardiologists blinded to patient outcomes. Most tests (68%) were in patients with chest pain or possible acute coronary syndrome (ACS). Another 20% were for preoperative evaluation. The rate of inappropriate testing was 13%. Imaging modality did not correlate with appropriate use. Only 2% of the chest pain or possible ACS were inappropriate, compared to 49% of the preoperative exams (P < 0.001). The most common reason a test was considered inappropriate was for a low-risk patient for preoperative exam (77% of inappropriate tests). Using Thrombolysis in Myocardial Infarction score 0 to define inappropriate testing in the possible ACS cohort might make an additional 27% inappropriate. The rate of inappropriate use of cardiac stress testing with imaging in the inpatient setting is similar to that in the ambulatory setting. However, there is wide variation in inappropriate testing based on the indication for the test. Taking risk into consideration in possible ACS patients could result in a larger number of tests being considered inappropriate. © 2014 Wiley Periodicals, Inc.

  3. Remission in rheumatoid arthritis: a comparison of the 2 newly proposed ACR/EULAR remission criteria with the rheumatoid arthritis disease activity index-5, a patient self-report disease activity index.

    PubMed

    Rintelen, Bernhard; Sautner, Judith; Haindl, Pia; Mai, Harsono; Brezinschek, Hans-Peter; Leeb, Burkhard F

    2013-04-01

    We analyzed whether a patient self-report remission criterion, such as that according to the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), meets the criteria of the 2011 proposed American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) definition of remission. The 2 approaches of the ACR/EULAR proposal [Boolean- and Simplified Disease Activity Index (SDAI)-based] as well as the RADAI-5 were used to assess whether patients with RA are in remission. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and kappa analyses were performed to illustrate the relationship among the different approaches defining remission at a group level. In total, 705 patients' assessments were included. Eighty-nine patients were classified as being in remission according to the Boolean-based and 169 according to the SDAI-based definition of the ACR/EULAR proposals, and 154 according to the RADAI-5. Sixty-eight assessments were classified as being in remission according to all 3 definitions. In the case of RADAI-5 remission, sensitivity was 78%, specificity 86%, PPV 45%, and NPV 96%, indicating remission according to the Boolean-based definition; and 60%, 92%, 66%, and 90%, respectively, indicating remission according to the SDAI-based definition. In the case of remission according to the SDAI-based ACR/EULAR definition, sensitivity was 52%, specificity 100%, PPV 98%, and NPV 87%, also indicating remission according to the Boolean definition; while according to the Boolean definition the values were 98%, 87%, 52%, and 100%, respectively. Kappa statistics showed fair to good agreement for all 3 definitions. Nearly twice as many assessments were classified as being in remission using the SDAI-based or the RADAI-5 definitions when compared to the Boolean-based definition. Remission according to the RADAI-5 also was highly specific for both ACR/EULAR criteria. Sensitivity for the RADAI-5 criterion was even better for the Boolean

  4. The 2010 ACR/EULAR criteria are not sufficiently accurate in the early identification of autoantibody-negative rheumatoid arthritis: Results from the Leiden-EAC and ESPOIR cohorts.

    PubMed

    Boeters, Debbie M; Gaujoux-Viala, Cécile; Constantin, Arnaud; van der Helm-van Mil, Annette H M

    2017-10-01

    The 2010 ACR/EULAR criteria were derived to classify rheumatoid arthritis (RA) earlier in time. Previous studies indeed observed that the 2010 criteria were fulfilled earlier than the 1987 criteria. This study determined whether the 2010 criteria perform equally in early classification of autoantibody-positive and autoantibody-negative RA. From the total Leiden-EAC (n = 3448) and ESPOIR (n = 813) RA patients who fulfilled the 1987 RA criteria at 1 year but not at presentation were selected (n = 463 and n = 53, respectively), as these patients were classified with delay with the 1987 criteria. These RA patients were studied on fulfilling the 2010 criteria at baseline (as 2010 positivity indicated that these RA patients were earlier identified) and these analyses were stratified for patients with and without anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF). Analyses were repeated for DMARD start within the first year as reference for RA (instead of fulfilling the 1987 criteria). In the EAC, 75% of the selected RA patients did already fulfill the 2010 criteria at baseline. In ESPOIR this was 57%, indeed demonstrating early classification with the 2010 criteria. Among the selected autoantibody-positive RA patients of the EAC, 93% was already identified at baseline with the 2010 criteria. Within autoantibody-negative RA this was 51% (p < 0.001), indicating that 49% of autoantibody-negative RA patients were not early classified with the 2010 criteria. Similarly, within autoantibody-positive RA patients in ESPOIR 92% were 2010 positive at baseline, whereas this was only 25% within autoantibody-negative RA (p < 0.001), indicating that 75% of autoantibody-negative RA patients were not early classified with the 2010 criteria. Similar results were obtained when DMARD start was the reference for RA. The 2010 criteria perform well in the early identification of autoantibody-positive RA, but autoantibody-negative RA patients are still frequently missed

  5. Role of erosions typical of rheumatoid arthritis in the 2010 ACR/EULAR rheumatoid arthritis classification criteria: results from a very early arthritis cohort.

    PubMed

    Brinkmann, Gina Hetland; Norli, Ellen S; Bøyesen, Pernille; van der Heijde, Désirée; Grøvle, Lars; Haugen, Anne J; Nygaard, Halvor; Bjørneboe, Olav; Thunem, Cathrine; Kvien, Tore K; Mjaavatten, Maria D; Lie, Elisabeth

    2017-11-01

    To determine how the European League Against Rheumatism (EULAR) definition of erosive disease (erosion criterion) contributes to the number of patients classified as rheumatoid arthritis (RA) according to the 2010 American College of Rheumatology/EULAR RA classification criteria (2010 RA criteria) in an early arthritis cohort. Patients from the observational study Norwegian Very Early Arthritis Clinic with joint swelling ≤16 weeks, a clinical diagnosis of RA or undifferentiated arthritis, and radiographs of hands and feet were included. Erosive disease was defined according to the EULAR definition accompanying the 2010 RA criteria. We calculated the additional number of patients being classified as RA based on the erosion criteria at baseline and during follow-up. Of the 289 included patients, 120 (41.5%) fulfilled the 2010 RA criteria, whereas 15 (5.2%) fulfilled only the erosion criterion at baseline. 118 patients had radiographic follow-up at 2 years, of whom 6.8% fulfilled the 2010 RA criteria and only one patient fulfilled solely the erosion criterion during follow-up. Few patients with early arthritis were classified as RA based on solely the erosion criteria, and of those who did almost all did so at baseline. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. The use of appropriateness criteria for the selection of clinical preventive services for a Pacific island health service.

    PubMed

    Durand, A M; Decherong, Kate; Ngirasowei, Janice; Bechesrrak, Yuriko; Malsol, Selerina; Osarch, Sylvia; Marcil, Angela; Kuartei, Stevenson; Dever, Greg

    2005-03-01

    Clinical preventive services are measures performed in the clinic setting for the prevention of disease and the promotion of health. The general practice/public health physician residency class of the Palau Area Health Education Center reviewed existing clinical preventive services protocols for the Ministry of Health of the Republic of Palau and revised them, taking four criteria into consideration for each candidate intervention (local patterns of disease and risk factors, evidence for effectiveness of the intervention, local system capability for delivery of the intervention and its consequences, and competing priorities). The resulting package of interventions is much more focused and appropriate to local conditions than was the one that it replaced. It has the potential to improve the health status of the population by making better use of available resources.

  7. 75 FR 58448 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Future Plant Designs The ACRS Subcommittee on Future Plant Designs will hold a meeting on October 21, 2010, at 11545... Subcommittee will review current Design Acceptance Criteria associated with Digital Instrumentation and...

  8. Patients with seronegative RA have more inflammatory activity compared with patients with seropositive RA in an inception cohort of DMARD-naïve patients classified according to the 2010 ACR/EULAR criteria.

    PubMed

    Nordberg, Lena Bugge; Lillegraven, Siri; Lie, Elisabeth; Aga, Anna-Birgitte; Olsen, Inge Christoffer; Hammer, Hilde Berner; Uhlig, Till; Jonsson, Maria Karolina; van der Heijde, Désirée; Kvien, Tore K; Haavardsholm, Espen Andre

    2017-02-01

    To compare the presentation of seropositive and seronegative early rheumatoid arthritis (RA) in disease-modifying antirheumatic drug (DMARD)-naïve patients classified according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. All patients had symptom duration from first swollen joint <2 years and were DMARD naïve with an indication for DMARD treatment. Patients were stratified as seropositive (positive rheumatoid factor (RF)+ and/or anticitrullinated peptide antibody (ACPA)+) or seronegative (RF- and ACPA-), and disease characteristics were compared between groups. A total of 234 patients were included, and 36 (15.4%) were seronegative. Ultrasonography (US) scores for joints (median 55 vs 25, p<0.001) and tendons (median 3 vs 0, p<0.001), number of swollen joints (median 17 vs 8, p<0.001), disease activity score (DAS; mean 3.9 vs 3.4, p=0.03) and physician global assessment (mean 49.1 vs 38.9, p=0.006) were significantly higher in seronegative patients compared with seropositive. Total van der Heijde-modified Sharp score, Richie Articular Index and patient-reported outcome measures were similar between groups. Seronegative patients had higher levels of inflammation, assessed both clinically and by US, than seropositive patients. These differences may reflect the high number of involved joints required for seronegative patients to fulfil the 2010 ACR/EULAR classification criteria for RA. NCT01205854; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Synergistic toxic effects of zinc pyrithione and copper to three marine species: Implications on setting appropriate water quality criteria.

    PubMed

    Bao, Vivien W W; Leung, Kenneth M Y; Kwok, Kevin W H; Zhang, Amy Q; Lui, Gilbert C S

    2008-01-01

    Zinc pyrithione (ZnPT) is widely applied in conjunction with copper (Cu) in antifouling paints as a substitute for tributyltin. The combined effects of ZnPT and Cu on marine organisms, however, have not been fully investigated. This study examined the toxicities of ZnPT alone and in combination with Cu to the diatom Thalassiosira pseudonana, polychaete larvae Hydroides elegans and amphipod Elasmopus rapax. Importantly, ZnPT and Cu resulted in a strong synergistic effect with isobologram interaction parameter lambda>1 for all test species. The combined toxicity of ZnPT and Cu was successfully modelled using the non-parametric response surface and its contour. Such synergistic effects may be partly due to the formation of copper pyrithione. It is, therefore, inadequate to assess the ecological risk of ZnPT to marine organisms solely based on the toxicity data generated from the biocide alone. To better protect precious marine resources, it is advocated to develop appropriate water quality criteria for ZnPT with the consideration of its compelling synergistic effects with Cu at environmentally realistic concentrations.

  10. Analytical method transfer using equivalence tests with reasonable acceptance criteria and appropriate effort: extension of the ISPE concept.

    PubMed

    Kaminski, L; Schepers, U; Wätzig, H

    2010-12-15

    A method development process is commonly finalized by a method transfer from the developing to the routine laboratory. Statistical tests are performed in order to survey if a transfer succeeded or failed. However, using the classic two-sample t-test can lead to misjudgments and unsatisfying transfer results due to its test characteristics. Therefore the International Society of Pharmaceutical Engineering (ISPE) employed a fixed method transfer design using equivalence tests in their Guide for Technology Transfer. Although it was well received by analytical laboratories worldwide this fixed design can easily bring about high beta-errors (rejection of successful transfers) or high workload (many analysts employed during transfer) if sigma(AN) (error due to different analysts) exceeds 0.6%. Hence this work introduces an extended concept which will help to circumvent this disadvantage by providing guidance to select a personalized and more appropriate experimental design. First of all it demonstrates that former t-test related acceptance criteria can be scaled by a factor of 1.15, which allows for a broader tolerance without a loss of decision certainty. Furthermore a decision guidance to choose the proper number of analysts or series at given percentage acceptance limits (%AL) is presented.

  11. Effects of therapeutic drug monitoring criteria in a computerized prescriber-order-entry system on the appropriateness of vancomycin level orders.

    PubMed

    Traugott, Kristi A; Maxwell, Pamela R; Green, Kay; Frei, Christopher; Lewis, James S

    2011-02-15

    The effects of therapeutic drug monitoring (TDM) criteria in a computerized prescriber-order-entry (CPOE) system on the appropriateness of orders for vancomycin levels were evaluated. Vancomycin TDM criteria were developed and implemented in a CPOE system. These criteria were displayed via a pop-up alert message when vancomycin levels were ordered and included directions for appropriate timing and justification for routine monitoring. Data for two groups of adult inpatients who had vancomycin levels ordered before and after criteria implementation were compared. Medical records were retrospectively reviewed for these patients to collect information regarding patient demographics, vancomycin dosage and indication, concurrent antibiotics and nephrotoxic agents during vancomycin therapy, length of stay, duration of vancomycin therapy, and number of vancomycin levels drawn. The primary outcome was the percent change in appropriate vancomycin levels ordered after criteria implementation. A total of 200 patients were analyzed, 100 in each group. The percentage of appropriate orders for vancomycin levels significantly increased after criteria implementation (from 58% to 68%, p = 0.02). The greatest effect on appropriateness occurred with the first level ordered (52% versus 70% in the preimplementation and postimplementation groups, respectively; p = 0.01). The majority of inappropriate levels were due to improper timing of sample collections, accounting for 55% of the inappropriate levels evaluated. A significant increase in the number of appropriately ordered and drawn serum vancomycin levels occurred after implementation of TDM criteria in the hospital's CPOE system. The majority of orders that were deemed inappropriate were due to improper timing of laboratory collection.

  12. Can physicians identify inappropriate nuclear stress tests? An examination of inter-rater reliability for the 2009 appropriate use criteria for radionuclide imaging.

    PubMed

    Ye, Siqin; Rabbani, LeRoy E; Kelly, Christopher R; Kelly, Maureen R; Lewis, Matthew; Paz, Yehuda; Peck, Clara L; Rao, Shaline; Bokhari, Sabahat; Weiner, Shepard D; Einstein, Andrew J

    2015-01-01

    We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications. Four hundred patients were randomly selected from a consecutive cohort of patients undergoing nuclear stress testing at an academic medical center. Raters with different levels of training (including cardiology attending physicians, cardiology fellows, internal medicine hospitalists, and internal medicine interns) classified individual nuclear stress tests using the 2009 Appropriate Use Criteria. Consensus classification by 2 cardiologists was considered the operational gold standard, and sensitivity and specificity of individual raters for identifying inappropriate tests were calculated. Inter-rater reliability of the Appropriate Use Criteria was assessed using Cohen κ statistics for pairs of different raters. The mean age of patients was 61.5 years; 214 (54%) were female. The cardiologists rated 256 (64%) of 400 nuclear stress tests as appropriate, 68 (18%) as uncertain, 55 (14%) as inappropriate; 21 (5%) tests were unable to be classified. Inter-rater reliability for noncardiologist raters was modest (unweighted Cohen κ, 0.51, 95% confidence interval, 0.45-0.55). Sensitivity of individual raters for identifying inappropriate tests ranged from 47% to 82%, while specificity ranged from 85% to 97%. Inter-rater reliability for the 2009 Appropriate Use Criteria for radionuclide imaging is modest, and there is considerable variation in the ability of raters at different levels of training to identify inappropriate tests. © 2015 American Heart Association, Inc.

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... determine whether it is appropriate to recommend that a feasibility study be conducted? 404.44 Section 404... will Reclamation apply to determine whether it is appropriate to recommend that a feasibility study be... feasibility study, or whether the investigation should be terminated without conducting a feasibility...

  14. Revascularization heart team recommendations as an adjunct to appropriate use criteria for coronary revascularization in patients with complex coronary artery disease.

    PubMed

    Sanchez, Carlos E; Dota, Anthony; Badhwar, Vinay; Kliner, Dustin; Smith, A J Conrad; Chu, Danny; Toma, Catalin; Wei, Lawrence; Marroquin, Oscar C; Schindler, John; Lee, Joon S; Mulukutla, Suresh R

    2016-10-01

    To evaluate how a comprehensive evidence-based clinical review by a multidisciplinary revascularization heart team on treatment decisions for revascularization in patients with complex coronary artery disease using SYNTAX scores combined with Society of Thoracic Surgeons-derived clinical variables can be additive to the utilization of Appropriate Use Criteria for coronary revascularization. Decision-making regarding the use of revascularization for coronary artery disease has come under major scrutiny due to inappropriate overuse of revascularization. There is little data in routine clinical practice evaluating how a structured, multidisciplinary heart team approach may be used in combination with the Appropriate Use Criteria for revascularization. From May 1, 2012 to January 1, 2015, multidisciplinary revascularization heart team meetings were convened to discuss evidence-based management of 301 patients with complex coronary artery disease. Heart team recommendations were adjudicated with the Appropriate Use Criteria for coronary revascularization for each clinical scenario using the Society for Cardiovascular Angiography and Interventions' Quality Improvement Toolkit (SCAI-QIT) Appropriate Use Criteria App. Concordance of the Heart Team to Appropriate Use Criteria had a 99.3% appropriate primary indication for coronary revascularization. Among patients who underwent percutaneous revascularization, 34.9% had an inappropriate or uncertain indication as recommended by the Heart Team. Patients with uncertain or inappropriate percutaneous coronary interventions had significantly higher SYNTAX score (27.3 ± 6.6; 28.5 ± 5.5; 19.2 ± 6; P < 0.0001) and Society of Thoracic Surgeons-Predicted Risk of Mortality (6.1% ± 4.7%; 8.1% ± 6.3%; 3.7% ± 4.1%; P < 0.0081) compared to appropriate indications, frequently had concomitant forms of advanced comorbidities and frailty in the setting of symptomatic coronary artery disease. A formal

  15. Adherence to the 2010 American College of Cardiology Foundation Appropriate Use Criteria for Cardiac Computed Tomography: Quality Analysis at a Tertiary Referral Center.

    PubMed

    Sidhu, Manavjot S; Lumish, Heidi; Uthamalingam, Shanmugam; Engel, Leif-Christopher; Abbara, Suhny; Brady, Thomas J; Hoffmann, Udo; Ghoshhajra, Brian B

    2016-03-01

    In November 2010, the American College of Cardiology Foundation published revised appropriateness criteria (AC) for cardiac computed tomography (CT). We evaluated adherence to these criteria by providers of different subspecialties at a tertiary referral center. Reports of 383 consecutive patients who underwent clinically indicated cardiac CT from December 1, 2010, to July 31, 2011, were reviewed by physicians with appropriate training in cardiac CT. Scans were classified as appropriate, inappropriate, or uncertain based on the revised 2010 AC. Studies that did not fall under any of the specified indications were labeled as unclassified. Adherence to the AC was also analyzed as a function of provider type. Research scans were excluded from this analysis. Three hundred eight exams (80%) were classified as appropriate; 26 (7%), as inappropriate; 30 (8%), as uncertain; and 19 (5%), as unclassified. Of the 19 (5%) unclassified cardiac CT exams, the most common indication was for evaluation of suspected aortic dissection. Three hundred five exams (80%) were referred by cardiologists; 73 (19%), by internists; and 5 (1%), by neurologists. Of the 305 cardiology-referred studies, 221 (73%) were ordered by general cardiologists; 28 (9%), by interventional cardiologists; and 56 (19%), by electrophysiologists. There was no significant difference in adherence to the criteria between provider specialties or between cardiology subspecialties (P > 0.05). high across provider specialties.

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... in the investigation, whether the alternative: (1) Identifies viable water supplies and water rights sufficient to supply the proposed service area, including all practicable water sources such as lower quality...

  17. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... in the investigation, whether the alternative: (1) Identifies viable water supplies and water rights sufficient to supply the proposed service area, including all practicable water sources such as lower quality...

  18. 43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Appraisal Investigations § 404.44 What criteria... in the investigation, whether the alternative: (1) Identifies viable water supplies and water rights sufficient to supply the proposed service area, including all practicable water sources such as lower quality...

  19. Can utilization review criteria be used to determine appropriate pediatric patient placement for a critical care bed expansion?

    PubMed

    Jamieson, Donna; Mikhailov, Theresa A; Maletta, Kristyn; Kuhn, Evelyn M; Giuliani, Lauren; Musolf, Jeanne; Fischer, Kay; Collins, Maureen

    2011-01-01

    The rising trend in critical care utilization has led to the expansion of critical care beds in many hospitals across the country. Traditional models of estimating bed capacity requirements use administrative data such as inpatient admissions, length of stay, and case mix index. The use of such data has been limited in quantifying the complexities of demand variables in critical care bed needs. Mathematical modeling is another method for estimating numbers of beds required. It captures the dynamic changes in the management of critically ill patients that occur when units become full. Depending on data analysis methods used, bed need underestimation or overestimation can occur. In our study, we used utilization review criteria to understand changes in level of care (LOC) during the course of patients' stays and to validate critical care bed expansion needs. Using LOC criteria, we studied the proportion of our intermediate care patients in an acute care unit that met acute, intermediate, or critical care criteria. We also evaluated whether these proportions were related to specific factors such as census ratios, staffing proportions, or severity of illness. Using LOC criteria was helpful in validating our critical care bed projection, which was previously derived from mathematical modeling. The findings also validated our assessment for additional specialty acute care beds.

