Evaluation of the methodological quality of studies of the performance of diagnostic tests for bovine tuberculosis using QUADAS.

PubMed

Downs, Sara H; More, Simon J; Goodchild, Anthony V; Whelan, Adam O; Abernethy, Darrell A; Broughan, Jennifer M; Cameron, Angus; Cook, Alasdair J; Ricardo de la Rua-Domenech, R; Greiner, Matthias; Gunn, Jane; Nuñez-Garcia, Javier; Rhodes, Shelley; Rolfe, Simon; Sharp, Michael; Upton, Paul; Watson, Eamon; Welsh, Michael; Woolliams, John A; Clifton-Hadley, Richard S; Parry, Jessica E

2018-05-01

There has been little assessment of the methodological quality of studies measuring the performance (sensitivity and/or specificity) of diagnostic tests for animal diseases. In a systematic review, 190 studies of tests for bovine tuberculosis (bTB) in cattle (published 1934-2009) were assessed by at least one of 18 reviewers using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) checklist adapted for animal disease tests. VETQUADAS (VQ) included items measuring clarity in reporting (n = 3), internal validity (n = 9) and external validity (n = 2). A similar pattern for compliance was observed in studies of different diagnostic test types. Compliance significantly improved with year of publication for all items measuring clarity in reporting and external validity but only improved in four of the nine items measuring internal validity (p < 0.05). 107 references, of which 83 had performance data eligible for inclusion in a meta-analysis were reviewed by two reviewers. In these references, agreement between reviewers' responses was 71% for compliance, 32% for unsure and 29% for non-compliance. Mean compliance with reporting items was 2, 5.2 for internal validity and 1.5 for external validity. The index test result was described in sufficient detail in 80.1% of studies and was interpreted without knowledge of the reference standard test result in only 33.1%. Loss to follow-up was adequately explained in only 31.1% of studies. The prevalence of deficiencies observed may be due to inadequate reporting but may also reflect lack of attention to methodological issues that could bias the results of diagnostic test performance estimates. QUADAS was a useful tool for assessing and comparing the quality of studies measuring the performance of diagnostic tests but might be improved further by including explicit assessment of population sampling strategy. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

A systematic review of the PTSD Checklist's diagnostic accuracy studies using QUADAS.

PubMed

McDonald, Scott D; Brown, Whitney L; Benesek, John P; Calhoun, Patrick S

2015-09-01

Despite the popularity of the PTSD Checklist (PCL) as a clinical screening test, there has been no comprehensive quality review of studies evaluating its diagnostic accuracy. A systematic quality assessment of 22 diagnostic accuracy studies of the English-language PCL using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) assessment tool was conducted to examine (a) the quality of diagnostic accuracy studies of the PCL, and (b) whether quality has improved since the 2003 STAndards for the Reporting of Diagnostic accuracy studies (STARD) initiative regarding reporting guidelines for diagnostic accuracy studies. Three raters independently applied the QUADAS tool to each study, and a consensus among the 4 authors is reported. Findings indicated that although studies generally met standards in several quality areas, there is still room for improvement. Areas for improvement include establishing representativeness, adequately describing clinical and demographic characteristics of the sample, and presenting better descriptions of important aspects of test and reference standard execution. Only 2 studies met each of the 14 quality criteria. In addition, study quality has not appreciably improved since the publication of the STARD Statement in 2003. Recommendations for the improvement of diagnostic accuracy studies of the PCL are discussed. (c) 2015 APA, all rights reserved).

Status, quality and specific needs of Zika virus (ZIKV) diagnostic capacity and capability in National Reference Laboratories for arboviruses in 30 EU/EEA countries, May 2016

PubMed Central

Mögling, Ramona; Zeller, Hervé; Revez, Joana; Koopmans, Marion; Reusken, Chantal

2017-01-01

With international travel, Zika virus (ZIKV) is introduced to Europe regularly. A country's ability to robustly detect ZIKV introduction and local transmission is important to minimise the risk for a ZIKV outbreak. Therefore, sufficient expertise and diagnostic capacity and capability are required in European laboratories. To assess the capacity, quality, operational specifics (guidelines and algorithms), technical and interpretation issues and other possible difficulties that were related to ZIKV diagnostics in European countries, a questionnaire was conducted among national reference laboratories in 30 countries in the European Union/European Economic Area (EU/EEA) in May 2016. While the coverage and capacity of ZIKV diagnostics in the EU/EEA national reference laboratories were found to be adequate, the assessment of the quality and needs indicated several crucial points of improvement that will need support at national and EU/EEA level to improve ZIKV preparedness, response and EU/EEA ZIKV surveillance activities. PMID:28920574

Virtual guidance as a tool to obtain diagnostic ultrasound for spaceflight and remote environments.

PubMed

Martin, David S; Caine, Timothy L; Matz, Timothy; Lee, Stuart M C; Stenger, Michael B; Sargsyan, Ashot E; Platts, Steven H

2012-10-01

With missions planned to travel greater distances from Earth at ranges that make real-time two-way communication impractical, astronauts will be required to perform autonomous medical diagnostic procedures during future exploration missions. Virtual guidance is a form of just-in-time training developed to allow novice ultrasound operators to acquire diagnostically-adequate images of clinically relevant anatomical structures using a prerecorded audio/visual tutorial viewed in real-time. Individuals without previous experience in ultrasound were recruited to perform carotid artery (N = 10) and ophthalmic (N = 9) ultrasound examinations using virtual guidance as their only training tool. In the carotid group, each untrained operator acquired two-dimensional, pulsed and color Doppler of the carotid artery. In the ophthalmic group, operators acquired representative images of the anterior chamber of the eye, retina, optic nerve, and nerve sheath. Ultrasound image quality was evaluated by independent imaging experts. Of the studies, 8 of the 10 carotid and 17 of 18 of the ophthalmic images (2 images collected per study) were judged to be diagnostically adequate. The quality of all but one of the ophthalmic images ranged from adequate to excellent. Diagnostically-adequate carotid and ophthalmic ultrasound examinations can be obtained by previously untrained operators with assistance from only an audio/video tutorial viewed in real time while scanning. This form of just-in-time training, which can be applied to other examinations, represents an opportunity to acquire important information for NASA flight surgeons and researchers when trained medical personnel are not available or when remote guidance is impractical.

How does study quality affect the results of a diagnostic meta-analysis?

PubMed Central

Westwood, Marie E; Whiting, Penny F; Kleijnen, Jos

2005-01-01

Background The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three

WE-AB-206-01: Diagnostic Ultrasound Imaging Quality Assurance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zagzebski, J.

The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. The goal of this ultrasound hands-on workshop is to demonstrate quality control (QC) testing in diagnostic ultrasound and to provide updates in ACR ultrasound accreditation requirements. The first half of this workshop will include two presentations reviewing diagnostic ultrasound QA/QC and ACR ultrasound accreditation requirements. The second half of the workshop will include live demonstrations of basic QC tests. An array of ultrasound testing phantoms and ultrasound scanners will be available for attendees to learn diagnostic ultrasound QC in a hands-on environmentmore » with live demonstrations and on-site instructors. The targeted attendees are medical physicists in diagnostic imaging. Learning Objectives: Gain familiarity with common elements of a QA/QC program for diagnostic ultrasound imaging dentify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools Learn ACR ultrasound accreditation requirements Jennifer Walter is an employee of American College of Radiology on Ultrasound Accreditation.« less

Diet quality of Italian yogurt consumers: an application of the probability of adequate nutrient intake score (PANDiet).

PubMed

Mistura, Lorenza; D'Addezio, Laura; Sette, Stefania; Piccinelli, Raffaela; Turrini, Aida

2016-01-01

The diet quality in yogurt consumers and non-consumers was evaluated by applying the probability of adequate nutrient intake (PANDiet) index to a sample of adults and elderly from the Italian food consumption survey INRAN SCAI 2005-06. Overall, yogurt consumers had a significantly higher mean intake of energy, calcium and percentage of energy from total sugars whereas the mean percentage of energy from total fat, saturated fatty acid and total carbohydrate were significantly (p < 0.01) lower than in non-consumers. The PANDiet index was significantly higher in yogurt consumers than in non-consumers, (60.58 ± 0.33 vs. 58.58 ± 0.19, p < 0.001). The adequacy sub-score for 17 nutrients for which usual intake should be above the reference value was significantly higher among yogurt consumers. The items of calcium, potassium and riboflavin showed the major percentage variation between consumers and non-consumers. Yogurt consumers were more likely to have adequate intakes of vitamins and minerals, and a higher quality score of the diet.

Temporal trends in receipt of adequate lymphadenectomy in bladder cancer 1988 to 2010.

PubMed

Cole, Alexander P; Dalela, Deepansh; Hanske, Julian; Mullane, Stephanie A; Choueiri, Toni K; Meyer, Christian P; Nguyen, Paul L; Menon, Mani; Kibel, Adam S; Preston, Mark A; Bellmunt, Joaquim; Trinh, Quoc-Dien

2015-12-01

The importance of pelvic lymphadenectomy (LND) for diagnostic and therapeutic purposes at the time of radical cystectomy (RC) for bladder cancer is well documented. Although some debate remains on the optimal number of lymph nodes removed, 10 nodes has been proposed as constituting an adequate LND. We used data from the Surveillance, Epidemiology, and End Results database to examine predictors and temporal trends in the receipt of an adequate LND at the time of RC for bladder cancer. Within the Surveillance, Epidemiology, and End Results database, we extracted data on all patients with nonmetastatic bladder cancer receiving RC in the years 1988 to 2010. First, we assess the proportion of individuals undergoing RC who received an adequate LND (≥10 nodes removed) over time. Second, we calculate odds ratios (ORs) of receiving an adequate LND using logistic regression modeling to compare study periods. Covariates included sex, race, age, region, tumor stage, urban vs. rural location, and insurance status. Among the 5,696 individuals receiving RC during the years 1988 to 2010, 2,576 (45.2%) received an adequate LND. Over the study period, the proportion of individuals receiving an adequate LND increased from 26.4% to 61.3%. The odds of receiving an adequate LND increased over the study period; a patient undergoing RC in 2008 to 2010 was over 4-fold more likely to receive an adequate LND relative to a patient treated in 1988 to 1991 (OR = 4.63, 95% CI: 3.32-6.45). In addition to time of surgery, tumor stage had a positive association with receipt of adequate LND (OR = 1.49 for stage IV [T4 N1 or N0] vs. stage I [T1 or Tis], 95% CI: 1.22-1.82). Age, sex, marital status, and race were not significant predictors of adequate LND. Adequacy of pelvic LND remains an important measure of surgical quality in bladder cancer. Our data show that over the years 1988 to 2010, the likelihood of receiving an adequate LND has increased substantially; however, a substantial minority of

The importance of quality assurance/quality control of diagnostics to increase the confidence in global foot-and-mouth disease control.

PubMed

De Clercq, K; Goris, N; Barnett, P V; MacKay, D K

2008-01-01

The last decade international trade in animals and animal products was liberated and confidence in this global trade can increase only if appropriate control measures are applied. As foot-and-mouth disease (FMD) diagnostics will play an essential role in this respect, the Food and Agriculture Organization European Commission for the Control of Foot-and-Mouth Disease (EUFMD) co-ordinates, in collaboration with the European Commission, several programmes to increase the quality of FMD diagnostics. A quality assurance (QA) system is deemed essential for laboratories involved in certifying absence of FMDV or antibodies against the virus. Therefore, laboratories are encouraged to validate their diagnostic tests fully and to install a continuous quality control (QC) monitoring system. Knowledge of performance characteristics of diagnostics is essential to interpret results correctly and to calculate sample rates in regional surveillance campaigns. Different aspects of QA/QC of classical and new FMD virological and serological diagnostics are discussed in respect to the EU FMD directive (2003/85/EC). We recommended accepting trade certificates only from laboratories participating in international proficiency testing on a regular basis.

Region 9: California Adequate Letter (1/22/2018)

EPA Pesticide Factsheets

This December 19, 2017 letter form EPA, finding adequate certain motor vehicle emissions budgets for the 2006 fine particulate matter (PM2.5) National Ambient Air Quality Standars in the Final 2016 Air Quality Managemnet Plan for the South Coast area (2016

Endorsing good quality assurance practices in molecular pathology: risks and recommendations for diagnostic laboratories and external quality assessment providers.

PubMed

Tembuyser, Lien; Dequeker, Elisabeth M C

2016-01-01

Quality assurance is an indispensable element in a molecular diagnostic laboratory. The ultimate goal is to warrant patient safety. Several risks that can compromise high quality procedures are at stake, from sample collection to the test performed by the laboratory, the reporting of test results to clinicians, and the organization of effective external quality assessment schemes. Quality assurance should therefore be safeguarded at each level and should imply a holistic multidisciplinary approach. This review aims to provide an overview of good quality assurance practices and discusses certain risks and recommendations to promote and improve quality assurance for both diagnostic laboratories and for external quality assessment providers. The number of molecular targets is continuously rising, and new technologies are evolving. As this poses challenges for clinical implementation and increases the demand for external quality assessment, the formation of an international association for improving quality assurance in molecular pathology is called for.

Quality of information accompanying on-line marketing of home diagnostic tests.

PubMed

Datta, Adrija K; Selman, Tara J; Kwok, Tony; Tang, Teresa; Khan, Khalid S

2008-01-01

To assess the quality of information provided to consumers by websites marketing medical home diagnostic tests. A cross-sectional analysis of a database developed from searching targeted websites. Data sources were websites written in English which marketed medical home diagnostic tests. A meta-search engine was used to identify the first 20 citations for each type of home diagnostic medical test. Relevant websites limited to those written in English were reviewed independently and in triplicate, with disputes resolved by two further reviewers. Information on the quality of these sites was extracted using a pre-piloted performer. 168 websites were suitable for inclusion in the review. The quality of these sites showed marked variation. Only 24 of 168 (14.2%) complied with at least three-quarters of the quality items and just over half (95 of 168, 56.5%) reported official approval or certification of the test. Information on accuracy of the test marketed was reported by 87 of 168 (51.7%) websites, with 15 of 168 (8.9%) providing a scientific reference. Instructions for use of the product were found in 97 of 168 (57.9%). However, the course of action to be taken after obtaining the test result was stated in only 63 of 168 (37.5%) for a positive result and 43 of 168 (25.5%) for a negative result. The quality of information posted on commercial websites marketing home tests online is unsatisfactory and potentially misleading for consumers.

Evaluating radiographers' diagnostic accuracy in screen-reading mammograms: what constitutes a quality study?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Debono, Josephine C, E-mail: josephine.debono@bci.org.au; Poulos, Ann E; Westmead Breast Cancer Institute, Westmead, New South Wales

The aim of this study was to first evaluate the quality of studies investigating the diagnostic accuracy of radiographers as mammogram screen-readers and then to develop an adapted tool for determining the quality of screen-reading studies. A literature search was used to identify relevant studies and a quality evaluation tool constructed by combining the criteria for quality of Whiting, Rutjes, Dinnes et al. and Brealey and Westwood. This constructed tool was then applied to the studies and subsequently adapted specifically for use in evaluating quality in studies investigating diagnostic accuracy of screen-readers. Eleven studies were identified and the constructed toolmore » applied to evaluate quality. This evaluation resulted in the identification of quality issues with the studies such as potential for bias, applicability of results, study conduct, reporting of the study and observer characteristics. An assessment of the applicability and relevance of the tool for this area of research resulted in adaptations to the criteria and the development of a tool specifically for evaluating diagnostic accuracy in screen-reading. This tool, with further refinement and rigorous validation can make a significant contribution to promoting well-designed studies in this important area of research and practice.« less

How to conduct a high-quality original study on a diagnostic research topic.

PubMed

Yao, Xiaomei; Vella, Emily

2017-09-01

As health research methodologists and journal reviewers, we noticed that the methodological rigor of many publications on diagnostic or prognostic topics in the medical literature could be improved. We present a concise and clear series of reviews to help clinicians and health researchers to master the basic key components of how to conduct a high-quality original study or systematic review on a diagnostic or prognostic research topic from a methodological perspective. This is the first review of the series, which focuses on how to conduct a high-quality diagnostic study. We are introducing four aspects: clarifying the objectives; generating an appropriate research question; planning the study design; and reporting and analyzing data. This review highlights that diagnostic test accuracy outcomes are surrogates for patient outcomes, a diagnostic test has three roles, the "PIRO" components should be included in a diagnostic research question, a new study should be registered, multiple index tests can be compared in one study, and prevalence affects test accuracy outcomes. This review also emphasizes reporting any thresholds, calculating sample size, and performing a two-by-three table to calculate diagnostic outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

READING DIAGNOSTIC APPROACHES.

ERIC Educational Resources Information Center

PURDY, ROBERT J.; AND OTHERS

A DIAGNOSTIC KIT DESIGNED TO HELP CLASSROOM TEACHERS DIAGNOSE READING DIFFICULTIES MORE ADEQUATELY AND MOTIVATE PUPILS MORE EFFECTIVELY IS PRESENTED. SUGGESTIONS ARE APPLICABLE TO LOWER PRIMARY CHILDREN. DIAGNOSTIC TECHNIQUES ARE OUTLINED FOR SUBJECTIVE AND OBJECTIVE OBSERVATION OF LANGUAGE ABILITY, VISUAL PERCEPTION SKILLS, AUDITORY…

Virtual Guidance Ultrasound: A Tool to Obtain Diagnostic Ultrasound for Remote Environments

NASA Technical Reports Server (NTRS)

Caine,Timothy L.; Martin David S.; Matz, Timothy; Lee, Stuart M. C.; Stenger, Michael B.; Platts, Steven H.

2012-01-01

Astronauts currently acquire ultrasound images on the International Space Station with the assistance of real-time remote guidance from an ultrasound expert in Mission Control. Remote guidance will not be feasible when significant communication delays exist during exploration missions beyond low-Earth orbit. For example, there may be as much as a 20- minute delay in communications between the Earth and Mars. Virtual-guidance, a pre-recorded audio-visual tutorial viewed in real-time, is a viable modality for minimally trained scanners to obtain diagnostically-adequate images of clinically relevant anatomical structures in an autonomous manner. METHODS: Inexperienced ultrasound operators were recruited to perform carotid artery (n = 10) and ophthalmic (n = 9) ultrasound examinations using virtual guidance as their only instructional tool. In the carotid group, each each untrained operator acquired two-dimensional, pulsed, and color Doppler of the carotid artery. In the ophthalmic group, operators acquired representative images of the anterior chamber of the eye, retina, optic nerve, and nerve sheath. Ultrasound image quality was evaluated by independent imaging experts. RESULTS: Eight of the 10 carotid studies were judged to be diagnostically adequate. With one exception the quality of all the ophthalmic images were adequate to excellent. CONCLUSION: Diagnostically-adequate carotid and ophthalmic ultrasound examinations can be obtained by untrained operators with instruction only from an audio/video tutorial viewed in real time while scanning. This form of quick-response-guidance, can be developed for other ultrasound examinations, represents an opportunity to acquire important medical and scientific information for NASA flight surgeons and researchers when trained medical personnel are not present. Further, virtual guidance will allow untrained personnel to autonomously obtain important medical information in remote locations on Earth where communication is

A New Dual-purpose Quality Control Dosimetry Protocol for Diagnostic Reference-level Determination in Computed Tomography.

PubMed

Sohrabi, Mehdi; Parsi, Masoumeh; Sina, Sedigheh

2018-05-17

A diagnostic reference level is an advisory dose level set by a regulatory authority in a country as an efficient criterion for protection of patients from unwanted medical exposure. In computed tomography, the direct dose measurement and data collection methods are commonly applied for determination of diagnostic reference levels. Recently, a new quality-control-based dose survey method was proposed by the authors to simplify the diagnostic reference-level determination using a retrospective quality control database usually available at a regulatory authority in a country. In line with such a development, a prospective dual-purpose quality control dosimetry protocol is proposed for determination of diagnostic reference levels in a country, which can be simply applied by quality control service providers. This new proposed method was applied to five computed tomography scanners in Shiraz, Iran, and diagnostic reference levels for head, abdomen/pelvis, sinus, chest, and lumbar spine examinations were determined. The results were compared to those obtained by the data collection and quality-control-based dose survey methods, carried out in parallel in this study, and were found to agree well within approximately 6%. This is highly acceptable for quality-control-based methods according to International Atomic Energy Agency tolerance levels (±20%).

Test-treatment RCTs are susceptible to bias: a review of the methodological quality of randomized trials that evaluate diagnostic tests.

PubMed

Ferrante di Ruffano, Lavinia; Dinnes, Jacqueline; Sitch, Alice J; Hyde, Chris; Deeks, Jonathan J

2017-02-24

There is a growing recognition for the need to expand our evidence base for the clinical effectiveness of diagnostic tests. Many international bodies are calling for diagnostic randomized controlled trials to provide the most rigorous evidence of impact to patient health. Although these so-called test-treatment RCTs are very challenging to undertake due to their methodological complexity, they have not been subjected to a systematic appraisal of their methodological quality. The extent to which these trials may be producing biased results therefore remains unknown. We set out to address this issue by conducting a methodological review of published test-treatment trials to determine how often they implement adequate methods to limit bias and safeguard the validity of results. We ascertained all test-treatment RCTs published 2004-2007, indexed in CENTRAL, including RCTs which randomized patients to diagnostic tests and measured patient outcomes after treatment. Tests used for screening, monitoring or prognosis were excluded. We assessed adequacy of sequence generation, allocation concealment and intention-to-treat, appropriateness of primary analyses, blinding and reporting of power calculations, and extracted study characteristics including the primary outcome. One hundred three trials compared 105 control with 119 experimental interventions, and reported 150 primary outcomes. Randomization and allocation concealment were adequate in 57 and 37% of trials. Blinding was uncommon (patients 5%, clinicians 4%, outcome assessors 21%), as was an adequate intention-to-treat analysis (29%). Overall 101 of 103 trials (98%) were at risk of bias, as judged using standard Cochrane criteria. Test-treatment trials are particularly susceptible to attrition and inadequate primary analyses, lack of blinding and under-powering. These weaknesses pose much greater methodological and practical challenges to conducting reliable RCT evaluations of test-treatment strategies than standard

Quality of information accompanying on-line marketing of home diagnostic tests

PubMed Central

Datta, Adrija K; Selman, Tara J; Kwok, Tony; Tang, Teresa; Khan, Khalid S

2008-01-01

Objective To assess the quality of information provided to consumers by websites marketing medical home diagnostic tests. Design A cross-sectional analysis of a database developed from searching targeted websites. Setting Data sources were websites written in English which marketed medical home diagnostic tests. Main outcome measures A meta-search engine was used to identify the first 20 citations for each type of home diagnostic medical test. Relevant websites limited to those written in English were reviewed independently and in triplicate, with disputes resolved by two further reviewers. Information on the quality of these sites was extracted using a pre-piloted performer. Results 168 websites were suitable for inclusion in the review. The quality of these sites showed marked variation. Only 24 of 168 (14.2%) complied with at least three-quarters of the quality items and just over half (95 of 168, 56.5%) reported official approval or certification of the test. Information on accuracy of the test marketed was reported by 87 of 168 (51.7%) websites, with 15 of 168 (8.9%) providing a scientific reference. Instructions for use of the product were found in 97 of 168 (57.9%). However, the course of action to be taken after obtaining the test result was stated in only 63 of 168 (37.5%) for a positive result and 43 of 168 (25.5%) for a negative result. Conclusions The quality of information posted on commercial websites marketing home tests online is unsatisfactory and potentially misleading for consumers. PMID:18263912

Diagnostic Accuracy of Global Pharma Health Fund Minilab™ in Assessing Pharmacopoeial Quality of Antimicrobials.

PubMed

Pan, Hui; Ba-Thein, William

2018-01-01

Global Pharma Health Fund (GPHF) Minilab™, a semi-quantitative thin-layer chromatography (TLC)-based commercially available test kit, is widely used in drug quality surveillance globally, but its diagnostic accuracy is unclear. We investigated the diagnostic accuracy of Minilab system for antimicrobials, using high-performance liquid chromatography (HPLC) as reference standard. Following the Minilab protocols and the Pharmacopoeia of the People's Republic of China protocols, Minilab-TLC and HPLC were used to test five common antimicrobials (506 batches) for relative concentration of active pharmaceutical ingredients. The prevalence of poor-quality antimicrobials determined, respectively, by Minilab TLC and HPLC was amoxicillin (0% versus 14.9%), azithromycin (0% versus 17.4%), cefuroxime axetil (14.3% versus 0%), levofloxacin (0% versus 3.0%), and metronidazole (0% versus 38.0%). The Minilab TLC had false-positive and false-negative detection rates of 2.6% (13/506) and 15.2% (77/506) accordingly, resulting in the following test characteristics: sensitivity 0%, specificity 97.0%, positive predictive value 0, negative predictive value 0.8, positive likelihood ratio 0, negative likelihood ratio 1.0, diagnostic odds ratio 0, and adjusted diagnostic odds ratio 0.2. This study demonstrates unsatisfying diagnostic accuracy of Minilab system in screening poor-quality antimicrobials of common use. Using Minilab as a stand-alone system for monitoring drug quality should be reconsidered.