  20. ASCI 2010 appropriateness criteria for cardiac computed tomography: a report of the Asian Society of Cardiovascular Imaging Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging Guideline Working Group.

    PubMed

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

    2010-02-01

    In Asia, the healthcare system, populations and patterns of disease differ from Western countries. The current reports on the criteria for cardiac CT scans, provided by Western professional societies, are not appropriate for Asian cultures. The Asian Society of Cardiovascular Imaging, the only society dedicated to cardiovascular imaging in Asia, formed a Working Group and invited 23 Technical Panel members representing a variety of Asian countries to rate the 51 indications for cardiac CT in clinical practice in Asia. The indications were rated as 'appropriate' (7-9), 'uncertain' (4-6), or 'inappropriate' (1-3) on a scale of 1-9. The median score was used for the final result if there was no disagreement. The final ratings for indications were 33 appropriate, 14 uncertain and 4 inappropriate. And 20 of them are highly agreed (19 appropriate and 1 inappropriate). Specifically, the Asian representatives considered cardiac CT as an appropriate modality for Kawasaki disease and congenital heart diseases in follow up and in symptomatic patients. In addition, except for some specified conditions, cardiac CT was considered to be an appropriate modality for one-stop shop ischemic heart disease evaluation due to its general appropriateness in coronary, structure and function evaluation. This report is expected to have a significant impact on the clinical practice, research and reimbursement policy in Asia.

  1. Praise Acres Project

    ERIC Educational Resources Information Center

    Hayes, Carolyn

    2004-01-01

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

  2. Praise Acres Project

    ERIC Educational Resources Information Center

    Hayes, Carolyn

    2004-01-01

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

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

    PubMed Central

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

    2015-01-01

    In Latin American, there is currently a regional action with the main purposes of putting the concept of severe neonatal morbidity in practice and formulating proposals for interventions. A general overview of neonatal health conditions, including morbidity and mortality, is provided to update regional knowledge on the topic. An example of the development and implementation of the concept of maternal near miss is also provided, followed by results from a systematic review covering all previously published studies on Neonatal Near Miss. Finally, some proposals for building a common concept on the topic and for launching a prospective surveillance study are presented. A Neonatal Near Miss is a neonate who had a severe morbidity (organ dysfunction or failure) but who survived this condition within the first 27 days of life. The pragmatic criteria recommended to be used are as follows: birth weight below 1700 g, Apgar score below 7 at 5 minutes of life and gestational age below 33 weeks. As a proxy for organ dysfunction, the following management criteria are also confirmed: parenteral therapeutic antibiotics; nasal continuous positive airway pressure; any intubation during the first 27 days of life; phototherapy within the first 24 h of life; cardiopulmonary resuscitation; the use of vasoactive drugs, anticonvulsants, surfactants, blood products and steroids for refractory hypoglycemia and any surgical procedure. Although this study starts from a regional perspective, this topic is clearly globally relevant. All nations, especially low and middle-income countries, could benefit from the proposed standardization. PMID:26735223

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

    PubMed

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

    2015-12-01

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

  5. Molecular cloning and characterization of acrA and acrE genes of Escherichia coli.

    PubMed Central

    Ma, D; Cook, D N; Alberti, M; Pon, N G; Nikaido, H; Hearst, J E

    1993-01-01

    The DNA fragment containing the acrA locus of the Escherichia coli chromosome has been cloned by using a complementation test. The nucleotide sequence indicates the presence of two open reading frames (ORFs). Sequence analysis suggests that the first ORF encodes a 397-residue lipoprotein with a 24-amino-acid signal peptide at its N terminus. One inactive allele of acrA from strain N43 was shown to contain an IS2 element inserted into this ORF. Therefore, this ORF was designated acrA. The second downstream ORF is predicted to encode a transmembrane protein of 1,049 amino acids and is named acrE. Genes acrA and acrE are probably located on the same operon, and both of their products are likely to affect drug susceptibilities observed in wild-type cells. The cellular localizations of these polypeptides have been analyzed by making acrA::TnphoA and acrE::TnphoA fusion proteins. Interestingly, AcrA and AcrE share 65 and 77% amino acid identity with two other E. coli polypeptides, EnvC and EnvD, respectively. Drug susceptibilities in one acrA mutant (N43) and one envCD mutant (PM61) have been determined and compared. Finally, the possible functions of these proteins are discussed. Images PMID:8407802

  6. How Big Is an Acre?

    ERIC Educational Resources Information Center

    Augustin, Byron D.; Brandes, Donald

    1984-01-01

    Many students do not have the slightest idea of how much land is in an acre. A diagram of the official playing field for American football is used to illustrate the approximate size of an acre of land. (RM)

  7. The Role of 18F-FDG PET/CT in Large-Vessel Vasculitis: Appropriateness of Current Classification Criteria?

    PubMed Central

    Balink, H.; Bennink, R. J.; van Eck-Smit, B. L. F.; Verberne, H. J.

    2014-01-01

    Patients with clinical suspicion of large-vessel vasculitis (LVV) may present with nonspecific signs and symptoms and increased inflammatory parameters and may remain without diagnosis after routine diagnostic procedures. Both the nonspecificity of the radiopharmaceutical 18F-FDG and the synergy of integrating functional and anatomical images with PET/CT offer substantial benefit in the diagnostic work-up of patients with clinical suspicion for LVV. A negative temporal artery biopsy, an ultrasonography without an arterial halo, or a MRI without aortic wall thickening or oedema do not exclude the presence of LVV and should therefore not exclude the use of 18F-FDG PET/CT when LVV is clinically suspected. This overview further discusses the notion that there is substantial underdiagnosis of LVV. Late diagnosis of LVV may lead to surgery or angioplasty in occlusive forms and is often accompanied by serious aortic complications and a fatal outcome. In contrast to the American College of Rheumatology 1990 criteria for vasculitis, based on late LVV effects like arterial stenosis and/or occlusion, 18F-FDG PET/CT sheds new light on the classification of giant cell arteritis (GCA) and Takayasu arteritis (TA). The combination of these observations makes the role of 18F-FDG PET/CT in the assessment of patients suspected for having LVV promising. PMID:25328890

  8. ACR Presidential Address ACR: Imagine the World Without Her.

    PubMed

    Ellenbogen, Paul H

    2015-09-01

    Imagine the world without the ACR. Imagine that Wilhelm Conrad Roentgen had died before November 8, 1895. Imagine that Albert Soiland, MD, had not founded the ACR in 1923. What would medicine look like now? The ACR is important in many ways: advocacy and economics, education, quality and safety, clinical research, publication, leadership, and diversity. The ACR is vital to patients, radiologists, and other physicians. The ACR is unique: No other organization or group of societies could fill the void. So instead of imagining a world without the ACR, imagine a better world-one in which patients always come first, and all imaging professionals are active members of the ACR. We are the lucky ones-we can change the world. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  9. MO-AB-207-01: ACR Update in CT

    SciTech Connect

    McNitt-Gray, M.

    2015-06-15

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

  10. MO-AB-207-02: ACR Update in MR

    SciTech Connect

    Price, R.

    2015-06-15

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

  11. MO-AB-207-04: ACR Update in Mammography

    SciTech Connect

    Berns, E.

    2015-06-15

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2013-03-01

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

  14. Exploring the enablers and barriers to implementing the Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria in Australia: a qualitative study.

    PubMed

    Page, Amy Theresa; Clifford, Rhonda Marise; Potter, Kathleen; Seubert, Liza; McLachlan, Andrew J; Hill, Xaysja; King, Stephanie; Clark, Vaughan; Ryan, Cristin; Parekh, Nikesh; Etherton-Beer, Christopher D

    2017-08-23

    The Medication Appropriateness Tool for Comorbid Health conditions in Dementia (MATCH-D) criteria provide expert consensus guidance about medication use for people with dementia. This study aimed to identify enablers and barriers to implementing the criteria in practice. Participants came from both rural and metropolitan communities in two Australian states. Focus groups were held with consumers, general practitioners, nurses and pharmacists. data were analysed thematically. Nine focus groups were conducted. Fifty-five participants validated the content of MATCH-D, appraising them as providing patient-centred principles of care. Participants identified potential applications (including the use of MATCH-D as a discussion aid or educational tool for consumers about medicines) and suggested supporting resources. Participants provided insights into applying MATCH-D in practice and suggested resources to be included in an accompanying toolkit. These data provide external validation of MATCH-D and an empiric basis for their translation to practice. Following resource development, we plan to evaluate the feasibility and efficacy of implementation in practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

    PubMed Central

    Cardona-Morrell, Magnolia; Hillman, Ken

    2015-01-01

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

  16. Can Physicians Identify Inappropriate Nuclear Stress Tests? An Examination of Inter-rater Reliability for the 2009 Appropriate Use Criteria for Radionuclide Imaging

    PubMed Central

    Ye, Siqin; Rabbani, LeRoy E.; Kelly, Christopher R.; Kelly, Maureen R.; Lewis, Matthew; Paz, Yehuda; Peck, Clara L.; Rao, Shaline; Bokhari, Sabahat; Weiner, Shepard D.; Einstein, Andrew J.

    2014-01-01

    Background We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria (AUC) for radionuclide imaging (RNI) and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications. Methods and Results Four hundred patients were randomly selected from a consecutive cohort of patients undergoing nuclear stress testing at an academic medical center. Raters with different levels of training (including cardiology attending physicians, cardiology fellows, internal medicine hospitalists, and internal medicine interns) classified individual nuclear stress tests using the 2009 AUC. Consensus classification by two cardiologists was considered the operational gold standard, and sensitivity and specificity of individual raters for identifying inappropriate tests was calculated. Inter-rater reliability of the AUC was assessed using Cohen’s kappa statistics for pairs of different raters. The mean age of patients was 61.5 years; 214 (54%) were female. The cardiologists rated 256 (64%) of 400 NSTs as appropriate, 68 (18%) as uncertain, 55 (14%) as inappropriate; 21 (5%) tests were unable to be classified. Inter-rater reliability for non-cardiologist raters was modest (unweighted Cohen’s kappa, 0.51, 95% confidence interval, 0.45 to 0.55). Sensitivity of individual raters for identifying inappropriate tests ranged from 47% to 82%, while specificity ranged from 85% to 97%. Conclusions Inter-rater reliability for the 2009 AUC for RNI is modest, and there is considerable variation in the ability of raters at different levels of training to identify inappropriate tests. PMID:25563660

  17. A proposed approach for quantitative benefit-risk assessment in diagnostic radiology guideline development: the American College of Radiology Appropriateness Criteria Example.

    PubMed

    Agapova, Maria; Bresnahan, Brian B; Higashi, Mitchell; Kessler, Larry; Garrison, Louis P; Devine, Beth

    2017-02-01

    The American College of Radiology develops evidence-based practice guidelines to aid appropriate utilization of radiological procedures. Panel members use expert opinion to weight trade-offs and consensus methods to rate appropriateness of imaging tests. These ratings include an equivocal range, assigned when there is disagreement about a technology's appropriateness and the evidence base is weak or for special circumstances. It is not clear how expert consensus merges with the evidence base to arrive at an equivocal rating. Quantitative benefit-risk assessment (QBRA) methods may assist decision makers in this capacity. However, many methods exist and it is not clear which methods are best suited for this application. We perform a critical appraisal of QBRA methods and propose several steps that may aid in making transparent areas of weak evidence and barriers to consensus in guideline development. We identify QBRA methods with potential to facilitate decision making in guideline development and build a decision aid for selecting among these methods. This study identified 2 families of QBRA methods suited to guideline development when expert opinion is expected to contribute substantially to decision making. Key steps to deciding among QBRA methods involve identifying specific benefit-risk criteria and developing a state-of-evidence matrix. For equivocal ratings assigned for reasons other than disagreement or weak evidence base, QBRA may not be needed. In the presence of disagreement but the absence of a weak evidence base, multicriteria decision analysis approaches are recommended; and in the presence of weak evidence base and the absence of disagreement, incremental net health benefit alone or combined with multicriteria decision analysis is recommended. Our critical appraisal further extends investigation of the strengths and limitations of select QBRA methods in facilitating diagnostic radiology clinical guideline development. The process of using the decision

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

    PubMed

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

    2012-04-01

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

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

    PubMed

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

    2012-02-28

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

  20. 78 FR 2694 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Fukushima...

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    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Fukushima; Cancellation of the January 18, 2013, ACRS Subcommittee Meeting The ACRS Subcommittee meeting on...

  1. 78 FR 34677 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the Acrs Subcommittee on Materials...

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    ... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the Acrs Subcommittee on Materials, Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels... pellet-cladding interaction during anticipated operational occurrences for Pressurized Water...

  2. 77 FR 76089 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

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    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR... Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

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    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels... Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

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    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels.... Cayetano Santos, Chief, Technical Support Branch, Advisory Committee on Reactor Safeguards. BILLING...

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

  7. 76 FR 34779 - Advisory Committee On Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Radiation...

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

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

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

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

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    2011-06-21

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

  12. 76 FR 27101 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

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

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

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

  14. 76 FR 55716 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of The ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

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

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

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

  16. 78 FR 17944 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

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

  17. 78 FR 79020 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

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

  18. 76 FR 61119 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

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

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

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

  20. 78 FR 79019 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

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

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-17

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

  2. 78 FR 56756 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-13

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

  3. 76 FR 24540 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-02

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

  4. 75 FR 55365 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Joint Subcommittee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-10

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Joint Subcommittee The ACRS Subcommittees on Thermal Hydraulics Phenomena; Advanced Boiling Water Reactor (ABWR); and Materials,...

  5. 76 FR 55717 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability and Probabilistic Risk Assessment The ACRS Subcommittee on Reliability and PRA will hold a...

  6. 76 FR 18585 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water...

  7. 77 FR 47680 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittees on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-09

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittees on Reliability and PRA and Fukushima; Revision to Notice of Meetings The (ACRS) Subcommittee on Fukushima...

  8. Classification criteria for rheumatoid arthritis.

    PubMed

    MacGregor, A J

    1995-05-01

    The development of classification schemes for RA in the last 40 years has followed the increasingly precise understanding of the nature of the clinical disease and the recognition of the different requirements of classification methods in clinic and population settings. In published studies of RA in clinic patients the most widely used criteria sets have been the 1958 ARA (ACR) criteria and its 1961 adaptation (the Rome (active) criteria). These sets classified disease as 'classical', 'definite', 'probable' and 'possible' RA based on criteria comprising clinical, serological, radiological and histological features (the latter were dropped from the Rome criteria set because of their impracticality). More recently, a new criteria set (the 1987 ARA criteria) has been developed using statistical techniques. This set was derived using RA cases and controls attending hospital clinics. It is based on the earlier criteria sets but accommodates the characteristic pattern of joint involvement in RA more precisely. The criteria recognize only the single disease category of 'rheumatoid arthritis'. In validation studies, the 1987 criteria set has been found to have enhanced specificity over earlier schemes in clinic-based studies of RA. The sensitivity may, however, be reduced, in particular in studies of early disease. The application of classification criteria for case recognition in the population and family studies of RA has proved more problematic. In these settings, there is the additional requirement to recognize individuals with remitted and inactive disease as RA cases. The 1966 New York criteria were developed for this specific purpose, however their format proved cumbersome and they have not been widely adopted. The 1987 criteria set is insufficiently sensitive to recognize inactive disease if the criteria are applied exactly as they have been defined. The sensitivity of the 1987 criteria set is, however, substantially enhanced if the criteria are adapted to

  9. Physician adherence to ACR gout treatment guidelines: perception versus practice.

    PubMed

    Oderda, Gary M; Shiozawa, Aki; Walsh, Michael; Hess, Kyle; Brixner, Diana I; Feehan, Michael; Akhras, Kasem

    2014-05-01

    In October 2012, the American College of Rheumatology (ACR) published recommendations for chronic gout treatment goals and pharmacotherapy. Identify potential gaps between real-world chronic gout treatment, ACR guideline recommendations, and physicians' perceived guideline adherence by evaluating records of patients classified as having "higher" and "lower" guideline adherence as defined by the investigators. A comprehensive quantitative survey was administered between February 11 and February 22, 2013, to physicians treating patients with gout; the survey included a patient record chart review informed by prior qualitative interviews. Eight criteria from the ACR gout management guidelines were used to compose the survey. To assess ACR guideline adherence, information from records of patients with chronic gout treated by primary care physicians (PCPs) and rheumatologists was scored from 0 (no adherence) to 8 (total adherence), in accordance with ACR guideline recommendations. Physicians also indicated how closely they believed patient treatment followed current guidelines on a 10-point scale. Of the 350 records of patients with chronic gout, all but 3 PCP patients were adherent on ≥ 1 guideline recommendation, but nearly all patients could be considered nonadherent, considering all potential recommendations. Patients with chronic gout treated by rheumatologists tended to be managed more closely to ACR guidelines than patients treated by PCPs (mean scores: rheumatologists 5.8/8 ± 1.7 vs 4.3/8 ± 1.7 for PCPs). Among patients classified as having "higher adherence" based on adherence scores, there was low adherence on first-line urate lowering therapy dose, acute prophylaxis dosing, and length of prophylaxis treatment. Among PCPs and rheumatologists, there was a disparity between how closely physicians believed patient treatment followed guidelines and actual adherence with ACR guidelines based on adherence scores. For 16.4% of patients treated by PCPs and 18

  10. Appropriate risk criteria for OATP inhibition at the drug discovery stage based on the clinical relevancy between OATP inhibitors and drug-induced adverse effect.

    PubMed

    Nakakariya, Masanori; Goto, Akihiko; Amano, Nobuyuki

    2016-10-01

    DDI could be caused by the inhibition of OATP-mediated hepatic uptakes. The aim of this study is to set the risk criteria for the compounds that would cause DDI via OATP inhibition at the drug discovery stage. The IC50 values of OATP inhibitors for human OATP-mediated atorvastatin uptake were evaluated in the expression system. In order to set the risk criteria for OATP inhibition, the relationship was clarified between OATP inhibitory effect and severe adverse effects of OATP substrates, rhabdomyolysis, hyperbilirubinemia and jaundice. Rhabdomyolysis would be caused in the atorvastatin AUC more than 9-fold of that at a minimum therapeutic dose. The atorvastatin AUC was 6- to 9-fold increased with the OATP inhibitors of which IC50 values were ≤1 μmol/L. Hyperbilirubinemia and jaundice would be caused with the OATP inhibitors of which IC50 values were ≤6 μmol/L. This investigation showed that the compounds with IC50 of ≤1 μmol/L would have high risk for OATP-mediated DDI that would cause severe side effects. Before the detailed analysis based on the dosage, unbound fraction in blood and effective concentration to evaluate the clinical DDI potency, this criteria enable high throughput screening and optimize lead compounds at the drug discovery stage.

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

    PubMed

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

    2013-01-01

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

  12. MO-AB-207-03: ACR Update in Nuclear Medicine

    SciTech Connect

    Harkness, B.

    2015-06-15

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

  13. MO-AB-207-00: ACR Update in MR, CT, Nuclear Medicine, and Mammography

    SciTech Connect

    2015-06-15

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

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

    SciTech Connect

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

    2014-06-15

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

  15. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons.

    PubMed

    Patel, Manesh R; Calhoon, John H; Dehmer, Gregory J; Grantham, James Aaron; Maddox, Thomas M; Maron, David J; Smith, Peter K

    2017-03-06

    The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes (ACS) and stable ischemic heart disease were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and in an effort to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing ACS and stable ischemic heart disease individually. This document presents the AUC for ACS. Clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, presence of clinical instability or ongoing ischemic symptoms, prior reperfusion therapy, risk level as assessed by noninvasive testing, fractional flow reserve testing, and coronary anatomy. This update provides a reassessment of clinical scenarios that the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization. A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range (4 to 6

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

    PubMed

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

    2010-12-01

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

  17. Review of criteria appropriate for a very low probability of pulmonary embolism on ventilation-perfusion lung scans: a position paper.

    PubMed

    Stein, P D; Gottschalk, A

    2000-01-01

    The "low-probability" interpretation of ventilation-perfusion lung scans has been characterized as misleading or even dangerous because of the high prevalence of pulmonary embolism associated with such an interpretation. Since the completion of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study, analyses of the PIOPED database have allowed identification of several abnormalities seen on ventilation-perfusion scans that have a positive predictive value (PPV) for pulmonary embolism of less than 10%. These include nonsegmental perfusion abnormalities (PPV = 8%), perfusion defects smaller than the corresponding areas of increased opacity at chest radiography (PPV = 8%), matched ventilation-perfusion abnormalities in two or three zones of a single lung (PPV = 3%), one to three small segmental perfusion defects (PPV = 1%), triple matched defects in the upper or middle lung zone (PPV = 4%), and the stripe sign (PPV = 7%). Use of these abnormalities as interpretative criteria constitutes "very low probability" interpretation and will reduce the number of low-probability interpretations of ventilation-perfusion lung scans, which may be considered nondiagnostic because of the unacceptably high rate of false-negative results. This will enhance the utility of the ventilation-perfusion lung scan for screening patients with suspected pulmonary embolism.

  18. Update on appropriate use criteria for amyloid PET imaging: dementia experts, mild cognitive impairment, and education. Amyloid Imaging Task Force of the Alzheimer’s Association and Society for Nuclear Medicine and Molecular Imaging.

    PubMed

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

    2013-07-01

    Amyloid PET imaging is a novel diagnostic test that can detect in living humans one of the two defining pathologic lesions of Alzheimer disease, amyloid-β deposition in the brain. The Amyloid Imaging Task Force of the Alzheimer's Association and Society for Nuclear Medicine and Molecular Imaging previously published appropriate use criteria for amyloid PET as an important tool for increasing the certainty of a diagnosis of Alzheimer disease in specific patient populations. Here, the task force further clarifies and expands 3 topics discussed in the original paper: first, defining dementia experts and their use of proper documentation to demonstrate the medical necessity of an amyloid PET scan; second, identifying a specific subset of individuals with mild cognitive impairment for whom an amyloid PET scan is appropriate; and finally, developing educational programs to increase awareness of the amyloid PET appropriate use criteria and providing instructions on how this test should be used in the clinical decision-making process. Copyright © 2013 The Alzheimer's Association. All rights reserved.

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

    PubMed

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

    2014-02-01

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

  20. 77 FR 24745 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Thermal..., ``Evaluation of Long- Term Cooling Considering Particulate, Fibrous and Chemical Debris in the Recirculating... Branch, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P ...

  1. 78 FR 29783 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-21

    ... Renewal; Cancellation of the May 22, 2013, ACRS Subcommittee Meeting The ACRS Plant License Renewal Subcommittee meeting scheduled for May 22, 2013 has been cancelled. The notice of this meeting was previously...

  2. 77 FR 45700 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ...); Meeting of the ACRS Subcommittee On Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will... addressing the Fukushima Near Term Task Force (NTTF) Recommendation 1: Enhanced Regulatory Framework....

  3. 76 FR 34276 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-13

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR) will hold a meeting on June 21, 2011, Room T-2B1,...

  4. 76 FR 68793 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-07

    ... No: 2011-28737] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic Simplified Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Economic Simplified Boiling Water Reactor (ESBWR) will hold a meeting on November 30,...

  5. 76 FR 34778 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-14

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels... room. Dated: June 7, 2011 Cayetano Santos, Chief, Reactor Safety Branch A, Advisory Committee...

  6. 78 FR 31987 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-28

    ... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels..., Technical Support Branch, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  7. 78 FR 37595 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-21

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR.... Kathy Weaver, Acting Chief, Technical Support Branch, Advisory Committee on Reactor Safeguards....

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic Simplified Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Economic Simplified Boiling Water Reactor (ESBWR) will hold a meeting on May 26, 2011, Room T-2B1, 11545 Rockville Pike,...

  9. 76 FR 5218 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-28

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor... inconvenience. Dated: January 24, 2011. Antonio Dias, Chief, Reactor Safety Branch B, Advisory Committee...

  10. 77 FR 59678 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR... Branch, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  11. 76 FR 55718 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels will hold a meeting... (RES) initiative on quantitatively ensuring ``extremely low (XLPR) probability of rupture'' for...

  12. 76 FR 62866 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-11

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Economic Simplified Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Economic Simplified Boiling Water Reactor (ESBWR) will hold a meeting on October 21, 2011, Room T-2B1, 11545 Rockville...

  13. 76 FR 72451 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-23

    ...-72452] [FR Doc No: 2011-30238] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels will hold a meeting on December 15,...

  14. 76 FR 16016 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of The ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of The ACRS Subcommittee on Materials, Metallurgy And Reactor Fuels; Notice of Meeting The ACRS Subcommittee on Materials, Metallurgy and Reactor...: March 15, 2011. Cayetano Santos, Chief, Reactor Safety Branch A, Advisory Committee on...

  15. 75 FR 58449 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels will hold a meeting... inconvenience. Dated: September 17, 2010. Antonio Dias, Chief, Reactor Safety Branch B, Advisory Committee...

  16. 78 FR 20959 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-08

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor The ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR) will hold a meeting.... Antonio Dias, Technical Advisor, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  17. 76 FR 34276 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-13

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Digital Instrumentation and Control Systems; Notice of Meeting The ACRS Subcommittee on Digital Instrumentation and... the results and status of new NRC nuclear power plant digital system research activities which deal...

  18. 76 FR 52715 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital Instrumentation and Control Systems; Notice of Meeting The ACRS Subcommittee on Digital Instrumentation and... Diversity on Defense-In-Depth in Digital Computer-Based I&C Systems,'' and other related activities on...

  19. 75 FR 82092 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... Doc No: 2010-32810] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on January 12, 2011, Room...

  20. 75 FR 27840 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-18

    ... Doc No: 2010-11823] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on May 18, 2010, Room T-2B1, 11545...

  1. 75 FR 82093 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... Doc No: 2010-32822] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on January 11, 2011, Room...

  2. 75 FR 27841 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-18

    ... Doc No: 2010-11820] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on May 18, 2010, Room T-2B1, 11545...

  3. 76 FR 44964 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ...] [FR Doc No: 2011-18954] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on August 17, 2011, Room...

  4. 78 FR 70597 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-26

    ... Doc No: 2013-28328] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on December 3, 2013, Room...

  5. 77 FR 31044 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-24

    ...] [FR Doc No: 2012-12611] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on June 5, 2012, Room...

  6. 75 FR 51499 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Thermal Hydraulics Phenomena The ACRS Subcommittee on Thermal Hydraulics Phenomena will hold a meeting on September 7...

  7. 76 FR 53979 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Thermal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-30

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Thermal Hydraulics Phenomena; Notice of Meeting The ACRS Subcommittee on Thermal Hydraulics Phenomena will hold a...

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-01

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Thermal-Hydraulics Phenomena; Notice of Meeting The ACRS Subcommittee on Thermal-Hydraulics Phenomena will hold a...

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Thermal Hydraulic Phenomena The ACRS Subcommittee on Thermal Hydraulic Phenomena will hold a meeting on October 18... 5 p.m. The Subcommittee will review the thermal-hydraulic research activities in the Office of...

  10. 75 FR 30077 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ESBWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-28

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ESBWR The ACRS Subcommittee on Economic Simplified Boiling Water Reactor (ESBWR) will hold a meeting on June...

  11. 75 FR 32229 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ABWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-07

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ABWR The ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR) will hold a meeting on June 23-24, 2010, Room...

  12. 75 FR 57536 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ABWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on ABWR The ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR) will hold a meeting on October 20, 2010, Room...

  13. 75 FR 66803 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-29

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on ABWR will hold a meeting...

  14. 78 FR 24441 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-25

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR) will hold a meeting on May 8-9, 2013, Room T-2B1...

  15. 78 FR 65008 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-30

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR) will hold a meeting on November 6, 2013, Room T...

  16. 75 FR 66803 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-29

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Evolutionary Power Reactor (EPR); Notice of Meeting The ACRS Subcommittee on EPR will hold a meeting on November 30, 2010, Room T-2B1, 11545 Rockville Pike,...

  17. 77 FR 59676 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-28

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on October 3, 2012, Room...

  18. 77 FR 68161 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on December 5, 2012, Room T-2B3... requested in the March 2012 10 CFR 50.54(f) letters to address Fukushima Near-Term Task Force Report, Task...

  19. 78 FR 17945 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on April 10, 2013, Room T-2B1... requested in the March 2012 10 CFR 50.54(f) letters to address Fukushima Near-Term Task Force Report Task...

  20. 77 FR 28903 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-16

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on May 22, 2012, Room...

  1. 77 FR 74697 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-17

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on January 18, 2013, Room...

  2. 78 FR 51752 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on September 18, 2013, Room...

  3. 77 FR 31676 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-29

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on June 20, 2012, Room...

  4. 78 FR 65008 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-30

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on November 5, 2013, Room...

  5. 77 FR 68161 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-15

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on December 4, 2012, Room...

  6. 77 FR 45699 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... [Federal Register Volume 77, Number 148 (Wednesday, August 1, 2012)] [Notices] [Page 45699] [FR Doc No: 2012-18757] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima...

  7. 76 FR 27103 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-10

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on May 26, 2011, Room T-2B1... Subcommittee will review recent events at the Fukushima site in Japan. The Subcommittee will hear...

  8. 78 FR 27442 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on May 23, Room T-2B1,...

  9. 77 FR 52371 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-29

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on September 5, 2012, Room...

  10. 78 FR 50457 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-19

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on September 4, 2013, Room...

  11. 76 FR 34778 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-14

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on June 23, 2011, Room T-2B1... Subcommittee will review recent events at the Fukushima site in Japan. The Subcommittee will hear...

  12. 76 FR 44377 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on August 16, 2011, Room T-2B1... events at the Fukushima Dai-Ichi reactor site in Japan. The Subcommittee will hear presentations by...

  13. 77 FR 28637 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-15

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on May 22- 23, 2012, Room...

  14. 77 FR 64147 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-18

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Fukushima; Notice of Meeting The ACRS Subcommittee on Fukushima will hold a meeting on October 31, 2012, Room...

  15. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons.

    PubMed

    Patel, Manesh R; Calhoon, John H; Dehmer, Gregory J; Grantham, James Aaron; Maddox, Thomas M; Maron, David J; Smith, Peter K

    2017-06-12

    The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes and stable ischemic heart disease (SIHD) were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing SIHD and acute coronary syndromes individually. This document presents the AUC for SIHD.Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status; risk level as assessed by noninvasive testing; coronary disease burden; and, in some scenarios, fractional flow reserve testing, presence or absence of diabetes, and SYNTAX score. This update provides a reassessment of clinical scenarios that the writing group felt were affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization.A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range of 4 to 6 indicate that

  16. 7 CFR 760.632 - Payment acres.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... acreage of a crop produced on land that is not eligible for crop insurance or NAP. (h) For any crop acreage for which crop insurance or NAP coverage is canceled, those acres will no longer be considered...

  17. 7 CFR 760.632 - Payment acres.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... acreage of a crop produced on land that is not eligible for crop insurance or NAP. (h) For any crop acreage for which crop insurance or NAP coverage is canceled, those acres will no longer be considered...

  18. 7 CFR 760.632 - Payment acres.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... acreage of a crop produced on land that is not eligible for crop insurance or NAP. (h) For any crop acreage for which crop insurance or NAP coverage is canceled, those acres will no longer be considered...

  19. 7 CFR 760.632 - Payment acres.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... acreage of a crop produced on land that is not eligible for crop insurance or NAP. (h) For any crop acreage for which crop insurance or NAP coverage is canceled, those acres will no longer be considered...

  20. 7 CFR 760.632 - Payment acres.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... acreage of a crop produced on land that is not eligible for crop insurance or NAP. (h) For any crop acreage for which crop insurance or NAP coverage is canceled, those acres will no longer be considered...

  1. ARM Cloud Retrieval Ensemble Data Set (ACRED)

    SciTech Connect

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

    2011-09-12

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

  2. The Automated Conflict Resolution System (ACRS)

    NASA Technical Reports Server (NTRS)

    Kaplan, Ted; Musliner, Andrew; Wampler, David

    1993-01-01

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

  3. 78 FR 79019 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

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

  4. Appropriateness of computed tomography and magnetic resonance imaging scans in the Eden and Central Karoo districts of the Western Cape Province, South Africa.

    PubMed

    Becker, J; Jenkins, L S; de Swardt, M; Sayed, R; Viljoen, M

    2014-11-01

    Computed tomography (CT) and magnetic resonance imaging (MRI) are an essential part of modern healthcare. Marked increases in clinical demand for these imaging modalities are straining healthcare expenditure and threatening health system sustainability. The number of CT and MRI scans requested in the Eden and Central Karoo districts of the Western Cape Province, South Africa (SA), almost doubled from 2011 to 2013. To determine the appropriateness of CT and MRI scans and relate this to the requesting department and clinician. This was a retrospective analytical cohort study. All scans during October 2012 were analysed as a sample. Appropriateness of scans was determined using the American College of Radiologists (ACR) Appropriateness Criteria and the Royal College of Radiology Guidelines. Appropriateness was also correlated back to the requesting department and clinician. Of a total of 219 scans, 53.0% were abnormal. Overall 6.4% of scans were considered inappropriate. Interns and registrars requested no inappropriate scans. The orthopaedics department scored the highest rate of appropriate scans (80.0%) and the oncology department the highest rate of inappropriate scans (20.8%). The limited resources available for healthcare in a developing country like SA should be a motivation to implement control mechanisms aimed at appropriate utilisation of imaging examinations. The Eden and Central Karoo districts have a low rate of inappropriate scans (6.4%). We recommend that the current preauthorisation system by consultants and other senior clinicians continues, but with increased clinician awareness of the ACR Appropriateness Criteria and the Royal College guidelines.

  5. Appropriate strategies.

    PubMed

    Halty, M

    1979-01-01

    Technology strategies are concerned with the production, distribution, and consumption of technology. Observation of less developed countries (LDCs) and international organizations shows that little attention is given to the development of a technology strategy. LDCs need to formulate a strategy of self-reliant technological development for the next decade. They should no longer be content to stand in a technologically dependent relationship to the developed countries. Such strategies must balance the ratio between investment in indigenous technologies and expenditure for foreign technology. The strategies change according to the level of industrialization achieved. The following considerations come into development of technology strategies: 1) determination of an appropriate balance among the accumulation, consumption, and distribution of technology; 2) the amount and level of government support; and 3) the balance between depth and breadth of technology to be encouraged.

  6. Emergency radiology elective improves second-year medical students' perceived confidence and knowledge of appropriate imaging utilization.

    PubMed

    Leschied, Jessica R; Knoepp, Ursula S; Hoff, Carrie Nicole; Mazza, Michael B; Klein, Katherine A; Mullan, Patricia B; Kelly, Aine M

    2013-09-01

    Given recent advances in and wider availability of complex imaging, physicians are expected to understand imaging appropriateness. We introduced second-year medical students to the American College of Radiology Appropriateness Criteria (ACR-AC) in an interactive case-based elective to demonstrate their use in imaging for common emergency department clinical complaints. Prospective pre- and post-test design assessed second-year medical students' performance on case-based knowledge applications and self-assessed confidence related to ACR-AC guidelines compared to second-year students participating in a different concurrent radiology elective. Students participated in a 3-day elective covering the ACR-AC, comparative effective imaging, and risks associated with imaging radiation exposure, with outcomes of perceived confidence using a 5-point Likert scale and knowledge of ACR-AC using case-based multiple choice questions. Analysis included computing mean scores and assessing effect sizes for changes in knowledge. Before the elective, 24 students scored an average of 3.45 questions correct of 8 (43.1%). On course completion, students scored an average of 5.3 questions correct of the same questions (66.3%) (P < .001; effect size [Cohen's d] = 1.3940. In the comparison group, 12 students scored an average of 3.08 questions (38.5%) correctly pretest and 3.09 questions (38.6%) correctly post-test (P > .85; effect size = 0.008). Students' confidence in ordering appropriate imaging improved nearly 2-fold from a range of 1.9 to 3.2 (on a scale of 1.0 to 5.0) to a range of 3.7 to 4.5. Following a short radiology elective, second-year medical students improved their knowledge of appropriate image utilization and perceived awareness of the indications, contraindications, and effects of radiation exposure related to medical imaging. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-01

    ... [Federal Register Volume 77, Number 148 (Wednesday, August 1, 2012)] [Notices] [Pages 45699-45700] [FR Doc No: 2012-18759] NUCLEAR REGULATORY COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Economic Simplified Boiling Water Reactors (ESBWR); Notice of...

  8. 76 FR 7883 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Power...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ...'s evaluation of the Point Beach Units 1 and 2 Extended Power Uprate application. The Subcommittee will hear presentations by and hold discussions with the NRC staff, NextEra Energy Point Beach LLC, and... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Power Uprates...

  9. The Expanding Significance of One Acre.

    ERIC Educational Resources Information Center

    Gilbert, Daniel R., Jr.

    2003-01-01

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

  10. 76 FR 11525 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... and Probabilistic Risk Assessment (PRA); Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA), Room T-2B1, 11545 Rockville Pike, Rockville, Maryland. The entire...

  11. 76 FR 22934 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-25

    ... and Probabilistic Risk Assessment; Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on May 11, 2011, Room T-2B3, 11545 Rockville...

  12. 76 FR 18586 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

    ... and Probabilistic Risk Assessment (PRA); Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on April 20, 2011, Room T-2B1, 11545 Rockville...

  13. 76 FR 71609 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-18

    ... and Probabilistic Risk Assessment; Notice of Meeting The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on December 14, 2011, Room T-2B3, 11545 Rockville...

  14. 76 FR 32240 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-03

    ... Instrumentation and Control Systems; Notice of Meeting The ACRS Subcommittee on Digital Instrumentation and Control Systems (DI&C) will hold a meeting on June 7, 2011, Room T-2B1, 11545 Rockville Pike,...

  15. 7 CFR 1412.44 - Notification of base acres.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  16. 7 CFR 1412.44 - Notification of base acres.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Notification of base acres. 1412.44 Section 1412.44... through 2012 § 1412.44 Notification of base acres. The operator and owners of record of a farm will be notified in writing of the number of base acres eligible for enrollment in a contract, unless such...

  17. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  18. 7 CFR 1412.44 - Notification of base acres.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Notification of base acres. 1412.44 Section 1412.44... Through 2012 § 1412.44 Notification of base acres. The operator and owners of record of a farm will be notified in writing of the number of base acres eligible for enrollment in a contract, unless such...

  19. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Election of base acres. 1412.21 Section 1412.21... CROP REVENUE ELECTION PROGRAM FOR THE 2008 AND SUBSEQUENT CROP YEARS Establishment of Base Acres for a Farm for Covered Commodities § 1412.21 Election of base acres. (a) Subject to adjustments in...

  20. 7 CFR 1412.44 - Notification of base acres.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  1. 7 CFR 1412.44 - Notification of base acres.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Notification of base acres. 1412.44 Section 1412.44... Through 2012 § 1412.44 Notification of base acres. The operator and owners of record of a farm will be notified in writing of the number of base acres eligible for enrollment in a contract, unless such...

  2. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Election of base acres. 1412.21 Section 1412.21... CROP REVENUE ELECTION PROGRAM FOR THE 2008 AND SUBSEQUENT CROP YEARS Establishment of Base Acres for a Farm for Covered Commodities § 1412.21 Election of base acres. (a) Subject to adjustments in...

  3. 77 FR 61791 - Advisory Committee On Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee On US-APWR...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-11

    ... COMMISSION Advisory Committee On Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee On US-APWR; Notice of Meeting The ACRS Subcommittee on US-APWR will hold a meeting on October 18- 19, 2012, Room T... review Chapter 4, ``Reactor,'' of the Safety Evaluation Reports associated with the US-APWR...

  4. 77 FR 73497 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-10

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR; Notice of Meeting The ACRS Subcommittee on US-APWR will hold a meeting on January 15, 2013, Room T-2B3... Reports are associated with the design certification of the US-APWR. The Subcommittee will...

  5. 77 FR 56240 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on US-APWR...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-12

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on US-APWR; Notice of Meeting The ACRS Subcommittee on US-APWR will hold a meeting on September 20, 2012, Room...

  6. 78 FR 47802 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-06

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR; Notice of Meeting The ACRS Subcommittee on US-APWR will hold a meeting on September 17-18, 2013, Room T... Chapter 6, ``Engineered Safety Features,'' of the Safety Evaluation Report (SER) associated with the...

  7. 78 FR 59076 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR; Notice of Meeting The ACRS Subcommittee on US-APWR will hold a meeting on October 1, 2013, Room T-2B1... the US-APWR design. The Subcommittee will hear presentations by and hold discussions...

  8. 78 FR 20959 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-08

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on US-APWR The ACRS Subcommittee on US-APWR will hold a meeting on April 25- 26, 2013, Room T-2B1, 11545 Rockville..., ``Instrumentation and Control,'' of the Safety Evaluation Report (SER) associated with the US-APWR...

  9. 78 FR 68867 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on US-APWR...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-15

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on US-APWR; Notice of Meeting The ACRS Subcommittee on US-APWR will hold a meeting on November 20-21, 2013, Room T... the Safety Evaluation Report (SER) associated with the US-APWR design certification and the...

  10. 76 FR 44376 - Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-25

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS), Meeting of the ACRS Subcommittee on U.S. Advanced Pressurized Water Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Advanced Pressurized Water Reactor (US-APWR) will hold a meeting on Augus...