Why India should become a global leader in high-quality, affordable TB diagnostics

PubMed Central

Small, Peter

2012-01-01

The scale up of DOTS in India is one of the greatest public health accomplishments, and yet undiagnosed and poorly managed TB continues to fuel the epidemic such that India continues to have the highest number of TB cases in the world. Recognizing these challenges, the Government of India has set an ambitious goal of providing universal access to quality diagnosis and treatment for all TB patients in the country. Innovative tools and delivery systems in both the public and private sectors are essential for reaching this goal. Fortunately, India has the potential to solve its TB problem with “home-grown” solutions. Just as Indian pharmaceutical companies revolutionized access to high-quality, affordable AIDS drugs through generic production, Indian diagnostic companies could also become the world's hub for high-quality generic diagnostics. In the long term, India has the potential to lead the world in developing innovative TB diagnostics. For this to happen, Indian industry must move from the import and imitation approach to genuine innovation in both product development as well as delivery. This must be supported by permissive policies and enhanced funding by the Indian government and the private sector. Strict regulation of diagnostics, increased attention to quality assurance in laboratories, and greater engagement of the private health care providers are also needed to effectively deliver innovative products and approaches. PMID:22771602

Region 8: Utah Adequate Letter (6/10/2005)

EPA Pesticide Factsheets

This letter from EPA to Utah Department of Environmental Quality determined Salt Lake Citys' and Ogdens' Carbon Monoxide (CO) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes.

21 CFR 1000.55 - Recommendation for quality assurance programs in diagnostic radiology facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Recommendation for quality assurance programs in... Recommendations § 1000.55 Recommendation for quality assurance programs in diagnostic radiology facilities. (a) Applicability. Quality assurance programs as described in paragraph (c) of this section are recommended for all...

21 CFR 1000.55 - Recommendation for quality assurance programs in diagnostic radiology facilities.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Recommendation for quality assurance programs in... Recommendations § 1000.55 Recommendation for quality assurance programs in diagnostic radiology facilities. (a) Applicability. Quality assurance programs as described in paragraph (c) of this section are recommended for all...

21 CFR 1000.55 - Recommendation for quality assurance programs in diagnostic radiology facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Recommendation for quality assurance programs in... Recommendations § 1000.55 Recommendation for quality assurance programs in diagnostic radiology facilities. (a) Applicability. Quality assurance programs as described in paragraph (c) of this section are recommended for all...

Limits of the possible: diagnostic image quality in coronary angiography with third-generation dual-source CT.

PubMed

Ochs, Marco M; Siepen, Fabian Aus dem; Fritz, Thomas; Andre, Florian; Gitsioudis, Gitsios; Korosoglou, Grigorios; Seitz, Sebastian; Bogomazov, Yuriy; Schlett, Christopher L; Sokiranski, Roman; Sommer, Andre; Gückel, Friedemann; Brado, Matthias; Kauczor, Hans-Ulrich; Görich, Johannes; Friedrich, Matthias G W; Katus, Hugo A; Buss, Sebastian J

2017-07-01

The usage of coronary CT angiography (CTA) is appropriate in patients with acute or chronic chest pain; however the diagnostic accuracy may be challenged with increased Agatston score (AS), increased heart rate, arrhythmia and severe obesity. Thus, we aim to determine the potential of the recently introduced third-generation dual-source CT (DSCT) for CTA in a 'real-life' clinical setting. Two hundred and sixty-eight consecutive patients (age: 67 ± 10 years; BMI: 27 ± 5 kg/m²; 61% male) undergoing clinically indicated CTA with DSCT were included in the retrospective single-center analysis. A contrast-enhanced volume dataset was acquired in sequential (SSM) (n = 151) or helical scan mode (HSM) (n = 117). Coronary segments were classified in diagnostic or non-diagnostic image quality. A subset underwent invasive angiography to determine the diagnostic accuracy of CTA. SSM (96.8 ± 6%) and HSM (97.5 ± 8%) provided no significant differences in the overall diagnostic image quality. However, AS had significant influence on diagnostic image quality exclusively in SSM (B = 0.003; p = 0.0001), but not in HSM. Diagnostic image quality significantly decreased in SSM in patients with AS ≥2,000 (p = 0.03). SSM (sensitivity: 93.9%; specificity: 96.7%; PPV: 88.6%; NPV: 98.3%) and HSM (sensitivity: 97.4%; specificity: 94.3%; PPV: 86.0%; NPV: 99.0%) provided comparable diagnostic accuracy (p = n.s.). SSM yielded significantly lower radiation doses as compared to HSM (2.1 ± 2.0 vs. 5.1 ± 3.3 mSv; p = 0.0001) in age and BMI-matched cohorts. SSM in third-generation DSCT enables significant dose savings and provides robust diagnostic image quality in patients with AS ≤2000 independent of heart rate, heart rhythm or obesity.

Does clinical pretest probability influence image quality and diagnostic accuracy in dual-source coronary CT angiography?

PubMed

Thomas, Christoph; Brodoefel, Harald; Tsiflikas, Ilias; Bruckner, Friederike; Reimann, Anja; Ketelsen, Dominik; Drosch, Tanja; Claussen, Claus D; Kopp, Andreas; Heuschmid, Martin; Burgstahler, Christof

2010-02-01

To prospectively evaluate the influence of the clinical pretest probability assessed by the Morise score onto image quality and diagnostic accuracy in coronary dual-source computed tomography angiography (DSCTA). In 61 patients, DSCTA and invasive coronary angiography were performed. Subjective image quality and accuracy for stenosis detection (>50%) of DSCTA with invasive coronary angiography as gold standard were evaluated. The influence of pretest probability onto image quality and accuracy was assessed by logistic regression and chi-square testing. Correlations of image quality and accuracy with the Morise score were determined using linear regression. Thirty-eight patients were categorized into the high, 21 into the intermediate, and 2 into the low probability group. Accuracies for the detection of significant stenoses were 0.94, 0.97, and 1.00, respectively. Logistic regressions and chi-square tests showed statistically significant correlations between Morise score and image quality (P < .0001 and P < .001) and accuracy (P = .0049 and P = .027). Linear regression revealed a cutoff Morise score for a good image quality of 16 and a cutoff for a barely diagnostic image quality beyond the upper Morise scale. Pretest probability is a weak predictor of image quality and diagnostic accuracy in coronary DSCTA. A sufficient image quality for diagnostic images can be reached with all pretest probabilities. Therefore, coronary DSCTA might be suitable also for patients with a high pretest probability. Copyright 2010 AUR. Published by Elsevier Inc. All rights reserved.

Region 6: Texas Adequate Letter (4/16/2010)

EPA Pesticide Factsheets

This letter from EPA to Texas Commission on Environmental Quality determined 2021 motor vehicle emission budgets for nitrogen oxides (NOx) and volatile organic compounds (VOCs) for Beaumont/Port Arthur area adequate for transportation conformity purposes

Democratizing molecular diagnostics for the developing world.

PubMed

Abou Tayoun, Ahmad N; Burchard, Paul R; Malik, Imran; Scherer, Axel; Tsongalis, Gregory J

2014-01-01

Infectious diseases that are largely treatable continue to pose a tremendous burden on the developing world despite the availability of highly potent drugs. The high mortality and morbidity rates of these diseases are largely due to a lack of affordable diagnostics that are accessible to resource-limited areas and that can deliver high-quality results. In fact, modified molecular diagnostics for infectious diseases were rated as the top biotechnology to improve health in developing countries. In this review, we describe the characteristics of accessible molecular diagnostic tools and discuss the challenges associated with implementing such tools at low infrastructure sites. We highlight our experience as part of the "Grand Challenge" project supported by the Gates Foundation for addressing global health inequities and describe issues and solutions associated with developing adequate technologies or molecular assays needed for broad access in the developing world. We believe that sharing this knowledge will facilitate the development of new molecular technologies that are extremely valuable for improving global health.

Quality Assessment of Comparative Diagnostic Accuracy Studies: Our Experience Using a Modified Version of the QUADAS-2 Tool

ERIC Educational Resources Information Center

Wade, Ros; Corbett, Mark; Eastwood, Alison

2013-01-01

Assessing the quality of included studies is a vital step in undertaking a systematic review. The recently revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool (QUADAS-2), which is the only validated quality assessment tool for diagnostic accuracy studies, does not include specific criteria for assessing comparative studies. As…

Discussion of the quality control and performance testing of ultrasound diagnostic equipment

NASA Astrophysics Data System (ADS)

Jiang, Junjie

2018-03-01

In recent years, with the rapid development of ultrasonography, the application and popularization of new technology used in ultrasound equipment, the level of providing diagnostic information for doctors enhances unceasingly, which has become the indispensable diagnostic tool for medical institutions. The performance of equipment is directly related to the doctor’s diagnosis and the patient’s health, therefore, it is very important to choose a good method for quality control and performance testing.

Quality Assurance of Rapid Diagnostic Tests for Malaria in Routine Patient Care in Rural Tanzania

PubMed Central

McMorrow, Meredith L.; Masanja, M. Irene; Kahigwa, Elizeus; Abdulla, Salim M. K.; Kachur, S. Patrick

2010-01-01

Histidine-rich protein II (HRP2)-based malaria rapid diagnostic tests (RDTs) have shown high sensitivity and specificity for detecting Plasmodium falciparum malaria in a variety of study settings. However, RDTs are susceptible to heat and humidity and variation in individual performance, which may affect their use in field settings. We evaluated sensitivity and specificity of RDTs during routine use for malaria case management in peripheral health facilities. From December 2007 to October 2008, HRP2-based ParaHIT-f RDTs were introduced in 12 facilities without available microscopy in Rufiji District, Tanzania. Health workers received a single day of instruction on how to perform an RDT and thick blood smear. Job aids, Integrated Management of Childhood Illness guidelines, and national malaria treatment algorithms were reviewed. For quality assurance (QA), thick blood smears for reference microscopy were collected for 2 to 3 days per week from patients receiving RDTs; microscopy was not routinely performed at the health facilities. Slides were stained and read centrally within 72 hours of collection by a reference microscopist. When RDT and blood smear results were discordant, blood smears were read by additional reference microscopists blinded to earlier results. Facilities were supervised monthly by the district laboratory supervisor or a member of the study team. Ten thousand six hundred fifty (10,650) patients were tested with RDTs, and 51.5% (5,488/10,650) had a positive test result. Blood smear results were available for 3,914 patients, of whom 40.1% (1,577/3,914) were positive for P. falciparum malaria. Overall RDT sensitivity was 90.7% (range by facility 85.7–96.5%) and specificity was 73.5% (range 50.0–84.3%). Sensitivity increased with increasing parasite density. Successful implementation of RDTs was achieved in peripheral health facilities with adequate training and supervision. Quality assurance is essential to the adequate performance of any

Region 10: Oregon Oakridge Adequate Letter (6/21/2017)

EPA Pesticide Factsheets

EPA approves motor vehicle emissions budget in the Oakridge-Westfir PM2.5 Attainment State Implementation Plan for the 2006 PM2.5 national ambient air quality standard, adequate for transportation conformity purposes.

Severe oligohydramnios with intact membranes: an indication for diagnostic amnioinfusion.

PubMed

Pryde, P G; Hallak, M; Lauria, M R; Littman, L; Bottoms, S F; Johnson, M P; Evans, M I

2000-01-01

To quantify the improvement in ultrasonographic fetal imaging following diagnostic amnioinfusion for the indication of unexplained midtrimester oligohydramnios. Patients referred for unexplained midtrimester oligohydramnios were retrospectively reviewed. Videotapes of those undergoing diagnostic antenatal amnioinfusion were analyzed for quality of visualization of routinely imaged structures before and after the infusion procedure. The overall rate of adequate visualization of fetal structures improved from 50.98 to 76.79% (p < 0.0001). In fetuses having preinfusion-identified obstructive uropathy, there was improvement in identification of associated anomalies from 11.8 to 31.3%. Several authors have suggested that diagnostic amnioinfusion can facilitate fetal imaging and increase diagnostic precision in the setting of unexplained severe oligohydramnios. We have quantified the improvement in the rate of optimal visualization of fetal structures which likely translates, in experienced hands, into this observed improved diagnostic precision. Of particular importance is the improvement in appreciation of associated anomalies in cases of obstructive uropathy in which such findings may determine whether or not invasive fetal therapy is indicated. Copyright 2000 S. Karger AG, Basel.

Systematic reviews of diagnostic tests in endocrinology: an audit of methods, reporting, and performance.

PubMed

Spencer-Bonilla, Gabriela; Singh Ospina, Naykky; Rodriguez-Gutierrez, Rene; Brito, Juan P; Iñiguez-Ariza, Nicole; Tamhane, Shrikant; Erwin, Patricia J; Murad, M Hassan; Montori, Victor M

2017-07-01

Systematic reviews provide clinicians and policymakers estimates of diagnostic test accuracy and their usefulness in clinical practice. We identified all available systematic reviews of diagnosis in endocrinology, summarized the diagnostic accuracy of the tests included, and assessed the credibility and clinical usefulness of the methods and reporting. We searched Ovid MEDLINE, EMBASE, and Cochrane CENTRAL from inception to December 2015 for systematic reviews and meta-analyses reporting accuracy measures of diagnostic tests in endocrinology. Experienced reviewers independently screened for eligible studies and collected data. We summarized the results, methods, and reporting of the reviews. We performed subgroup analyses to categorize diagnostic tests as most useful based on their accuracy. We identified 84 systematic reviews; half of the tests included were classified as helpful when positive, one-fourth as helpful when negative. Most authors adequately reported how studies were identified and selected and how their trustworthiness (risk of bias) was judged. Only one in three reviews, however, reported an overall judgment about trustworthiness and one in five reported using adequate meta-analytic methods. One in four reported contacting authors for further information and about half included only patients with diagnostic uncertainty. Up to half of the diagnostic endocrine tests in which the likelihood ratio was calculated or provided are likely to be helpful in practice when positive as are one-quarter when negative. Most diagnostic systematic reviews in endocrine lack methodological rigor, protection against bias, and offer limited credibility. Substantial efforts, therefore, seem necessary to improve the quality of diagnostic systematic reviews in endocrinology.

Study on the quality assurance of diagnostic X-ray machines and assessment of the absorbed dose to patients

NASA Astrophysics Data System (ADS)

Hassan, G. M.; Rabie, N.; Mustafa, K. A.; Abdel-Khalik, S. S.

2012-09-01

Radiation exposure and image quality in X-ray diagnostic radiology provide a clear understanding of the relationship between the radiation dose delivered to a patient and image quality in optimizing medical diagnostic radiology. Because a certain amount of radiation is unavoidably delivered to patients, this should be as low as reasonably achievable. Several X-ray diagnostic machines were used at different medical diagnostic centers in Egypt for studying the beam quality and the dose delivered to the patient. This article studies the factors affecting the beam quality, such as the kilo-volt peak (kVp), exposure time (mSc), tube current (mAs) and the absorbed dose in (μGy) for different examinations. The maximum absorbed dose measured per mAs was 594±239 and 12.5±3.7 μGy for the abdomen and the chest, respectively, while the absorbed dose at the elbow was 18±6 μGy, which was the minimum dose recorded. The compound and expanded uncertainties accompanying these measurements were 4±0.35% and 8±0.7%, respectively. The measurements were done through quality control tests as acceptance procedures.

External quality assurance for HIV point-of-care testing in Africa: A collaborative country-partner approach to strengthen diagnostic services

PubMed Central

2016-01-01

It is important to consider the role of diagnostics and the critical need for quality diagnostics services in resource-limited settings. Accurate diagnostic tests play a key role in patient management and the prevention and control of most infectious diseases. As countries plan for implementation of HIV early infant diagnosis and viral load point-of-care testing, the London School of Hygiene & Tropical Medicine has worked with countries and partners with an interest in external quality assurance to support quality point-of-care testing on the continent. Through a series of collaborative consultations and workshops, the London School of Hygiene & Tropical Medicine has gathered lessons learned, tools, and resources and developed quality assurance models that will support point-of-care testing. The London School of Hygiene & Tropical Medicine is committed to the continued advancement of laboratory diagnostics in Africa and quality laboratory services and point-of-care testing. PMID:28879132

Access to diphtheria antitoxin for therapy and diagnostics.

PubMed

Both, L; White, J; Mandal, S; Efstratiou, A

2014-06-19

The most effective treatment for diphtheria is swift administration of diphtheria antitoxin (DAT) with conjunct antibiotic therapy. DAT is an equine immunoglobulin preparation and listed among the World Health Organization Essential Medicines. Essential Medicines should be available in functioning health systems at all times in adequate amounts, in appropriate dosage forms, with assured quality, and at prices individuals and the community can afford. However, DAT is in scarce supply and frequently unavailable to patients because of discontinued production in several countries, low economic viability, and high regulatory requirements for the safe manufacture of blood-derived products. DAT is also a cornerstone of diphtheria diagnostics but several diagnostic reference laboratories across the European Union (EU) and elsewhere routinely face problems in sourcing DAT for toxigenicity testing. Overall, global access to DAT for both therapeutic and diagnostic applications seems inadequate. Therefore--besides efforts to improve the current supply of DAT--accelerated research and development of alternatives including monoclonal antibodies for therapy and molecular-based methods for diagnostics are required. Given the rarity of the disease, it would be useful to organise a small stockpile centrally for all EU countries and to maintain an inventory of DAT availability within and between countries.

CHALLENGES IN SETTING UP QUALITY CONTROL IN DIAGNOSTIC RADIOLOGY FACILITIES IN NIGERIA.

PubMed

Inyang, S O; Egbe, N O; Ekpo, E

2015-01-01

The Nigerian Nuclear Regulatory Authority (NNRA) was established to regulate and control the use of radioactive and radiation emitting sources in Nigeria. Quality control (QC) on diagnostic radiology equipment form part of the fundamental requirements for the authorization of diagnostic radiology facilities in the Country. Some quality control tests (output, exposure linearity and reproducibility) were measured on the x-ray machines in the facilities that took part in the study. Questionnaire was developed to evaluate the frequencies at which QC tests were conducted in the facilities and the challenges in setting up QC. Results show great variation in the values of the QC parameters measured. Inadequate cooperation by facilities management, lack of QC equipment and insufficient staff form the major challenges in setting up QC in the facilities under study. The responses on the frequencies at which QC tests should be conducted did not correspond to the recommended standards; indicating that personnel were not familiar with QC implementation and may require further training on QC.

Quality-of-Life Differences among Diagnostic Subgroups of Children Receiving Ventilating Tubes for Otitis Media.

PubMed

Heidemann, Christian Hamilton; Lauridsen, Henrik Hein; Kjeldsen, Anette Drøhse; Faber, Christian Emil; Johansen, Eva Charlotte Jung; Godballe, Christian

2015-10-01

The pathological picture may differ considerably between diagnostic subgroups of children with otitis media receiving ventilating tubes. The aims of this study are to investigate differences in quality of life among diagnostic subgroups of children treated with ventilating tubes and to investigate possible predictors for clinical success. Longitudinal observational study. Secondary care units. Four hundred ninety-one families were enrolled in the study. The Otitis Media-6 questionnaire was applied in the assessment of child quality of life. Caregivers completed questionnaires at 7 time points from before treatment to 18-month follow-up. Logistic regression analysis was used to investigate possible predictors for clinical success. Response rates ranged from 96% to 81%; diagnostic distribution: 15% recurrent acute otitis media (rAOM), 47% otitis media with effusion (OME), and 38% mixed diagnosis of rAOM and OME (rAOM/OME). There were no significant differences between children diagnosed with rAOM and children diagnosed with rAOM/OME. However, these children had a significantly poorer quality of life at baseline compared with children diagnosed with only OME. Factors associated with clinical success included a diagnosis of rAOM, number of interrupted nights, physician visits, and canceled social activities due to OM. Results highlight the importance of distinguishing between diagnostic subgroups of children having ventilating tube treatment. A diagnosis of rAOM was found to predict baseline quality of life. Children with rAOM with or without OME were found to suffer significantly more than children with only OME before treatment. Factors associated with disease severity were found to predict clinical success. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

21 CFR 801.119 - In vitro diagnostic products.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false In vitro diagnostic products. 801.119 Section 801...) MEDICAL DEVICES LABELING Exemptions From Adequate Directions for Use § 801.119 In vitro diagnostic products. A product intended for use in the diagnosis of disease and which is an in vitro diagnostic...

21 CFR 801.119 - In vitro diagnostic products.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false In vitro diagnostic products. 801.119 Section 801...) MEDICAL DEVICES LABELING Exemptions From Adequate Directions for Use § 801.119 In vitro diagnostic products. A product intended for use in the diagnosis of disease and which is an in vitro diagnostic...

A whole-heart motion-correction algorithm: Effects on CT image quality and diagnostic accuracy of mechanical valve prosthesis abnormalities.

PubMed

Suh, Young Joo; Kim, Young Jin; Kim, Jin Young; Chang, Suyon; Im, Dong Jin; Hong, Yoo Jin; Choi, Byoung Wook

2017-11-01

We aimed to determine the effect of a whole-heart motion-correction algorithm (new-generation snapshot freeze, NG SSF) on the image quality of cardiac computed tomography (CT) images in patients with mechanical valve prostheses compared to standard images without motion correction and to compare the diagnostic accuracy of NG SSF and standard CT image sets for the detection of prosthetic valve abnormalities. A total of 20 patients with 32 mechanical valves who underwent wide-coverage detector cardiac CT with single-heartbeat acquisition were included. The CT image quality for subvalvular (below the prosthesis) and valvular regions (valve leaflets) of mechanical valves was assessed by two observers on a four-point scale (1 = poor, 2 = fair, 3 = good, and 4 = excellent). Paired t-tests or Wilcoxon signed rank tests were used to compare image quality scores and the number of diagnostic phases (image quality score≥3) between the standard image sets and NG SSF image sets. Diagnostic performance for detection of prosthetic valve abnormalities was compared between two image sets with the final diagnosis set by re-operation or clinical findings as the standard reference. NG SSF image sets had better image quality scores than standard image sets for both valvular and subvalvular regions (P < 0.05 for both). The number of phases that were of diagnostic image quality per patient was significantly greater in the NG SSF image set than standard image set for both valvular and subvalvular regions (P < 0.0001). Diagnostic performance of NG SSF image sets for the detection of prosthetic abnormalities (20 pannus and two paravalvular leaks) was greater than that of standard image sets (P < 0.05). Application of NG SSF can improve CT image quality and diagnostic accuracy in patients with mechanical valves compared to standard images. Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Implementation of quality assurance in diagnostic radiology in Bosnia and Herzegovina (Republic of Srpska).

PubMed

Bosnjak, J; Ciraj-Bjelac, O; Strbac, B

2008-01-01

Application of a quality control (QC) programme is very important when optimisation of image quality and reduction of patient exposure is desired. QC surveys of diagnostics imaging equipment in Republic of Srpska (entity of Bosnia and Herzegovina) has been systematically performed since 2001. The presented results are mostly related to the QC test results of X-ray tubes and generators for diagnostic radiology units in 92 radiology departments. In addition, results include workplace monitoring and usage of personal protective devices for staff and patients. Presented results showed the improvements in the implementation of the QC programme within the period 2001--2005. Also, more attention is given to appropriate maintenance of imaging equipment, which was one of the main problems in the past. Implementation of a QC programme is a continuous and complex process. To achieve good performance of imaging equipment, additional tests are to be introduced, along with image quality assessment and patient dosimetry. Training is very important in order to achieve these goals.

Challenges in Routine Implementation and Quality Control of Rapid Diagnostic Tests for Malaria–Rufiji District, Tanzania

PubMed Central

McMorrow, Meredith L.; Masanja, M. Irene; Abdulla, Salim M. K.; Kahigwa, Elizeus; Kachur, S. Patrick

2018-01-01

Rapid diagnostic tests (RDTs) represent an alternative to microscopy for malaria diagnosis and have shown high sensitivity and specificity in a variety of study settings. Current World Health Organization (WHO) guidelines for quality control of RDTs provide detailed instructions on pre-field testing, but offer little guidance for quality assurance once RDTs are deployed in health facilities. From September 2006 to April 2007, we introduced a histidine-rich protein II (HRP2)-based RDT (Paracheck) for suspected malaria cases five years of age and older in nine health facilities in Rufiji District, Tanzania, to assess sensitivity and specificity of RDTs in routine use at rural health facilities. Thick blood smears were collected for all patients tested with RDTs and stained and read by laboratory personnel in each facility. Thick smears were subsequently reviewed by a reference microscopist to determine RDT sensitivity and specificity. In all nine health facilities, there were significant problems with the quality of staining and microscopy. Sensitivity and specificity of RDTs were difficult to assess given the poor quality of routine blood smear staining. Mean operational sensitivity of RDTs based on reference microscopy was 64.8%, but varied greatly by health facility, range 18.8–85.9%. Sensitivity of RDTs increased with increasing parasite density. Specificity remained high at 87.8% despite relatively poor slide quality. Institution of quality control of RDTs based on poor quality blood smear staining may impede reliable measurement of sensitivity and specificity and undermine confidence in the new diagnostic. There is an urgent need for the development of alternative quality control procedures for rapid diagnostic tests that can be performed at the facility level. PMID:18784230

Next generation diagnostic molecular pathology: critical appraisal of quality assurance in Europe.