  11. 76 FR 44964 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ... No: 2011-18952] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR) will hold a meeting on August 18, 2011, Room...

  12. 77 FR 4838 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-31

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

  13. β-Lactam Selectivity of Multidrug Transporters AcrB and AcrD Resides in the Proximal Binding Pocket*

    PubMed Central

    Kobayashi, Naoki; Tamura, Norihisa; van Veen, Hendrik W.; Yamaguchi, Akihito; Murakami, Satoshi

    2014-01-01

    β-Lactams are mainstream antibiotics that are indicated for the prophylaxis and treatment of bacterial infections. The AcrA-AcrD-TolC multidrug efflux system confers much stronger resistance on Escherichia coli to clinically relevant anionic β-lactam antibiotics than the homologous AcrA-AcrB-TolC system. Using an extensive combination of chimeric analysis and site-directed mutagenesis, we searched for residues that determine the difference in β-lactam specificity between AcrB and AcrD. We identified three crucial residues at the “proximal” (or access) substrate binding pocket. The simultaneous replacement of these residues in AcrB by those in AcrD (Q569R, I626R, and E673G) transferred the β-lactam specificity of AcrD to AcrB. Our findings indicate for the first time that the difference in β-lactam specificity between AcrB and AcrD relates to interactions of the antibiotic with residues in the proximal binding pocket. PMID:24558035

  14. 78 FR 17945 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant Designs; Notice of Meeting The ACRS Subcommittee on Future Plant Designs will hold a meeting on April 9... based licensing framework for the Next Generation Nuclear Plant (NGNP). The Subcommittee will...

  15. 76 FR 64123 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-17

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant Designs; Notice of Meeting The ACRS Subcommittee on Future Plant Designs will hold a meeting on November...

  16. 77 FR 74698 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-17

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant Designs; Notice of Meeting The ACRS Subcommittee on Future Plant Designs will hold a meeting on January 17... Generation Nuclear Plant (NGNP) fuel and source term research and development of risk-informed...

  17. 76 FR 16016 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant Designs The ACRS Subcommittee on Future Plant Designs will hold a meeting on April 5, 2011, at...

  18. 75 FR 51501 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and Procedures The ACRS Subcommittee on Planning and Procedures will hold a meeting on September 8, 2010, at... conduct of the meeting, persons planning to attend should check with these references if such...

  19. 75 FR 67783 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-03

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

  20. 76 FR 67232 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-31

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR) will hold a meeting on November 14-15, 2011...

  1. 76 FR 4739 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-26

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR); Notice of Meeting The ACRS Subcommittee on U.S. EPR will hold a meeting on February 7-8, 2011, Room T-2B1, 11545...

  2. 76 FR 16458 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-23

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

  3. 76 FR 11525 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR); Notice of Meeting The ACRS Subcommittee on U.S. EPR will hold a meeting on March 23, 2011, Room T-2B1, 11545 Rockville...

  4. 75 FR 82094 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... [Federal Register Volume 75, Number 249 (Wednesday, December 29, 2010)] [Notices] [Page 82094] [FR Doc No: 2010-32814] NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR); Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power...

  5. 76 FR 22935 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-25

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR) will hold a meeting on May 11, 2011, Room T...

  6. 78 FR 50457 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-19

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital I&C; Notice of Meeting The ACRS Subcommittee on Digital I&C will hold a briefing on September 19, 2013, Room T... identification of digital system failure modes and use of hazard analysis methods for digital safety systems....

  7. 75 FR 30077 - Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-28

    ... COMMISSION Advisory Committee On Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee On Digital I&C Systems The ACRS Subcommittee on Digital Instrumentation and Control (DI&C) Systems will hold a meeting on... Digital Instrumentation and Control (DI&C) Probabilistic Risk Assessment (PRA). Topics will include...

  8. 77 FR 67688 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-13

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C; Notice of Meeting The ACRS Subcommittee on Digital I&C will hold a meeting on November 16, 2012, Room...

  9. 76 FR 7882 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C Systems The ACRS Subcommittee on Digital Instrumentation & Control (DI&C) Systems will hold a meeting...

  10. 75 FR 51499 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Digital I&C Systems The ACRS Subcommittee on Digital Instrumentation and Controls (I&C) Systems will hold a meeting on...--8:30 a.m. until 12 p.m. The Subcommittee will review Digital I&C Interim Staff Guidance on...

  11. 76 FR 71610 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Power Uprates...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-18

    ... with the staff's review of the Turkey Point Units 3 and 4 extended power uprate application. The... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Power Uprates; Notice of Meeting The ACRS Subcommittee on Power Uprates will hold a meeting on December 14, 2011, Room T...

  12. Developmentally Appropriate Practices: Shifting the Emphasis to Individual Appropriateness.

    ERIC Educational Resources Information Center

    Carta, Judith J.

    1994-01-01

    This brief article responds to a previous article on guidelines developed by professional associations for developmentally appropriate early childhood special education practices. The importance of individualization in the application of practices is emphasized, and sample criteria are offered for evaluating the practices. (DB)

  13. Constructability -- from Qinshan to the ACR

    SciTech Connect

    Elgohary, Medhat; Fairclough, Neville; Ricciuti, Rick

    2003-09-01

    Atomic Energy of Canada Limited (AECL) has recognized the importance of constructability for many years, and it is applying its principals to CANDU projects with increasing success. The CANDU 6 Nuclear Power Plant has been constructed eleven times in the last 25 years. However, the last two units completed on the Qinshan project in China have employed some very innovative construction methods that have not been used on the previous units. In order to make nuclear power generation more competitive, shorter construction schedules and reduced project cost and risks are essential objectives. The application of constructability principles is a major contributor to achieving these objectives. The success of Qinshan has increased the confidence in the new construction methods, which are being implemented on the ACR (Advanced CANDU Reactor) successfully. An ACR construction strategy that utilizes advanced construction techniques has been developed by AECL. The strategy includes paralleling of activities by using extensive modularization and the vertical installation of equipment and modules into the reactor building using a VHL (Very Heavy Lift) crane. This strategy allows short schedules to be met with a minimum risk to the project.

  14. 76 FR 55717 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-08

    ... and Probabilistic Risk Assessment The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a meeting on September 20, 2011, Room T-2B1, 11545 Rockville Pike, Rockville... Modifying the Risk-Informed Regulatory Guidance for New Reactors. The Subcommittee will hear...

  15. 77 FR 60480 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Digital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-03

    ... Instrumentation and Control Systems; Notice of Meeting The ACRS Subcommittee on Digital Instrumentation and Control Systems (DI&C) will hold a meeting on October 30, 2012, Room T-2B1, 11545 Rockville Pike... and discuss the Design Specific Review Standard (DSRS) for Instrumentation and Control of the...

  16. 75 FR 61781 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-06

    ... and PRA The ACRS Subcommittee on Reliability and Probabilistic Risk Assessment (PRA) will hold a... statement on Safety Culture. The Subcommittee will hear presentations by and hold discussions with...: September 30, 2010. Antonio Dias, Chief, Reactor Safety Branch B, Advisory Committee on Reactor...

  17. [Evaluation of the appropriateness of public hospital use using AEP, Disease Staging, and other DRG-based criteria (essential levels of care--Italian LEA): results and degree of agreement among the different methodologies].

    PubMed

    Manzoli, L; Di Candia, V; Mucciconi, A; Di Corcia, T; Ceccagnoli, M A; Chiatti, C; Cau, E; Capasso, L; Di Virgilio, M; Angeli, G; Di Giovanni, P; Panella, M; Di Stanislao, F; Schioppa, F

    2010-01-01

    Currently, more than one instrument has been found to be reliable and valid for the assessment of hospital admission appropriateness. However; data on the level of agreement among these methodologies are extremely scarce. The study was aimed at evaluating whether the percentages of organizational (in)appropriateness resulting from some of the most diffused instruments (Italian Appropriateness Evaluation Protocol--AEP/PRUO; Disease Staging; Essential Levels of Care--LEA, version 2001 and 2008) are substantially concordant, or they largely depend upon the methodology. For each public hospital of Abruzzo, Italy, the amount of inappropriateness has been computed using six indicators: inappropriate days of care (PRUO1); totally inappropriate admissions (PRU02); early admissions DRGs according to the first Law on Italian LEA (LEA01); admissions assigned to one of the 108 potentially inappropriate DRGs according to the second Law on Italian LEA, currently inactive (LEA08). The sample was composed by all ordinary admissions made in 2006 in the Region, with the exception of PRUO indicators, which were based upon the manual revision of 2% of all admissions that could be assessed using PRUO methodology. We found a good correlation among most indicators based upon administrative discharge data (DS1, DS2 and LEA01), whereas the results obtained using PRUO and new LEA (LEA08) were discordant, and marked differences were observed also between the two PRUO indicators. Although the limitations of the study permit only preliminary conclusions, in future appropriateness evaluations it may be reasonable to use more than one indicator--allowing the creation of combined scores--and rank hospitals in large categories--avoiding excessively precise scores--as such rankings might relevantly differ depending upon the used instrument.

  18. 12 CFR 1010.9 - Twenty acre lots.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Twenty acre lots. 1010.9 Section 1010.9 Banks and Banking BUREAU OF CONSUMER FINANCIAL PROTECTION LAND REGISTRATION (REGULATION J) General Requirements § 1010.9 Twenty acre lots. (a) The sale of lots in a subdivision is exempt from the registration...

  19. 12 CFR 1010.9 - Twenty acre lots.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 8 2014-01-01 2014-01-01 false Twenty acre lots. 1010.9 Section 1010.9 Banks and Banking BUREAU OF CONSUMER FINANCIAL PROTECTION LAND REGISTRATION (REGULATION J) General Requirements § 1010.9 Twenty acre lots. (a) The sale of lots in a subdivision is exempt from the registration...

  20. 12 CFR 1010.9 - Twenty acre lots.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Twenty acre lots. 1010.9 Section 1010.9 Banks and Banking BUREAU OF CONSUMER FINANCIAL PROTECTION LAND REGISTRATION (REGULATION J) General Requirements § 1010.9 Twenty acre lots. (a) The sale of lots in a subdivision is exempt from the registration...

  1. High-speed ACR/NEMA interface

    NASA Astrophysics Data System (ADS)

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

    1990-08-01

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

  2. 76 FR 5220 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-28

    ... small modular reactor applications. The Subcommittee will hear presentations by and hold discussions... COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Future Plant... rescheduling would result in a major inconvenience. Dated: January 24, 2011. Antonio Dias, Chief, Reactor...

  3. 7 CFR 1412.23 - Base acres and Conservation Reserve Program.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Base acres and Conservation Reserve Program. 1412.23... Base Acres for a Farm for Covered Commodities § 1412.23 Base acres and Conservation Reserve Program. (a... of production flexibility contract acres or base acres protected by a Conservation Reserve...

  4. 7 CFR 1412.23 - Base acres and Conservation Reserve Program.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  5. 7 CFR 1412.23 - Base acres and Conservation Reserve Program.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Base acres and Conservation Reserve Program. 1412.23... Base Acres for a Farm for Covered Commodities § 1412.23 Base acres and Conservation Reserve Program. (a... of production flexibility contract acres or base acres protected by a Conservation Reserve...

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  7. Summary of the ACRE inaugural meeting.

    PubMed

    Bloomgarden, Zachary T

    2009-01-01

    The charter meeting of the Association of Clinical Researchers and Educators (ACRE) provided a powerful set of arguments against assertions that physician-industry collaboration is harmful and represents a "conflict of interest." Such collaboration has, in fact, improved medical care for patients, a case made overwhelmingly by patients and patient advocacy groups at the meeting. The contentions that physician-industry collaboration is problematic are not based on evidence. They depend on unjustified generalization from inevitable, sometimes egregious, but vanishingly uncommon adverse outcomes of industry-physician interaction without reference to how so much more commonly these interactions add value. Furthermore, the claim that physician-industry collaboration is unprofessional is refuted by rational scrutiny. Indeed, the term "conflict of interest" itself is vague, inviting subjectivity and deserving to be rejected. The unwarranted success of conflict of interest regulation has prevailed because of the failure of physicians, educators, and innovators, through apathy and intimidation, to pay attention to its fallacies and resist its dangers. It has arisen from activist ambitions and from misalignment between the purposes of medical practitioners, educators, and innovators and those of administrators in medical journals and in academic medical centers. The media and politicians have not appreciated these misalignments and have accepted conflict of interest arguments at face value. Regulation emanating from conflict of interest criticism is confusing, onerous, expensive, disrespectful, and damaging. Prohibitions against speaking about medical products inhibit physician and patient education concerning rapidly emerging and complex therapies. Input by physicians cognizant of compliance requirements into such presentations should be encouraged. Restrictions to the free flow of corporate support of academic health centers, professional societies, and patient

  8. ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress echocardiography: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine.

    PubMed

    Douglas, Pamela S; Khandheria, Bijoy; Stainback, Raymond F; Weissman, Neil J; Peterson, Eric D; Hendel, Robert C; Stainback, Raymond F; Blaivas, Michael; Des Prez, Roger D; Gillam, Linda D; Golash, Terry; Hiratzka, Loren F; Kussmaul, William G; Labovitz, Arthur J; Lindenfeld, JoAnn; Masoudi, Frederick A; Mayo, Paul H; Porembka, David; Spertus, John A; Wann, L Samuel; Wiegers, Susan E; Brindis, Ralph G; Douglas, Pamela S; Hendel, Robert C; Patel, Manesh R; Peterson, Eric D; Wolk, Michael J; Allen, Joseph M

    2008-03-18

    The American College of Cardiology Foundation (ACCF) and the American Society of Echocardiography (ASE) together with key specialty and subspecialty societies, conducted an appropriateness review for stress echocardiography. The review assessed the risks and benefits of stress echocardiography for several indications or clinical scenarios and scored them on a scale of 1 to 9 (based upon methodology developed by the ACCF to assess imaging appropriateness). The upper range (7 to 9) implies that the test is generally acceptable and is a reasonable approach, and the lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach. The midrange (4 to 6) indicates a clinical scenario for which the indication for a stress echocardiogram is uncertain. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Use of stress echocardiography for risk assessment in patients with coronary artery disease (CAD) was viewed favorably, while routine repeat testing and general screening in certain clinical scenarios were viewed less favorably. It is anticipated that these results will have a significant impact on physician decision making and performance, reimbursement policy, and will help guide future research.

  9. Validation of ACR/EULAR definition of remission in rheumatoid arthritis from RA practice: the ESPOIR cohort

    PubMed Central

    2012-01-01

    Introduction In development of the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) remission definitions using clinical trials data, one criterion used to compare different remission definitions was whether, compared with those not in remission, those in remission had evidence of later disease stability defined by x-ray and functional status. Validation of the RA remission criteria using observational study data is necessary before recommending their use in practice. Methods Using data from those who met RA criteria in the ESPOIR cohort, we matched each person in remission with a person not in remission and then carried out analyses comparing later stability of x-ray and health assessment questionnaire (HAQ) between the two groups. We compared the predictive validity of the same candidate definitions of remission evaluated in the ACR/EULAR process. To minimize potential bias and produce more stable results, we used a bootstrap resampling approach to select those not in remission, repeating the sample matching analysis process 500 times. Results Results were similar to those of clinical trials analyzed for the ACR/EULAR remission criteria. Specifically, the ACR/EULAR remission definitions using either an simple disease activity index (SDAI) ≤ 3.3, clinical disease activity index (CDAI) ≤ 2.8 or a definition of remission requiring tender joint count, swollen joint count, patient global assessment all ≤ 1 performed as well or better than other candidate definitions of remission in terms of predicting later x-ray and function stability. Conclusions ACR/EULAR definitions of remission developed for trials are similarly valid in observational studies in RA and could be used in practice. PMID:22747951

  10. Validation of ACR/EULAR definition of remission in rheumatoid arthritis from RA practice: the ESPOIR cohort.

    PubMed

    Zhang, Bin; Combe, Bernard; Rincheval, Nathalie; Felson, David T

    2012-06-29

    In development of the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) remission definitions using clinical trials data, one criterion used to compare different remission definitions was whether, compared with those not in remission, those in remission had evidence of later disease stability defined by x-ray and functional status. Validation of the RA remission criteria using observational study data is necessary before recommending their use in practice. Using data from those who met RA criteria in the ESPOIR cohort, we matched each person in remission with a person not in remission and then carried out analyses comparing later stability of x-ray and health assessment questionnaire (HAQ) between the two groups. We compared the predictive validity of the same candidate definitions of remission evaluated in the ACR/EULAR process. To minimize potential bias and produce more stable results, we used a bootstrap resampling approach to select those not in remission, repeating the sample matching analysis process 500 times. Results were similar to those of clinical trials analyzed for the ACR/EULAR remission criteria. Specifically, the ACR/EULAR remission definitions using either an simple disease activity index (SDAI) ≤ 3.3, clinical disease activity index (CDAI) ≤ 2.8 or a definition of remission requiring tender joint count, swollen joint count, patient global assessment all ≤ 1 performed as well or better than other candidate definitions of remission in terms of predicting later x-ray and function stability. ACR/EULAR definitions of remission developed for trials are similarly valid in observational studies in RA and could be used in practice.

  11. 76 FR 61118 - Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Advanced Boiling Water Reactor; Notice of Meeting The ACRS Subcommittee on Advanced Boiling Water Reactor...

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

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

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

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

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

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

  14. Reporting disease activity in clinical trials of patients with rheumatoid arthritis: EULAR/ACR collaborative recommendations.

    PubMed

    Aletaha, D; Landewe, R; Karonitsch, T; Bathon, J; Boers, M; Bombardier, C; Bombardieri, S; Choi, H; Combe, B; Dougados, M; Emery, P; Gomez-Reino, J; Keystone, E; Koch, G; Kvien, T K; Martin-Mola, E; Matucci-Cerinic, M; Michaud, K; O'Dell, J; Paulus, H; Pincus, T; Richards, P; Simon, L; Siegel, J; Smolen, J S; Sokka, T; Strand, V; Tugwell, P; van der Heijde, D; van Riel, P; Vlad, S; van Vollenhoven, R; Ward, M; Weinblatt, M; Wells, G; White, B; Wolfe, F; Zhang, B; Zink, A; Felson, D

    2008-10-15

    To make recommendations on how to report disease activity in clinical trials of rheumatoid arthritis (RA) endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). The project followed the EULAR standardized operating procedures, which use a three-step approach: 1) expert-based definition of relevant research questions (November 2006); 2) systematic literature search (November 2006 to May 2007); and 3) expert consensus on recommendations based on the literature search results (May 2007). In addition, since this is the first joint EULAR/ACR publication on recommendations, an extra step included a meeting with an ACR panel to approve the recommendations elaborated by the expert group (August 2007). Eleven relevant questions were identified for the literature search. Based on the evidence from the literature, the expert panel recommended that each trial should report the following items: 1) disease activity response and disease activity states; 2) appropriate descriptive statistics of the baseline, the endpoints and change of the single variables included in the core set; 3) baseline disease activity levels (in general); 4) the percentage of patients achieving a low disease activity state and remission; 5) time to onset of the primary outcome; 6) sustainability of the primary outcome; 7) fatigue. These recommendations endorsed by EULAR and ACR will help harmonize the presentations of results from clinical trials. Adherence to these recommendations will provide the readership of clinical trials with more details of important outcomes, while the higher level of homogeneity may facilitate the comparison of outcomes across different trials and pooling of trial results, such as in meta-analyses.

  15. 75 FR 66401 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-28

    ... Pressurized-Water Reactor (US-APWR); Notice of Meeting The ACRS Subcommittee on US-APWR will hold a meeting on... Evaluation report (SER) associated with the US-APWR design certification. The Subcommittee will...

  16. Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational study.