PubMed

Dubbink, Hendrikus J; Deans, Zandra C; Tops, Bastiaan B J; van Kemenade, Folkert J; Koljenović, S; van Krieken, Han J M; Blokx, Willeke A M; Dinjens, Winand N M; Groenen, Patricia J T A

2014-06-01

Tumor evaluation in pathology is more and more based on a combination of traditional histopathology and molecular analysis. Due to the rapid development of new cancer treatments that specifically target aberrant proteins present in tumor cells, treatment decisions are increasingly based on the molecular features of the tumor. Not only the number of patients eligible for targeted precision medicine, but also the number of molecular targets per patient and tumor type is rising. Diagnostic molecular pathology, the discipline that determines the molecular aberrations present in tumors for diagnostic, prognostic or predictive purposes, is faced with true challenges. The laboratories have to meet the need of comprehensive molecular testing using only limited amount of tumor tissue, mostly fixed in formalin and embedded in paraffin (FFPE), in short turnaround time. Choices must be made for analytical methods that provide accurate, reliable and cost-effective results. Validation of the test procedures and results is essential. In addition, participation and good performance in internal (IQA) and external quality assurance (EQA) schemes is mandatory. In this review, we critically evaluate the validation procedure for comprehensive molecular tests as well as the organization of quality assurance and assessment of competence of diagnostic molecular pathology laboratories within Europe. Copyright © 2014 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

Melioidosis Diagnostic Workshop, 20131

PubMed Central

AuCoin, David; Baccam, Prasith; Baggett, Henry C.; Baird, Rob; Bhengsri, Saithip; Blaney, David D.; Brett, Paul J.; Brooks, Timothy J.G.; Brown, Katherine A.; Chantratita, Narisara; Cheng, Allen C.; Dance, David A.B.; Decuypere, Saskia; Defenbaugh, Dawn; Gee, Jay E.; Houghton, Raymond; Jorakate, Possawat; Lertmemongkolchai, Ganjana; Limmathurotsakul, Direk; Merlin, Toby L.; Mukhopadhyay, Chiranjay; Norton, Robert; Peacock, Sharon J.; Rolim, Dionne B.; Simpson, Andrew J.; Steinmetz, Ivo; Stoddard, Robyn A.; Stokes, Martha M.; Sue, David; Tuanyok, Apichai; Whistler, Toni; Wuthiekanun, Vanaporn; Walke, Henry T.

2015-01-01

Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions. PMID:25626057

Region 10: Idaho Northern Ada County Adequate Letter (6/21/2013)

EPA Pesticide Factsheets

EPA approves motor vehicle emissions budget in the Northern Ada County PM10 State Implementation Plan, Maintenance Plan: Ten-Year Update for PM10 national ambient air quality standard, adequate for transportation conformity purposes.

DETERMINATION OF NATIONAL DIAGNOSTIC REFERENCE LEVELS IN COMPUTED TOMOGRAPHY EXAMINATIONS OF IRAN BY A NEW QUALITY CONTROL-BASED DOSE SURVEY METHOD.

PubMed

Sohrabi, Mehdi; Parsi, Masoumeh; Mianji, Fereidoun

2018-05-01

National diagnostic reference levels (NDRLs) of Iran were determined for the four most common CT examinations including head, sinus, chest and abdomen/pelvis. A new 'quality control (QC)-based dose survey method', as developed by us, was applied to 157 CT scanners in Iran (2014-15) with different slice classes, models and geographic spread across the country. The NDRLs for head, sinus, chest and abdomen/pelvis examinations are 58, 29, 12 and 14 mGy for CTDIVol and 750, 300, 300 and 650 mGy.cm for DLP, respectively. The 'QC-based dose survey method' was further proven that it is a simple, accurate and practical method for a time and cost-effective NDRLs determination. One effective approach for optimization of the CT examination protocols at the national level is the provision of an adequate standardized training of the radiologists, technicians and medical physicists on the patient radiation protection principles and implementation of the DRL concept in clinical practices.

Diagnostic quality driven physiological data collection for personal healthcare.

PubMed

Jea, David; Balani, Rahul; Hsu, Ju-Lan; Cho, Dae-Ki; Gerla, Mario; Srivastava, Mani B

2008-01-01

We believe that each individual is unique, and that it is necessary for diagnosis purpose to have a distinctive combination of signals and data features that fits the personal health status. It is essential to develop mechanisms for reducing the amount of data that needs to be transferred (to mitigate the troublesome periodically recharging of a device) while maintaining diagnostic accuracy. Thus, the system should not uniformly compress the collected physiological data, but compress data in a personalized fashion that preserves the 'important' signal features for each individual such that it is enough to make the diagnosis with a required high confidence level. We present a diagnostic quality driven mechanism for remote ECG monitoring, which enables a notation of priorities encoded into the wave segments. The priority is specified by the diagnosis engine or medical experts and is dynamic and individual dependent. The system pre-processes the collected physiological information according to the assigned priority before delivering to the backend server. We demonstrate that the proposed approach provides accurate inference results while effectively compressing the data.

[The Quality Analysis of National Supervising Sampling for Rubella Virus IgM Diagnostic Kits in 2014].

PubMed

Yu, Tina; Qu, Shoufang; Zhang, Xiaoyan; Sun, Nan; Gao, Shangxian; Li, Haining; Huang, Jie

2015-07-01

To evaluate the quality status of rubella virus IgM diagnostic kits by national supervising sampling. Using legal inspection combining with exploratory study, the positive and negative coincidence rate, detection limit and repeatability of kits were verified. The results showed that 15 of 16 batches of kits were qualified using legal inspection, and the passing rate was 93.8%. The unqualified item was negative coincidence rate. In exploratory study, only 11 batches (68.8%) complied with industry standard. The unqualified items were negative coincidence rate, detection limit and repeatability. At present, rubella virus IgM diagnostic Kits have some quality problems in the market. It is recommended that we adopt industry standard and national reference panel in the registration inspection for the future, which will prompt enterprises to improve quality.

42 CFR 438.207 - Assurances of adequate capacity and services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Access Standards § 438.207 Assurances of adequate capacity and services. (a) Basic rule. The State... with the State's requirements for availability of services, as set forth in § 438.206. (e) CMS' right...

[Risk on bias assessment: (6) A Revised Tool for the Quality Assessment on Diagnostic Accuracy Studies (QUADAS-2)].

PubMed

Qu, Y J; Yang, Z R; Sun, F; Zhan, S Y

2018-04-10

This paper introduced the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2), including the development and comparison with the original QUADAS, and illustrated the application of QUADAS-2 in a published paper related to the study on diagnostic accuracy which was included in systematic review and Meta-analysis. QUADAS-2 presented considerable improvement over the original tool. Confused items that included in QUADAS had disappeared and the quality assessment of the original study replaced by the rating of risk on bias and applicability. This was implemented through the description on the four main domains with minimal overlapping and answering the signal questions in each domain. The risk of bias and applicability with 'high','low' or 'unclear' was in line with the risk of bias assessment of intervention studies in Cochrane, so to replace the total score of quality assessment in QUADAS. Meanwhile, QUADAS-2 was also applicable to assess the diagnostic accuracy studies in which follow-up without prognosis was involved in golden standard. It was useful to assess the overall methodological quality of the study despite more time consuming than the original QUADAS. However, QUADAS-2 needs to be modified to apply in comparative studies on diagnostic accuracy and we hope the users would follow the updates and give their feedbacks on line.

[THE VIRTUAL CYTOLOGIC SLIDES FOR EXTERNAL EVALUATION OF QUALITY OF IMPLEMENTATION OF CYTOLOGIC ANALYSES IN CLINICAL DIAGNOSTIC LABORATORIES: POSSIBILITIES AND PERSPECTIVES].

PubMed

Djangirova, T V; Shabalova, I P; Pronichev, A N; Polyakov, E V

2015-08-01

The article considers application of technology of analysis of cytological slides in external quality control of clinical diagnostic laboratories. The advantages of virtual slides are demonstrated against other applied technologies of external evaluation of quality i.e. slide plate and digital micro-photography. The conditions of formation of virtual slides for external evaluation of quality of clinical diagnostic laboratories. The technology of their application is described. The success of practical application of considered technology in the Federal system of external evaluation of quality is emphasized.

Diagnostic quality of 50 and 100 µm computed radiography compared with screen–film mammography in operative breast specimens

PubMed Central

Pagliari, C M; Hoang, T; Reddy, M; Wilkinson, L S; Poloniecki, J D; Given-Wilson, R M

2012-01-01

Objective To compare reader ratings of the clinical diagnostic quality of 50 and 100 μm computed radiography (CR) systems with screen–film mammography (SFM) in operative specimens. Methods Mammograms of 57 fresh operative breast specimens were analysed by 10 readers. Exposures were made with identical position and compression with three mammographic systems (Fuji 100CR, 50CR and SFM). Images were anonymised and readers blinded to the CR system used. A five-point comparative scoring system (−2 to +2) was used to assess seven quality criteria and overall diagnostic value. Statistical analysis was subsequently performed of reader ratings (n=16 925). Results For most quality criteria, both CR systems were rated as equivalent to or better than SFM. The CR systems were significantly better at demonstrating skin edge and background tissue (p<1×10−5). Microcalcification was best demonstrated on the CR50 system (p<1×10−5). The overall diagnostic value of both CR systems was rated as being as good as or better than SFM (p<1×10−5). Conclusion In this clinical setting, the overall diagnostic performance of both CR systems was as good as or better than SFM, with the CR50 system performing better than the CR100. PMID:22096218

State Implementation Plans (SIP): Submissions that EPA has Found Adequate or Inadequate

EPA Pesticide Factsheets

EPA/OTAQ’s State and Local Transportation Resources are for air quality and transportation government and community leaders. Information on state implementation plans (SIPs) that EPA has found either adequate or inadequate is provided here.

The methodological quality of diagnostic test accuracy studies for musculoskeletal conditions can be improved.

PubMed

Henschke, Nicholas; Keuerleber, Julia; Ferreira, Manuela; Maher, Christopher G; Verhagen, Arianne P

2014-04-01

To provide an overview of reporting and methodological quality in diagnostic test accuracy (DTA) studies in the musculoskeletal field and evaluate the use of the QUality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist. A literature review identified all systematic reviews that evaluated the accuracy of clinical tests to diagnose musculoskeletal conditions and used the QUADAS checklist. Two authors screened all identified reviews and extracted data on the target condition, index tests, reference standard, included studies, and QUADAS items. A descriptive analysis of the QUADAS checklist was performed, along with Rasch analysis to examine the construct validity and internal reliability. A total of 19 systematic reviews were included, which provided data on individual items of the QUADAS checklist for 392 DTA studies. In the musculoskeletal field, uninterpretable or intermediate test results are commonly not reported, with 175 (45%) studies scoring "no" to this item. The proportion of studies fulfilling certain items varied from 22% (item 11) to 91% (item 3). The interrater reliability of the QUADAS checklist was good and Rasch analysis showed excellent construct validity and internal consistency. This overview identified areas where the reporting and performance of diagnostic studies within the musculoskeletal field can be improved. Copyright © 2014 Elsevier Inc. All rights reserved.

Latent class analysis of diagnostic science assessment data using Bayesian networks

NASA Astrophysics Data System (ADS)

Steedle, Jeffrey Thomas

2008-10-01

Diagnostic science assessments seek to draw inferences about student understanding by eliciting evidence about the mental models that underlie students' reasoning about physical systems. Measurement techniques for analyzing data from such assessments embody one of two contrasting assessment programs: learning progressions and facet-based assessments. Learning progressions assume that students have coherent theories that they apply systematically across different problem contexts. In contrast, the facet approach makes no such assumption, so students should not be expected to reason systematically across different problem contexts. A systematic comparison of these two approaches is of great practical value to assessment programs such as the National Assessment of Educational Progress as they seek to incorporate small clusters of related items in their tests for the purpose of measuring depth of understanding. This dissertation describes an investigation comparing learning progression and facet models. Data comprised student responses to small clusters of multiple-choice diagnostic science items focusing on narrow aspects of understanding of Newtonian mechanics. Latent class analysis was employed using Bayesian networks in order to model the relationship between students' science understanding and item responses. Separate models reflecting the assumptions of the learning progression and facet approaches were fit to the data. The technical qualities of inferences about student understanding resulting from the two models were compared in order to determine if either modeling approach was more appropriate. Specifically, models were compared on model-data fit, diagnostic reliability, diagnostic certainty, and predictive accuracy. In addition, the effects of test length were evaluated for both models in order to inform the number of items required to obtain adequately reliable latent class diagnoses. Lastly, changes in student understanding over time were studied with a

Preliminary enquiry into the availability, price and quality of malaria rapid diagnostic tests in the private health sector of six malaria-endemic countries.

PubMed

Albertini, A; Djalle, D; Faye, B; Gamboa, D; Luchavez, J; Mationg, M L; Mwangoka, G; Oyibo, W; Bennett, J; Incardona, S; Lee, E

2012-02-01

This enquiry aimed to provide a snap-shot of availability, price and quality of malaria rapid diagnostic tests (RDTs) in private health facilities at selected sites in six malaria-endemic countries in Africa, South East Asia and South America. In each study site, data collectors surveyed private healthcare facilities which were selected based on accessibility from their home institution. Using a questionnaire, information was recorded about the facility itself and the malaria RDT(s) available. Where possible, a small number of RDTs were procured and quality control tested using a standardized procedure. Of the 324 private healthcare facilities visited, 35 outlets (mainly private clinics and hospitals) were found to supply 10 different types of RDTs products. RDT prices across the six countries ranged from US$1.00 to $16.81. Five of the 14 malaria RDTs collected failed quality control testing. In the private outlets sampled, the availability of RDTs was limited. Some of the RDTs whose quality we tested demonstrated inadequate sensitivity. This presents a number of risks. Given the more widespread distribution of antimalarials currently planned for private sector facilities, parasite-based diagnosis in this sector will be essential to adhere to the WHO guidelines for effective case management of malaria. Considerable regulation and quality control are also necessary to assure the availability of accurate and reliable RDTs, as well as adequate case management and provider adherence to RDT results. Public sector engagement is likely to be essential in this process. © 2011 Blackwell Publishing Ltd.

Effect of scan quality on diagnostic accuracy of spectral-domain optical coherence tomography in glaucoma.

PubMed

Rao, Harsha L; Addepalli, Uday K; Yadav, Ravi K; Senthil, Sirisha; Choudhari, Nikhil S; Garudadri, Chandra S

2014-03-01

To evaluate the effect of scan quality on the diagnostic accuracies of optic nerve head (ONH), retinal nerve fiber layer (RNFL), and ganglion cell complex (GCC) parameters of spectral-domain optical coherence tomography (SD OCT) in glaucoma. Cross-sectional study. Two hundred fifty-two eyes of 183 control subjects (mean deviation [MD]: -1.84 dB) and 207 eyes of 159 glaucoma patients (MD: -7.31 dB) underwent ONH, RNFL, and GCC scanning with SD OCT. Scan quality of SD OCT images was based on signal strength index (SSI) values. Influence of SSI on diagnostic accuracy of SD OCT was evaluated by receiver operating characteristic (ROC) regression. Diagnostic accuracies of all SD OCT parameters were better when the SSI values were higher. This effect was statistically significant (P < .05) for ONH and RNFL but not for GCC parameters. In mild glaucoma (MD of -5 dB), area under ROC curve (AUC) for rim area, average RNFL thickness, and average GCC thickness parameters improved from 0.651, 0.678, and 0.726, respectively, at an SSI value of 30 to 0.873, 0.962, and 0.886, respectively, at an SSI of 70. AUCs of the same parameters in advanced glaucoma (MD of -15 dB) improved from 0.747, 0.890, and 0.873, respectively, at an SSI value of 30 to 0.922, 0.994, and 0.959, respectively, at an SSI of 70. Diagnostic accuracies of SD OCT parameters in glaucoma were significantly influenced by the scan quality even when the SSI values were within the manufacturer-recommended limits. These results should be considered while interpreting the SD OCT scans for glaucoma. Copyright © 2014 Elsevier Inc. All rights reserved.

International quality assurance project in colorectal cancer-unifying diagnostic and histopathological evaluation.

PubMed

Jannasch, O; Udelnow, A; Romano, G; Dziki, A; Pavalkis, D; Lippert, H; Mroczkowski, P

2014-04-01

Several European countries are undertaking quality control projects in colorectal cancer. These efforts have led to improvements in survival, but a comparison between different projects reveals questionable results. The aim of this study is the presentation of results from hospitals in three different European countries participating in the International Quality Assurance in Colorectal Cancer (IQACC) project. For this publication, patients with cancer of the colon or rectum treated in 2009 and 2010 and recorded in the IQACC (Germany, Poland and Italy) were analysed. The comparison included number of patients, age, preoperative diagnostics (CT of the abdomen and thorax, MRI, colonoscopy, ultrasound, tumour markers), surgical approach, metastasis, height of rectal cancer and histopathological examination of a specimen (T stage, N stage and MERCURY classification for rectum resection). For short-term outcomes, general complications, wound dehiscence, tumour-free status at discharge, anastomotic leakage and in-hospital mortality were analysed. A total of 12,691 patients (6,756 with colon cancer, 5,935 with rectal cancer) were included in the analysis. Preoperative diagnostics differed significantly between countries. For pT and pN stages, several quality differences could be demonstrated, including missing stages (colon cancer: pT 5.7-12.5 %, pN 2.5-11.0 %; rectal cancer: pT 1.1-5.6 %, pN 1.1-15.5 %). The most relevant differences for short-term outcomes in colon cancer were found in general complications (4.2-22.8 %) and tumour-free status at discharge (74.5-91.7 %). In-hospital deaths ranged between 2.5 and 4.3 % and did not show significant differences. For rectal cancer, the country with the highest percentage of tumours localised less than 4 cm from the anal verge (16.0 %) showed the lowest frequency of amputation (8.5 %). Outcome differences were found for general complications (3.2-18.8 %), anastomotic leakage (0-4.3 %) and tumour-free status at discharge (72

Diagnostic tolerance for missing sensor data

NASA Technical Reports Server (NTRS)

Scarl, Ethan A.

1989-01-01

For practical automated diagnostic systems to continue functioning after failure, they must not only be able to diagnose sensor failures but also be able to tolerate the absence of data from the faulty sensors. It is shown that conventional (associational) diagnostic methods will have combinatoric problems when trying to isolate faulty sensors, even if they adequately diagnose other components. Moreover, attempts to extend the operation of diagnostic capability past sensor failure will necessarily compound those difficulties. Model-based reasoning offers a structured alternative that has no special problems diagnosing faulty sensors and can operate gracefully when sensor data is missing.

Diagnostic and functional structure of a high-resolution thyroid nodule clinic.

PubMed

Fernández-García, José Carlos; Mancha-Doblas, Isabel; Ortega-Jiménez, María Victoria; Ruiz-Escalante, José Francisco; Castells-Fusté, Ignasi; Tofé-Povedano, Santiago; Argüelles-Jiménez, Iñaki; Tinahones, Francisco José

2014-01-01

Appearance of a thyroid nodule has become a daily occurrence in clinical practice. Adequate thyroid nodule assessment requires several diagnostic tests and multiple medical appointments, which results in a substantial delay in diagnosis. Implementation of a high-resolution thyroid nodule clinic largely avoids these drawbacks by condensing in a single appointment all tests required for adequate evaluation of thyroid nodule. This paper reviews the diagnostic and functional structure of a high-resolution thyroid nodule clinic. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Comorbidity structure of psychological disorders in the online e-PASS data as predictors of psychosocial adjustment measures: psychological distress, adequate social support, self-confidence, quality of life, and suicidal ideation.

PubMed

Al-Asadi, Ali M; Klein, Britt; Meyer, Denny

2014-10-28

A relative newcomer to the field of psychology, e-mental health has been gaining momentum and has been given considerable research attention. Although several aspects of e-mental health have been studied, 1 aspect has yet to receive attention: the structure of comorbidity of psychological disorders and their relationships with measures of psychosocial adjustment including suicidal ideation in online samples. This exploratory study attempted to identify the structure of comorbidity of 21 psychological disorders assessed by an automated online electronic psychological assessment screening system (e-PASS). The resulting comorbidity factor scores were then used to assess the association between comorbidity factor scores and measures of psychosocial adjustments (ie, psychological distress, suicidal ideation, adequate social support, self-confidence in dealing with mental health issues, and quality of life). A total of 13,414 participants were assessed using a complex online algorithm that resulted in primary and secondary Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnoses for 21 psychological disorders on dimensional severity scales. The scores on these severity scales were used in a principal component analysis (PCA) and the resulting comorbidity factor scores were related to 4 measures of psychosocial adjustments. A PCA based on 17 of the 21 psychological disorders resulted in a 4-factor model of comorbidity: anxiety-depression consisting of all anxiety disorders, major depressive episode (MDE), and insomnia; substance abuse consisting of alcohol and drug abuse and dependency; body image-eating consisting of eating disorders, body dysmorphic disorder, and obsessive-compulsive disorders; depression-sleep problems consisting of MDE, insomnia, and hypersomnia. All comorbidity factor scores were significantly associated with psychosocial measures of adjustment (P<.001). They were positively related to psychological distress and

Comorbidity Structure of Psychological Disorders in the Online e-PASS Data as Predictors of Psychosocial Adjustment Measures: Psychological Distress, Adequate Social Support, Self-Confidence, Quality of Life, and Suicidal Ideation

PubMed Central

Klein, Britt; Meyer, Denny

2014-01-01

Background A relative newcomer to the field of psychology, e-mental health has been gaining momentum and has been given considerable research attention. Although several aspects of e-mental health have been studied, 1 aspect has yet to receive attention: the structure of comorbidity of psychological disorders and their relationships with measures of psychosocial adjustment including suicidal ideation in online samples. Objective This exploratory study attempted to identify the structure of comorbidity of 21 psychological disorders assessed by an automated online electronic psychological assessment screening system (e-PASS). The resulting comorbidity factor scores were then used to assess the association between comorbidity factor scores and measures of psychosocial adjustments (ie, psychological distress, suicidal ideation, adequate social support, self-confidence in dealing with mental health issues, and quality of life). Methods A total of 13,414 participants were assessed using a complex online algorithm that resulted in primary and secondary Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnoses for 21 psychological disorders on dimensional severity scales. The scores on these severity scales were used in a principal component analysis (PCA) and the resulting comorbidity factor scores were related to 4 measures of psychosocial adjustments. Results A PCA based on 17 of the 21 psychological disorders resulted in a 4-factor model of comorbidity: anxiety-depression consisting of all anxiety disorders, major depressive episode (MDE), and insomnia; substance abuse consisting of alcohol and drug abuse and dependency; body image–eating consisting of eating disorders, body dysmorphic disorder, and obsessive-compulsive disorders; depression–sleep problems consisting of MDE, insomnia, and hypersomnia. All comorbidity factor scores were significantly associated with psychosocial measures of adjustment (P<.001). They were

[The quality management in clinical diagnostic laboratory in conditions of the Federal Center of traumatology, orthopedics and endoprosthesis replacement of Minzdrav of Russia (Cheboksary)].

PubMed

Nikolaev, N S; Nazarova, V V; Dobrovol'skaia, N Iu; Orlova, A V; Pchelova, N N

2014-10-01

The article presents experience of clinical diagnostic laboratory of the Federal Center of traumatology, orthopedics and endoprosthesis replacement of Minzdrav of Russia (Cheboksary) in the area of quality management of medical laboratory services on the basis of evaluation of efficacy and effectiveness of processes. The factors effecting quality of functioning of clinical diagnostic laboratory are indicated. The criteria and indicators of efficacy of work of employees of clinical diagnostic laboratory are presented.

MO-AB-210-00: Diagnostic Ultrasound Imaging Quality Control and High Intensity Focused Ultrasound Therapy Hands-On Workshop

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

The goal of this ultrasound hands-on workshop is to demonstrate advancements in high intensity focused ultrasound (HIFU) and to demonstrate quality control (QC) testing in diagnostic ultrasound. HIFU is a therapeutic modality that uses ultrasound waves as carriers of energy. HIFU is used to focus a beam of ultrasound energy into a small volume at specific target locations within the body. The focused beam causes localized high temperatures and produces a well-defined regions of necrosis. This completely non-invasive technology has great potential for tumor ablation and targeted drug delivery. At the workshop, attendees will see configurations, applications, and hands-on demonstrationsmore » with on-site instructors at separate stations. The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. At the workshop, an array of ultrasound testing phantoms and ultrasound scanners will be provided for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations of the techniques. Target audience: Medical physicists and other medical professionals in diagnostic imaging and radiation oncology with interest in high-intensity focused ultrasound and in diagnostic ultrasound QC. Learning Objectives: Learn ultrasound physics and safety for HIFU applications through live demonstrations Get an overview of the state-of-the art in HIFU technologies and equipment Gain familiarity with common elements of a quality control program for diagnostic ultrasound imaging Identify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools List of supporting vendors for HIFU and diagnostic ultrasound QC hands-on workshop: Philips Healthcare Alpinion Medical Systems Verasonics, Inc Zonare Medical Systems, Inc Computerized Imaging Reference Systems (CIRS), Inc. GAMMEX, Inc., Cablon Medical BV Steffen Sammet: NIH/NCI grant 5R25CA132822, NIH/NINDS grant

Status of US ITER Diagnostics

NASA Astrophysics Data System (ADS)

Stratton, B.; Delgado-Aparicio, L.; Hill, K.; Johnson, D.; Pablant, N.; Barnsley, R.; Bertschinger, G.; de Bock, M. F. M.; Reichle, R.; Udintsev, V. S.; Watts, C.; Austin, M.; Phillips, P.; Beiersdorfer, P.; Biewer, T. M.; Hanson, G.; Klepper, C. C.; Carlstrom, T.; van Zeeland, M. A.; Brower, D.; Doyle, E.; Peebles, A.; Ellis, R.; Levinton, F.; Yuh, H.