    PubMed

    Lee, Yvonne C; Cui, Jing; Lu, Bing; Frits, Michelle L; Iannaccone, Christine K; Shadick, Nancy A; Weinblatt, Michael E; Solomon, Daniel H

    2011-06-08

    Disease remission has become a feasible goal for most rheumatoid arthritis (RA) patients; however, patient-reported symptoms, such as pain, may persist despite remission. We assessed the prevalence of pain in RA patients in remission according to the Disease Activity Score (DAS28-CRP4) and the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria. Data were analyzed from RA patients in the Brigham Rheumatoid Arthritis Sequential Study with data at baseline and 1 year. DAS28 remission was defined as DAS28-CRP4 <2.6. The ACR/EULAR remission criteria included (a) one or more swollen joints, (b) one or more tender joints, (c) C-reactive protein ≤1 mg/dl, and (d) patient global assessment score ≤1. Pain severity was measured by using the pain score from the Multi-Dimensional Health Assessment Questionnaire (MDHAQ). The associations between baseline clinical predictors and MDHAQ pain at baseline and 1 year were assessed by using multivariable linear regression. Among the 865 patients with data at baseline and 1 year, 157 (18.2%) met DAS28-CRP4 remission criteria at both time points. Thirty-seven (4.3%) met the ACR/EULAR remission criteria at baseline and 1 year. The prevalence of clinically significant pain (MDHAQ pain ≥4) at baseline ranged from 11.9% among patients meeting DAS28-CRP4 remission criteria to none among patients meeting ACR/EULAR remission criteria. Patient global assessment, MDHAQ function, MDHAQ fatigue, MDHAQ sleep, and arthritis self-efficacy were significantly associated with MDHAQ pain in cross-sectional (P ≤ 0.0005) and longitudinal analyses (P ≤ 0.03). Low swollen-joint counts were associated with high MDHAQ pain in longitudinal analyses (P = 0.02) but not cross-sectional analyses. Other measures of inflammatory disease activity and joint damage were not significantly associated with MDHAQ pain at baseline or at 1 year. Clinically significant pain continues among a substantial proportion of

  17. American College of Rheumatology criteria at inception, and accrual over 5 years in the SLICC inception cohort.

    PubMed

    Urowitz, Murray B; Gladman, Dafna D; Ibañez, Dominique; Sanchez-Guerrero, Jorge; Romero-Diaz, Juanita; Gordon, Caroline; Bae, Sang-Cheol; Clarke, Anne E; Bernatsky, Sasha; Fortin, Paul R; Hanly, John G; Isenberg, David; Rahman, Anisur; Wallace, Daniel J; Ginzler, Ellen; Petri, Michelle; Bruce, Ian N; Merrill, Joan T; Nived, Ola; Sturfelt, Gunnar; Dooley, Mary Anne; Alarcón, Graciela S; Fessler, Barri; Steinsson, Kristjan; Ramsey-Goldman, Rosalind; Zoma, Asad; Khamashta, Munther; Manzi, Susan; van Vollenhoven, Ronald; Ramos-Casals, Manuel; Aranow, Cynthia; Stoll, Thomas

    2014-05-01

    To determine the frequency of each American College of Rheumatology (ACR) criterion met at time of enrollment, and the increase in each of the criteria over 5 years. In 2000 the Systemic Lupus International Collaborating Clinics (SLICC) recruited an international inception cohort of patients with systemic lupus erythematosus (SLE; ≥ 4 ACR criteria) who were followed at yearly intervals according to a standard protocol. Descriptive statistics were used to assess the total and cumulative number of ACR criteria met at each visit. Regression models were done to compare the increase of individual and cumulative criteria as a function of race/ethnicity group, and sex. In all, 768 patients have been followed for a minimum of 5 years. Overall, 59.1% of the patients had an increase in the number of ACR criteria they met over the 5-year period. The mean number of ACR criteria met at enrollment was 5.04 ± 1.13 and at year 5 was 6.03 ± 1.42. At enrollment, nonwhite patients had a higher number of ACR criteria (5.19 ± 1.23) than white patients. The total number of criteria increased in both white and nonwhite ethnicities, but increased more among whites. Males had a slightly lower number of criteria at enrollment compared to females and males accrued fewer criteria at 5 years. In this international inception cohort of SLE patients with at least 4 ACR criteria at entry, there was an accumulation of ACR criteria over the following 5 years. The distribution of criteria both at inception and over 5 years is affected by sex and ethnicity.

  18. The American College of Rheumatology and the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus in two multiethnic cohorts: a commentary.

    PubMed

    Pons-Estel, G J; Wojdyla, D; McGwin, G; Magder, L S; Petri, M A; Pons-Estel, B A; Alarcón, G S

    2014-01-01

    The authors offer some comments on the advantages and possible drawbacks of using the SLICC criteria in longitudinal observational studies and clinical trials after applying and comparing them to the ACR criteria in two multinational, multiethnic lupus cohorts.

  19. 7 CFR 1412.23 - Base acres and Conservation Reserve Program.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Base acres and Conservation Reserve Program. 1412.23... Base Acres for a Farm for Covered Commodities § 1412.23 Base acres and Conservation Reserve Program. (a... year, adjust the base acres for covered commodities and peanuts with respect to the farm by the...

  20. New diagnostic criteria for fibromyalgia: Here to stay?

    PubMed

    Moyano, Sebastián; Kilstein, Jorge Guillermo; Alegre de Miguel, Cayetano

    2015-01-01

    To assess the percentage of patients that fulfill the American College of Rheumatology (ACR) 1990 as well as the ACR 2010 classification criteria, to evaluate whether there is a correlation between tender points and the Widespread Pain Index (WPI) as well as signs and symptoms that predict a fibromyalgia (FM) subtype and to identify those which have greater impact on functioning. We performed a cross-sectional comparative study of 206 patients with previous clinical diagnosis of FM. The studied variables were age, sex, years of disease, tender points, control points, WPI, Symptom Severity Score, subtype of FM, presence of other rheumatic disorders and the Fibromyalgia Impact Questionnaire (FIQ) score. The new diagnostic criteria of FM correctly classified 87,03% of patients who satisfied the ACR 1990 criteria. Both criteria were equally effective in assessing the impact of the disease. FM had a severe impact on the quality of life in 74,87% of patients. Somatoform disorder was the predominant subtype. Hyperalgesic FM had a significantly lower FIQ score than the somatoform disorder and depressive subtypes. The ACR 2010 criteria are a simple evaluation tool to use in the primary care setting, that incorporate both peripheral pain and somatic symptoms. New and old criteria should coexist; they enable a major comprehension and ease the management of this prevalent disease. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  1. Appropriateness of Percutaneous Coronary Intervention

    PubMed Central

    Chan, Paul S.; Patel, Manesh R.; Klein, Lloyd W.; Krone, Ronald J.; Dehmer, Gregory J.; Kennedy, Kevin; Nallamothu, Brahmajee K.; Douglas Weaver, W.; Masoudi, Frederick A.; Rumsfeld, John S.; Brindis, Ralph G.; Spertus, John A.

    2012-01-01

    Context Despite the widespread use of percutaneous coronary intervention (PCI), the appropriateness of these procedures in contemporary practice is unknown. Objective To assess the appropriateness of PCI in the United States. Design, Setting, and Patients Multicenter, prospective study of patients within the National Cardiovascular Data Registry undergoing PCI between July 1, 2009, and September 30, 2010, at 1091 US hospitals. The appropriateness of PCI was adjudicated using the appropriate use criteria for coronary revascularization. Results were stratified by whether the procedure was performed for an acute (ST-segment elevation myocardial infarction, non–ST-segment elevation myocardial infarction, or unstable angina with high-risk features) or nonacute indication. Main Outcome Measures Proportion of acute and nonacute PCIs classified as appropriate, uncertain, or inappropriate; extent of hospital-level variation in inappropriate procedures. Results Of 500 154 PCIs, 355 417 (71.1%) were for acute indications (ST-segment elevation myocardial infarction, 103 245 [20.6%]; non–ST-segment elevation myocardial infarction, 105 708 [21.1%]; high-risk unstable angina, 146 464 [29.3%]), and 144 737 (28.9%) for nonacute indications. For acute indications, 350 469 PCIs (98.6%) were classified as appropriate, 1055 (0.3%) as uncertain, and 3893 (1.1%) as inappropriate. For nonacute indications, 72 911 PCIs (50.4%) were classified as appropriate, 54 988 (38.0%) as uncertain, and 16 838 (11.6%) as inappropriate. The majority of inappropriate PCIs for nonacute indications were performed in patients with no angina (53.8%), low-risk ischemia on noninvasive stress testing (71.6%), or suboptimal (≤1 medication) antianginal therapy (95.8%). Furthermore, although variation in the proportion of inappropriate PCI across hospitals was minimal for acute procedures, there was substantial hospital variation for nonacute procedures (median hospital rate for inappropriate PCI, 10

  2. 78 FR 47803 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-06

    ... comments should notify the Designated Federal Official (DFO), John Lai (Telephone 301-415-5197 or Email: John.Lai@nrc.gov ) five days prior to the meeting, if possible, so that appropriate arrangements can...

  3. 77 FR 10786 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-23

    ... comments should notify the Designated Federal Official (DFO), John Lai (Telephone 301-415-5197 or Email: John.Lai@nrc.gov ) five days prior to the meeting, if possible, so that appropriate arrangements can...

  4. 78 FR 20958 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Reliability...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-08

    ... comments should notify the Designated Federal Official (DFO), John Lai (Telephone 301-415-5197 or Email: John.Lai@nrc.gov ) five days prior to the meeting, if possible, so that appropriate arrangements can...

  5. 75 FR 44818 - Advisory Committee on Reactor Safeguards (ACRS): Meeting of the ACRS Subcommittee on Plant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-29

    ... should notify the Designated Federal Official (DFO), Girija Shukla (Telephone 301-415-6855 or E-mail Girija.Shukla@nrc.gov ) five days prior to the meeting, if possible, so that appropriate arrangements...

  6. Comparison of Urine Albumin-to-Creatinine Ratio (ACR) Between ACR Strip Test and Quantitative Test in Prediabetes and Diabetes.

    PubMed

    Nah, Eun Hee; Cho, Seon; Kim, Suyoung; Cho, Han Ik

    2017-01-01

    Albuminuria is generally known as a sensitive marker of renal and cardiovascular dysfunction. It can be used to help predict the occurrence of nephropathy and cardiovascular disorders in diabetes. Individuals with prediabetes have a tendency to develop macrovascular and microvascular pathology, resulting in an increased risk of retinopathy, cardiovascular diseases, and chronic renal diseases. We evaluated the clinical value of a strip test for measuring the urinary albumin-to-creatinine ratio (ACR) in prediabetes and diabetes. Spot urine samples were obtained from 226 prediabetic and 275 diabetic subjects during regular health checkups. Urinary ACR was measured by using strip and laboratory quantitative tests. The positive rates of albuminuria measured by using the ACR strip test were 15.5% (microalbuminuria, 14.6%; macroalbuminuria, 0.9%) and 30.5% (microalbuminuria, 25.1%; macroalbuminuria, 5.5%) in prediabetes and diabetes, respectively. In the prediabetic population, the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the ACR strip method were 92.0%, 94.0%, 65.7%, 99.0%, and 93.8%, respectively; the corresponding values in the diabetic population were 80.0%, 91.6%, 81.0%, 91.1%, and 88.0%, respectively. The median [interquartile range] ACR values in the strip tests for measurement ranges of <30, 30-300, and >300 mg/g were 9.4 [6.3-15.4], 46.9 [26.5-87.7], and 368.8 [296.2-575.2] mg/g, respectively, using the laboratory method. The ACR strip test showed high sensitivity, specificity, and negative predictive value, suggesting that the test can be used to screen for albuminuria in cases of prediabetes and diabetes.

  7. Continuing Appropriations Act, 2012

    THOMAS, 112th Congress

    Rep. Graves, Sam [R-MO-6

    2011-07-21

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

  8. Continuing Appropriations Act, 2011

    THOMAS, 111th Congress

    Rep. Lowey, Nita M. [D-NY-18

    2009-06-26

    09/30/2010 Became Public Law No: 111-242. (TXT | PDF) (All Actions) Notes: Continuing appropriations through 12/3/2010. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  9. Continuing Appropriations Resolution, 2015

    THOMAS, 113th Congress

    Rep. Rogers, Harold [R-KY-5

    2014-09-09

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

  10. Continuing Appropriations Act, 2012

    THOMAS, 112th Congress

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

    2011-05-26

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

  11. Continuing Appropriations Resolution, 2015

    THOMAS, 113th Congress

    Rep. Rogers, Harold [R-KY-5

    2014-09-09

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

  12. Continuing Appropriations Act, 2012

    THOMAS, 112th Congress

    Rep. Graves, Sam [R-MO-6

    2011-07-21

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

  13. Continuing Appropriations Act, 2012

    THOMAS, 112th Congress

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

    2011-05-26

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

  14. Continuing Appropriations Act, 2012

    THOMAS, 112th Congress

    Rep. Graves, Sam [R-MO-6

    2011-07-21

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

  15. Continuing Appropriations Act, 2011

    THOMAS, 111th Congress

    Rep. Lowey, Nita M. [D-NY-18

    2009-06-26

    09/30/2010 Became Public Law No: 111-242. (TXT | PDF) (All Actions) Notes: Continuing appropriations through 12/3/2010. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  16. Continuing Appropriations Act, 2012

    THOMAS, 112th Congress

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

    2011-05-26

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

  17. Continuing Appropriations Resolution, 2015

    THOMAS, 113th Congress

    Rep. Rogers, Harold [R-KY-5

    2014-09-09

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

  18. Continuing Appropriations Act, 2011

    THOMAS, 111th Congress

    Rep. Lowey, Nita M. [D-NY-18

    2009-06-26

    09/30/2010 Became Public Law No: 111-242. (PDF) (All Actions) Notes: Continuing appropriations through 12/3/2010. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  19. Omnibus Appropriations Act, 2009

    THOMAS, 111th Congress

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

    2009-02-23

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

  20. Omnibus Appropriations Act, 2009

    THOMAS, 111th Congress

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

    2009-02-23

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

  1. Omnibus Appropriations Act, 2009

    THOMAS, 111th Congress

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

    2009-02-23

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

  2. Omnibus Appropriations Act, 2009

    THOMAS, 111th Congress

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

    2009-02-23

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

  3. 24 CFR 1710.9 - Twenty acre lots.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  4. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DIRECT AND COUNTER-CYCLICAL PROGRAM AND AVERAGE... (b) of this section, base acres for covered commodities and peanuts are as defined in § 1412.3. (b... pulse crops are equal to the sum of the following: (i) The 4-year average of the acreage planted or...

  5. 7 CFR 1412.21 - Election of base acres.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DIRECT AND COUNTER-CYCLICAL PROGRAM AND AVERAGE... (b) of this section, base acres for covered commodities and peanuts are as defined in § 1412.3. (b... pulse crops are equal to the sum of the following: (i) The 4-year average of the acreage planted or...

  6. Gray squirrels reproduce in a 2-acre enclosure

    Treesearch

    H. Reed Sanderson; Larry A. Berry

    1973-01-01

    A 2-acre enclosure was built in a 40-year-old hardwood stand, and 5 to 19 gray squirrels (Sciurus carolinensis) were confined in it during 3 years. Reproductive behavior of the squirrels was the same at all population densities, but densities above 12 may have reduced productivity. For 10 to 12 squirrels, behavior was about normal and productivity...

  7. ACR testing of a dedicated head SPECT unit.

    PubMed

    Sensakovic, William F; Hough, Matthew C; Kimbley, Elizabeth A

    2014-07-08

    Physics testing necessary for program accreditation is rigorously defined by the ACR. This testing is easily applied to most conventional SPECT systems based on gamma camera technology. The inSPira HD is a dedicated head SPECT system based on a rotating dual clamshell design that acquires data in a dual-spiral geometry. The unique geometry and configuration force alterations of the standard ACR physics testing protocol. Various tests, such as intrinsic planar uniformity and/or resolution, do not apply. The Data Spectrum Deluxe Phantom used for conventional SPECT testing cannot fit in the inSPira HD scanner bore, making (currently) unapproved use of the Small Deluxe SPECT Phantom necessary. Matrix size, collimator type, scanning time, reconstruction method, and attenuation correction were all varied from the typically prescribed ACR instructions. Visible spheres, sphere contrast, visible rod groups, uniformity, and root mean square (RMS) noise were measured. The acquired SPECT images surpassed the minimum ACR requirements for both spatial resolution (9.5 mm spheres resolved) and contrast (6.4 mm rod groups resolved). Sphere contrast was generally high. Integral uniformity was 4% and RMS noise was 1.7%. Noise appeared more correlated than in images from a conventional SPECT scanner. Attenuation-corrected images produced from direct CT scanning of the phantom and a manufacturer supplied model of the phantom demonstrated negligible differences.

  8. Diocese of Boise Uses ACRE and IFG To Design Programs.

    ERIC Educational Resources Information Center

    Craven, Jack

    2002-01-01

    Describes the development and implementation of adult religious education programs by the Diocese of Boise. Utilizing both the Assessment of Catholic Religious Education (ACRE) and Information for Growth (IFG) assessment instruments, the pastors identified topics of particular interest to members of their congregation and then used this…

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

    ERIC Educational Resources Information Center

    Clemons, Mark

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

  10. 7 CFR 1412.73 - Sharing of ACRE payments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... determined based on shares recorded on the report of acreage filed in accordance with § 1412.66. Each... share recorded on report of acreage filed in accordance with part 718 of this title and § 1412.66 of this part. (d) In a case where a producer has failed to sign an ACRE program contract for the producer...

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

    ERIC Educational Resources Information Center

    Burch, Kerry

    2008-01-01

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

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

    ERIC Educational Resources Information Center

    Clemons, Mark

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

  13. AcrB, AcrD, and MdtABC multidrug efflux systems are involved in enterobactin export in Escherichia coli.

    PubMed

    Horiyama, Tsukasa; Nishino, Kunihiko

    2014-01-01

    Escherichia coli produces the iron-chelating compound enterobactin to enable growth under iron-limiting conditions. After biosynthesis, enterobactin is released from the cell. However, the enterobactin export system is not fully understood. Previous studies have suggested that the outer membrane channel TolC is involved in enterobactin export. There are several multidrug efflux transporters belonging to resistance-nodulation-cell division (RND) family that require interaction with TolC to function. Therefore, several RND transporters may be responsible for enterobactin export. In this study, we investigated whether RND transporters are involved in enterobactin export using deletion mutants of multidrug transporters in E. coli. Single deletions of acrB, acrD, mdtABC, acrEF, or mdtEF did not affect the ability of E. coli to excrete enterobactin, whereas deletion of tolC did affect enterobactin export. We found that multiple deletion of acrB, acrD, and mdtABC resulted in a significant decrease in enterobactin export and that plasmids carrying the acrAB, acrD, or mdtABC genes restored the decrease in enterobactin export exhibited by the ΔacrB acrD mdtABC mutant. These results indicate that AcrB, AcrD, and MdtABC are required for the secretion of enterobactin.

  14. Incidence of systemic lupus erythematosus in a population-based cohort using revised 1997 American College of Rheumatology and the 2012 Systemic Lupus International Collaborating Clinics classification criteria.

    PubMed

    Ungprasert, P; Sagar, V; Crowson, C S; Amin, S; Makol, A; Ernste, F C; Osborn, T G; Moder, K G; Niewold, T B; Maradit-Kremers, H; Ramsey-Goldman, R; Chowdhary, V R

    2017-03-01

    In 2012, the Systemic Lupus International Collaborating Clinics (SLICC) group published a new set of classification criteria for systemic lupus erythematosus (SLE). Studies applying these criteria to real-life scenarios have found either equal or greater sensitivity and equal or lower specificity to the 1997 ACR classification criteria (ACR 97). Nonetheless, there are no studies that have used the SLICC 12 criteria to investigate the incidence of lupus. We used the resource of the Rochester Epidemiology Project to identify incident SLE patients in Olmsted County, Minnesota, from 1993 to 2005, who fulfilled the ACR 97 or SLICC 12 criteria. A total of 58 patients met criteria by SLICC 12 and 44 patients met criteria by ACR 97. The adjusted incidence of 4.9 per 100,000 person-years by SLICC 12 was higher than that by ACR 97 (3.7 per 100,000 person-years, p = 0.04). The median duration from the appearance of first criterion to fulfillment of the criteria was shorter for the SLICC 12 than for ACR 97 (3.9 months vs 8.1 months). The higher incidence by SLICC 12 criteria came primarily from the ability to classify patients with renal-limited disease, the expansion of the immunologic criteria and the expansion of neurologic criteria.

  15. 77 FR 2571 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on Regulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-18

    ... of Regulatory Guide (RG) 1.127, ``Inspection of Water-Control Structures Associated with Nuclear... relevant issues and facts, and formulate proposed positions and actions, as appropriate, for deliberation... made. Thirty-five hard copies of each presentation or handout should be provided to the DFO thirty...

  16. ACR white paper: New practice models--hospital employment of radiologists: a report from the ACR Future Trends Committee.

    PubMed

    Medverd, Jonathan R; Muroff, Lawrence R; Brant-Zawadzki, Michael N; Lexa, Frank J; Levin, David C

    2012-11-01

    In response to the current era of rapid evolution of health care delivery and financing, radiologists are increasingly considering, as well as confronting, new practice models. Hospital employment is one such opportunity. Within this report to the ACR membership, the potential advantages and risks for radiologists considering hospital employment are examined.

  17. 76 FR 68793 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-07

    ... [Federal Register Volume 76, Number 215 (Monday, November 7, 2011)] [Notices] [Page 68793] [FR Doc... participation in ACRS meetings were published in the Federal Register on October 17, 2011 (76 FR 64127-64128... Assistant, Reactor Safety Branch, Advisory Committee on Reactor Safeguards. [FR Doc. 2011-28738 Filed...

  18. 78 FR 70597 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Planning and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-26

    ..., Rockville, Maryland. The meeting will be open to public attendance with the exception of a portion that may... that are open to the public. Detailed procedures for the conduct of and participation in ACRS meetings...-25-13; 8:45 am] BILLING CODE 7590-01-P ...

  19. The 2016 classification criteria for primary Sjogren's syndrome: what's new?

    PubMed

    Franceschini, Franco; Cavazzana, Ilaria; Andreoli, Laura; Tincani, Angela

    2017-03-31

    New 2016 ACR/EULAR classification criteria for primary Sjogren's syndrome (SS) have been developed and endorsed by the ACR. The newly proposed criteria include simple-to-perform items.Two important points of the new criteria should be considered. Firstly, they indicate that either salivary gland biopsy or anti-Ro must be positive in order to corroborate the inflammatory and autoimmune nature of the disease. Secondly, the criteria recognize the systemic nature of SS, namely that patients without salivary or ocular glandular symptoms, but with extraglandular manifestations and B cell activation markers were also included in the SS classification. Additionally, the new criteria modified some technical points. The ocular staining score threshold was increased to 5 due to the higher specificity. The immunological profile includes only anti-Ro antibodies, while positivity for antinuclear antibodies and rheumatoid factor or isolated anti-La was excluded due to a lack of specificity.The 2016 ACR/EULAR criteria are suitable for early identification of SS, providing patients with the opportunity of enrollment in clinical trials for new specific treatment. Although validation has been successful, the real life application of these criteria will test their performance.

  20. Significance of breast lesion descriptors in the ACR BI-RADS MRI lexicon.

    PubMed

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

    2009-04-01

    In recent years, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has altered the clinical management for women with breast cancer. In March 2007, the American Cancer Society (ACS) issued a new guideline recommending annual MRI screening for high-risk women. This guideline is expected to substantially increase the number of women each year who receive breast MRI. The diagnosis of breast MRI involves the description of morphological and enhancement kinetics features. To standardize the communication language, the Breast Imaging Reporting and Data System (BI-RADS) MRI lexicon was developed by the American College of Radiology (ACR). In this article, the authors will review various appearances of breast lesions on MRI by using the standardized terms of the ACR BI-RADS MRI lexicon. The purpose is to familiarize all medical professionals with the breast MRI lexicon because the use of this imaging modality is rapidly growing in the field of breast disease. By using this common language, a comprehensive analysis of both morphological and kinetic features used in image interpretation will help radiologists and other clinicians to communicate more clearly and consistently. This may, in turn, help physicians and patients to jointly select an appropriate management protocol for each patient's clinical situation. (c) 2009 American Cancer Society

  1. Consolidated Appropriations Act, 2012

    THOMAS, 112th Congress

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

    2011-05-31

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

  2. Continuing Appropriations Act, 2014

    THOMAS, 113th Congress

    Rep. Black, Diane [R-TN-6

    2013-07-22

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

  3. Consolidated Appropriations Act, 2012

    THOMAS, 112th Congress

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

    2011-05-31

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

  4. Appropriate Technology Bibliography.

    ERIC Educational Resources Information Center

    Firestein, Kenneth; And Others

    This bibliography of literature on appropriate technology is divided into three parts. Part 1 is an alphabetical listing of entries by title. Entries with numbers at the beginning of the title are listed first. Each entry includes author, publication year, publisher, source, total pages, institution, and other information. Part 2 is a rotated or…

  5. Continuing Appropriations Act, 2014

    THOMAS, 113th Congress

    Rep. Black, Diane [R-TN-6

    2013-07-22

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

  6. Continuing Appropriations Act, 2014

    THOMAS, 113th Congress

    Rep. Black, Diane [R-TN-6

    2013-07-22

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

  7. Special Appropriation Act Projects

    EPA Pesticide Factsheets

    EPA is sometimes directed to provide funding to a specific entity for study, purpose, or activity.This information will be of interest to a community or other entity that has been identified in one of EPA's appropriations acts to receive such funding.

  8. Optimal Appropriateness Measurement.

    ERIC Educational Resources Information Center

    Levine, Michael V.; Drasgow, Fritz

    1988-01-01

    Some examinees' test-taking behavior may be so idiosyncratic that their test scores are not comparable to those of more typical examinees. A new theoretical approach to appropriateness measurement is proposed that specifies a likelihood ratio test and an efficient computer algorithm for computing the test statistic. (TJH)

  9. Consolidated Appropriations Act, 2012

    THOMAS, 112th Congress

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

    2011-05-31

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

  10. Consolidated Appropriations Act, 2012

    THOMAS, 112th Congress

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

    2011-05-31

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

  11. 78 FR 2694 - Meeting of the ACRS Subcommittee on Planning and Procedures; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-14

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Planning and... Reactor Safeguards. BILLING CODE 7590-01-P...

  12. 7 CFR 1412.41 - Direct and counter-cyclical program contract or ACRE program contract.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (3) Terminated at an earlier date by mutual consent of all parties, including CCC. (d) A transfer or... acres on the farm must sign a new DCP or ACRE program contract and provide supporting documentation such...

  13. A novel packing arrangement of AcrB in the lipid bilayer membrane.

    PubMed

    Ly, K; Bartho, J D; Eicher, T; Pos, K M; Mitra, A K

    2014-12-20

    The central component AcrB of the Escherichia coli drug efflux complex AcrA-AcrB-TolC has been extensively investigated by X-ray crystallography of detergent-protein 3-D crystals. In these crystals, AcrB packs as trimers - the functional unit. We visualized the AcrB-AcrB interaction in its native environment by examining E. coli lipid reconstituted 2-D crystals, which were overwhelmingly formed by asymmetric trimers stabilized by strongly-interacting monomers from adjacent trimers. Most interestingly, we observed lattices formed by an arrangement of AcrB monomers distinct from that in traditional trimers. This hitherto unobserved packing, might play a role in the biogenesis of trimeric AcrB.

  14. The Acre vertebrate fauna: Age, diversity, and geography

    NASA Astrophysics Data System (ADS)

    Cozzuol, Mario Alberto

    2006-07-01

    The vertebrate faunal assemblage associated with the Neogene deposits in the Acre region (southwestern Amazonia) is secured as Late Miocene on the basis of a correlation with the 'Mesopotamian' faunal assemblage from the Paraná region of Argentina and Uruguay. Both assemblages occur in the time span of the Huayquerian South American Land Mammal Age (SALMA). The Acre, 'Mesopotamian' (Argentina and Uruguay), and Urumaco (Venezuela) assemblages are considered faunistically correlated and contemporaneous on the basis of their shared amniote taxa. The Laventan assemblage from Colombia has important faunistic affinities with the previous three but is older. A paleogeographic scenario is proposed to explain the long-distance correlation among those assemblages. On the basis of data from geology, field observations, fauna, and palynology, the validity of the Ucayali unconformity as a time marker along all of western Amazonia is rejected.

  15. Consolidated Appropriations Act, 2010

    THOMAS, 111th Congress

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

    2009-07-22

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

  16. Consolidated Appropriations Act, 2010

    THOMAS, 111th Congress

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

    2009-07-22

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

  17. Consolidated Appropriations Act, 2010

    THOMAS, 111th Congress

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

    2009-07-22

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

  18. Consolidated Appropriations Act, 2010

    THOMAS, 111th Congress

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

    2009-07-22

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

  19. 78 FR 8202 - Meeting of the Joint ACRS Subcommittees on Thermal Hydraulic Phenomena and Materials, Metallurgy...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-05

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Joint ACRS Subcommittees on Thermal Hydraulic Phenomena and Materials, Metallurgy and Reactor Fuels; Notice of Meeting The Joint ACRS Subcommittees on Thermal Hydraulic Phenomena and Materials, Metallurgy and Reactor Fuels will hold a meeting...

  20. 76 FR 57082 - Advisory Committee on Reactor Safeguards; Meeting of the ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-15

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

  1. 76 FR 76442 - Advisory Committee On Reactor Safeguards Meeting of The ACRS Subcommittee on Materials...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-07

    ... COMMISSION Advisory Committee On Reactor Safeguards Meeting of The ACRS Subcommittee on Materials, Metallurgy & Reactor Fuels Revision to December 15, 2011, ACRS Meeting Federal Register Notice The Federal Register Notice for the ACRS Subcommittee Meeting on Materials, Metallurgy & Reactor Fuels scheduled to be held...

  2. 7 CFR 1412.79 - Executed ACRE contract not in conformity with regulations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Executed ACRE contract not in conformity with... Average Crop Revenue Election (ACRE) Program § 1412.79 Executed ACRE contract not in conformity with... conformity with the provisions of this part, the provisions of this part will prevail....

  3. 7 CFR 1412.79 - Executed ACRE contract not in conformity with regulations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Executed ACRE contract not in conformity with... Average Crop Revenue Election (ACRE) Program § 1412.79 Executed ACRE contract not in conformity with... conformity with the provisions of this part, the provisions of this part will prevail....

  4. 42 CFR 456.5 - Evaluation criteria.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Evaluation criteria. 456.5 Section 456.5 Public...) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL General Provisions § 456.5 Evaluation criteria. The agency must establish and use written criteria for evaluating the appropriateness and quality of...

  5. Pharmacokinetic-pharmacodynamic modeling of fostamatinib efficacy on ACR20 to support dose selection in patients with rheumatoid arthritis (RA).

    PubMed

    Maringwa, John; Kågedal, Matts; Hamrén, Ulrika Wählby; Martin, Paul; Cox, Eugène; Hamrén, Bengt

    2015-03-01

    R788 (fostamatinib) is an oral prodrug that is rapidly converted into a relatively selective spleen tyrosine kinase (SYK) inhibitor R406, evaluated for the treatment of rheumatoid arthritis (RA). This analysis aimed at developing a pharmacodynamic model for efficacy using pooled ACR20 data from two phase II studies in patients with rheumatoid arthritis (TASKi1 and TASKi2), describing the effect of fostamatinib as a function of fostamatinib exposure (dose, R406 plasma concentration) and other explanatory variables. The exposure-response relationship of fostamatinib was implemented into a continuous time Markov model describing the time course of transition probabilities between the three possible states of ACR20 non-responder, responder, and dropout at each visit. The probability of transition to the ACR20 response state was linearly (at the rate constant level) related to average R406 plasma concentrations and the onset of this drug effect was fast. Further, increases of fostamatinib dose resulted in increased dropout and subsequent loss of efficacy. This analysis provided an increased understanding of the exposure-response relationship, and provided support for fostamatinib 100 mg BID an appropriate dose regimen for further clinical evaluation.

  6. Radiation therapy: appropriateness review

    SciTech Connect

    Not Available

    1981-03-01

    Review of the appropriateness of radiation therapy services for the Finger Lakes Region was based on the standards adopted by the Finger Lakes Health Systems Agency (FLHSA) Executive Committee. The standards were developed to address considerations of availability, accessibility, acceptability, continuity, need, financial viability, cost effectiveness, and quality. The FLHSA found that megavoltage radiation therapy services currently being provided are appropriate for residents of the Finger Lakes Region. The overall pattern of performance was satisfactory. The following were among the findings: (1) radiation therapy services are accessible to patients in terms of travel time, hours of operation, and referral source; (2) all regional equipment meets minimum standards for source axis distance and rotational capability; (3) the nine megavoltage radiation therapy units meet the needs of both the regional population and the substantial number of persons from adjacent areas who travel to the Region for radiation therapy services; (4) minimum utilization standards for cases and treatments are met or nearly met by all institutional providers; (5) the two private providers of radiation therapy services are underutilized; and (6) each institutional provider's cost per treatment falls within the accepted range.

  7. In patients with early rheumatoid arthritis, the new ACR/EULAR definition of remission identifies patients with persistent absence of functional disability and suppression of ultrasonographic synovitis.

    PubMed

    Sakellariou, Garifallia; Scirè, Carlo Alberto; Verstappen, Suzanne M M; Montecucco, Carlomaurizio; Caporali, Roberto

    2013-02-01

    To test the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) and disease activity score in 44 and 28 joints (DAS, DAS28) definitions of remission in early rheumatoid arthritis (RA), against disability and ultrasound-detectable synovitis. In an observational study of early RA patients, remission rates were determined and compared in 166 patients. The remission definitions included the simplified disease activity index (SDAI≤3.3), ACR/EULAR (categorical), DAS28 (<2.6) and DAS (<1.6). The health assessment questionnaire (HAQ) was completed at baseline and 12 months, power Doppler-positive synovitis (PDPS) was assessed at baseline, 6 and 12 months. Cross-sectionally, the outcomes were low functional disability (HAQ≤0.5) or absent PDPS in all joints, while longitudinally the outcomes were stable low functional disability and persistent absent PDPS in all joints. At baseline, 33.7% of patients achieved DAS28 remission, 43.37% DAS remission, 16.8% SDAI remission, 13.8% ACR/EULAR remission. DAS28, SDAI and ACR/EULAR remission was cross-sectionally associated with low functional disability and absent PDPS. All definitions were longitudinally associated with low functional disability: positive likelihood ratios (LR+) of 3.24 for DAS28, 2.14 for DAS, 4.86 for SDAI, 5.67 for ACR/EULAR criteria, and with absent PDPS for DAS28 (LR+ 1.66), SDAI (LR+ 6.46), ACR/EULAR (LR+ 5.07). The new remission definitions confirmed their validity in an observational setting and identify patients with better disease control.

  8. WE-D-207-03: CT Protocols for Screening and the ACR Designated Lung Screening Program

    SciTech Connect

    McNitt-Gray, M.

    2015-06-15

    In the United States, Lung Cancer is responsible for more cancer deaths than the next four cancers combined. In addition, the 5 year survival rate for lung cancer patients has not improved over the past 40 to 50 years. To combat this deadly disease, in 2002 the National Cancer Institute launched a very large Randomized Control Trial called the National Lung Screening Trial (NLST). This trial would randomize subjects who had substantial risk of lung cancer (due to age and smoking history) into either a Chest X-ray arm or a low dose CT arm. In November 2010, the National Cancer Institute announced that the NLST had demonstrated 20% fewer lung cancer deaths among those who were screened with low-dose CT than with chest X-ray. In December 2013, the US Preventive Services Task Force recommended the use of Lung Cancer Screening using low dose CT and a little over a year later (Feb. 2015), CMS announced that Medicare would also cover Lung Cancer Screening using low dose CT. Thus private and public insurers are required to provide Lung Cancer Screening programs using CT to the appropriate population(s). The purpose of this Symposium is to inform medical physicists and prepare them to support the implementation of Lung Screening programs. This Symposium will focus on the clinical aspects of lung cancer screening, requirements of a screening registry for systematically capturing and tracking screening patients and results (such as required Medicare data elements) as well as the role of the medical physicist in screening programs, including the development of low dose CT screening protocols. Learning Objectives: To understand the clinical basis and clinical components of a lung cancer screening program, including eligibility criteria and other requirements. To understand the data collection requirements, workflow, and informatics infrastructure needed to support the tracking and reporting components of a screening program. To understand the role of the medical physicist in

  9. The provisional ACR/EULAR definition of remission in RA: a comment on the patient global assessment criterion.

    PubMed

    Vermeer, Marloes; Kuper, Hillechiena H; van der Bijl, Arie E; Baan, Henriëtte; Posthumus, Marcel D; Brus, Herman L M; van Riel, Piet L C M; van de Laar, Mart A F J

    2012-06-01

    The provisional ACR/European League Against Rheumatism (EULAR) definition of remission in RA requires a score of ≤1 on the patient global assessment (PGA, 0-10 scale). We explored the relation between the PGA criterion and the patient's clinical disease state in an observational dataset. Data of 512 newly diagnosed RA patients of the Dutch Rheumatoid Arthritis Monitoring (DREAM) remission induction cohort were analysed. Both 28-joint counts and more comprehensive joint counts (tender joint count-53, swollen joint count-44) were used. ACR/EULAR remission was present in 20.1% of the patients when using 28-joint counts and in 17.4% of the patients when applying more comprehensive joint counts. In 108 patients, the PGA score was >1 despite fulfilment of the remaining criteria (TJC28, SJC28 and CRP in mg/dl ≤1). Residual disease activity was observed in 31.5% (34/108) and median (interquartile range) scores on PGA, pain and fatigue were 2.4 (1.8-4.0), 2.0 (1.1-3.0) and 2.7 (1.3-5.0), respectively. Applying more comprehensive joint counts showed comparable results. In 19.5% (100/512) of patients, disease activity was absent (TJC53 = 0, SJC44 = 0, and CRP ≤1). In 41% (n = 41) of these patients, the PGA score was >1. Receiver operating characteristic analysis showed moderate accuracy of the PGA to discriminate between fulfilment and no fulfilment of all remaining criteria. Frequently, patients did not meet the PGA criterion despite a good clinical disease state. Apparently the PGA is not solely influenced by RA disease activity. In patients with marked divergence between the PGA and objective clinical measurements, caution should be taken when applying the provisional ACR/EULAR definition of remission.

  10. Overexpression and purification of the three components of the Enterobacter aerogenes AcrA-AcrB-TolC multidrug efflux pump.

    PubMed

    Masi, Muriel; Pagès, Jean-Marie; Pradel, Elizabeth

    2003-03-25

    The tripartite AcrA-AcrB-TolC system is the major efflux pump of the nosocomial pathogen Enterobacter aerogenes. AcrA is a trimeric periplasmic lipoprotein anchored in the inner membrane, AcrB is an inner membrane transporter and TolC is a trimeric outer membrane channel. In order to reconstitute the AcrA-AcrB-TolC system of E. aerogenes in artificial membranes, we overexpressed and purified the three proteins. The E. aerogenes acrA, acrB and tolC open reading frames were individually inserted in the expression vector pET24a(+), in frame with a sequence coding a C-terminal hexahistidine tag to allow purification by INAC (Immobilized Nickel Affinity Chromatography). The mature AcrA-6His was overproduced in a soluble form in the cytoplasm of Escherichia coli BL21(DE3). AcrA-6His was purified under native conditions in two steps using INAC and gel permeation chromatography. We obtained about 25 mg of 97% pure AcrA-6His per liter of culture. AcrB-6His was solubilized from the membrane fraction of E. coli C43(DE3) in 300 mM NaCl, 5% Triton X-100 and purified in one step by INAC. The AcrB-6His enriched fraction was eluted with 100 mM imidazole. The final yield was 1-2 mg of 95% pure AcrB-6His per liter of culture. The membrane fraction of E. coli BL21(DE3)pLysS containing TolC-6His was first treated with 2% Triton X-100, 30 mM MgCl(2) to solubilize the inner membrane proteins. After ultracentrifugation, the pellet was treated with 5% Triton X-100, 5 mM EDTA to solubilize the outer membrane proteins. Approximately 5 mg of 95% pure TolC-6His trimers per liter of culture was purified by INAC.

  11. IgA vasculitis in adults: the performance of the EULAR/PRINTO/PRES classification criteria in adults.

    PubMed

    Hočevar, Alojzija; Rotar, Ziga; Jurčić, Vesna; Pižem, Jože; Čučnik, Saša; Vizjak, Alenka; van den Broeke, Rianne; Tomšič, Matija

    2016-03-02

    In 2010, EULAR/PRINTO/PRES proposed new classification criteria for paediatric IgA vasculitis (IgAV) that have a higher diagnostic sensitivity than the 1990 ACR criteria. These criteria have so far not been evaluated in adults, in whom IgAV is considered as a rare disease. Our main objective was to compare the diagnostic performance of EULAR/PRINTO/PRES and ACR classification criteria in adult IgAV. Adult IgAV cases fulfilling the 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides (ICHCCNV) definition of IgAV at a secondary/tertiary rheumatology referral centre were critically reviewed in a partially retrospective and partially prospective manner. First, we compared the diagnostic sensitivity of ACR and EULAR/PRINTO/PRES criteria in this group of patients. Second, the diagnostic specificity of ACR and EULAR/PRINTO/PRES was determined by applying these criteria to a control group of patients with other systemic vasculitides. Between 1 January 2010 and 31 December 2014 350 new cases of systemic vasculitis were identified. IgAV was diagnosed in 129, and other systemic vasculitides in 221 (123 had large, six medium and 92 small vessel vasculitis) cases according to ICHCCNV. The diagnostic sensitivity and specificity of the IgAV EULAR/PRINTO/PRES criteria were 99.2 % (95 % CI 95.4-99.9 %) and 86.0 % (95 % CI 80.7-90.3 %), and of the ACR criteria 86.8 % (95 % CI 79.7-92.1 %) and 81.0 % (95 % CI 75.2-85.9 %), respectively with an inter-criteria agreement of 77.5 % (95 % CI: 70.8-84.1 %). In the adult population the EULAR/PRINTO/PRES IgAV classification criteria had a higher sensitivity and specificity than the ACR criteria.