2013-10-01

The US is providing 7 diagnostics to ITER: the Upper Visible/IR cameras, the Low Field Side Reflectometer, the Motional Stark Effect diagnostic, the Electron Cyclotron Emission diagnostic, the Toroidal Interferometer/Polarimeter, the Core Imaging X-Ray Spectrometer, and the Diagnostic Residual Gas Analyzer. The front-end components of these systems must operate with high reliability in conditions of long pulse operation, high neutron and gamma fluxes, very high neutron fluence, significant neutron heating (up to 7 MW/m3) , large radiant and charge exchange heat flux (0.35 MW/m2) , and high electromagnetic loads. Opportunities for repair and maintenance of these components will be limited. These conditions lead to significant challenges for the design of the diagnostics. Space constraints, provision of adequate radiation shielding, and development of repair and maintenance strategies are challenges for diagnostic integration into the port plugs that also affect diagnostic design. The current status of design of the US ITER diagnostics is presented and R&D needs are identified. Supported by DOE contracts DE-AC02-09CH11466 (PPPL) and DE-AC05-00OR22725 (UT-Battelle, LLC).

Biosafety principles and practices for the veterinary diagnostic laboratory.

PubMed

Kozlovac, Joseph; Schmitt, Beverly

2015-01-01

Good biosafety and biocontainment programs and practices are critical components of the successful operation of any veterinary diagnostic laboratory. In this chapter we provide information and guidance on critical biosafety management program elements, facility requirements, protective equipment, and procedures necessary to ensure that the laboratory worker and the environment are adequately protected in the challenging work environment of the veterinary diagnostic laboratory in general and provide specific guidance for those laboratories employing molecular diagnostic techniques.

Multidisciplinary molecular diagnostics: the 9th European meeting on molecular diagnostics.

PubMed

Loonen, Anne J M; Schuurman, Rob; van den Brule, Adriaan J C

2016-01-01

This report presents a summary of the 9th European Meeting on Molecular Diagnostics held in Noordwijk, The Netherlands, 14-16 October 2015. This 3-day conference covered many relevant topics in the field of molecular diagnostics in humans, including infectious disease, oncology, outbreak management, population-based cancer screening, standardization and quality control, chronic diseases and pharmacogenetics. Beyond these different areas, shared values are new technologies and novel technical and clinical applications. Approximately 450 participants, the majority coming from European countries, attended the meeting. Besides high quality scientific presentations, more than 35 diagnostic companies presented their latest innovations, altogether in an informal and inspiring scientific ambience.

Pre-diagnostic Sleep Duration and Sleep Quality in Relation to Subsequent Cancer Survival

PubMed Central

Phipps, Amanda I.; Bhatti, Parveen; Neuhouser, Marian L.; Chen, Chu; Crane, Tracy E.; Kroenke, Candyce H.; Ochs-Balcom, Heather; Rissling, Michelle; Snively, Beverly M.; Stefanick, Marcia L.; Treggiari, Miriam M.; Watson, Nathaniel F.

2016-01-01

Study Objectives: Poor sleep quality and short sleep duration have been associated with elevated risk for several cancer types; however, the relationship between sleep and cancer outcomes has not been well characterized. We assessed the association between pre-diagnostic sleep attributes and subsequent cancer survival within the Women's Health Initiative (WHI). Methods: We identified WHI participants in whom a first primary invasive cancer had been diagnosed during follow-up (n = 21,230). Participants provided information on sleep characteristics at enrollment. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between these pre-diagnostic sleep characteristics and cancer-specific survival for all cancers combined and separately for common cancers. Analyses were adjusted for age, study arm, cancer site, marital status, income, smoking, physical activity, and time to diagnosis. Results: No individual pre-diagnostic sleep characteristics were found to be significantly associated with cancer survival in analyses of all cancer sites combined; however, women who reported short sleep duration (≤ 6 h sleep/night) combined with frequent snoring (≥ 5 nights/w experienced significantly poorer cancer-specific survival than those who reported 7–8 h of sleep/night and no snoring (HR = 1.32, 95% CI: 1.14–1.54). Short sleep duration (HR = 1.46, 95% CI: 1.07–1.99) and frequent snoring (HR = 1.34, 95% CI: 0.98–1.85) were each associated with poorer breast cancer survival; those reporting short sleep combined with frequent snoring combined had substantially poorer breast cancer survival than those reporting neither (HR = 2.14, 95% CI: 1.47–3.13). Conclusions: Short sleep duration combined with frequent snoring reported prior to cancer diagnosis may influence subsequent cancer survival, particularly breast cancer survival. Citation: Phipps AI, Bhatti P, Neuhouser ML, Chen C, Crane TE, Kroenke CH, Ochs-Balcom H

A computational framework for converting textual clinical diagnostic criteria into the quality data model.

PubMed

Hong, Na; Li, Dingcheng; Yu, Yue; Xiu, Qiongying; Liu, Hongfang; Jiang, Guoqian

2016-10-01

Constructing standard and computable clinical diagnostic criteria is an important but challenging research field in the clinical informatics community. The Quality Data Model (QDM) is emerging as a promising information model for standardizing clinical diagnostic criteria. To develop and evaluate automated methods for converting textual clinical diagnostic criteria in a structured format using QDM. We used a clinical Natural Language Processing (NLP) tool known as cTAKES to detect sentences and annotate events in diagnostic criteria. We developed a rule-based approach for assigning the QDM datatype(s) to an individual criterion, whereas we invoked a machine learning algorithm based on the Conditional Random Fields (CRFs) for annotating attributes belonging to each particular QDM datatype. We manually developed an annotated corpus as the gold standard and used standard measures (precision, recall and f-measure) for the performance evaluation. We harvested 267 individual criteria with the datatypes of Symptom and Laboratory Test from 63 textual diagnostic criteria. We manually annotated attributes and values in 142 individual Laboratory Test criteria. The average performance of our rule-based approach was 0.84 of precision, 0.86 of recall, and 0.85 of f-measure; the performance of CRFs-based classification was 0.95 of precision, 0.88 of recall and 0.91 of f-measure. We also implemented a web-based tool that automatically translates textual Laboratory Test criteria into the QDM XML template format. The results indicated that our approaches leveraging cTAKES and CRFs are effective in facilitating diagnostic criteria annotation and classification. Our NLP-based computational framework is a feasible and useful solution in developing diagnostic criteria representation and computerization. Copyright © 2016 Elsevier Inc. All rights reserved.

Quality-control issues on high-resolution diagnostic monitors.

PubMed

Parr, L F; Anderson, A L; Glennon, B K; Fetherston, P

2001-06-01

Previous literature indicates a need for more data collection in the area of quality control of high-resolution diagnostic monitors. Throughout acceptance testing, which began in June 2000, stability of monitor calibration was analyzed. Although image quality on all monitors was found to be acceptable upon initial acceptance testing using VeriLUM software by Image Smiths, Inc (Germantown, MD), it was determined to be unacceptable during the clinical phase of acceptance testing. High-resolution monitors were evaluated for quality assurance on a weekly basis from installation through acceptance testing and beyond. During clinical utilization determination (CUD), monitor calibration was identified as a problem and the manufacturer returned and recalibrated all workstations. From that time through final acceptance testing, high-resolution monitor calibration and monitor failure rate remained a problem. The monitor vendor then returned to the site to address these areas. Monitor defocus was still noticeable and calibration checks were increased to three times per week. White and black level drift on medium-resolution monitors had been attributed to raster size settings. Measurements of white and black level at several different size settings were taken to determine the effect of size on white and black level settings. Black level remained steady with size change. White level appeared to increase by 2.0 cd/m2 for every 0.1 inches decrease in horizontal raster size. This was determined not to be the cause of the observed brightness drift. Frequency of calibration/testing is an issue in a clinical environment. The increased frequency required at our site cannot be sustained. The medical physics division cannot provide dedicated personnel to conduct the quality-assurance testing on all monitors at this interval due to other physics commitments throughout the hospital. Monitor access is also an issue due to radiologists' need to read images. Some workstations are in use 7 AM

Diagnostic Air Quality Model Evaluation of Source-Specific ...

EPA Pesticide Factsheets

Ambient measurements of 78 source-specific tracers of primary and secondary carbonaceous fine particulate matter collected at four midwestern United States locations over a full year (March 2004–February 2005) provided an unprecedented opportunity to diagnostically evaluate the results of a numerical air quality model. Previous analyses of these measurements demonstrated excellent mass closure for the variety of contributing sources. In this study, a carbon-apportionment version of the Community Multiscale Air Quality (CMAQ) model was used to track primary organic and elemental carbon emissions from 15 independent sources such as mobile sources and biomass burning in addition to four precursor-specific classes of secondary organic aerosol (SOA) originating from isoprene, terpenes, aromatics, and sesquiterpenes. Conversion of the source-resolved model output into organic tracer concentrations yielded a total of 2416 data pairs for comparison with observations. While emission source contributions to the total model bias varied by season and measurement location, the largest absolute bias of −0.55 μgC/m3 was attributed to insufficient isoprene SOA in the summertime CMAQ simulation. Biomass combustion was responsible for the second largest summertime model bias (−0.46 μgC/m3 on average). Several instances of compensating errors were also evident; model underpredictions in some sectors were masked by overpredictions in others. The National Exposure Research L

7 CFR 3017.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Adequate evidence. 3017.900 Section 3017.900 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER... Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

29 CFR 98.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 1 2012-07-01 2012-07-01 false Adequate evidence. 98.900 Section 98.900 Labor Office of the Secretary of Labor GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 98.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

29 CFR 98.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 1 2011-07-01 2011-07-01 false Adequate evidence. 98.900 Section 98.900 Labor Office of the Secretary of Labor GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 98.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

29 CFR 98.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 1 2013-07-01 2013-07-01 false Adequate evidence. 98.900 Section 98.900 Labor Office of the Secretary of Labor GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 98.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF... Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 2 Grants and Agreements 1 2012-01-01 2012-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF... Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

Quality control in diagnostic immunohistochemistry: integrated on-slide positive controls.

PubMed

Bragoni, A; Gambella, A; Pigozzi, S; Grigolini, M; Fiocca, R; Mastracci, L; Grillo, F

2017-11-01

Standardization in immunohistochemistry is a priority in modern pathology and requires strict quality control. Cost containment has also become fundamental and auditing of all procedures must take into account both these principles. Positive controls must be routinely performed so that their positivity guarantees the appropriateness of the immunohistochemical procedure. The aim of this study is to develop a low cost (utilizing a punch biopsy-PB-tool) procedure to construct positive controls which can be integrated in the patient's tissue slide. Sixteen frequently used control blocks were selected and multiple cylindrical samples were obtained using a 5-mm diameter punch biopsy tool, separately re-embedding them in single blocks. For each diagnostic immunoreaction requiring a positive control, an integrated PB-control section (cut from the appropriate PB-control block) was added to the top right corner of the diagnostic slide before immunostaining. This integrated control technique permitted a saving of 4.75% in total direct lab costs and proved to be technically feasible and reliable. Our proposal is easy to perform and within the reach of all pathology labs, requires easily available tools, its application costs is less than using external paired controls and ensures that a specific control for each slide is always available.

Improved image quality and diagnostic potential using ultra-high-resolution computed tomography of the lung with small scan FOV: A prospective study

PubMed Central

Wang, Yali; Hamal, Preeti; You, Xiaofang; Mao, Haixia; Li, Fei; Sun, Xiwen

2017-01-01

The aim of this study was to assess whether CT imaging using an ultra-high-resolution CT (UHRCT) scan with a small scan field of view (FOV) provides higher image quality and helps to reduce the follow-up period compared with a conventional high-resolution CT (CHRCT) scan. We identified patients with at least one pulmonary nodule at our hospital from July 2015 to November 2015. CHRCT and UHRCT scans were conducted in all enrolled patients. Three experienced radiologists evaluated the image quality using a 5-point score and made diagnoses. The paired images were displayed side by side in a random manner and annotations of scan information were removed. The following parameters including image quality, diagnostic confidence of radiologists, follow-up recommendations and diagnostic accuracy were assessed. A total of 52 patients (62 nodules) were included in this study. UHRCT scan provides a better image quality regarding the margin of nodules and solid internal component compared to that of CHRCT (P < 0.05). Readers have higher diagnostic confidence based on the UHRCT images than of CHRCT images (P<0.05). The follow-up recommendations were significantly different between UHRCT and CHRCT images (P<0.05). Compared with the surgical pathological findings, UHRCT had a relative higher diagnostic accuracy than CHRCT (P > 0.05). These findings suggest that the UHRCT prototype scanner provides a better image quality of subsolid nodules compared to CHRCT and contributes significantly to reduce the patients' follow-up period. PMID:28231320

The experiences of health-related quality of life in patients with nonspecific symptoms who undergo a diagnostic evaluation for cancer: a qualitative interview study.

PubMed

Moseholm, Ellen; Lindhardt, Bjarne Oerskov; Rydahl-Hansen, Susan

2017-09-01

The diagnostic phase of cancer can affect health-related quality of life (HRQoL). The aim of this study was to investigate how patients with nonspecific symptoms experience HRQoL while undergoing diagnostic evaluations for cancer. Twenty-one participants who had completed a fast-track evaluation for possible cancer at one of three hospitals in the Capital Region, Denmark were interviewed 2-4 weeks after completing diagnostic evaluations. The interviews were semi-structured and were supported by an interview guide based on the same themes as in The European Organisation for Research and Treatment of Cancer Quality of Life questionnaire (EORCT-QLQ-C30). Data analysis was based on qualitative content analysis by Krippendorff. The analysis generated six categories: symptoms, physical-, role-, emotional-, cognitive- and social functioning, and the diagnostic fast-track experience. From these categories, a main theme was identified: Health-related quality of life is not solely affected by the diagnostic process. The results provide a comprehensive understanding of HRQoL in the diagnostic phase of possible cancer, which can be used not only to enhance evidence-based care, but also in the interpretation of the EORTC-QLQ-C30 scores. Psycho-social support with a focus on individual informational needs during the diagnostic phase may be warranted. © 2016 Nordic College of Caring Science.

Adaptive prospective ECG-triggered sequence coronary angiography in dual-source CT without heart rate control: Image quality and diagnostic performance.

PubMed

Pan, Chang-Jie; Qian, Nong; Wang, Tao; Tang, Xiao-Qiang; Xue, Yue-Jun

2013-02-01

The aim of this study was to evaluate the accuracy of using second generation dual-source CT (DSCT) to obtain high quality images and diagnostic performance and to reduce the radiation dose in adaptive prospective electrocardiography (ECG)-triggered sequence (CorAdSeq) CT coronary angiography (CTCA) without heart rate control. No prescan β-blockers were administered. Un-enhanced CT and CTCA with adaptive prospective CorAdSeq scanning without heart rate control were performed in 683 consecutive patients divided into two body mass index (BMI) groups: BMI <25 kg/m(2) (group A, n=412) and BMI ≥25 kg/m(2) (group B, n=271). The image quality and quantitative stenosis of all coronary segments with a diameter ≥1 mm were assessed. The mean heart rate (MHR), heart rate variability (HRV) and radiation dose values were recorded. In 426 cases, the diagnostic performance was evaluated using quantitative conventional coronary angiography as the reference standard. Diagnostic image quality was obtained in 98.5% of segments in group A and in 98.8% of segments in group B, with no significant differences between the groups. No correlations were observed between the image quality score and MHR or HRV (P=0.492, P=0.564, respectively). The effective radiation doses in groups A and B were 2.57±1.01 mSv and 6.36±1.88 mSv, respectively. The sensitivities and specificities of diagnosing coronary heart disease per patient were 99.6% and 97.8% in group A and 99.5% and 97.5% in group B, respectively (P>0.05). Adaptive prospective CorAdSeq scanning, without heart rate control, by second generation DSCT had a high image quality and diagnostic performance for coronary artery stenosis with lower radiation doses.

Measuring the quality-of-life effects of diagnostic and screening tests.

PubMed

Swan, J Shannon; Miksad, Rebecca A

2009-08-01

Health-related quality of life (HRQL) is a central concept for understanding the outcomes of medical care. When used in cost-effectiveness analysis, HRQL is typically measured for conditions persisting over long time frames (years), and quality-adjusted life year (QALY) values are generated. Consequently, years are the basic unit of time for cost-effectiveness analysis results: dollars spent per QALY gained. However, shorter term components of health care may also affect HRQL, and there is increased interest in measuring and accounting for these events. In radiology, the short-term HRQL effects of screening and diagnostic testing may affect a test's cost-effectiveness, even though they may only last for days. The unique challenge in radiology HRQL assessment is to realistically tap into the testing and screening experience while remaining consistent with QALY theory. The authors review HRQL assessment and highlight methods developed to specifically address the short-term effects of radiologic screening and testing.

Diagnosing common bile duct obstruction: comparison of image quality and diagnostic performance of three-dimensional magnetic resonance cholangiopancreatography with and without compressed sensing.

PubMed

Kwon, Heejin; Reid, Scott; Kim, Dongeun; Lee, Sangyun; Cho, Jinhan; Oh, Jongyeong

2018-01-04

This study aimed to evaluate image quality and diagnostic performance of a recently developed navigated three-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) with compressed sensing (CS) based on parallel imaging (PI) and conventional 3D-MRCP with PI only in patients with abnormal bile duct dilatation. This institutional review board-approved study included 45 consecutive patients [non-malignant common bile duct lesions (n = 21) and malignant common bile duct lesions (n = 24)] who underwent MRCP of the abdomen to evaluate bile duct dilatation. All patients were imaged at 3T (MR 750, GE Healthcare, Waukesha, WI) including two kinds of 3D-MRCP using 352 × 288 matrices with and without CS based on PI. Two radiologists independently and blindly assessed randomized images. CS acceleration reduced the acquisition time on average 5 min and 6 s to a total of 2 min and 56 s. The all CS cine image quality was significantly higher than standard cine MR image for all quantitative measurements. Diagnostic accuracy for benign and malignant lesions is statistically different between standard and CS 3D-MRCP. Total image quality and diagnostic accuracy at biliary obstruction evaluation demonstrates that CS-accelerated 3D-MRCP sequences can provide superior quality of diagnostic information in 42.5% less time. This has the potential to reduce motion-related artifacts and improve diagnostic efficacy.

Diagnostic Lumbar Puncture

PubMed Central

Doherty, Carolynne M; Forbes, Raeburn B

2014-01-01

Diagnostic Lumbar Puncture is one of the most commonly performed invasive tests in clinical medicine. Evaluation of an acute headache and investigation of inflammatory or infectious disease of the nervous system are the most common indications. Serious complications are rare, and correct technique will minimise diagnostic error and maximise patient comfort. We review the technique of diagnostic Lumbar Puncture including anatomy, needle selection, needle insertion, measurement of opening pressure, Cerebrospinal Fluid (CSF) specimen handling and after care. We also make some quality improvement suggestions for those designing services incorporating diagnostic Lumbar Puncture. PMID:25075138

Human rabies in India: an audit from a rabies diagnostic laboratory.

PubMed

Mani, Reeta Subramaniam; Anand, Ashwini Manoor; Madhusudana, Shampur Narayan

2016-04-01

Rabies, an acute progressive encephalomyelitis, continues to be a serious public health problem in India and many other countries in Asia and Africa. The low level of commitment to rabies control is partly attributable to challenges in laboratory diagnosis and lack of adequate surveillance to indicate the disease burden. A laboratory audit of human rabies cases was undertaken to disseminate information on the clinical, demographic, prophylactic and most importantly the laboratory diagnostic aspects of rabies. A retrospective analysis of all clinically suspected human rabies cases, whose samples were received at a rabies diagnostic laboratory in South India in the last 3 years, was performed. Clinical and demographic details of patients were obtained. The clinical samples included cerebrospinal fluid (CSF), serum, saliva and nuchal skin biopsy collected antemortem, and brain tissue obtained post-mortem. Various laboratory tests were performed for diagnosis. Clinical samples from 128 patients with suspected rabies, from 11 states in India, were received for diagnostic confirmation. About 94% of the victims reported dog-bites, more than a third of them were children and most of the victims did not receive adequate post-exposure prophylaxis. Antemortem confirmation of rabies by a combination of laboratory diagnostic assays (detection of viral RNA in CSF, skin and saliva, and neutralising antibodies in CSF) could be achieved in 40.6% cases. Increasing awareness about adequate post-exposure prophylaxis, additional rabies diagnostic facilities, and enhanced human and animal rabies surveillance to indicate the true disease burden are essential to control this fatal disease. © 2016 John Wiley & Sons Ltd.

External quality assessment of dengue and chikungunya diagnostics in the Asia Pacific region, 2015

PubMed Central

Soh, Li Ting; Squires, Raynal C; Tan, Li Kiang; Pok, Kwoon Yong; Yang, HuiTing; Liew, Christina; Shah, Aparna Singh; Aaskov, John; Abubakar, Sazaly; Hasabe, Futoshi; Ng, Lee Ching

2016-01-01

Objective To conduct an external quality assessment (EQA) of dengue and chikungunya diagnostics among national-level public health laboratories in the Asia Pacific region following the first round of EQA for dengue diagnostics in 2013. Methods Twenty-four national-level public health laboratories performed routine diagnostic assays on a proficiency testing panel consisting of two modules. Module A contained serum samples spiked with cultured dengue virus (DENV) or chikungunya virus (CHIKV) for the detection of nucleic acid and DENV non-structural protein 1 (NS1) antigen. Module B contained human serum samples for the detection of anti-DENV antibodies. Results Among 20 laboratories testing Module A, 17 (85%) correctly detected DENV RNA by reverse transcription polymerase chain reaction (RT–PCR), 18 (90%) correctly determined serotype and 19 (95%) correctly identified CHIKV by RT–PCR. Ten of 15 (66.7%) laboratories performing NS1 antigen assays obtained the correct results. In Module B, 18/23 (78.3%) and 20/20 (100%) of laboratories correctly detected anti-DENV IgM and IgG, respectively. Detection of acute/recent DENV infection by both molecular (RT–PCR) and serological methods (IgM) was available in 19/24 (79.2%) participating laboratories. Discussion Accurate laboratory testing is a critical component of dengue and chikungunya surveillance and control. This second round of EQA reveals good proficiency in molecular and serological diagnostics of these diseases in the Asia Pacific region. Further comprehensive diagnostic testing, including testing for Zika virus, should comprise future iterations of the EQA. PMID:27508088

The impact of urban gardens on adequate and healthy food: a systematic review.

PubMed

Garcia, Mariana T; Ribeiro, Silvana M; Germani, Ana Claudia Camargo Gonçalves; Bógus, Cláudia M

2018-02-01

To examine the impacts on food and nutrition-related outcomes resulting from participation in urban gardens, especially on healthy food practices, healthy food access, and healthy food beliefs, knowledge and attitudes. The systematic review identified studies by searching the PubMed, ERIC, LILACS, Web of Science and Embase databases. An assessment of quality and bias risk of the studies was carried out and a narrative summary was produced. Studies published as original articles in peer-reviewed scientific journals in English, Spanish or Portuguese between 2005 and 2015 were included. The studies included were based on data from adult participants in urban gardens. Twenty-four studies were initially selected based on the eligibility criteria, twelve of which were included. There was important heterogeneity of settings, population and assessment methods. Assessment of quality and bias risk of the studies revealed the need for greater methodological rigour. Most studies investigated community gardens and employed a qualitative approach. The following were reported: greater fruit and vegetable consumption, better access to healthy foods, greater valuing of cooking, harvest sharing with family and friends, enhanced importance of organic production, and valuing of adequate and healthy food. Thematic patterns related to adequate and healthy food associated with participation in urban gardens were identified, revealing a positive impact on practices of adequate and healthy food and mainly on food perceptions.

Sci-Fri AM: MRI and Diagnostic Imaging - 02: Quality Improvement: Diagnostic Reference Levels for Interior Health CT exams – L-Spine, Chest/Abdomen/pelvis, Abdomen/Pelvis, Head

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bjarnason, Thorarin

Diagnostic Reference Levels are used to optimize patient dose and image quality in the clinical setting. It is assumed that the majority of exams are of diagnostic quality, or the radiologists would request protocol adjustments. By investigating the dose indicator distributions from all scanners, the upper DRL can be set to the 75th percentile of the distribution and a lower DRL can be set to the 10th percentile. Scanners using doses consistently outside the upper/lower DRL range can be adjusted accordingly. 11 CT scanners, all contributing to the American College of Radiology Dose Index Registry (ACR DIR) were used inmore » this study. Dose indicator data were compiled from the ACR DIR data and local DRLs established. Scanners with median doses outside the upper/lower DRL were followed-up with. Using effective dose and exam volumes, collective dose was determined before and after protocol adjustments to evaluate the effect of this quality improvement effort. The quality initiative is complete for L-spine and Chest/Abdomen/Pelvis exams and only initial surveys were completed for Head and Abdomen/Pelvis examsg. Median Scanner Dose reductions were 8.8 and 4.9 % for L-spine and Chest/Abdomen/Pelvis exams, respectively, resulting with collective dose reductions of 0.7 and 3.2 person•Sv/yr. Follow-up is ongoing for Abdomen/Pelvis and Head exams.« less

Health laboratories in the Tanga region of Tanzania: the quality of diagnostic services for malaria and other communicable diseases.

PubMed

Ishengoma, D R S; Rwegoshora, R T; Mdira, K Y; Kamugisha, M L; Anga, E O; Bygbjerg, I C; Rønn, A M; Magesa, S M

2009-07-01

Although critical for good case management and the monitoring of health interventions, the health-laboratory services in sub-Saharan Africa are grossly compromised by poor infrastructures and a lack of trained personnel, essential reagents and other supplies. The availability and quality of diagnostic services in 37 health laboratories in three districts of the Tanga region of Tanzania have recently been assessed. The results of the survey, which involved interviews with health workers, observations and a documentary review, revealed that malaria accounted for >50% of admissions and out-patient visits. Most (92%) of the laboratories were carrying out malaria diagnosis and 89% were measuring haemoglobin concentrations but only one (3%) was conducting culture and sensitivity tests, and those only on urine and pus samples. Only 14 (17%) of the 84 people found working in the visited laboratories were laboratory technologists with a diploma certificate or higher qualification. Sixteen (43%) of the study laboratories each had five or fewer types of equipment and only seven (19%) had more than 11 types each. Although 11 (30%) of the laboratories reported that they conducted internal quality control, none had standard operating procedures (SOP) on display or evidence of such quality assurance. Although malaria was the main health problem, diagnostic services for malaria and other diseases were inadequate and of poor quality because of the limited human resources, poor equipment and shortage of supplies. If the health services in Tanga are not to be overwhelmed by the progressively increasing burden of HIV/AIDS, malaria, tuberculosis and other emerging and re-emerging diseases, more funding and appropriate policies to improve the availability and quality of the area's diagnostic services will clearly be required.

Diagnostic image quality in gynaecological ultrasound: Who should measure it, what should we measure and how?

PubMed Central

Knapp, Karen

2013-01-01

Assessment of diagnostic image quality in gynaecological ultrasound is an important aspect of imaging department quality assurance. This may be addressed through audit, but who should undertake the audit, what should be measured and how, remains contentious. The aim of this study was to identify whether peer audit is a suitable method of assessing the diagnostic quality of gynaecological ultrasound images. Nineteen gynaecological ultrasound studies were independently assessed by six sonographers utilising a pilot version of an audit tool. Outcome measures were levels of inter-rater agreement using different data collection methods (binary scores, Likert scale, continuous scale), effect of ultrasound study difficulty on study score and whether systematic differences were present between reviewers of different clinical grades and length of experience. Inter-rater agreement ranged from moderate to good depending on the data collection method. A continuous scale gave the highest level of inter-rater agreement with an intra-class correlation coefficient of 0.73. A strong correlation (r = 0.89) between study difficulty and study score was yielded. Length of clinical experience between reviewers had no effect on the audit scores, but individuals of a higher clinical grade gave significantly lower scores than those of a lower grade (p = 0.04). Peer audit is a promising tool in the assessment of ultrasound image quality. Continuous scales seem to be the best method of data collection implying a strong element of heuristically driven decision making by reviewing ultrasound practitioners. PMID:27433192

Improvement of diagnostic agreement among pathologists in resolving an "atypical glands suspicious for cancer" diagnosis in prostate biopsies using a novel "Disease-Focused Diagnostic Review" quality improvement process.

PubMed

Shah, Rajal B; Leandro, Gioacchino; Romerocaces, Gloria; Bentley, James; Yoon, Jiyoon; Mendrinos, Savvas; Tadros, Yousef; Tian, Wei; Lash, Richard

2016-10-01

One of the major goals of an anatomic pathology laboratory quality program is to minimize unwarranted diagnostic variability and equivocal reporting. This study evaluated the utility of Miraca Life Sciences' "Disease-Focused Diagnostic Review" (DFDR) quality program in improving interobserver diagnostic reproducibility associated with classification of "atypical glands suspicious for adenocarcinoma" (ATYP) in prostate biopsies. Seventy-one selected prostate biopsies with a focus of ATYP were reviewed by 8 pathologists. Participants were blinded to the original diagnosis and were first asked to classify the ATYP as benign, atypical, or limited adenocarcinoma. DFDR comprised a "theoretical consensus" (in which pathologists first reached consensus on the morphological features they considered relevant for the diagnosis of limited prostatic adenocarcinoma), a didactic review including relevant literature, and "practical consensus" (pathologists performed joint microscopic sessions, reconciling each other's observations and positions evaluating a separate unique slide set). Participants were finally asked to reclassify the original 71 ATYP cases based on knowledge gleaned from DFDR. Pre- and post-DFDR interobserver reproducibility of overall diagnostic agreement was assessed. Interobserver reproducibility measured by Fleiss κ values of pre- and post-DFDR was 0.36 and 0.59, respectively (P=.006). Post-DFDR, there were significant improvement for "100% concordance" (P=.011) and reduction for "no consensus" (P=.0004) categories. Despite a lower pre-DFDR reproducibility for non-uropathology fellowship-trained (n=3, κ=0.38) versus uropathology fellowship-trained (n=5, κ=0.43) pathologists, both groups achieved similarly high post-DFDR κ levels (κ=0.58 and 0.56, respectively). DFDR represents an effective tool to formally achieve diagnostic consensus and reduce variability associated with critical diagnoses in an anatomic pathology practice. Copyright © 2016 Elsevier

[Comparison of diagnostic quality in hysterosalpingography between iodinated non-ionic contrast media with low and high osmolarity].

PubMed

Piccotti, K; Guida, D; Carbonetti, F; Stefanetti, L; Macioce, A; Cremona, A; David, V

Comparison of diagnostic quality in hysterosalpingography between low and high-osmolality contrast media. We performed a retrospective evaluation of two cohorts of patients who underwent HSG using contrast media with different osmolarity: the first group ,47 patients, underwent hysterosalpingography in the period September 2011-December 2012 using Iopromide 370 mg/ml; the second group, 50 patients, underwent HSG from January 2013 to October 2013 using Iomeprol 400 mg/ml. Three radiologists, in consensus reading,, reviewed the radiographs by assessing the following four parameters: opacification of the uterine cavity, uterine profiles definition, Fallopian tubes visualization, contrast media spillage into peritoneum. A score-scale from 0 to 3 was assigned for each of the mentioned parameter (0 = minimum non-diagnostic exam, 1 = sufficient examination; 2 = good quality examination; maximum 3 = high quality images). We documented a statistically significant higher quality in displaying Fallopian tubes among patients studied through high osmolarity contrast medium (Iopromide 370 mg/ml) than what obtained through lower osmolarity contrast medium (Iomeprol 400 mg/ml). The use of high osmolarity contrast medium enabled better visualization of the tubes and a greater number of diagnoses of chronic aspecific salpigintis due to the increased osmolality and viscosity of Iomeprol 400 mg/ml. There were no significant differences between the two contrast agents in the evaluation of intra-uterine pathology and in the evaluation of the tubal patency.

Links between Autism Spectrum Disorder Diagnostic Status and Family Quality of Life

PubMed Central

McKechanie, Andrew G.; Moffat, Vivien J.; Johnstone, Eve C.; Fletcher-Watson, Sue

2017-01-01

Quality of life is often relatively lowered in families of children with additional needs, and this may be particularly the case where additional needs are accompanied by an autism spectrum disorder (ASD). Here we explore the effects of diagnostic status specifically, comparing families with children with an ASD diagnosis with others who a) have additional needs but no signs of ASD; and b) have additional needs and signs of ASD but no diagnosis. Mothers (n = 76) of children with additional needs completed standardised questionnaires about quality of life, stress, service provision, child behaviour and presence and severity of ASD traits. In addition, a group of mothers of typically developing young people (n = 17) completed standardised questionnaires on individual and family quality of life and on the behaviour of their son or daughter. Mothers of typically developing young people had significantly higher individual and family quality of life scores than each of the three other groups. Increased severity of ASD was associated with increased maternal stress, which in turn was associated with decreased family and maternal quality of life. The group reporting the lowest quality of life and the highest stress were the mothers of individuals with signs of ASD but no diagnosis. This pattern did not seem to be explained by lack of access to services, or rates of intellectual disability or challenging behaviour in this sub-group. The finding that poor quality of life and high stress was most apparent in the sub-group of mothers with children who had signs of ASD but did not have a diagnosis of ASD suggests that an interesting topic for further investigation is whether receipt of a diagnosis itself can positively influence quality of life and levels of maternal stress. PMID:28368363

Communication gaps in nursing home transfers to the ED: impact on turnaround time, disposition, and diagnostic testing.

PubMed

Nelson, Drew; Washton, Danae; Jeanmonod, Rebecca

2013-04-01

This study aims to determine the source of communication gaps in history of present illness (HPI), medical history, and advanced directives in nursing home (NH) patients transferred to the emergency department (ED). We also attempt to determine if these gaps create differences in patient turnaround time (TAT), disposition decision, or diagnostic testing. A convenience sample of patients transferred from NHs to a level 1 community trauma center was enrolled by the physicians caring for them. The physicians assessed the adequacy and source of the history for each patient. The patient's chart was then retrospectively reviewed to determine disposition, ED TAT, and diagnostic tests ordered. One hundred patients were enrolled. Physicians found that NH paperwork contained adequate HPI 35% of the time. Patients could provide their own HPI 28% of the time. In 32% of patients, adequate HPI could not be obtained from the patient, NH paperwork, or NH personnel. Comparing patients in whom adequate HPI was available (n = 68) to those in whom HPI was not available (n = 32), there was no difference in TAT (146 vs 173 minutes, P = .22), admissions (60% vs 66%, P = .66), or diagnostic testing (P = .89-1.0). Emergency department physicians often do not have adequate HPI in patients transferred from NHs. The absence of adequate information does not affect patient TAT, disposition decision, or ED diagnostic testing. Copyright © 2013 Elsevier Inc. All rights reserved.

Impact of iterative metal artifact reduction on diagnostic image quality in patients with dental hardware.

PubMed

Weiß, Jakob; Schabel, Christoph; Bongers, Malte; Raupach, Rainer; Clasen, Stephan; Notohamiprodjo, Mike; Nikolaou, Konstantin; Bamberg, Fabian

2017-03-01

Background Metal artifacts often impair diagnostic accuracy in computed tomography (CT) imaging. Therefore, effective and workflow implemented metal artifact reduction algorithms are crucial to gain higher diagnostic image quality in patients with metallic hardware. Purpose To assess the clinical performance of a novel iterative metal artifact reduction (iMAR) algorithm for CT in patients with dental fillings. Material and Methods Thirty consecutive patients scheduled for CT imaging and dental fillings were included in the analysis. All patients underwent CT imaging using a second generation dual-source CT scanner (120 kV single-energy; 100/Sn140 kV in dual-energy, 219 mAs, gantry rotation time 0.28-1/s, collimation 0.6 mm) as part of their clinical work-up. Post-processing included standard kernel (B49) and an iterative MAR algorithm. Image quality and diagnostic value were assessed qualitatively (Likert scale) and quantitatively (HU ± SD) by two reviewers independently. Results All 30 patients were included in the analysis, with equal reconstruction times for iMAR and standard reconstruction (17 s ± 0.5 vs. 19 s ± 0.5; P > 0.05). Visual image quality was significantly higher for iMAR as compared with standard reconstruction (3.8 ± 0.5 vs. 2.6 ± 0.5; P < 0.0001, respectively) and showed improved evaluation of adjacent anatomical structures. Similarly, HU-based measurements of degree of artifacts were significantly lower in the iMAR reconstructions as compared with the standard reconstruction (0.9 ± 1.6 vs. -20 ± 47; P < 0.05, respectively). Conclusion The tested iterative, raw-data based reconstruction MAR algorithm allows for a significant reduction of metal artifacts and improved evaluation of adjacent anatomical structures in the head and neck area in patients with dental hardware.

A special ionisation chamber for quality control of diagnostic and mammography X ray equipment.

PubMed

Costa, A M; Caldas, L V E

2003-01-01

A quality control program for X ray equipment used for conventional radiography and mammography requires the constancy check of the beam qualities in terms of the half-value layers. In this work, a special double-faced parallel-plate ionisation chamber was developed with inner electrodes of different materials, in a tandem system. Its application will be in quality control programs of diagnostic and mammography X ray equipment for confirmation of half-value layers previously determined by the conventional method. Moreover, the chamber also may be utilised for measurements of air kerma values (and air kerma rates) in X radiation fields used for conventional radiography and mammography. The chamber was studied in relation to the characteristics of saturation, ion collection efficiency, polarity effects, leakage current, and short-term stability. The energy dependence in response of each of the two faces of the chamber was determined over the conventional radiography and mammography X ray ranges (unattenuated beams). The different energy response of the two faces of the chamber allowed the formation of a tandem system useful for the constancy check of beam qualities.

5 CFR 919.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

5 CFR 919.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

5 CFR 919.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

5 CFR 919.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

5 CFR 919.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

Improving the diagnostic quality and adequacy of shoulder radiographs in a District General Hospital

PubMed Central

Richards, Bethany; Riley, James; Saithna, Adnan

2016-01-01

A high rate of suboptimal shoulder radiographs was identified during a service evaluation exercise in our orthopaedic outpatient clinics. Inadequate radiographs require a return to the radiology department for further imaging, a resultant increased workload, delays in the clinic, increased radiation for patients, and inconvenience and decreased patient satisfaction. Furthermore, if a sub-optimal radiograph is accepted there is concern that diagnoses may be missed. The aim of this project was to decrease the rate of suboptimal radiographs by delivering a teaching package directed towards quality improvement. Evaluation criteria were set for standard orthopaedic shoulder radiographs (Anterior-posterior, axillary, and Velpeau views). Baseline data collection was performed over three, two-week periods and included all patients attending the shoulder clinic. The percentage of x-rays which were deemed adequate was only 19.4% for anterior-posterior views and 57.9% for axillary views. A comprehensive educational package was delivered to radiographers. This included a formal PowerPoint based teaching session, hands on training with practice using a skeleton, posters with step-by step instructions on how to obtain an adequate image, and PDF aide memoires suitable for viewing on a smartphone. Two subsequent two-week periods of data collection were performed to evaluate the benefit of this intervention. Delivery of focussed training and provision of easily accessible aide memoires to facilitate improved quality of radiographs resulted in a significant (p<0.05) reduction in the rate of inadequate images. There was also a significant decreases in the rate of return to the radiology department for repeat imaging. PMID:27559473

Reduced bone mineral density is not associated with significantly reduced bone quality in men and women practicing long-term calorie restriction with adequate nutrition.

PubMed

Villareal, Dennis T; Kotyk, John J; Armamento-Villareal, Reina C; Kenguva, Venkata; Seaman, Pamela; Shahar, Allon; Wald, Michael J; Kleerekoper, Michael; Fontana, Luigi

2011-02-01

Calorie restriction (CR) reduces bone quantity but not bone quality in rodents. Nothing is known regarding the long-term effects of CR with adequate intake of vitamin and minerals on bone quantity and quality in middle-aged lean individuals. In this study, we evaluated body composition, bone mineral density (BMD), and serum markers of bone turnover and inflammation in 32 volunteers who had been eating a CR diet (approximately 35% less calories than controls) for an average of 6.8 ± 5.2 years (mean age 52.7 ± 10.3 years) and 32 age- and sex-matched sedentary controls eating Western diets (WD). In a subgroup of 10 CR and 10 WD volunteers, we also measured trabecular bone (TB) microarchitecture of the distal radius using high-resolution magnetic resonance imaging. We found that the CR volunteers had significantly lower body mass index than the WD volunteers (18.9 ± 1.2 vs. 26.5 ± 2.2 kg m(-2) ; P = 0.0001). BMD of the lumbar spine (0.870 ± 0.11 vs. 1.138 ± 0.12 g cm(-2) , P = 0.0001) and hip (0.806 ± 0.12 vs. 1.047 ± 0.12 g cm(-2) , P = 0.0001) was also lower in the CR than in the WD group. Serum C-terminal telopeptide and bone-specific alkaline phosphatase concentration were similar between groups, while serum C-reactive protein (0.19 ± 0.26 vs. 1.46 ± 1.56 mg L(-1) , P = 0.0001) was lower in the CR group. Trabecular bone microarchitecture parameters such as the erosion index (0.916 ± 0.087 vs. 0.877 ± 0.088; P = 0.739) and surface-to-curve ratio (10.3 ± 1.4 vs. 12.1 ± 2.1, P = 0.440) were not significantly different between groups. These findings suggest that markedly reduced BMD is not associated with significantly reduced bone quality in middle-aged men and women practicing long-term calorie restriction with adequate nutrition.

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 2 Grants and Agreements 1 2011-01-01 2011-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF.... Adequate evidence means information sufficient to support the reasonable belief that a particular act or...

Assessment of image quality in soft tissue and bone visualization tasks for a dedicated extremity cone-beam CT system.

PubMed

Demehri, S; Muhit, A; Zbijewski, W; Stayman, J W; Yorkston, J; Packard, N; Senn, R; Yang, D; Foos, D; Thawait, G K; Fayad, L M; Chhabra, A; Carrino, J A; Siewerdsen, J H

2015-06-01

To assess visualization tasks using cone-beam CT (CBCT) compared to multi-detector CT (MDCT) for musculoskeletal extremity imaging. Ten cadaveric hands and ten knees were examined using a dedicated CBCT prototype and a clinical multi-detector CT using nominal protocols (80 kVp-108mAs for CBCT; 120 kVp- 300 mAs for MDCT). Soft tissue and bone visualization tasks were assessed by four radiologists using five-point satisfaction (for CBCT and MDCT individually) and five-point preference (side-by-side CBCT versus MDCT image quality comparison) rating tests. Ratings were analyzed using Kruskal-Wallis and Wilcoxon signed-rank tests, and observer agreement was assessed using the Kappa-statistic. Knee CBCT images were rated "excellent" or "good" (median scores 5 and 4) for "bone" and "soft tissue" visualization tasks. Hand CBCT images were rated "excellent" or "adequate" (median scores 5 and 3) for "bone" and "soft tissue" visualization tasks. Preference tests rated CBCT equivalent or superior to MDCT for bone visualization and favoured the MDCT for soft tissue visualization tasks. Intraobserver agreement for CBCT satisfaction tests was fair to almost perfect (κ ~ 0.26-0.92), and interobserver agreement was fair to moderate (κ ~ 0.27-0.54). CBCT provided excellent image quality for bone visualization and adequate image quality for soft tissue visualization tasks. • CBCT provided adequate image quality for diagnostic tasks in extremity imaging. • CBCT images were "excellent" for "bone" and "good/adequate" for "soft tissue" visualization tasks. • CBCT image quality was equivalent/superior to MDCT for bone visualization tasks.

Contrast-enhanced time-resolved 4D MRA of congenital heart and vessel anomalies: image quality and diagnostic value compared with 3D MRA.

PubMed

Vogt, Florian M; Theysohn, Jens M; Michna, Dariusz; Hunold, Peter; Neudorf, Ulrich; Kinner, Sonja; Barkhausen, Jörg; Quick, Harald H

2013-09-01

To evaluate time-resolved interleaved stochastic trajectories (TWIST) contrast-enhanced 4D magnetic resonance angiography (MRA) and compare it with 3D FLASH MRA in patients with congenital heart and vessel anomalies. Twenty-six patients with congenital heart and vessel anomalies underwent contrast-enhanced MRA with both 3D FLASH and 4D TWIST MRA. Images were subjectively evaluated regarding total image quality, artefacts, diagnostic value and added diagnostic value of 4D dynamic imaging. Quantitative comparison included signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and vessel sharpness measurements. Three-dimensional FLASH MRA was judged to be significantly better in terms of image quality (4.0 ± 0.6 vs 3.4 ± 0.6, P < 0.05) and artefacts (3.8 ± 0.4 vs 3.3 ± 0.5, P < 0.05); no difference in diagnostic value was found (4.2 ± 0.4 vs 4.0 ± 0.4); important additional functional information was found in 21/26 patients. SNR and CNR were higher in the pulmonary trunk in 4D TWIST, but slightly higher in the systemic arteries in 3D FLASH. No difference in vessel sharpness delineation was found. Although image quality was inferior compared with 3D FLASH MRA, 4D TWIST MRA yields robust images and added diagnostic value through dynamic acquisition was found. Thus, 4D TWIST MRA is an attractive alternative to 3D FLASH MRA. • New magnetic resonance angiography (MRA) techniques are increasingly introduced for congenital cardiovascular problems. • Time-resolved angiography with interleaved stochastic trajectories (TWIST) is an example. • Four-dimensional TWIST MRA provided inferior image quality compared to 3D FLASH MRA but without significant difference in vessel sharpness. • Four-dimensional TWIST MRA gave added diagnostic value.

A new full-field digital mammography system with and without the use of an advanced post-processing algorithm: comparison of image quality and diagnostic performance.

PubMed

Ahn, Hye Shin; Kim, Sun Mi; Jang, Mijung; Yun, Bo La; Kim, Bohyoung; Ko, Eun Sook; Han, Boo-Kyung; Chang, Jung Min; Yi, Ann; Cho, Nariya; Moon, Woo Kyung; Choi, Hye Young

2014-01-01

To compare new full-field digital mammography (FFDM) with and without use of an advanced post-processing algorithm to improve image quality, lesion detection, diagnostic performance, and priority rank. During a 22-month period, we prospectively enrolled 100 cases of specimen FFDM mammography (Brestige®), which was performed alone or in combination with a post-processing algorithm developed by the manufacturer: group A (SMA), specimen mammography without application of "Mammogram enhancement ver. 2.0"; group B (SMB), specimen mammography with application of "Mammogram enhancement ver. 2.0". Two sets of specimen mammographies were randomly reviewed by five experienced radiologists. Image quality, lesion detection, diagnostic performance, and priority rank with regard to image preference were evaluated. Three aspects of image quality (overall quality, contrast, and noise) of the SMB were significantly superior to those of SMA (p < 0.05). SMB was significantly superior to SMA for visualizing calcifications (p < 0.05). Diagnostic performance, as evaluated by cancer score, was similar between SMA and SMB. SMB was preferred to SMA by four of the five reviewers. The post-processing algorithm may improve image quality with better image preference in FFDM than without use of the software.

Diagnostic microbiology in veterinary dermatology: present and future.

PubMed

Guardabassi, Luca; Damborg, Peter; Stamm, Ivonne; Kopp, Peter A; Broens, Els M; Toutain, Pierre-Louis

2017-02-01

The microbiology laboratory can be perceived as a service provider rather than an integral part of the healthcare team. The aim of this review is to discuss the current challenges of providing a state-of-the-art diagnostic veterinary microbiology service including the identification (ID) and antimicrobial susceptibility testing (AST) of key pathogens in veterinary dermatology. The Study Group for Veterinary Microbiology (ESGVM) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) identified scientific, technological, educational and regulatory issues impacting the predictive value of AST and the quality of the service offered by microbiology laboratories. The advent of mass spectrometry has significantly reduced the time required for ID of key pathogens such as Staphylococcus pseudintermedius. However, the turnaround time for validated AST methods has remained unchanged for many years. Beyond scientific and technological constraints, AST methods are not harmonized and clinical breakpoints for some antimicrobial drugs are either missing or inadequate. Small laboratories, including in-clinic laboratories, are usually not adequately equipped to run up-to-date clinical microbiologic diagnostic tests. ESGVM recommends the use of laboratories employing mass spectrometry for ID and broth micro-dilution for AST, and offering assistance by expert microbiologists on pre- and post-analytical issues. Setting general standards for veterinary clinical microbiology, promoting antimicrobial stewardship, and the development of new, validated and rapid diagnostic methods, especially for AST, are among the missions of ESGVM. © 2017 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the ESVD and ACVD.

Initial clinical experience with a 64-MDCT whole-body scanner in an emergency department: better time management and diagnostic quality?

PubMed

Rieger, Michael; Czermak, Benedikt; El Attal, Rene; Sumann, Günther; Jaschke, Werner; Freund, Martin

2009-03-01

The objective of this study was to assess time management and diagnostic quality when using a 64-multidetector-row computed tomography (MDCT) whole-body scanner to evaluate polytraumatized patients in an emergency department. Eighty-eight consecutive polytraumatized patients with injury severity score (ISS) > or = 18 (mean ISS = 29) were included in this study. Documented and evaluated data were crash history, trauma mechanism, number and pattern of injuries, injury severity, diagnostics, time flow, and missed diagnoses. Data were stored in our hospital information system. Seven time intervals were evaluated. In particular, attention was paid to the "acquisition interval," the "reformatting and evaluation time" as well as the "CT time" (time from CT start to preliminary diagnosis). A standardized whole-body CT was performed. The acquired CT data together with automatically generated multiplanar reformatted images ("direct MPR") were transferred to a 3D rendering workstation. Diagnostic quality was determined on the basis of missed diagnoses. Head-to-toe scout images were possible because volume coverage was up to 2 m. Experienced radiologists at an affiliated workstation performed radiologic evaluation of the acquired datasets immediately after acquisition. The "acquisition interval" was 12 minutes +/- 4.9 minutes, the "reformatting and evaluation interval" 7.0 minutes +/- 2.1 minutes, and the "CT time" 19 minutes +/- 6.1 minutes. Altogether, 7 of 486 lesions were recognized but not communicated in the "reformatting and evaluation interval", and 10 injuries were initially missed and detected during follow-up. This study indicates that 64-MDCT saves time, especially in the "reformatting and evaluation interval." Diagnostic quality is high, as reflected by the small number of missed diagnoses.