  12. ACR-NEMA Standard: The Reality Vs. The Ideal

    NASA Astrophysics Data System (ADS)

    Good, Walter F.; Herron, John M.; Maitz, Glenn S.; Gur, David

    1988-06-01

    We have designed and installed ACR-NEMA communications capability on an IBM PC AT personal computer. Our implementation consists of an IBM PC AT bus compatible interface board with a custom device driver running under the MS DOS operating system. The interface board, which occupies one 16 bit bus slot, is capable of sending or receiving single data frames at rates in excess of the 8 MBytes/sec target specified in the standard. A full implementation (including multiple virtual channels) of all communication protocol layers from the physical layer through the session layer are operational in the driver. Sustained transmission rates between two AT computers equipped with this interface have been measured to be 750 KBytes per second for buffer-to-buffer transmission in "data acknowledge" service class. We have identified several difficulties inherent in the ACR/NEMA standard. These and the question of whether the overall philosophy of the standard optimally meets the needs of a real radiology department are discussed.

  13. Characterization of the multidrug efflux regulator AcrR from Escherichia coli

    PubMed Central

    Su, Chih-Chia; Rutherford, Denae J.; Yu, Edward W.

    2007-01-01

    The Escherichia coli AcrR represses transcription of the acrB gene, which encodes the multidrug efflux pump AcrB that extrudes a wide variety of toxic compounds, by binding its target operator DNA. Fluorescence polarization was performed using purified, recombinant AcrR that contains a 6xHis tag at the C-terminus and a fluorescein-labeled 28-base pair oligonucleotide bearing a predicted palindrome (IR) operator sequence. Binding of AcrR to the predicted IR sequence occurred with a dissociation constant (KD) in the nanomolar range. Fluorescence polarization assays were also applied to characterize the affinity and specificity of AcrR interaction with three different fluorescent ligands, rhodamine 6G, ethidium and proflavin. The KD values for these ligands range from 4.2 to 10.1 μM, suggesting that AcrR is capable of recognizing a wide range of structurally dissimilar toxic compounds as it is in the case of the AcrB multidrug efflux pump. We found that the binding of rhodamine 6G to AcrR is inhibited by the presence of ethidium. In contrast, the dissociation constant of proflavin binding to AcrR was not affected by ethidium, a result suggesting that ethidium and proflavin are bound to distinct binding sites. PMID:17644067

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

    PubMed

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

    2016-02-26

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

  15. Unauthorized Appropriations and Expiring Authorizations.

    DTIC Science & Technology

    1998-01-15

    Education Act * EPA programs for environmental education FY 1996 APPROPRIATIONS AUTHORIZED: $ 14,000,000 UNAUTHORIZED FY 1998 APPROPRIATIONS...incarcerated individuals FY 1995 APPROPRIATIONS AUTHORIZED: $ 45,000,000 UNAUTHORIZED FY 1998 APPROPRIATIONS: $ 10,214,000 P. L. 101-619 National Environmental

  16. Are the 1990 American College of Rheumatology vasculitis classification criteria still valid?

    PubMed

    Seeliger, Benjamin; Sznajd, Jan; Robson, Joanna C; Judge, Andrew; Craven, Anthea; Grayson, Peter C; Suppiah, Ravi S; Watts, Richard A; Merkel, Peter A; Luqmani, Raashid A

    2017-07-01

    Advances in diagnostic techniques have led to better distinction between types of vasculitis, potentially affecting the utility of the 1990 ACR classification criteria for vasculitis. This study tested the performance of these criteria in a contemporary vasculitis cohort. The Diagnosis and Classification in Vasculitis Study provided detailed clinical, serological, pathological and radiological data from patients with primary systemic vasculitis and clinical context-specific comparator conditions. Fulfilment of six ACR criteria sets and their diagnostic performance was evaluated in patients with a given type of vasculitis and its comparator conditions. Data from 1095 patients with primary systemic vasculitis and 415 with comparator conditions were available. For classification, sensitivities and specificities for ACR classification criteria were, respectively, 81.1% and 94.9% for GCA; 73.6% and 98.3% for Takayasu's arteritis; 65.6% and 88.7% for granulomatosis with polyangiitis; 57.0% and 99.8% for eosinophilic granulomatosis with polyangiitis; 40.6% and 87.8% for polyarteritis nodosa; 28.9% and 88.5% for microscopic polyangiitis; and 72.7% and 96.3% for IgA-vasculitis. Overall sensitivity was 67.1%. Of cases identified by their respective criteria, 16.9% also met criteria for other vasculitides. Diagnostic specificity ranged from 64.2 to 98.9%; overall, 113/415 comparators (27.2%) fulfilled at least one of the ACR classification criteria sets. Since publication of the ACR criteria for vasculitis, the sensitivity for each type of vasculitis, except GCA, has diminished, although the specificities have remained high, highlighting the need for updated classification criteria.

  17. Intraspecific variation of Taenia taeniaeformis as determined by various criteria.

    PubMed

    Azuma, H; Okamoto, M; Oku, Y; Kamiya, M

    1995-01-01

    The intraspecific variation of four laboratory-reared isolates of Taenia taeniaformis the SRN and KRN isolates from Norway rats, Rattus norvegicus, captured in Japan and Malaysia, respectively; the BMM isolated from a house mouse, Mus musculus, captured in Belgium; and the ACR isolate from a gray red-backed vole, Clethrionomys rufocanus bedfordiae, captured in Japan was examined by various criteria. Eggs of each of the four isolates were orally inoculated into several species of intermediate host. They were most infective to the rodent species from which the original metacestode of each isolate had been isolated in the field, and only the ACR isolate was infective to the gray red-backed vole. Although little difference was found between the SRN, KRN, and BMM isolates by the other criteria, including the morphology of rostellar hooks, the protein composition of the metacestode, and restriction endonuclease analysis of DNA, the ACR isolate was clearly different from the others. It was considered that the ACR isolate was independent as a strain distinct from the other three isolates.

  18. An Image Archive With The ACR/NEMA Message Formats

    NASA Astrophysics Data System (ADS)

    Seshadri, Sridhar B.; Khalsa, Satjeet; Arenson, Ronald L.; Brikman, Inna; Davey, Michael J.

    1988-06-01

    An image archive has been designed to manage and store radiologic images received from within the main Hospital and a from a suburban orthopedic clinic. Images are stored on both magnetic as well as optical media. Prior comparison examinations are combined with the current examination to generate a 'viewing folder' that is sent to the display station for primary diagnosis. An 'archive-manager' controls the database managment, periodic optical disk backup and 'viewing-folder' generation. Images are converted into the ACR/NEMA message format before being written to the optical disk. The software design of the 'archive-manager' and its associated modules is presented. Enhancements to the system are discussed.

  19. Unauthorized Appropriations and Expiring Authorizations

    DTIC Science & Technology

    2015-01-15

    Homeownership and Economic Opportunity Act of 2000P.L. 106-569 Removal of regulatory barriers to homeownership* FY 2005 Appropriation Authorized: Indefinite...3,660,000 Amends the Great Ape Conservation Act of 2000 (sec. 703, 16 U.S.C. 6305)* FY 2010 Appropriation Authorized: 5,000,000 Unauthorized FY 2015...note) * FY 2011 Appropriation Authorized: 1,000,000 Unauthorized FY 2015 Appropriations: Not Available Great Lakes Fish and Wildlife Restoration Act

  20. Launch Commit Criteria Monitoring Agent

    NASA Technical Reports Server (NTRS)

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

    2005-01-01

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

  1. Introducing first-year radiology residents to the ACR at the AMCLC from 2009-2011: the potential impact for ACR and state radiological society memberships.

    PubMed

    Brady, Ryan; McMenomy, Brendan; Chauhan, Anil; Siebert, Derrick; Smith, Kevin; Eckmann, David R

    2013-05-01

    This study was designed to determine if first-year radiology resident attendance at the ACR AMCLC over a period of 3 years from 2009 to 2011 led to increased resident knowledge regarding the ACR and Minnesota Radiological Society (MRS), and whether resident involvement in the conference would influence their decisions to participate in the ACR and state radiological societies in the future. All first-year radiology residents from the University of Minnesota and the Mayo Clinic residency programs were invited to attend the ACR AMCLC from 2009 to 2011. Local radiology and radiation oncology groups provided funding for travel and hotel expenses, and both residency programs granted residents one day off from clinical duties to travel. Preconference and postconference questionnaires were used to assess residents' knowledge of the general structure and function of the ACR and MRS. Postconference questionnaires were also used to assess residents' satisfaction with the conference and determine their likelihood of joining the ACR and MRS in the future. A total of 46 residents from the residency programs attended the conference over this time period. Residents' knowledge regarding the ACR and MRS increased after the conference, with improved performance on postconference objective and subjective responses. The number of issues residents identified as important to radiology increased after the conference. The vast majority of residents had a very positive experience at the conference and were "highly likely" or "likely" to join the ACR and MRS in the future. Results from the first 3 years of this ongoing study indicate that attending the ACR AMCLC has been an overwhelmingly positive experience for first-year radiology residents from the University of Minnesota and the Mayo Clinic programs. Residents' knowledge regarding the ACR and MRS increased nearly 2-fold following the conference. Future state radiological society and ACR membership rates among the participants in our

  2. Detection of acrA, acrB, aac(6')-Ib-cr, and qepA genes among clinical isolates of Escherichia coli and Klebsiella pneumoniae.

    PubMed

    Heidary, Mohsen; Bahramian, Aghil; Hashemi, Ali; Goudarzi, Mehdi; Omrani, Vahid Fallah; Eslami, Gita; Goudarzi, Hossein

    2017-03-01

    The distribution of drug resistance among clinical isolates of Escherichia coli and Klebsiella pneumoniae has limited the therapeutic options. The aim of this study was to report the prevalence of quinolone resistance genes among E. coli and K. pneumoniae clinical strains isolated from three educational hospitals of Tehran, Iran. A total of 100 strains of E. coli from Labbafinejad and Taleghani Hospitals and 100 strains of K. pneumoniae from Mofid Children and Taleghani Hospitals were collected between January 2013 and May 2014. Antimicrobial susceptibility tests were done by disk diffusion method based on Clinical and Laboratory Standards Institute guidelines. Detection of qepA, aac(6')-Ib-cr, acrA, and acrB genes was done by polymerase chain reaction (PCR). In this study, fosfomycin and imipenem against E. coli and fosfomycin and tigecycline against K. pneumoniae had the best effect in antimicrobial susceptibility tests. PCR assay using specific primers demonstrated that the prevalence of qepA, aac(6')-Ib-cr, acrA, and acrB genes among the 100 E. coli isolates was 0 (0%), 87 (87%), 92 (92%), and 84 (84%), respectively. The prevalence of qepA, aac(6')-Ib-cr, acrA, and acrB genes among the 100 K. pneumoniae isolates was 4 (4%), 85 (85%), 94 (94%), and 87 (87%), respectively. The distribution of qepA, aac(6')-Ib-cr, acrA, and acrB resistance determinants in E. coli and K. pneumoniae is a great concern. Therefore, infection control and prevention of spread of drug-resistant bacteria need careful management of medication and identification of resistant isolates.

  3. Ranking independent timber investments by alternative investment criteria

    Treesearch

    Thomas J. Mills; Gary E. Dixon

    1982-01-01

    A sample of 231 independent timber investments were ranked by internal rate of return, present net worth per acre and the benefit cost ratio—the last two discounted by 3, 6.4. 7.5. and 10 percent—to determine if the different criteria had a practical influence on timber investment ranking. The samples in this study were drawn from a group of timber investments...

  4. 36 CFR 401.11 - Demolition criteria.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false Demolition criteria. 401.11... MEMORIALS § 401.11 Demolition criteria. As authorized by the provisions of 36 U.S.C. 2106(e), the Commission... appropriate foreign authorities agree to the demolition; and (b)(1) The sponsor of the memorial consents to...

  5. 36 CFR 401.11 - Demolition criteria.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false Demolition criteria. 401.11... MEMORIALS § 401.11 Demolition criteria. As authorized by the provisions of 36 U.S.C. 2106(e), the Commission... appropriate foreign authorities agree to the demolition; and (b)(1) The sponsor of the memorial consents to...

  6. 36 CFR 401.11 - Demolition criteria.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 3 2013-07-01 2012-07-01 true Demolition criteria. 401.11... MEMORIALS § 401.11 Demolition criteria. As authorized by the provisions of 36 U.S.C. 2106(e), the Commission... appropriate foreign authorities agree to the demolition; and (b)(1) The sponsor of the memorial consents to...

  7. A zinc-binding citrus protein metallothionein can act as a plant defense factor by controlling host-selective ACR-toxin production.

    PubMed

    Nishimura, Satoshi; Tatano, Satoshi; Miyamoto, Yoko; Ohtani, Kouhei; Fukumoto, Takeshi; Gomi, Kenji; Tada, Yasuomi; Ichimura, Kazuya; Akimitsu, Kazuya

    2013-01-01

    Metallothionein is a small cysteine-rich protein known to have a metal-binding function. We isolated three different lengths of rough lemon cDNAs encoding a metallothionein (RlemMT1, RlemMT2 and RlemMT3), and only RlemMT1-recombinant protein had zinc-binding activity. Appropriate concentration of zinc is an essential micronutrient for living organisms, while excess zinc is toxic. Zinc also stimulates the production of host-selective ACR-toxin for citrus leaf spot pathogen of Alternaria alternata rough lemon pathotype. Trapping of zinc by RlemMT1-recombinant protein or by a zinc-scavenging agent in the culture medium caused suppression of ACR-toxin production by the fungus. Since ACR-toxin is the disease determinant for A. alternata rough lemon pathotype, addition of RlemMT1 to the inoculum suspension led to a significant decrease in symptoms on rough lemon leaves as a result of reduced ACR-toxin production from the zinc trap around infection sites. RlemMT1-overexpression mutant of A. alternata rough lemon pathotype also produced less ACR-toxin and reduced virulence on rough lemon. This suppression was caused by an interruption of zinc absorption by cells from the trapping of the mineral by RlemMT1 and an excess supplement of ZnSO(4) restored toxin production and pathogenicity. Based on these results, we propose that zinc adsorbents including metallothionein likely can act as a plant defense factor by controlling toxin biosynthesis via inhibition of zinc absorption by the pathogen.

  8. 75 FR 10840 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Advanced Boiling...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-09

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Advanced Boiling Water Reactor (ABWR); Notice of Meeting The ACRS Subcommittee on ABWR will hold a meeting on March 18... 3, 2010. Antonio F. Dias, Chief, Reactor Safety Branch B, Advisory Committee on Reactor...

  9. 75 FR 7632 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Advanced Boiling...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-22

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Advanced Boiling Water Reactor (ABWR) The ACRS Subcommittee on ABWR will hold a meeting on March 2, 2010, at 11545...: February 12, 2010. Antonio F. Dias, Chief Reactor Safety Branch B, Advisory Committee on Reactor...

  10. 75 FR 13611 - Meeting of the ACRS Subcommittee on Reliability and PRA; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-22

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS Subcommittee on Reliability... would result in major inconvenience. Dated: March 15, 2010. Antonio F. Dias, Chief, Reactor Safety Branch B, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  11. 75 FR 38564 - Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Plant Operations...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-02

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the Subcommittee on Plant Operations and Fire Protection The ACRS Subcommittee on Plant Operations and Fire Protection will hold a...

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

    EPA Science Inventory

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

  13. 76 FR 80410 - Advisory Committee on Reactor Safeguards; Meeting of the ACRS Subcommittee on Radiation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-23

    ... Verifying Compliance with Packaging Requirements for Shipment and Receipt of Radioactive Material.'' The... the ACRS Subcommittee on Radiation Protection and Nuclear Materials; Notice of Meeting The ACRS Subcommittee on Radiation Protection and Nuclear Materials will hold a meeting on January 18, 2012, Room T-2B3...

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

    EPA Science Inventory

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

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

    SciTech Connect

    Gray S. Chang

    2008-09-01

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

  16. ACR11 is an Activator of Plastid-Type Glutamine Synthetase GS2 in Arabidopsis thaliana.

    PubMed

    Osanai, Takashi; Kuwahara, Ayuko; Otsuki, Hitomi; Saito, Kazuki; Yokota Hirai, Masami

    2017-03-06

    Glutamine synthetase (GS) is an important enzyme for nitrogen assimilation, and GS2, encoded by GLN2, is the only plastid-type GS in Arabidopsis thaliana. A co-expression analysis suggested that the expression level of the gene encoding a uridylyltransferase-like protein, ACR11, is strongly correlated with GLN2 expression levels. Here we showed that the recombinant ACR11 protein increased GS2 activity in vitro by reducing the Km values of its substrate glutamine. A T-DNA insertion mutant of ACR11 exhibited a reduced GS activity under low nitrate conditions and reduced glutamine levels. Biochemical analyses revealed that ACR11 and GS2 interacted both in vitro and in vivo. These data demonstrate that ACR11 is an activator of GS2, giving it a mechanistic role in the nitrogen assimilation of A. thaliana.

  17. Crystal structure of AcrB in complex with a single transmembrane subunit reveals another twist.

    PubMed

    Törnroth-Horsefield, Susanna; Gourdon, Pontus; Horsefield, Rob; Brive, Lars; Yamamoto, Natsuko; Mori, Hirotada; Snijder, Arjan; Neutze, Richard

    2007-12-01

    Bacterial drug resistance is a serious concern for human health. Multidrug efflux pumps export a broad variety of substrates out of the cell and thereby convey resistance to the host. In Escherichia coli, the AcrB:AcrA:TolC efflux complex forms a principal transporter for which structures of the individual component proteins have been determined in isolation. Here, we present the X-ray structure of AcrB in complex with a single transmembrane protein, assigned by mass spectrometry as YajC. A specific rotation of the periplasmic porter domain of AcrB is also revealed, consistent with the hypothesized "twist-to-open" mechanism for TolC activation. Growth experiments with yajc-deleted E. coli reveal a modest increase in the organism's susceptibility to beta-lactam antibiotics, but this effect could not conclusively be attributed to the loss of interactions between YajC and AcrB.

  18. [The prevalence of tuberculosis in the state of Acre].

    PubMed

    Moreira, Analdemyra da Costa; Sanchez, Myllianne da Silva; Moreira, Suzianny da Silva; Lopes, Creso Machado

    2004-01-01

    It is a descriptive study with the aim of studying the prevalence of tuberculosis in the State of Acre from 1995 to 2001. The data were collected from the forms of the Program for Tuberculosis Control of the Health and Sanitation Office. The data show that the incidence has been maintaining an average of 343.7 new cases a year. The pulmonary type was the most prevalent one, accounting for 90.0%. Among the age groups, the 20-49 age range, with 1347 (56.0%) and the 60 and over-60 age range, with 412 (17.0%), stand out. From 1998 to 2001 the male sex was the most attacked one by the disease, when the year 2000 accounted for 58.2% of the cases. The average of the cure rate was 71.0% and abandonment of treatment was 14.8% in 2001 and 32.3% in 1995. The smallest percentage of death occurred in 1995 (1.0%) and the largest one in 1997 (7.0%). Five cases were notified for the occurrence of coinfection between TB/AIDS and HIV/TB. The program's population coverage was within 90% every year. From the 22 cities, 6 (27.3%) still do not have any action for controlling the disease.

  19. Unauthorized Appropriations and Expiring Authorizations

    DTIC Science & Technology

    1996-01-11

    levees Expiration Date: September 30> 1996 FY 1996 Appropriations Authorized: $ 5,000,000 P. L. 101-619 National Environmental Education Act * EPA programs...for environmental education Expiration Date: September 30, 1996 FY 1996 Appropriations Authorized: $ 14>000,000 P. L. 101-596 Great Lakes Critical

  20. DAPcentrism: Challenging Developmentally Appropriate Practice.

    ERIC Educational Resources Information Center

    Fleer, Marilyn, Ed.