Evaluation of subjective image quality in relation to diagnostic task for cone beam computed tomography with different fields of view.

PubMed

Lofthag-Hansen, Sara; Thilander-Klang, Anne; Gröndahl, Kerstin

2011-11-01

To evaluate subjective image quality for two diagnostic tasks, periapical diagnosis and implant planning, for cone beam computed tomography (CBCT) using different exposure parameters and fields of view (FOVs). Examinations were performed in posterior part of the jaws on a skull phantom with 3D Accuitomo (FOV 3 cm×4 cm) and 3D Accuitomo FPD (FOVs 4 cm×4 cm and 6 cm×6 cm). All combinations of 60, 65, 70, 75, 80 kV and 2, 4, 6, 8, 10 mA with a rotation of 180° and 360° were used. Dose-area product (DAP) value was determined for each combination. The images were presented, displaying the object in axial, cross-sectional and sagittal views, without scanning data in a random order for each FOV and jaw. Seven observers assessed image quality on a six-point rating scale. Intra-observer agreement was good (κw=0.76) and inter-observer agreement moderate (κw=0.52). Stepwise logistic regression showed kV, mA and diagnostic task to be the most important variables. Periapical diagnosis, regardless jaw, required higher exposure parameters compared to implant planning. Implant planning in the lower jaw required higher exposure parameters compared to upper jaw. Overall ranking of FOVs gave 4 cm×4 cm, 6 cm×6 cm followed by 3 cm×4 cm. This study has shown that exposure parameters should be adjusted according to diagnostic task. For this particular CBCT brand a rotation of 180° gave good subjective image quality, hence a substantial dose reduction can be achieved without loss of diagnostic information. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Health-related quality of life, anxiety and depression in the diagnostic phase of suspected cancer, and the influence of diagnosis.

PubMed

Moseholm, Ellen; Rydahl-Hansen, Susan; Overgaard, Dorthe; Wengel, Hanne S; Frederiksen, Rikke; Brandt, Malene; Lindhardt, Bjarne Ø

2016-05-20

Undergoing diagnostic evaluation for cancer has been associated with a high prevalence of anxiety and depression and affected health-related quality of life (HRQoL). The aims of this study were to assess HRQoL, anxiety, and depression pre- and post-diagnosis in patients undergoing diagnostic evaluations for cancer due to non-specific symptoms; to examine changes over time in relation to final diagnosis (cancer yes/no); and to assess the predictive value of pre-diagnostic psychological, socio-demographic and clinical factors. A prospective, multicenter survey study of patients suspected to have cancer based on non-specific symptoms was performed. Participants completed the EORTC-QLQ-C30 quality of life scale, HADS, SOC-13 and self-rated health before and after completing diagnostic evaluations. Intra- and inter-group differences between patients diagnosed with cancer versus patients with non-cancer diagnoses were calculated. The impact of baseline psychological, socio-demographic, and medical factors on HRQoL, anxiety and depression at follow-up was explored by bootstrapped multivariate linear regression analyses and logistic regression analyses. A total of 838 patients participated in this study; 679 (81 %) completed the follow-up. Twenty-two percent of the patients received a cancer diagnosis at the end of the follow-up. Patients presented initially with a high burden of symptoms and affected role and emotional functioning and global health/QL, irrespective of diagnosis. The prevalence of clinical anxiety prior to knowledge of the diagnosis was 32 % in patients with cancer and 35 % in patients who received a non-cancer diagnosis. HRQoL and anxiety improved after diagnosis, and a larger improvement was seen in patients who received a non-cancer diagnosis. There were no intra- or inter-group differences in the depression scores. The strongest predictors of global QL, anxiety, and depression after a known diagnosis were baseline scores, co-morbidity and poor self

Rotorcraft Diagnostics

NASA Technical Reports Server (NTRS)

Haste, Deepak; Azam, Mohammad; Ghoshal, Sudipto; Monte, James

2012-01-01

Health management (HM) in any engineering systems requires adequate understanding about the system s functioning; a sufficient amount of monitored data; the capability to extract, analyze, and collate information; and the capability to combine understanding and information for HM-related estimation and decision-making. Rotorcraft systems are, in general, highly complex. Obtaining adequate understanding about functioning of such systems is quite difficult, because of the proprietary (restricted access) nature of their designs and dynamic models. Development of an EIM (exact inverse map) solution for rotorcraft requires a process that can overcome the abovementioned difficulties and maximally utilize monitored information for HM facilitation via employing advanced analytic techniques. The goal was to develop a versatile HM solution for rotorcraft for facilitation of the Condition Based Maintenance Plus (CBM+) capabilities. The effort was geared towards developing analytic and reasoning techniques, and proving the ability to embed the required capabilities on a rotorcraft platform, paving the way for implementing the solution on an aircraft-level system for consolidation and reporting. The solution for rotorcraft can he used offboard or embedded directly onto a rotorcraft system. The envisioned solution utilizes available monitored and archived data for real-time fault detection and identification, failure precursor identification, and offline fault detection and diagnostics, health condition forecasting, optimal guided troubleshooting, and maintenance decision support. A variant of the onboard version is a self-contained hardware and software (HW+SW) package that can be embedded on rotorcraft systems. The HM solution comprises components that gather/ingest data and information, perform information/feature extraction, analyze information in conjunction with the dependency/diagnostic model of the target system, facilitate optimal guided troubleshooting, and offer

Preliminary evaluation of a high-resolution workstation for diagnostic interpretation of portable radiographs

NASA Astrophysics Data System (ADS)

Honeyman-Buck, Janice C.; Huda, Walter; Palmer, Carole K.; Frost, Meryll M.; Moser, Robert; Staab, Edward V.

1995-04-01

required to read from the workstation and that the increased time was spent using window/level and magnification/roam functions. This preliminary study suggests that the high resolution workstation developed at the University of Florida has adequate quality and functionality to be used for diagnostic interpretation of portable radiographs if given high resolution images. However, further investigation is indicated before we eliminate film in a CR environment.

Prostate cancer diagnostics: Clinical challenges and the ongoing need for disruptive and effective diagnostic tools.

PubMed

Sharma, Shikha; Zapatero-Rodríguez, Julia; O'Kennedy, Richard

The increased incidence and the significant health burden associated with carcinoma of the prostate have led to substantial changes in its diagnosis over the past century. Despite technological advancements, the management of prostate cancer has become progressively more complex and controversial for both early and late-stage disease. The limitations and potential harms associated with the use of prostate-specific antigen (PSA) as a diagnostic marker have stimulated significant investigation of numerous novel biomarkers that demonstrate varying capacities to detect prostate cancer and can decrease unnecessary biopsies. However, only a few of these markers have been approved for specific clinical settings while the others have not been adequately validated for use. This review systematically and critically assesses ongoing issues and emerging challenges in the current state of prostate cancer diagnostic tools and the need for disruptive next generation tools based on analysis of combinations of these biomarkers to enhance predictive accuracy which will benefit clinical diagnostics and patient welfare. Copyright © 2016. Published by Elsevier Inc.

Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia

PubMed Central

Ismail, Catheeja; Zabal, Johannah; Hernandez, Haniel J.; Woletz, Paula; Manning, Heather; Teixeira, Carla; DiPietro, Loretta; Blackman, Marc R.; Harris-Love, Michael O.

2015-01-01

Introduction: Age-related changes in muscle mass and muscle tissue composition contribute to diminished strength in older adults. The objectives of this study are to examine if an assessment method using mobile diagnostic ultrasound augments well-known determinants of lean body mass (LBM) to aid sarcopenia staging, and if a sonographic measure of muscle quality is associated with muscle performance. Methods: Twenty community-dwelling female subjects participated in the study (age = 43.4 ± 20.9 years; BMI: 23.8, interquartile range: 8.5). Dual energy X-ray absorptiometry (DXA) and diagnostic ultrasound morphometry were used to estimate LBM. Muscle tissue quality was estimated via the echogenicity using grayscale histogram analysis. Peak force was measured with grip dynamometry and scaled for body size. Bivariate and multiple regression analyses were used to determine the association of the predictor variables with appendicular lean mass (aLM/ht2), and examine the relationship between scaled peak force values and muscle echogenicity. The sarcopenia LBM cut point value of 6.75 kg/m2 determined participant assignment into the Normal LBM and Low LBM subgroups. Results: The selected LBM predictor variables were body mass index (BMI), ultrasound morphometry, and age. Although BMI exhibited a significant positive relationship with aLM/ht2 (adj. R2 = 0.61, p < 0.001), the strength of association improved with the addition of ultrasound morphometry and age as predictor variables (adj. R2 = 0.85, p < 0.001). Scaled peak force was associated with age and echogenicity (adj. R2 = 0.53, p < 0.001), but not LBM. The Low LBM subgroup of women (n = 10) had higher scaled peak force, lower BMI, and lower echogenicity values in comparison to the Normal LBM subgroup (n = 10; p < 0.05). Conclusions: Diagnostic ultrasound morphometry values are associated with LBM, and improve the BMI predictive model for aLM/ht2 in women. In addition, ultrasound proxy measures of muscle quality are more

Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia.

PubMed

Ismail, Catheeja; Zabal, Johannah; Hernandez, Haniel J; Woletz, Paula; Manning, Heather; Teixeira, Carla; DiPietro, Loretta; Blackman, Marc R; Harris-Love, Michael O

2015-01-01

Age-related changes in muscle mass and muscle tissue composition contribute to diminished strength in older adults. The objectives of this study are to examine if an assessment method using mobile diagnostic ultrasound augments well-known determinants of lean body mass (LBM) to aid sarcopenia staging, and if a sonographic measure of muscle quality is associated with muscle performance. Twenty community-dwelling female subjects participated in the study (age = 43.4 ± 20.9 years; BMI: 23.8, interquartile range: 8.5). Dual energy X-ray absorptiometry (DXA) and diagnostic ultrasound morphometry were used to estimate LBM. Muscle tissue quality was estimated via the echogenicity using grayscale histogram analysis. Peak force was measured with grip dynamometry and scaled for body size. Bivariate and multiple regression analyses were used to determine the association of the predictor variables with appendicular lean mass (aLM/ht(2)), and examine the relationship between scaled peak force values and muscle echogenicity. The sarcopenia LBM cut point value of 6.75 kg/m(2) determined participant assignment into the Normal LBM and Low LBM subgroups. The selected LBM predictor variables were body mass index (BMI), ultrasound morphometry, and age. Although BMI exhibited a significant positive relationship with aLM/ht(2) (adj. R (2) = 0.61, p < 0.001), the strength of association improved with the addition of ultrasound morphometry and age as predictor variables (adj. R (2) = 0.85, p < 0.001). Scaled peak force was associated with age and echogenicity (adj. R (2) = 0.53, p < 0.001), but not LBM. The Low LBM subgroup of women (n = 10) had higher scaled peak force, lower BMI, and lower echogenicity values in comparison to the Normal LBM subgroup (n = 10; p < 0.05). Diagnostic ultrasound morphometry values are associated with LBM, and improve the BMI predictive model for aLM/ht(2) in women. In addition, ultrasound proxy measures of muscle quality are more strongly associated with

A BMI-adjusted ultra-low-dose CT angiography protocol for the peripheral arteries-Image quality, diagnostic accuracy and radiation exposure.

PubMed

Schreiner, Markus M; Platzgummer, Hannes; Unterhumer, Sylvia; Weber, Michael; Mistelbauer, Gabriel; Loewe, Christian; Schernthaner, Ruediger E

2017-08-01

To investigate radiation exposure, objective image quality, and the diagnostic accuracy of a BMI-adjusted ultra-low-dose CT angiography (CTA) protocol for the assessment of peripheral arterial disease (PAD), with digital subtraction angiography (DSA) as the standard of reference. In this prospective, IRB-approved study, 40 PAD patients (30 male, mean age 72 years) underwent CTA on a dual-source CT scanner at 80kV tube voltage. The reference amplitude for tube current modulation was personalized based on the body mass index (BMI) with 120 mAs for [BMI≤25] or 150 mAs for [2570%) was assessed by two readers independently and compared to subsequent DSA. Radiation exposure was assessed with the computed tomography dose index (CTDIvol) and the dosis-length product (DLP). Objective image quality was assessed via contrast- and signal-to-noise ratio (CNR and SNR) measurements. Radiation exposure and image quality were compared between the BMI groups and between the BMI-adjusted ultra-low-dose protocol and the low-dose institutional standard protocol (ISP). The BMI-adjusted ultra-low-dose protocol reached high diagnostic accuracy values of 94% for Reader 1 and 93% for Reader 2. Moreover, in comparison to the ISP, it showed significantly (p<0.001) lower CTDIvol (1.97±0.55mGy vs. 4.18±0.62 mGy) and DLP (256±81mGy x cm vs. 544±83mGy x cm) but similar image quality (p=0.37 for CNR). Furthermore, image quality was similar between BMI groups (p=0.86 for CNR). A CT protocol that incorporates low kV settings with a personalized (BMI-adjusted) reference amplitude for tube current modulation and iterative reconstruction enables very low radiation exposure CTA, while maintaining good image quality and high diagnostic accuracy in the assessment of PAD. Copyright © 2017 Elsevier B.V. All rights reserved.

The diagnostic value of the premature ejaculation diagnostic tool and its association with intravaginal ejaculatory latency time.

PubMed

Kam, Sung Chul; Han, Deok Hyun; Lee, Sung Won

2011-03-01

Premature ejaculation (PE) is the most prevalent male ejaculation disorder. The premature ejaculation diagnostic tool (PEDT) was developed to systematically apply the DSM-IV-TR criteria in diagnostic PE. To evaluate the diagnostic value of the PEDT and its association with intravaginal ejaculatory latency time (IELT). (i) Korean validation of PEDT: data was collected from men interviewed by one of the two clinical experts, who made a diagnostic of present or absence of PE, using DSM-IV-TR criteria. A total of 103 patients with PE and 100 men without PE were enrolled into the study and requested to complete the PEDT; and (ii) The correlation between IELT and PEDT: 200 participants were enrolled and each participant was asked to make out PEDT. All participants were requested to measure IELT. Validity and reliability of the PEDT and its association with IELT. The geometric mean IELT of the PE group was 115.37 ± 78.14 seconds. The number of men reporting IELTs of <1, 1 to ≤ 2, and >2 minutes were 28 (28.6%), 29 (29.6%), and 41 (41.8%), respectively. The Cronbach's alpha score was calculated as 0.93, showing adequate internal consistency. The test-retest correlation coefficients of each item were higher than 0.72 and the correlation coefficients of the total score was 0.88. (P < 0.001) Sensitivity and specificity analyses suggested a score of ≤ 8 indicated no PE, 9 and 10 probable PE, and ≥ 11 PE. The PEDT total score and IELT showed an adequate negative correlation. (ρ = -0.77, P < 0.0001) also, the PEDT total score of the PE subgroup (IELT ≤ 2 minutes) and IELT showed a negative correlation. (ρ = -0.6, P < 0.0001) The PEDT was highly effective in detecting the presence of PE. The result of our study supports its validity as a diagnostic tool in the clinical setting. © 2010 International Society for Sexual Medicine.

External quality assessment for arbovirus diagnostics in the World Health Organization Western Pacific Region, 2013–2016: improving laboratory quality over the years

PubMed Central

Abdad, Mohammad Yazid; Squires, Raynal C; Cognat, Sebastien; Oxenford, Christopher John

2017-01-01

Arboviruses continue to pose serious public health threats in the World Health Organization (WHO) Western Pacific Region. As such, laboratories need to be equipped for their accurate detection. In 2011, to ensure test proficiency, the WHO Regional Office for the Western Pacific piloted an external quality assessment (EQA) programme for arbovirus diagnostics. By 2016, it had grown into a global programme with participation of 96 laboratories worldwide, including 25 laboratories from 19 countries, territories and areas in the Region. The test performance of the 25 laboratories in the Region in 2016 was high with 23 (92%) reporting correct results in all specimens for dengue and chikungunya viruses. For Zika virus, 18 (72%) of the 25 laboratories reported correct results in all specimens, while seven (28%) demonstrated at least one error. When comparing iterations of this EQA programme in the Region between 2013 and 2016, the number of participating laboratories increased from 18 to 25. The first round only included dengue virus, while the latest round additionally included chikungunya, Zika and yellow fever viruses. Proficiency for molecular detection of dengue virus remained high (83–94%) over the four-year period. The observed proficiency for arbovirus diagnostics between 2013 and 2016 is an indicator of laboratory quality improvement in the Region. PMID:29051839

[Diagnostic Errors in Medicine].

PubMed

Buser, Claudia; Bankova, Andriyana

2015-12-09

The recognition of diagnostic errors in everyday practice can help improve patient safety. The most common diagnostic errors are the cognitive errors, followed by system-related errors and no fault errors. The cognitive errors often result from mental shortcuts, known as heuristics. The rate of cognitive errors can be reduced by a better understanding of heuristics and the use of checklists. The autopsy as a retrospective quality assessment of clinical diagnosis has a crucial role in learning from diagnostic errors. Diagnostic errors occur more often in primary care in comparison to hospital settings. On the other hand, the inpatient errors are more severe than the outpatient errors.

General physicians do not take adequate travel histories.

PubMed

Price, Victoria A; Smith, Rachel A S; Douthwaite, Sam; Thomas, Sherine; Almond, D Solomon; Miller, Alastair R O; Beeching, Nicholas J; Thompson, Gail; Ustianowski, Andrew; Beadsworth, Mike B J

2011-01-01

Our aim was to document how often travel histories were taken and the quality of their content. Patients admitted over 2 months to acute medical units of two hospitals in the Northwest of England with a history of fever, rash, diarrhea, vomiting, jaundice, or presenting as "unwell post-travel" were identified. The initial medical clerking was assessed. A total of 132 relevant admissions were identified. A travel history was documented in only 26 patients (19.7%). Of the 16 patients who had traveled, there was no documentation of pretravel advice or of sexual/other activities abroad in 15 (93.8%) and 12 (75.0%) patients, respectively. There needs to be better awareness and education about travel-related illness and the importance of taking an adequate travel history. © 2011 International Society of Travel Medicine.

Clinical Dental Faculty Members' Perceptions of Diagnostic Errors and How to Avoid Them.

PubMed

Nikdel, Cathy; Nikdel, Kian; Ibarra-Noriega, Ana; Kalenderian, Elsbeth; Walji, Muhammad F

2018-04-01

Diagnostic errors are increasingly recognized as a source of preventable harm in medicine, yet little is known about their occurrence in dentistry. The aim of this study was to gain a deeper understanding of clinical dental faculty members' perceptions of diagnostic errors, types of errors that may occur, and possible contributing factors. The authors conducted semi-structured interviews with ten domain experts at one U.S. dental school in May-August 2016 about their perceptions of diagnostic errors and their causes. The interviews were analyzed using an inductive process to identify themes and key findings. The results showed that the participants varied in their definitions of diagnostic errors. While all identified missed diagnosis and wrong diagnosis, only four participants perceived that a delay in diagnosis was a diagnostic error. Some participants perceived that an error occurs only when the choice of treatment leads to harm. Contributing factors associated with diagnostic errors included the knowledge and skills of the dentist, not taking adequate time, lack of communication among colleagues, and cognitive biases such as premature closure based on previous experience. Strategies suggested by the participants to prevent these errors were taking adequate time when investigating a case, forming study groups, increasing communication, and putting more emphasis on differential diagnosis. These interviews revealed differing perceptions of dental diagnostic errors among clinical dental faculty members. To address the variations, the authors recommend adopting shared language developed by the medical profession to increase understanding.

Evaluating Frequency, Diagnostic Quality, and Cost of Lyme Borreliosis Testing in Germany: A Retrospective Model Analysis

PubMed Central

Müller, I.; Freitag, M. H.; Poggensee, G.; Scharnetzky, E.; Straube, E.; Schoerner, Ch.; Hlobil, H.; Hagedorn, H.-J.; Stanek, G.; Schubert-Unkmeir, A.; Norris, D. E.; Gensichen, J.; Hunfeld, K.-P.

2012-01-01

Background. Data on the economic impact of Lyme borreliosis (LB) on European health care systems is scarce. This project focused on the epidemiology and costs for laboratory testing in LB patients in Germany. Materials and Methods. We performed a sentinel analysis of epidemiological and medicoeconomic data for 2007 and 2008. Data was provided by a German statutory health insurance (DAK) company covering approx. 6.04 million members. In addition, the quality of diagnostic testing for LB in Germany was studied. Results. In 2007 and 2008, the incident diagnosis LB was coded on average for 15,742 out of 6.04 million insured members (0.26%). 20,986 EIAs and 12,558 immunoblots were ordered annually for these patients. For all insured members in the outpatient sector, a total of 174,820 EIAs and 52,280 immunoblots were reimbursed annually to health care providers (cost: 2,600,850€). For Germany, the overall expected cost is estimated at 51,215,105€. However, proficiency testing data questioned test quality and standardization of diagnostic assays used. Conclusion. Findings from this study suggest ongoing issues related to care for LB and may help to improve future LB disease management. PMID:22242037

Do we assess urethral function adequately in LUTD and NLUTD? ICI-RS 2015.

PubMed

Gajewski, Jerzy B; Rosier, Peter F W M; Rahnama'i, Sajjad; Abrams, Paul

2017-04-01

Urethral function, as well as anatomy, play a significant role in voiding reflex and abnormalities in one or both contribute to the pathophysiology of Lower Urinary Tract Dysfunction (LUTD). We have several diagnostic tools to assess the urethral function or dysfunction but the question remains, are these adequate? This is a report of the proceedings of Think Tank P1: 'Do we assess urethral function adequately in LUTD and NLUTD?' from the annual International Consultation on Incontinence-Research Society, which took place September 22-24, 2014 in Bristol, UK. We have collected and discussed, as a committee, the evidence with regard to the urethra and the available relevant methods of testing urethral function, with the emphasis on female and male voiding dysfunction. We looked into previous research and clinical studies and compiled summaries of pertinent testing related to urethral function. The discussion has focused on clinical applications and the desirability of further development of functional tests and analyses in this field. There are limitations to most of the urethral function tests. Future perspectives and research should concentrate on further development of functional testing and imaging techniques with emphasis on standardization and clinical application of these tests. Neurourol. Urodynam. 36:935-942, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

41 CFR 105-68.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Adequate evidence. 105-68.900 Section 105-68.900 Public Contracts and Property Management Federal Property Management... evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

41 CFR 105-68.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Adequate evidence. 105-68.900 Section 105-68.900 Public Contracts and Property Management Federal Property Management... evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

41 CFR 105-68.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false Adequate evidence. 105-68.900 Section 105-68.900 Public Contracts and Property Management Federal Property Management... evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

41 CFR 105-68.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false Adequate evidence. 105-68.900 Section 105-68.900 Public Contracts and Property Management Federal Property Management... evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

41 CFR 105-68.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false Adequate evidence. 105-68.900 Section 105-68.900 Public Contracts and Property Management Federal Property Management... evidence. Adequate evidence means information sufficient to support the reasonable belief that a particular...

Impact of centralized diagnostic review on quality of initial staging in Hodgkin lymphoma: experience of the German Hodgkin Study Group.

PubMed

Bröckelmann, Paul J; Goergen, Helen; Fuchs, Michael; Kriz, Jan; Semrau, Robert; Baues, Christian; Kobe, Carsten; Behringer, Karolin; Eichenauer, Dennis A; von Tresckow, Bastian; Klimm, Beate; Halbsguth, Teresa; Wongso, Diana; Plütschow, Annette; Haverkamp, Heinz; Dietlein, Markus; Eich, Hans T; Stein, Harald; Diehl, Volker; Borchmann, Peter; Engert, Andreas

2015-11-01

Accurate clinical staging is crucial for adequate risk-adapted treatment in Hodgkin lymphoma (HL) to prevent patients from under- or over-treatment. Within the latest German Hodgkin Study Group trial generation, diagnostic findings such as histopathology, computerized tomography imaging and clinical risk factors were re-evaluated by expert panels. Here, we retrospectively analysed 5965 patients and identified 399 in who major discordant findings changed their first-line treatment allocation. Histopathology review did not confirm the initial diagnosis of HL in 87 patients. Treatment allocation was revised in 312 of the remaining 5878 patients: 176 were assigned to a higher and 128 to a lower risk group, respectively; the correct treatment group remained unclear in 8 patients. Cases of revised treatment allocation accounted for 9·8%, 6·0%, 0·8%, and 14·8% of patients initially assigned to the HD13, HD14, HD15 trials and stage IA lymphocyte-predominant HL project, respectively. Most revisions were due to wrong application of clinical stage (20·5% of 312 patients with revised treatment group), histological subtype (9·0%) or the risk factors ≥3 involved areas (46·8%) or large mediastinal mass (9·3%). In conclusion, centralized review by experienced experts changed risk-adapted first-line treatment in a relevant proportion of HL patients. Quality control measures clearly improve the accuracy of treatment and should be implemented in clinical practice. © 2015 John Wiley & Sons Ltd.

Malaria Diagnostics in Clinical Trials

PubMed Central

Murphy, Sean C.; Shott, Joseph P.; Parikh, Sunil; Etter, Paige; Prescott, William R.; Stewart, V. Ann

2013-01-01

Malaria diagnostics are widely used in epidemiologic studies to investigate natural history of disease and in drug and vaccine clinical trials to exclude participants or evaluate efficacy. The Malaria Laboratory Network (MLN), managed by the Office of HIV/AIDS Network Coordination, is an international working group with mutual interests in malaria disease and diagnosis and in human immunodeficiency virus/acquired immunodeficiency syndrome clinical trials. The MLN considered and studied the wide array of available malaria diagnostic tests for their suitability for screening trial participants and/or obtaining study endpoints for malaria clinical trials, including studies of HIV/malaria co-infection and other malaria natural history studies. The MLN provides recommendations on microscopy, rapid diagnostic tests, serologic tests, and molecular assays to guide selection of the most appropriate test(s) for specific research objectives. In addition, this report provides recommendations regarding quality management to ensure reproducibility across sites in clinical trials. Performance evaluation, quality control, and external quality assessment are critical processes that must be implemented in all clinical trials using malaria tests. PMID:24062484

The next organizational challenge: finding and addressing diagnostic error.

PubMed

Graber, Mark L; Trowbridge, Robert; Myers, Jennifer S; Umscheid, Craig A; Strull, William; Kanter, Michael H

2014-03-01

Although health care organizations (HCOs) are intensely focused on improving the safety of health care, efforts to date have almost exclusively targeted treatment-related issues. The literature confirms that the approaches HCOs use to identify adverse medical events are not effective in finding diagnostic errors, so the initial challenge is to identify cases of diagnostic error. WHY HEALTH CARE ORGANIZATIONS NEED TO GET INVOLVED: HCOs are preoccupied with many quality- and safety-related operational and clinical issues, including performance measures. The case for paying attention to diagnostic errors, however, is based on the following four points: (1) diagnostic errors are common and harmful, (2) high-quality health care requires high-quality diagnosis, (3) diagnostic errors are costly, and (4) HCOs are well positioned to lead the way in reducing diagnostic error. FINDING DIAGNOSTIC ERRORS: Current approaches to identifying diagnostic errors, such as occurrence screens, incident reports, autopsy, and peer review, were not designed to detect diagnostic issues (or problems of omission in general) and/or rely on voluntary reporting. The realization that the existing tools are inadequate has spurred efforts to identify novel tools that could be used to discover diagnostic errors or breakdowns in the diagnostic process that are associated with errors. New approaches--Maine Medical Center's case-finding of diagnostic errors by facilitating direct reports from physicians and Kaiser Permanente's electronic health record--based reports that detect process breakdowns in the followup of abnormal findings--are described in case studies. By raising awareness and implementing targeted programs that address diagnostic error, HCOs may begin to play an important role in addressing the problem of diagnostic error.

Which Food Security Determinants Predict Adequate Vegetable Consumption among Rural Western Australian Children?

PubMed Central

Godrich, Stephanie L.; Lo, Johnny; Davies, Christina R.; Darby, Jill; Devine, Amanda

2017-01-01

Improving the suboptimal vegetable consumption among the majority of Australian children is imperative in reducing chronic disease risk. The objective of this research was to determine whether there was a relationship between food security determinants (FSD) (i.e., food availability, access, and utilisation dimensions) and adequate vegetable consumption among children living in regional and remote Western Australia (WA). Caregiver-child dyads (n = 256) living in non-metropolitan/rural WA completed cross-sectional surveys that included questions on FSD, demographics and usual vegetable intake. A total of 187 dyads were included in analyses, which included descriptive and logistic regression analyses via IBM SPSS (version 23). A total of 13.4% of children in this sample had adequate vegetable intake. FSD that met inclusion criteria (p ≤ 0.20) for multivariable regression analyses included price; promotion; quality; location of food outlets; variety of vegetable types; financial resources; and transport to outlets. After adjustment for potential demographic confounders, the FSD that predicted adequate vegetable consumption were, variety of vegetable types consumed (p = 0.007), promotion (p = 0.017), location of food outlets (p = 0.027), and price (p = 0.043). Food retail outlets should ensure that adequate varieties of vegetable types (i.e., fresh, frozen, tinned) are available, vegetable messages should be promoted through food retail outlets and in community settings, towns should include a range of vegetable purchasing options, increase their reliance on a local food supply and increase transport options to enable affordable vegetable purchasing. PMID:28054955

Which Food Security Determinants Predict Adequate Vegetable Consumption among Rural Western Australian Children?

PubMed

Godrich, Stephanie L; Lo, Johnny; Davies, Christina R; Darby, Jill; Devine, Amanda

2017-01-03

Improving the suboptimal vegetable consumption among the majority of Australian children is imperative in reducing chronic disease risk. The objective of this research was to determine whether there was a relationship between food security determinants (FSD) (i.e., food availability, access, and utilisation dimensions) and adequate vegetable consumption among children living in regional and remote Western Australia (WA). Caregiver-child dyads ( n = 256) living in non-metropolitan/rural WA completed cross-sectional surveys that included questions on FSD, demographics and usual vegetable intake. A total of 187 dyads were included in analyses, which included descriptive and logistic regression analyses via IBM SPSS (version 23). A total of 13.4% of children in this sample had adequate vegetable intake. FSD that met inclusion criteria ( p ≤ 0.20) for multivariable regression analyses included price; promotion; quality; location of food outlets; variety of vegetable types; financial resources; and transport to outlets. After adjustment for potential demographic confounders, the FSD that predicted adequate vegetable consumption were, variety of vegetable types consumed ( p = 0.007), promotion ( p = 0.017), location of food outlets ( p = 0.027), and price ( p = 0.043). Food retail outlets should ensure that adequate varieties of vegetable types (i.e., fresh, frozen, tinned) are available, vegetable messages should be promoted through food retail outlets and in community settings, towns should include a range of vegetable purchasing options, increase their reliance on a local food supply and increase transport options to enable affordable vegetable purchasing.

Hounsfield Unit inaccuracy in computed tomography lesion size and density, diagnostic quality vs attenuation correction

NASA Astrophysics Data System (ADS)

Szczepura, Katy; Thompson, John; Manning, David

2017-03-01

In computed tomography the Hounsfield Units (HU) are used as an indicator of the tissue type based on the linear attenuation coefficients of the tissue. HU accuracy is essential when this metric is used in any form to support diagnosis. In hybrid imaging, such as SPECT/CT and PET/CT, the information is used for attenuation correction (AC) of the emission images. This work investigates the HU accuracy of nodules of known size and HU, comparing diagnostic quality (DQ) images with images used for AC.

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 32 2013-07-01 2013-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 31 2014-07-01 2014-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 32 2012-07-01 2012-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

40 CFR 716.25 - Adequate file search.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 31 2011-07-01 2011-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a...

Image Quality Analysis of Various Gastrointestinal Endoscopes: Why Image Quality Is a Prerequisite for Proper Diagnostic and Therapeutic Endoscopy

PubMed Central

Ko, Weon Jin; An, Pyeong; Ko, Kwang Hyun; Hahm, Ki Baik; Hong, Sung Pyo

2015-01-01

Arising from human curiosity in terms of the desire to look within the human body, endoscopy has undergone significant advances in modern medicine. Direct visualization of the gastrointestinal (GI) tract by traditional endoscopy was first introduced over 50 years ago, after which fairly rapid advancement from rigid esophagogastric scopes to flexible scopes and high definition videoscopes has occurred. In an effort towards early detection of precancerous lesions in the GI tract, several high-technology imaging scopes have been developed, including narrow band imaging, autofocus imaging, magnified endoscopy, and confocal microendoscopy. However, these modern developments have resulted in fundamental imaging technology being skewed towards red-green-blue and this technology has obscured the advantages of other endoscope techniques. In this review article, we have described the importance of image quality analysis using a survey to consider the diversity of endoscope system selection in order to better achieve diagnostic and therapeutic goals. The ultimate aims can be achieved through the adoption of modern endoscopy systems that obtain high image quality. PMID:26473119

Service Quality Of Diagnostic Fine Needle Aspiration Cytology In A Tertiary Care Hospital Of Lahore (Process Measure As Patient's Perspective).

PubMed

Rizvi, Zainab; Usmani, Rabia Arshed; Rizvi, Amna; Wazir, Salim; Zahra, Taskeen; Rasool, Hafza

2017-01-01

Quality of any service is the most important aspect for the manufacturer as well as the consumer. The primary objective of any nation's health system is to provide supreme quality health care services to its patients. The objective of this study was to assess the quality of diagnostic fine needle aspiration cytology service in a tertiary care hospital. As Patient's perspectives provide valuable information on quality of process, therefore, patient's perception in terms of satisfaction with the service was measured. In this cross sectional analytical study, 291 patients undergoing fine needle aspiration cytology in Mayo Hospital were selected by systematic sampling technique. Information regarding satisfaction of patients with four dimensions of service quality process, namely "procedure, sterilization, conduct and competency of doctor" was collected through interview on questionnaire. The questionnaire was developed on SERVQUAL model, a measurement tool, for quality assessment of services provided to patients. All items were assessed on 2- point likert scale (0=dissatisfied, 1=satisfied). Frequencies and percentages of satisfied and dissatisfied patients were recorded for each item and all items in each dimension were scored. If the percentage of sum of all item scores of a dimension was ≥60, the dimension was 'good quality'. Whereas <60% was 'poor quality' dimension. Data was analysed using epi-info-3.5.1. Fisher test was applied to check statistical significance. (p-value <0.05). Out of the 4 dimensions of service quality process, Procedure (48.8%), Sterilization (51.5%) and practitioner conduct (50.9%) were perceived as 'poor' by the patients. Only practitioner competency (67.4%) was perceived as 'good'. Comparison of dimensions of service quality scoring with overall level of patient satisfaction revealed that all 4 dimensions were significantly related to patient dissatisfaction (p<.05). The study suggests that service quality of therapeutic and diagnostic

Predicting the Reasons of Customer Complaints: A First Step Toward Anticipating Quality Issues of In Vitro Diagnostics Assays with Machine Learning

PubMed Central

Kim, James; Li, Li; Liu, Hui

2018-01-01

Background Vendors in the health care industry produce diagnostic systems that, through a secured connection, allow them to monitor performance almost in real time. However, challenges exist in analyzing and interpreting large volumes of noisy quality control (QC) data. As a result, some QC shifts may not be detected early enough by the vendor, but lead a customer to complain. Objective The aim of this study was to hypothesize that a more proactive response could be designed by utilizing the collected QC data more efficiently. Our aim is therefore to help prevent customer complaints by predicting them based on the QC data collected by in vitro diagnostic systems. Methods QC data from five select in vitro diagnostic assays were combined with the corresponding database of customer complaints over a period of 90 days. A subset of these data over the last 45 days was also analyzed to assess how the length of the training period affects predictions. We defined a set of features used to train two classifiers, one based on decision trees and the other based on adaptive boosting, and assessed model performance by cross-validation. Results The cross-validations showed classification error rates close to zero for some assays with adaptive boosting when predicting the potential cause of customer complaints. Performance was improved by shortening the training period when the volume of complaints increased. Denoising filters that reduced the number of categories to predict further improved performance, as their application simplified the prediction problem. Conclusions This novel approach to predicting customer complaints based on QC data may allow the diagnostic industry, the expected end user of our approach, to proactively identify potential product quality issues and fix these before receiving customer complaints. This represents a new step in the direction of using big data toward product quality improvement. PMID:29764796

Adequate supervision for children and adolescents.

PubMed

Anderst, James; Moffatt, Mary

2014-11-01

Primary care providers (PCPs) have the opportunity to improve child health and well-being by addressing supervision issues before an injury or exposure has occurred and/or after an injury or exposure has occurred. Appropriate anticipatory guidance on supervision at well-child visits can improve supervision of children, and may prevent future harm. Adequate supervision varies based on the child's development and maturity, and the risks in the child's environment. Consideration should be given to issues as wide ranging as swimming pools, falls, dating violence, and social media. By considering the likelihood of harm and the severity of the potential harm, caregivers may provide adequate supervision by minimizing risks to the child while still allowing the child to take "small" risks as needed for healthy development. Caregivers should initially focus on direct (visual, auditory, and proximity) supervision of the young child. Gradually, supervision needs to be adjusted as the child develops, emphasizing a safe environment and safe social interactions, with graduated independence. PCPs may foster adequate supervision by providing concrete guidance to caregivers. In addition to preventing injury, supervision includes fostering a safe, stable, and nurturing relationship with every child. PCPs should be familiar with age/developmentally based supervision risks, adequate supervision based on those risks, characteristics of neglectful supervision based on age/development, and ways to encourage appropriate supervision throughout childhood. Copyright 2014, SLACK Incorporated.

Undergoing Diagnostic Evaluation for Possible Cancer Affects the Health-Related Quality of Life in Patients Presenting with Non-Specific Symptoms

PubMed Central

Moseholm, Ellen; Rydahl-Hansen, Susan; Lindhardt, Bjarne Ørskov

2016-01-01

Aim Undergoing diagnostic evaluation for possible cancer can affect health-related quality of life (HRQoL). The aims of this study were to examine the HRQoL in patients undergoing a diagnostic evaluation for possible cancer due to non-specific symptoms and further to investigate the impact of socio-demographic and medical factors associated with HRQoL at the time of diagnosis. Methods This was a prospective, multicenter survey study that included patients who were referred for a diagnostic evaluation due to non-specific cancer symptoms. Participants completed the EORTC-QLQ-C30 quality of life scale before and after completing the diagnostic evaluation. The baseline and follow-up EORTC-QLQ-C30 scores were compared with reference populations. The impact of socio-demographic and medical factors on HRQoL at follow-up was explored by bootstrapped multivariate linear regression. Results A total of 838 patients participated in the study; 680 (81%) also completed follow-up. Twenty-two percent of the patients received a cancer diagnosis at the end of follow-up. Patients presented initially with a high burden of symptoms, less role and emotional functioning and a lower global health/QoL. Most domains improved after diagnosis and no clinically important difference between baseline and follow-up scores was found. Patients reported effects on HRQoL both at baseline and at follow-up compared with the Danish reference population and had similar scores as a cancer reference population. Co-morbidity, being unemployed and receiving a cancer diagnosis had the greatest effect on HRQoL around the time of diagnosis. Conclusions Patients with non-specific symptoms reported an affected HRQoL while undergoing a diagnostic evaluation for possible cancer. Morbidity, being unemployed and receiving a cancer diagnosis had the greatest effect on HRQoL around the time of diagnosis. PMID:26840866

Undergoing Diagnostic Evaluation for Possible Cancer Affects the Health-Related Quality of Life in Patients Presenting with Non-Specific Symptoms.

PubMed

Moseholm, Ellen; Rydahl-Hansen, Susan; Lindhardt, Bjarne Ørskov

2016-01-01

Undergoing diagnostic evaluation for possible cancer can affect health-related quality of life (HRQoL). The aims of this study were to examine the HRQoL in patients undergoing a diagnostic evaluation for possible cancer due to non-specific symptoms and further to investigate the impact of socio-demographic and medical factors associated with HRQoL at the time of diagnosis. This was a prospective, multicenter survey study that included patients who were referred for a diagnostic evaluation due to non-specific cancer symptoms. Participants completed the EORTC-QLQ-C30 quality of life scale before and after completing the diagnostic evaluation. The baseline and follow-up EORTC-QLQ-C30 scores were compared with reference populations. The impact of socio-demographic and medical factors on HRQoL at follow-up was explored by bootstrapped multivariate linear regression. A total of 838 patients participated in the study; 680 (81%) also completed follow-up. Twenty-two percent of the patients received a cancer diagnosis at the end of follow-up. Patients presented initially with a high burden of symptoms, less role and emotional functioning and a lower global health/QoL. Most domains improved after diagnosis and no clinically important difference between baseline and follow-up scores was found. Patients reported effects on HRQoL both at baseline and at follow-up compared with the Danish reference population and had similar scores as a cancer reference population. Co-morbidity, being unemployed and receiving a cancer diagnosis had the greatest effect on HRQoL around the time of diagnosis. Patients with non-specific symptoms reported an affected HRQoL while undergoing a diagnostic evaluation for possible cancer. Morbidity, being unemployed and receiving a cancer diagnosis had the greatest effect on HRQoL around the time of diagnosis.

Diagnostic articulation tables

NASA Astrophysics Data System (ADS)

Mikhailov, V. G.

2002-09-01

In recent years, considerable progress has been made in the development of instrumental methods for general speech quality and intelligibility evaluation on the basis of modeling the auditory perception of speech and measuring the signal-to-noise ratio. Despite certain advantages (fast measurement procedures with a low labor consumption), these methods are not universal and, in essence, secondary, because they rely on the calibration based on subjective-statistical measurements. At the same time, some specific problems of speech quality evaluation, such as the diagnostics of the factors responsible for the deviation of the speech quality from standard (e.g., accent features of a speaker or individual voice distortions), can be solved by psycholinguistic methods. This paper considers different kinds of diagnostic articulation tables: tables of minimal pairs of monosyllabic words (DRT) based on the Jacobson differential features, tables consisting of multisyllabic quartets of Russian words (the choice method), and tables of incomplete monosyllables of the _VC/CV_ type (the supplementary note method). Comparative estimates of the tables are presented along with the recommendations concerning their application.

Quality of Informal Care Is Multidimensional

PubMed Central

Christie, Juliette; Smith, G. Rush; Williamson, Gail M.; Lance, Charles. E.; Shovali, Tamar E.; Silva, Luciana

2010-01-01

Purpose To demonstrate that assessing quality of informal care involves more than merely determining whether care recipient needs for assistance with activities of daily living (ADLs) are satisfied on a routine basis. Potentially harmful behavior (PHB), adequate care, and exemplary care (EC) are conceptually distinct dimensions of quality of care. We investigated the extent to which these three dimensions also are empirically distinguishable. Design 237 care recipients completed the quality of care measures, and their caregivers completed psychosocial measures of depressed affect, life events, cognitive status, and perceived pre-illness relationship quality. Results Confirmatory factor analyses indicated that PHB, adequate care, and EC are empirically distinct factors. Although PHB was moderately related to EC, adequate care was not associated with PHB and was only slightly related to EC. Psychosocial variables were not related to adequate care but were differentially associated with PHB and EC, providing further evidence for the distinction between the measures of quality of care used in this study. Conclusions Assessing quality of informal care is a complex endeavor. ADL assistance can be adequate in the presence of PHB and/or the absence of EC. Declines in EC may signal increases in PHB, independent of adequacy of care. These findings produce a brief, portable, and more comprehensive instrument for assessing quality of informal care. PMID:19469607

Quality of care along the cancer continuum: does receiving adequate lymph node evaluation for colon cancer lead to comprehensive postsurgical care?

PubMed

Parsons, Helen M; Tuttle, Todd M; Kuntz, Karen M; Begun, James W; McGovern, Patricia M; Virnig, Beth A

2012-09-01

Among surgically treated patients with colon cancer, lower long-term mortality has been demonstrated in those with 12 or more lymph nodes evaluated. We examined whether patients receiving adequate lymph node evaluation were also more likely to receive comprehensive postsurgical care, leading to lower mortality. We used the 1992 to 2007 Surveillance, Epidemiology, and End Results (SEER)-Medicare data to identify surgically treated American Joint Committee on Cancer (AJCC) stage III colon cancer patients. We used chi-square analyses and logistic regression to evaluate the association between adequate (≥12) lymph node evaluation and receipt of postsurgical care (adjuvant chemotherapy, surveillance colonoscopy, CT scans, and CEA testing) and Cox proportional hazards regression to evaluate 10-year all-cause mortality, adjusting for postsurgical care. Among 17,906 surgically treated stage III colon cancer patients, adequate (≥12) lymph node evaluation was not associated with receiving comprehensive postsurgical care after adjustment for patient and tumor characteristics (p > 0.05 for all). Initially, adequate lymph node evaluation was associated with lower all-cause mortality (hazard ratio [HR] 0.88; 95% CI [0.85 to 0.91]), but among 3-year survivors, the impact of adequate lymph node evaluation on lower mortality was diminished (HR 0.94; 95% CI [0.88 to 1.01]). However, receiving comprehensive postsurgical care was associated with continued lower mortality in 3-year survivors. Adequate lymph node evaluation for colon cancer was associated with lower mortality among all patients. However, among 3-year survivors, the association between lymph node evaluation and lower hazard of death was no longer significant, while postsurgical care remained strongly associated with lower long-term mortality, indicating that postsurgical care may partially explain the relationship between lymph node evaluation and mortality. Copyright © 2012 American College of Surgeons. Published

Diagnostic delay amongst tuberculosis patients in Jogjakarta Province, Indonesia is related to the quality of services in DOTS facilities.

PubMed

Ahmad, Riris Andono; Mahendradhata, Yodi; Utarini, Adi; de Vlas, Sake J

2011-04-01

To understand determinants of care-seeking patterns and diagnostic delay amongst tuberculosis (TB) patients diagnosed at direct observed treatment short course (DOTS) facilities in Jogjakarta, Indonesia. Cross-sectional survey amongst newly diagnosed TB patients in 89 DOTS facilities whose history of care-seeking was reconstructed through retrospective interviews gathering data on socio-demographic determinants, onset of TB symptoms, type of health facilities visited, duration of each care-seeking action were recorded. Two hundred and fifty-three TB patients were included in the study whose median duration of patients' delay was 1 week and whose total duration of diagnostic delay was 5.4 weeks. The median number of visits was 4. Many of the patients' socio-demographic determinants were not associated with the care-seeking patterns, and no socio-demographic determinants were associated with the duration of diagnostic delay. More than 60% of TB patients started their care-seeking processes outside DOTS facilities, but the number of visits in DOTS facilities was greater during the overall care-seeking process. Surprisingly, patient's immediate visits to a DOTS facility did not correspond to shorter diagnostic delay. Diagnostic delay in Jogjakarta province was not associated with patients' socio demographic factors, but rather with the health system providing DOTS services. This suggests that strengthening the health system and improving diagnostic quality within DOTS services is now a more rational strategy than expanding the TB programme to engage more providers. © 2010 Blackwell Publishing Ltd.

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining adequate...

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining adequate...

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining adequate...

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Responsibility for maintaining adequate safeguards. 1304.114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114 Responsibility for maintaining adequate safeguards. The Board has the responsibility for maintaining adequate...

Sampling and RNA quality for successful diagnostics using quantitative PCR

USDA-ARS?s Scientific Manuscript database

Diagnostic analyses of RNA targets are widely used in honey bee pathology. These diagnostics can be compromised by the actions of endogenous RNA-degrading enzymes activated upon bee death. RNA degradation can be minimized by storage at ultra-cold temperatures or by immersion in high-salt buffers. H...

Portuguese Family Physicians’ Awareness of Diagnostic and Laboratory Test Costs: A Cross-Sectional Study

PubMed Central

Sá, Luísa; Costa-Santos, Cristina; Teixeira, Andreia; Couto, Luciana; Costa-Pereira, Altamiro; Hespanhol, Alberto; Santos, Paulo; Martins, Carlos

2015-01-01

Background Physicians’ ability to make cost-effective decisions has been shown to be affected by their knowledge of health care costs. This study assessed whether Portuguese family physicians are aware of the costs of the most frequently prescribed diagnostic and laboratory tests. Methods A cross-sectional study was conducted in a representative sample of Portuguese family physicians, using computer-assisted telephone interviews for data collection. A Likert scale was used to assess physician’s level of agreement with four statements about health care costs. Family physicians were also asked to estimate the costs of diagnostic and laboratory tests. Each physician’s cost estimate was compared with the true cost and the absolute error was calculated. Results One-quarter (24%; 95% confidence interval: 23%–25%) of all cost estimates were accurate to within 25% of the true cost, with 55% (95% IC: 53–56) overestimating and 21% (95% IC: 20–22) underestimating the true actual cost. The majority (76%) of family physicians thought they did not have or were uncertain as to whether they had adequate knowledge of diagnostic and laboratory test costs, and only 7% reported receiving adequate education. The majority of the family physicians (82%) said that they had adequate access to information about the diagnostic and laboratory test costs. Thirty-three percent thought that costs did not influence their decision to order tests, while 27% were uncertain. Conclusions Portuguese family physicians have limited awareness of diagnostic and laboratory test costs, and our results demonstrate a need for improved education in this area. Further research should focus on identifying whether interventions in cost knowledge actually change ordering behavior, in identifying optimal methods to disseminate cost information, and on improving the cost-effectiveness of care. PMID:26356625

COMPARISON OF ADAPTIVE STATISTICAL ITERATIVE RECONSTRUCTION (ASIR™) AND MODEL-BASED ITERATIVE RECONSTRUCTION (VEO™) FOR PAEDIATRIC ABDOMINAL CT EXAMINATIONS: AN OBSERVER PERFORMANCE STUDY OF DIAGNOSTIC IMAGE QUALITY.