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

  1. Appropriate Technology as Indian Technology.

    ERIC Educational Resources Information Center

    Barry, Tom

    1979-01-01

    Describes the mounting enthusiasm of Indian communities for appropriate technology as an inexpensive means of providing much needed energy and job opportunities. Describes the development of several appropriate technology projects, and the goals and activities of groups involved in utilizing low scale solar technology for economic development on…

  2. Legislative Branch Appropriations Act, 2010

    THOMAS, 111th Congress

    Rep. Wasserman Schultz, Debbie [D-FL-20

    2009-06-17

    10/01/2009 Became Public Law No: 111-68. (TXT | PDF) (All Actions) Notes: Division A is the Legislative Branch Appropriations Act, 2010. Division B is the Continuing Appropriations Resolution, 2010. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  3. Legislative Branch Appropriations Act, 2010

    THOMAS, 111th Congress

    Rep. Wasserman Schultz, Debbie [D-FL-20

    2009-06-17

    10/01/2009 Became Public Law No: 111-68. (TXT | PDF) (All Actions) Notes: Division A is the Legislative Branch Appropriations Act, 2010. Division B is the Continuing Appropriations Resolution, 2010. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

  4. Legislative Branch Appropriations Act, 2010

    THOMAS, 111th Congress

    Rep. Wasserman Schultz, Debbie [D-FL-20

    2009-06-17

    10/01/2009 Became Public Law No: 111-68. (PDF) (All Actions) Notes: Division A is the Legislative Branch Appropriations Act, 2010. Division B is the Continuing Appropriations Resolution, 2010. Tracker: This bill has the status Became LawHere are the steps for Status of Legislation:

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

    PubMed

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

    2016-02-02

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

  6. Conversion to dementia in mild cognitive impairment diagnosed with DSM-5 criteria and with Petersen's criteria.

    PubMed

    Marcos, G; Santabárbara, J; Lopez-Anton, R; De-la-Cámara, C; Gracia-García, P; Lobo, E; Pírez, G; Menchón, J M; Palomo, T; Stephan, B C M; Brayne, C; Lobo, A

    2016-05-01

    In a background of revision of criteria for states of increased risk for progression to dementia, we compare the conversion rate to dementia and Alzheimer's disease (AD) of mild cognitive impairment (MCI) as diagnosed using DSM-5 (DSM-5-MCI) and Petersen's (P-MCI) criteria. A population representative cohort of 4057 dementia-free individuals 55+ years of age was followed up at 2.5 and 4.5 years in Zaragoza, Spain (ZARADEMP). Using the Geriatric Mental State- AGECAT for assessment, research psychiatrists diagnosed DSM-5-MCI and P-MCI following operationalized criteria. 'Conversion rate' (CR), 'annual conversion rate' (ACR), and incidence rate (IR) were calculated along with incidence rate ratio (IRR) to compare the performance of the intermediate cognitive definitions. At 4.5-year follow-up, in individuals aged 65+ years, ACRs for non-cases, P-MCI, and DSM-5-MCI were 0.8, 1.9 and 3.4, respectively, for global dementia. The IRRs were 2.9 and 5.3 for P-MCI and DSM5-MCI, respectively, being the non-cases the reference category. The corresponding values were slightly lower for AD. Conversion rate to dementia and AD was higher using DSM-5-MCI criteria than using Petersen's criteria. However, prediction of the construct still has some way to go, as most MCI individuals did not convert at 4.5-year follow-up. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. 77 FR 74696 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on AP-1000...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-17

    ... comments should notify the Designated Federal Official (DFO), Peter Wen (Telephone 301-415-2832 or Email: Peter.Wen@nrc.gov ) five days prior to the meeting, if possible, so that appropriate arrangements can be...

  8. 75 FR 1831 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on AP1000...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-13

    ... prior to the meeting, if possible, so that appropriate arrangements can be made. Thirty-five hard copies... compact disk containing each presentation at least 30 minutes before the meeting. Electronic recordings...

  9. Evaluation and critique of the ACR-NEMA standard for picture archiving and communications systems

    NASA Astrophysics Data System (ADS)

    Martinez, Ralph; Dallas, William J.; Komatsu, Ken-Ichi

    1990-08-01

    The ACR-NEMA standard for communications in digital radiology has been a topic for much discussion lately. The standard was developed to facilitate the development of multivender products which can communicate using a point-to-point standard interface. In this paper we describe, the combined experiences of Toshiba, Radiology, and Electrical and Computer Engineering at the University of Anzona with the ACR-NEMA standard. We also offer a candid evaluation and critique of the standard, for consideration by implementors of the current standard. The paper summarizes a prototype development effort using a high speed fiber optic network and the ACR-NEMA standard interface. We discuss the overall architecture of the prototype and the software design based on the International Standard Organization (ISO) upper layers. The transport layer and below was implemented using a Matrix-developed ACR-NEMA interface board. The paper discusses the problems encountered in the application of the ACR-NEMA standard in a networking environment for Picture Archiving and Communications Systems (PACS). We conclude that the current form of the ACR- NEMA standard does not provide a workable foundation for the development of cost effective and efficient digital radiology interfaces, especially in a networked PACS. We also discuss the PACS environment beyond the current ACR-NEMA standard and make recommendations for the feature direction of the standard.

  10. Criteria for and Appropriateness of Renal Transplantation in Elderly Patients With End-Stage Renal Disease: A Literature Review and Position Statement on Behalf of the European Renal Association-European Dialysis and Transplant Association Descartes Working Group and European Renal Best Practice.

    PubMed

    Segall, Liviu; Nistor, Ionuţ; Pascual, Julio; Mucsi, Istvan; Guirado, Lluis; Higgins, Robert; Van Laecke, Steven; Oberbauer, Rainer; Van Biesen, Wim; Abramowicz, Daniel; Gavrilovici, Cristina; Farrington, Ken; Covic, Adrian

    2016-10-01

    During the last 20 years, waiting lists for renal transplantation (RT) have grown significantly older. However, elderly patients (ie ≥65 years of age) are still more rarely referred or accepted to waiting lists and, if enlisted, have less chances of actually receiving a kidney allograft, than younger counterparts. In this review, we looked at evidence for the benefits and risks of RT in the elderly trying to answer the following questions: Should RT be advocated for elderly patients? What should be the criteria to accept elderly patients on the waiting list for RT? What strategies might be used to increase the rate of RT in waitlisted elderly candidates? For selected elderly patients, RT was shown to be superior to dialysis in terms of patient survival. Virtually all guidelines recommend that patients should not be deemed ineligible for RT based on age alone, although a short life expectancy generally might preclude RT. Concerning the assessment of comorbidities in the elderly, special attention should be paid to cardiac evaluation and screening for malignancy. Comorbidity scores and frailty assessment scales might help the decision making on eligibility. Psychosocial issues should also be evaluated. To overcome the scarcity of organ donors, elderly RT candidates should be encouraged to consider expanded criteria donors and living donors, as alternatives to deceased standard criteria donors. It has been demonstrated that expanded criteria donor RT in patients 60 years or older is associated with higher survival rates than remaining on dialysis, whereas living donor RT is superior to all other options.

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

    PubMed

    Schnitzer, Thomas J

    2002-04-01

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

  12. The 2015 ACR Commission on Human Resources Workforce Survey.

    PubMed

    Bluth, Edward I; Cox, Jan; Bansal, Swati; Green, Daniel

    2015-11-01

    The ACR Commission on Human Resources continues to conduct its annual electronic survey to better understand the present workforce scenario for radiologists. The Practice of Radiology Environment Database was used to identify group leads, who were asked to complete an electronic survey developed by the Commission on Human Resources. The survey asked group leaders to report the number of radiologists they currently employ or supervise, the number hired in 2014, and the numbers they plan to hire in 2015 and 2018. The leaders were asked to report the subspecialty area used as the main reason for hiring each physician, as well as the ages and genders of their current workforce. Thirty-two percent of group leaders responded to the survey, corresponding to 12,079 radiologists or 39% of all practicing radiologists. Twenty-one percent of the workforce is female and 79% is male. Ten percent of radiologists older than 65 years are women, while 32% younger than 35 are women. Twelve percent of radiologists work part-time, corresponding to a breakdown of 10% of men and 24% of women working part-time. The current workforce is 13% general radiologists and 87% subspecialists. In 2015, a projected 1,131 to 1,484 jobs will be available for radiologists. Job opportunities for radiologists seem to be increasing compared with 2013 and are relatively similar to 2014. Radiologists continue to subspecialize in greater numbers, but only 39% of radiologists practice more than 50% of the time in their subspecialties. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  13. The 2016 ACR Commission on Human Resources Workforce Survey.

    PubMed

    Bluth, Edward I; Bansal, Swati

    2016-10-01

    The ACR Commission on Human Resources conducts an annual electronic survey to better understand the present workforce scenario for radiologists. The Practice of Radiology Environment Database was used to identify group leads, who were asked to complete an electronic survey developed by the Commission on Human Resources. The survey asked group leads to report the number of radiologists they currently employ or supervise, the number hired in 2015, and the numbers they plan to hire in 2016 and 2019. Leaders were asked to report the subspecialty area used as the main reason for hiring each physician, as well the ages and genders of their current workforce. Thirty-two percent of group leaders, corresponding to 13,074 radiologists or 39% of all practicing radiologists, responded to this survey. The percentage of practicing radiologists who are male is 78.6%, compared with 21.4% who are female. Six percent of radiologists are older than 65 years, and 22% are between the ages of 56 and 65 years. Nineteen percent of radiologists older than 65 years retired in 2015. Fifteen percent of all radiologists work part-time. Among the part-time radiologists, 9% are male and 30% are female. General radiologists now make up only 13.3% of the radiologist workforce. In 2015, 45% of new hires moved from existing jobs; 55% were first-time hires. In 2016, it is projected that between 1,713 and 2,223 new jobs will be available, a 16.2% increase from hiring in 2015. Job opportunities for radiologists have continued to increase since 2013. Copyright © 2016. Published by Elsevier Inc.

  14. Subgroups of fibromyalgia patients using the 1990 American College of Rheumatology criteria and the modified 2010 preliminary diagnostic criteria: the al-Ándalus project.

    PubMed

    Segura-Jiménez, Víctor; Soriano-Maldonado, Alberto; Álvarez-Gallardo, Inmaculada C; Estévez-López, Fernando; Carbonell-Baeza, Ana; Delgado-Fernández, Manuel

    2016-01-01

    We aimed to investigate the symptom profiles in subsets of fibromyalgia patients according to the subgroups created from the satisfaction of the 1990 American College of Rheumatology (ACR) diagnostic criteria (1990c) and/or the modified 2010 ACR preliminary diagnostic criteria (m-2010c). A total of 913 (84 men) participants took part in this cross-sectional study. Participants were grouped as follows: i) 285 who did not fulfil any ACR diagnostic criteria (non-fibromyalgia); ii) 73 who fulfilled the 1990c only; iii) 96 who fulfilled the m-2010c only; iv) 459 who fulfilled both ACR diagnostic criteria. Experimental and clinical pain, chronic pain self-efficacy, pain catastrophising, fibromyalgia severity, fatigue, health-related quality of life, depression, state anxiety and physical fitness were assessed by means of several questionnaires and tests. Overall, the differences were consistent across all study outcomes (all, overall p<0.001), showing that the subgroup fulfilling both diagnostic criteria had the worst profile of all the subgroups, whereas those fulfilling any diagnostic criteria (non-fibromyalgia participants) had the most favourable results. Furthermore, the subgroup fulfilling the m-2010c only had a worse profile than the subgroup fulfilling the 1990c only, and presented similar but slightly better results than those fulfilling both diagnostic criteria. Our results reinforce the understanding of fibromyalgia as a heterogeneous condition. Subgrouping of fibromyalgia patients is highly recommendable, since these subgroups show diverse clinical pictures and therefore treatment options should be individually tailored to their specific profile. The combination of 1990c and the m-2010c is potentially useful to identify subgroups of fibromyalgia patients.

  15. Overexpression of the Multidrug Efflux Operon acrEF by Insertional Activation with IS1 or IS10 Elements in Salmonella enterica Serovar Typhimurium DT204 acrB Mutants Selected with Fluoroquinolones

    PubMed Central

    Olliver, Anne; Vallé, Michel; Chaslus-Dancla, Elisabeth; Cloeckaert, Axel

    2005-01-01

    High-level fluoroquinolone (FQ) resistance in Salmonella enterica serovar Typhimurium phage type DT204 has been previously shown to be essentially due to both multiple target gene mutations and active efflux by the AcrAB-TolC efflux system. In this study we show that in intermediatly resistant acrB-inactivated serovar Typhimurium DT204 mutants, high-level resistance to FQs can be restored on in vitro selection with FQs. In each FQ- resistant mutant selected from serovar Typhimurium DT204 acrB mutant strains, an insertion sequence (IS1 or IS10) was found integrated upstream of the acrEF operon, coding for AcrEF, an efflux pump highly homologous to AcrAB. In one of the strains, transposition of IS1 caused partial deletion of acrS, the putative local repressor gene of the acrEF operon. Sequence analysis showed that both IS1 and IS10 elements contain putative promoter sequences that might alter the expression of adjacent acrEF genes. Indeed, reverse transcription-PCR experiments showed an 8- to 10-fold increase in expression of acrF in these insertional mutants, relative to their respective parental strain, which correlated well with the resistance levels observed to FQs and other unrelated drugs. It is noteworthy that AcrEF did not contribute to the intrinsic drug resistance of serovar Typhimurium, since acrF deletion in wild-type strains did not result in any increase in drug susceptibility. Moreover, deletion of acrS did not cause any acrF overexpression or any decrease in drug susceptibility, suggesting that acrEF overexpression is mediated solely by the IS1 and IS10 promoter sequences and not by inactivity of AcrS. Southern blot experiments showed that the number of chromosomal IS1 and IS10 elements in the serovar Typhimurium DT204 genome was about 5 and 15 respectively. None were detected in epidemic serovar Typhimurium DT104 strains or in the serovar Typhimurium reference strain LT2. Carrying IS1 and/or IS10 elements in their chromosome may thus be a selective

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

    PubMed Central

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

    2005-01-01

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

  17. Superfund Record of Decision (EPA Region 1): Salem Acres Site, Salem, MA, March 1993

    SciTech Connect

    Not Available

    1993-03-01

    This decision document represents the selected remedial action for the Salem Acres Site in Salem, Massachusetts. The remedial action for the Salem Acres Site, as described in this ROD, addresses the principal threats to the human health and the environment posed by exposure of humans to contaminated soils from the Salem Acres Site. This remedy addresses all principal threats to human health and the environment posed by the sources of contamination at the Site resulting from dermal absorption and incidental ingestion of contaminants in surficial soils.

  18. 77 FR 74697 - Meeting of the ACRS, Subcommittee on U.S. Evolutionary Power Reactor; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-17

    ... COMMISSION Advisory Committee on Reactor Safeguards (ACRS) Meeting of the ACRS, Subcommittee on U.S. Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S..., 2012. Antonio Dias, Technical Advisor, Advisory Committee on Reactor Safeguards. BILLING CODE 7590-01-P...

  19. ACR 2016 Open-Microphone Session: ACR Membership 3.0-Moving From Member Volume to Value.

    PubMed

    Stern, Eric; Metter, Darlene; Everett, Catherine; Flug, Jonathan; Friedberg, Eric; Kotsenas, Amy; Nathan, Jennifer; Herrington, William

    2017-04-02

    This report of the 2016 ACR Council Open Microphone session reviews the discussion around interests and concerns of council members and state chapter leaders as to the perceived and real value of their ACR membership, and how the ACR might further enhance membership value and meaningful engagement with members.

  20. Additional Continuing Appropriations Amendments, 2011

    THOMAS, 112th Congress

    Rep. Rogers, Harold [R-KY-5

    2011-03-11

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

  1. Further Continuing Appropriations Amendments, 2011

    THOMAS, 112th Congress

    Rep. Rogers, Harold [R-KY-5

    2011-02-28

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

  2. Further Continuing Appropriations Amendments, 2011

    THOMAS, 112th Congress

    Rep. Rogers, Harold [R-KY-5

    2011-02-28

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

  3. Additional Continuing Appropriations Amendments, 2011

    THOMAS, 112th Congress

    Rep. Rogers, Harold [R-KY-5

    2011-03-11

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

  4. Additional Continuing Appropriations Amendments, 2011

    THOMAS, 112th Congress

    Rep. Rogers, Harold [R-KY-5

    2011-03-11

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

  5. Further Continuing Appropriations Amendments, 2011

    THOMAS, 112th Congress

    Rep. Rogers, Harold [R-KY-5

    2011-02-28

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

  6. Appropriate use of diagnostic imaging

    SciTech Connect

    Palmer, P.E.S.; Cockshott, W.P.

    1984-11-16

    This article discusses ways in which more appropriate use can be made of roentgenography with a resulting decrease in radiation doses to the patient population. The authors recommend that fewer films be made and that traditional roentgenography be replaced with endoscopy, ultrasound, computerized tomography, or angiography where appropriate. They also recommend that medical schools and medical subspecialty groups study the World Health Organization document which provides indications for diagnostic imaging, the choice of procedure and the limitations of each.

  7. Foreign Operations Appropriations: General Provisions

    DTIC Science & Technology

    2009-04-30

    Foreign Ops, 1993. Reported out of Senate Appropriations Committee (S. 1924; S. Rept. 100-236), December 4, 1987 . Sec. 7015. Reprogramming Notification...Committee (H.R. 3186; H. Rept. 100-283), August 6, 1987 . Sec. 7017. Limitation on Availability of Funds for International Organizations and...Reported out of Senate Appropriations Committee (S. 1924; S. Rept. 100-236), December 4, 1987 . Sec. 7023. Authorization Requirement Similar language

  8. Acceptance criteria for method equivalency assessments.

    PubMed

    Chatfield, Marion J; Borman, Phil J

    2009-12-15

    Quality by design (ICH-Topic Q8) requires that process control strategy requirements are met and maintained. The challenging task of setting appropriate acceptance criteria for assessment of method equivalence is a critical component of satisfying these requirements. The use of these criteria will support changes made to methods across the product lifecycle. A method equivalence assessment is required when a change is made to a method which may pose a risk to its ability to monitor the quality of the process. Establishing appropriate acceptance criteria are a vital, but not clearly understood, prerequisite to deciding the appropriate design/sample size of the equivalency study. A number of approaches are proposed in the literature for setting acceptance criteria for equivalence which address different purposes. This perspective discusses those purposes and then provides more details on setting acceptance criteria based on patient and producer risk, e.g., tolerance interval approach and the consideration of method or process capability. Applying these to a drug substance assay method for batch release illustrates that, for the equivalence assessment to be meaningful, a clear understanding and appraisal of the control requirements of the method is needed. Rather than a single exact algorithm, the analyst's judgment on a number of aspects is required in deciding the appropriate acceptance criteria.

  9. Appropriate and appropriated technology: lessons learned from ultrasound in Tanzania.

    PubMed

    Müller-Rockstroh, Babette

    2012-01-01

    In "the North" ultrasound has become a standard procedure in reproductive health services. In Sub-Saharan Africa where diagnostic imaging technology is increasingly transferred to, ultrasound is still quite a new technology. Its promotion as "appropriate" technology by international donors, however, overlooks the fact that ultrasound such as any technology when transferred is not automatically doing what it is intended to do. Rather, ultrasound may be used very differently. Hence, what ultrasound will actually do remains an empirical matter. This article offers an insight into the multiple constructions of ultrasound that exist in one hospital in Northwest Tanzania as the technology is appropriated by nurse-midwives, doctors, students, local healers, and pregnant women. If these emerging situated ultrasounds are made explicit, the question of whether a technology is appropriate becomes more complex than the ubiquitous term suggests.

  10. Dunbar Asphalt to Clean up 29-Acre Portion of Sharon Steel Superfund Site, Hermitage, Pa.

    EPA Pesticide Factsheets

    PHILADELPHIA (Sept. 14, 2015) The U.S. Environmental Protection Agency today announced a proposed settlement the government has reached with Dunbar Asphalt Products, Inc., to clean up a 29-acre portion of the Sharon Steel Corporation Superfund Site

  11. 43 CFR 2524.7 - Disposal of lands in excess of 160 acres.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  12. 43 CFR 2524.7 - Disposal of lands in excess of 160 acres.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  13. 43 CFR 2524.7 - Disposal of lands in excess of 160 acres.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  14. 43 CFR 2524.7 - Disposal of lands in excess of 160 acres.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  15. National Woodland Owner Survey: family forest ownerships with 1 to 9 acres, 2011-2013

    Treesearch

    Brett J. Butler; Stephanie A. Snyder

    2017-01-01

    This report summarizes results from the 2011-2013 National Woodland Owner Survey (NWOS) conducted by the U.S. Forest Service, Forest Inventory and Analysis program for family forest ownerships with forest holdings of 1-9 acres. Summaries are based on responses from 1,025 family ownerships with 1-9 acres of forest across 39 U.S. states. Survey summary tables are...

  16. The future of imaging biomarkers in radiologic practice: proceedings of the thirteenth annual ACR Forum.

    PubMed

    Krishnaraj, Arun; Weinreb, Jeffrey C; Ellenbogen, Paul H; Allen, Bibb; Norbash, Alexander; Kazerooni, Ella A

    2014-01-01

    The 2013 ACR Forum focused on the emerging field of imaging biomarkers and how best to integrate imaging biomarkers into clinical practice, promote research into imaging biomarkers, and leverage advances in bioinformatics. The recommendations generated from the Forum seek to inform ACR leadership on the best strategies to pursue to ensure that radiologists secure a preeminent role in the new era of precision and personalized medicine. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

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

    ERIC Educational Resources Information Center

    Bosch, Victoria Manglano; Hancock-Beaulieu, Micheline

    1995-01-01

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

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

    ERIC Educational Resources Information Center

    Bosch, Victoria Manglano; Hancock-Beaulieu, Micheline

    1995-01-01

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

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

    ERIC Educational Resources Information Center

    Andree, Carolyn

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

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

    ERIC Educational Resources Information Center

    Andree, Carolyn

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