PubMed

Hultenmo, Maria; Caisander, Håkan; Mack, Karsten; Thilander-Klang, Anne

2016-06-01

The diagnostic image quality of 75 paediatric abdominal computed tomography (CT) examinations reconstructed with two different iterative reconstruction (IR) algorithms-adaptive statistical IR (ASiR™) and model-based IR (Veo™)-was compared. Axial and coronal images were reconstructed with 70 % ASiR with the Soft™ convolution kernel and with the Veo algorithm. The thickness of the reconstructed images was 2.5 or 5 mm depending on the scanning protocol used. Four radiologists graded the delineation of six abdominal structures and the diagnostic usefulness of the image quality. The Veo reconstruction significantly improved the visibility of most of the structures compared with ASiR in all subgroups of images. For coronal images, the Veo reconstruction resulted in significantly improved ratings of the diagnostic use of the image quality compared with the ASiR reconstruction. This was not seen for the axial images. The greatest improvement using Veo reconstruction was observed for the 2.5 mm coronal slices. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Implementation of Size-Dependent Local Diagnostic Reference Levels for CT Angiography.

PubMed

Boere, Hub; Eijsvoogel, Nienke G; Sailer, Anna M; Wildberger, Joachim E; de Haan, Michiel W; Das, Marco; Jeukens, Cecile R L P N

2018-05-01

Diagnostic reference levels (DRLs) are established for standard-sized patients; however, patient dose in CT depends on patient size. The purpose of this study was to introduce a method for setting size-dependent local diagnostic reference levels (LDRLs) and to evaluate these LDRLs in comparison with size-independent LDRLs and with respect to image quality. One hundred eighty-four aortic CT angiography (CTA) examinations performed on either a second-generation or third-generation dual-source CT scanner were included; we refer to the second-generation dual-source CT scanner as "CT1" and the third-generation dual-source CT scanner as "CT2." The volume CT dose index (CTDI vol ) and patient diameter (i.e., the water-equivalent diameter) were retrieved by dose-monitoring software. Size-dependent DRLs based on a linear regression of the CTDI vol versus patient size were set by scanner type. Size-independent DRLs were set by the 5th and 95th percentiles of the CTDI vol values. Objective image quality was assessed using the signal-to-noise ratio (SNR), and subjective image quality was assessed using a 4-point Likert scale. The CTDI vol depended on patient size and scanner type (R 2 = 0.72 and 0.78, respectively; slope = 0.05 and 0.02 mGy/mm; p < 0.001). Of the outliers identified by size-independent DRLs, 30% (CT1) and 67% (CT2) were adequately dosed when considering patient size. Alternatively, 30% (CT1) and 70% (CT2) of the outliers found with size-dependent DRLs were not identified using size-independent DRLs. A negative correlation was found between SNR and CTDI vol (R 2 = 0.36 for CT1 and 0.45 for CT2). However, all outliers had a subjective image quality score of sufficient or better. We introduce a method for setting size-dependent LDRLs in CTA. Size-dependent LDRLs are relevant for assessing the appropriateness of the radiation dose for an individual patient on a specific CT scanner.

First round of external quality assessment of dengue diagnostics in the WHO Western Pacific Region, 2013.

PubMed

Pok, Kwoon Yong; Squires, Raynal C; Tan, Li Kiang; Takasaki, Tomohiko; Abubakar, Sazaly; Hasebe, Futoshi; Partridge, Jeffrey; Lee, Chin Kei; Lo, Janice; Aaskov, John; Ng, Lee Ching; Konings, Frank

2015-01-01

Accurate laboratory testing is a critical component of dengue surveillance and control. The objective of this programme was to assess dengue diagnostic proficiency among national-level public health laboratories in the World Health Organization (WHO) Western Pacific Region. Nineteen national-level public health laboratories performed routine dengue diagnostic assays on a proficiency testing panel consisting of two modules: one containing commercial serum samples spiked with cultured dengue viruses for the detection of nucleic acid and non-structural protein 1 (NS1) (Module A) and one containing human serum samples for the detection of anti-dengue virus antibodies (Module B). A review of logistics arrangements was also conducted. All 16 laboratories testing Module A performed reverse transcriptase polymerase chain reaction (RT-PCR) for both RNA and serotype detection. Of these, 15 had correct results for RNA detection and all 16 correctly serotyped the viruses. All nine laboratories performing NS1 antigen detection obtained the correct results. Sixteen of the 18 laboratories using IgM assays in Module B obtained the correct results as did the 13 laboratories that performed IgG assays. Detection of ongoing/recent dengue virus infection by both molecular (RT-PCR) and serological methods (IgM) was available in 15/19 participating laboratories. This first round of external quality assessment of dengue diagnostics was successfully conducted in national-level public health laboratories in the WHO Western Pacific Region, revealing good proficiency in both molecular and serological testing. Further comprehensive diagnostic testing for dengue virus and other priority pathogens in the Region will be assessed during future rounds.

Bulgarian experience in the establishment of reference dose levels and implementation of a quality control system in diagnostic radiology.

PubMed

Vassileva, J; Dimov, A; Slavchev, A; Karadjov, A

2005-01-01

Results from a Bulgarian patient dose survey in diagnostic radiology are presented. Reference levels for entrance surface dose (ESD) were 0.9 mGy for chest radiography (PA), 30 mGy for lumbar spine (Lat), 10 mGy for pelvis, 5 mGy for skull (AP), 3 mGy for skull (Lat) and 13 mGy for mammography. Quality control (QC) programmes were proposed for various areas of diagnostic radiology. Film processing QC warranted special attention. Proposed QC programmes included parameters to be tested, level of expertise needed and two action levels: remedial and suspension. Programmes were tested under clinical conditions to assess initial results and draw conclusions for further QC system development. On the basis of international experience, measurement protocols were developed for all parameters tested. QC equipment was provided as part of the PHARE project. A future problem for QC programme implementation may be the small number of medical physics experts in diagnostic radiology.

Adaptive statistical iterative reconstruction use for radiation dose reduction in pediatric lower-extremity CT: impact on diagnostic image quality.

PubMed

Shah, Amisha; Rees, Mitchell; Kar, Erica; Bolton, Kimberly; Lee, Vincent; Panigrahy, Ashok

2018-06-01

For the past several years, increased levels of imaging radiation and cumulative radiation to children has been a significant concern. Although several measures have been taken to reduce radiation dose during computed tomography (CT) scan, the newer dose reduction software adaptive statistical iterative reconstruction (ASIR) has been an effective technique in reducing radiation dose. To our knowledge, no studies are published that assess the effect of ASIR on extremity CT scans in children. To compare radiation dose, image noise, and subjective image quality in pediatric lower extremity CT scans acquired with and without ASIR. The study group consisted of 53 patients imaged on a CT scanner equipped with ASIR software. The control group consisted of 37 patients whose CT images were acquired without ASIR. Image noise, Computed Tomography Dose Index (CTDI) and dose length product (DLP) were measured. Two pediatric radiologists rated the studies in subjective categories: image sharpness, noise, diagnostic acceptability, and artifacts. The CTDI (p value = 0.0184) and DLP (p value <0.0002) were significantly decreased with the use of ASIR compared with non-ASIR studies. However, the subjective ratings for sharpness (p < 0.0001) and diagnostic acceptability of the ASIR images (p < 0.0128) were decreased compared with standard, non-ASIR CT studies. Adaptive statistical iterative reconstruction reduces radiation dose for lower extremity CTs in children, but at the expense of diagnostic imaging quality. Further studies are warranted to determine the specific utility of ASIR for pediatric musculoskeletal CT imaging.

[The experience of implementation of system of quality management in the Department of Laboratory Diagnostic of the N.V. Sklifosofskiy Research Institute of Emergency Care of Moscow Health Department: a lecture].

PubMed

Zenina, L P; Godkov, M A

2013-08-01

The article presents the experience of implementation of system of quality management into the practice of multi-field laboratory of emergency medical care hospital. The analysis of laboratory errors is applied and the modes of their prevention are demonstrated. The ratings of department of laboratory diagnostic of the N. V. Sklifosofskiy research institute of emergency care in the program EQAS (USA) Monthly Clinical Chemistry from 2007 are presented. The implementation of the system of quality management of laboratory analysis into department of laboratory diagnostic made it possible to support physicians of clinical departments with reliable information. The confidence of clinicians to received results increased. The effectiveness of laboratory diagnostic increased due to lowering costs of analysis without negative impact to quality of curative process.

Diagnostic instruments for behavioural addiction: an overview

PubMed Central

Albrecht, Ulrike; Kirschner, Nina Ellen; Grüsser, Sabine M.

2007-01-01

In non-substance-related addiction, the so-called behavioural addiction, no external psychotropic substances are consumed. The psychotropic effect consists of the body’s own biochemical processes induced only by excessive activities. Until recently, knowledge was limited with respect to clinically relevant excessive reward-seeking behaviour, such as pathological gambling, excessive shopping and working which meet diagnostic criteria of dependent behaviour. To date, there is no consistent concept for diagnosis and treatment of excessive reward-seeking behaviour, and its classification is uncertain. Therefore, a clear conceptualization of the so-called behavioural addictions is of great importance. The use of adequate diagnostic instruments is necessary for successful therapeutical implications. This article provides an overview of the current popular diagnostic instruments assessing the different forms of behavioural addiction. Especially in certain areas there are only few valid and reliable instruments available to assess excessive rewarding behaviours that fulfill the criteria of addiction. PMID:19742294

Whole-body computed tomography in trauma patients: optimization of the patient scanning position significantly shortens examination time while maintaining diagnostic image quality.

PubMed

Hickethier, Tilman; Mammadov, Kamal; Baeßler, Bettina; Lichtenstein, Thorsten; Hinkelbein, Jochen; Smith, Lucy; Plum, Patrick Sven; Chon, Seung-Hun; Maintz, David; Chang, De-Hua

2018-01-01

The study was conducted to compare examination time and artifact vulnerability of whole-body computed tomographies (wbCTs) for trauma patients using conventional or optimized patient positioning. Examination time was measured in 100 patients scanned with conventional protocol (Group A: arms positioned alongside the body for head and neck imaging and over the head for trunk imaging) and 100 patients scanned with optimized protocol (Group B: arms flexed on a chest pillow without repositioning). Additionally, influence of two different scanning protocols on image quality in the most relevant body regions was assessed by two blinded readers. Total wbCT duration was about 35% or 3:46 min shorter in B than in A. Artifacts in aorta (27 vs 6%), liver (40 vs 8%) and spleen (27 vs 5%) occurred significantly more often in B than in A. No incident of non-diagnostic image quality was reported, and no significant differences for lungs and spine were found. An optimized wbCT positioning protocol for trauma patients allows a significant reduction of examination time while still maintaining diagnostic image quality.

The costs of accessible quality assured syphilis diagnostics: informing quality systems for rapid syphilis tests in a Tanzanian setting.

PubMed

Sweeney, Sedona; Mosha, Jacklin F; Terris-Prestholt, Fern; Sollis, Kimberly A; Kelly, Helen; Changalucha, John; Peeling, Rosanna W

2014-08-01

To determine the costs of Rapid Syphilis Test (RSTs) as compared with rapid plasma reagin (RPR) when implemented in a Tanzanian setting, and to determine the relative impact of a quality assurance (QA) system on the cost of RST implementation. The incremental costs for RPR and RST screening programmes in existing antenatal care settings in Geita District, Tanzania were collected for 9 months in subsequent years from nine health facilities that varied in size, remoteness and scope of antenatal services. The costs per woman tested and treated were estimated for each facility. A sensitivity analysis was constructed to determine the impact of parameter and model uncertainty. In surveyed facilities, a total of 6362 women were tested with RSTs compared with 224 tested with RPR. The range of unit costs was $1.76-$3.13 per woman screened and $12.88-$32.67 per woman treated. Unit costs for the QA system came to $0.51 per woman tested, of which 50% were attributed to salaries and transport for project personnel. Our results suggest that rapid syphilis diagnostics are very inexpensive in this setting and can overcome some critical barriers to ensuring universal access to syphilis testing and treatment. The additional costs for implementation of a quality system were found to be relatively small, and could be reduced through alterations to the programme design. Given the potential for a quality system to improve quality of diagnosis and care, we recommend that QA activities be incorporated into RST roll-out. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

[Dispatchers' impressions and actual quality of cardiopulmonary resuscitation during telephone-assisted bystander cardiopulmonary resuscitation: a pooled analysis of 94 simulated, manikin-based scenarios].

PubMed

van Tulder, Raphael; Roth, Dominik; Laggner, Roberta; Krammel, Mario; Schriefl, Christoph; Kienbacher, Calvin; Novosad, Heinz; Chwojka, Constantin Christof; Sterz, Fritz; Havel, Christof; Schreiber, Wolfgang; Herkner, Harald

2017-02-01

The quality of telephone-assisted cardiopulmonary resuscitation (CPR) needs improvement. This study investigates whether a dispatchers' perception is an adequate measure of the actual quality of CPR provided by laypersons. Individual participant data from 3 randomized simulation trials, with identical methodology but different interventions, were combined for this analysis. Professional dispatchers gave telephone assistance to laypersons, who each provided 10 minutes of CPR on a manikin. Dispatchers were requested to classify the quality of providers' CPR as adequate or inadequate. Based on actual readings from manikins we classified providers' performance as adequate at 5-6 cm for depth and 100-120 compressions per minute (cpm) for rate. We calculated metrics of dispatcher accuracy. Six dispatchers rated the performance of 94 laypersons (38 women [42%]) with a mean (SD) age of 37 (14) years. In 905 analyzed minutes of telephone-assisted CPR, the mean compression depth and rate was 41 (13) mm and 98 (24) cpm, respectively. Analysis of dispatchers' diagnostic test accuracy for adequate compression depth yielded a sensitivity of 65% (95 CI 36%-95%) and specificity of 42% (95% CI, 32%-53%). Analysis of their assessment of adequate compression rate yielded a sensitivity of 75% (95% CI, 64%-86%) and specificity of 42% (95% CI, 32%-52%). Although dispatchers always underestimated the actual values of CPR parameters, the female dispatchers evaluations were less inaccurate than the evaluations of make dispatchers; the dispatchers overall (males and females together) underestimated the adequacy of female laypersons' CPR performance to a greater degree than female dispatchers did. The ability of dispatchers to estimate the quality of telephone-assisted CPR is limited. Dispatchers estimates of CPR adequacy needs to be studied further in order to find ways that telephone-assisted CPR might be improved.

Predicting the Reasons of Customer Complaints: A First Step Toward Anticipating Quality Issues of In Vitro Diagnostics Assays with Machine Learning.

PubMed

Aris-Brosou, Stephane; Kim, James; Li, Li; Liu, Hui

2018-05-15

Vendors in the health care industry produce diagnostic systems that, through a secured connection, allow them to monitor performance almost in real time. However, challenges exist in analyzing and interpreting large volumes of noisy quality control (QC) data. As a result, some QC shifts may not be detected early enough by the vendor, but lead a customer to complain. The aim of this study was to hypothesize that a more proactive response could be designed by utilizing the collected QC data more efficiently. Our aim is therefore to help prevent customer complaints by predicting them based on the QC data collected by in vitro diagnostic systems. QC data from five select in vitro diagnostic assays were combined with the corresponding database of customer complaints over a period of 90 days. A subset of these data over the last 45 days was also analyzed to assess how the length of the training period affects predictions. We defined a set of features used to train two classifiers, one based on decision trees and the other based on adaptive boosting, and assessed model performance by cross-validation. The cross-validations showed classification error rates close to zero for some assays with adaptive boosting when predicting the potential cause of customer complaints. Performance was improved by shortening the training period when the volume of complaints increased. Denoising filters that reduced the number of categories to predict further improved performance, as their application simplified the prediction problem. This novel approach to predicting customer complaints based on QC data may allow the diagnostic industry, the expected end user of our approach, to proactively identify potential product quality issues and fix these before receiving customer complaints. This represents a new step in the direction of using big data toward product quality improvement. ©Stephane Aris-Brosou, James Kim, Li Li, Hui Liu. Originally published in JMIR Medical Informatics (http

Agreement between patients and general practitioners on quality deviations during the cancer diagnostic pathway and associations with time to diagnosis.

PubMed

Jensen, Henry; Sperling, Cecilie; Sandager, Mette; Vedsted, Peter

2015-06-01

High quality and minimal delay are crucial and anticipated elements in the diagnostic cancer pathway as delay in the diagnosis may worsen the prognosis and cause lower patient satisfaction. The aim of this study was to describe agreement in reported quality deviations (QDs) between general practitioners (GPs) and cancer patients during the diagnostic pathway in primary care and to estimate the association between length of diagnostic interval and level of agreement on reported QDs. The study was carried out as a Danish cross-sectional study of incident cancer patients identified in the Danish National Patient Registry. Data were collected by independent questionnaires from patients (response rate: 53.0%) and their GPs (response rate: 73.8%), and 2177 pairs of questionnaires were subsequently combined. Agreement between GP- and patient-reported QDs was estimated using Cohen's Kappa, whereas the association between level of agreement and time to diagnosis was estimated using quantile regression. Patients reported QDs in 29.0% and GPs in 28.5% of the cases, but agreed only slightly on QD presence (Kappas between -0.08 and 0.26). Agreement on 'QD presence' was associated with a 54-day (95%CI: 44-64) longer time to diagnosis than agreement on 'no QD presence'. The association with a longer diagnostic interval was stronger when only GP reported a QD the association than when only patient reported a QD. Included GPs and patients agreed only slightly on QD presence although they reported the same amount of QDs; this suggests that GPs and patients see QDs as two different concepts. QD presence had a stronger impact on time to diagnosis when reported by the GP (alone or in agreement with the patient) than when reported by the patient alone. The GP may thus be the most important source of information on QD and diagnostic interval, while the patient information tends to underpin this assessment. © The Author 2015. Published by Oxford University Press. All rights reserved. For

Assessing FDG-PET diagnostic accuracy studies to develop recommendations for clinical use in dementia.

PubMed

Boccardi, Marina; Festari, Cristina; Altomare, Daniele; Gandolfo, Federica; Orini, Stefania; Nobili, Flavio; Frisoni, Giovanni B

2018-04-30

FDG-PET is frequently used as a marker of synaptic damage to diagnose dementing neurodegenerative disorders. We aimed to adapt the items of evidence quality to FDG-PET diagnostic studies, and assess the evidence available in current literature to assist Delphi decisions for European recommendations for clinical use. Based on acknowledged methodological guidance, we defined the domains, specific to FDG-PET, required to assess the quality of evidence in 21 literature searches addressing as many Population Intervention Comparison Outcome (PICO) questions. We ranked findings for each PICO and fed experts making Delphi decisions for recommending clinical use. Among the 1435 retrieved studies, most lacked validated measures of test performance, an adequate gold standard, and head-to-head comparison of FDG-PET and clinical diagnosis, and only 58 entered detailed assessment. Only two studies assessed the accuracy of the comparator (clinical diagnosis) versus any kind of gold-/reference-standard. As to the index-test (FDG-PET-based diagnosis), an independent gold-standard was available in 24% of the examined papers; 38% used an acceptable reference-standard (clinical follow-up); and 38% compared FDG-PET-based diagnosis only to baseline clinical diagnosis. These methodological limitations did not allow for deriving recommendations from evidence. An incremental diagnostic value of FDG-PET versus clinical diagnosis or lack thereof cannot be derived from the current literature. Many of the observed limitations may easily be overcome, and we outlined them as research priorities to improve the quality of current evidence. Such improvement is necessary to outline evidence-based guidelines. The available data were anyway provided to expert clinicians who defined interim recommendations.

Access and Quality of HIV-Related Point-of-Care Diagnostic Testing in Global Health Programs.

PubMed

Fonjungo, Peter N; Boeras, Debrah I; Zeh, Clement; Alexander, Heather; Parekh, Bharat S; Nkengasong, John N

2016-02-01

Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of human immunodeficiency virus (HIV)-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with other organizations, recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets, will require increased access to reliable and accurate POCT results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Determining the Optimal Number of Core Needle Biopsy Passes for Molecular Diagnostics.

PubMed

Hoang, Nam S; Ge, Benjamin H; Pan, Lorraine Y; Ozawa, Michael G; Kong, Christina S; Louie, John D; Shah, Rajesh P

2018-03-01

The number of core biopsy passes required for adequate next-generation sequencing is impacted by needle cut, needle gauge, and the type of tissue involved. This study evaluates diagnostic adequacy of core needle lung biopsies based on number of passes and provides guidelines for other tissues based on simulated biopsies in ex vivo porcine organ tissues. The rate of diagnostic adequacy for pathology and molecular testing from lung biopsy procedures was measured for eight operators pre-implementation (September 2012-October 2013) and post-implementation (December 2013-April 2014) of a standard protocol using 20-gauge side-cut needles for ten core biopsy passes at a single academic hospital. Biopsy pass volume was then estimated in ex vivo porcine muscle, liver, and kidney using side-cut devices at 16, 18, and 20 gauge and end-cut devices at 16 and 18 gauge to estimate minimum number of passes required for adequate molecular testing. Molecular diagnostic adequacy increased from 69% (pre-implementation period) to 92% (post-implementation period) (p < 0.001) for lung biopsies. In porcine models, both 16-gauge end-cut and side-cut devices require one pass to reach the validated volume threshold to ensure 99% adequacy for molecular characterization, while 18- and 20-gauge devices require 2-5 passes depending on needle cut and tissue type. Use of 20-gauge side-cut core biopsy needles requires a significant number of passes to ensure diagnostic adequacy for molecular testing across all tissue types. To ensure diagnostic adequacy for molecular testing, 16- and 18-gauge needles require markedly fewer passes.

Evaluation of a laboratory quality assurance pilot programme for malaria diagnostics in low-transmission areas of Kenya, 2013.

PubMed

Wanja, Elizabeth; Achilla, Rachel; Obare, Peter; Adeny, Rose; Moseti, Caroline; Otieno, Victor; Morang'a, Collins; Murigi, Ephantus; Nyamuni, John; Monthei, Derek R; Ogutu, Bernhards; Buff, Ann M

2017-05-25

One objective of the Kenya National Malaria Strategy 2009-2017 is scaling access to prompt diagnosis and effective treatment. In 2013, a quality assurance (QA) pilot was implemented to improve accuracy of malaria diagnostics at selected health facilities in low-transmission counties of Kenya. Trends in malaria diagnostic and QA indicator performance during the pilot are described. From June to December 2013, 28 QA officers provided on-the-job training and mentoring for malaria microscopy, malaria rapid diagnostic tests and laboratory QA/quality control (QC) practices over four 1-day visits at 83 health facilities. QA officers observed and recorded laboratory conditions and practices and cross-checked blood slides for malaria parasite presence, and a portion of cross-checked slides were confirmed by reference laboratories. Eighty (96%) facilities completed the pilot. Among 315 personnel at pilot initiation, 13% (n = 40) reported malaria diagnostics training within the previous 12 months. Slide positivity ranged from 3 to 7%. Compared to the reference laboratory, microscopy sensitivity ranged from 53 to 96% and positive predictive value from 39 to 53% for facility staff and from 60 to 96% and 52 to 80%, respectively, for QA officers. Compared to reference, specificity ranged from 88 to 98% and negative predictive value from 98 to 99% for health-facility personnel and from 93 to 99% and 99%, respectively, for QA officers. The kappa value ranged from 0.48-0.66 for facility staff and 0.57-0.84 for QA officers compared to reference. The only significant test performance improvement observed for facility staff was for specificity from 88% (95% CI 85-90%) to 98% (95% CI 97-99%). QA/QC practices, including use of positive-control slides, internal and external slide cross-checking and recording of QA/QC activities, all increased significantly across the pilot (p < 0.001). Reference material availability also increased significantly; availability of six microscopy job

40 CFR 51.354 - Adequate tools and resources.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 2 2014-07-01 2014-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain... assurance, data analysis and reporting, and the holding of hearings and adjudication of cases. A portion of...

40 CFR 51.354 - Adequate tools and resources.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 2 2011-07-01 2011-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain... assurance, data analysis and reporting, and the holding of hearings and adjudication of cases. A portion of...

40 CFR 51.354 - Adequate tools and resources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 2 2012-07-01 2012-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain... assurance, data analysis and reporting, and the holding of hearings and adjudication of cases. A portion of...

40 CFR 51.354 - Adequate tools and resources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 2 2013-07-01 2013-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain... assurance, data analysis and reporting, and the holding of hearings and adjudication of cases. A portion of...

Comparison of the diagnostic quality of computed tomography images of normal ocular and orbital structures acquired with and without the use of general anesthesia in the cat.

PubMed

Collins, Sean P; Matheson, Jodi S; Hamor, Ralph E; Mitchell, Mark A; Labelle, Amber L; O'Brien, Robert T

2013-09-01

To compare the diagnostic quality of computed tomography (CT) images of normal ocular and orbital structures acquired with and without the use of general anesthesia in the cat. Eleven privately owned cats with nasal disease presenting to a single referral hospital. All cats received a complete ophthalmic examination. A 16 multislice helical CT system was utilized to acquire images of the skull and neck with and without the use of general anesthesia. Images were acquired before and after the administration of intravenous iodinated contrast. Images of normal ocular and orbital structures were evaluated via consensus by two board-certified radiologists. Visibility of ocular and orbital structures, degree of motion, and streak artifact were assessed and scored for each image set in the transverse, dorsal, and sagittal planes. The use of general anesthesia did not significantly affect the diagnostic quality of images. No motion artifact was observed in any CT image. Streak artifact was significantly increased in scans performed in the transverse orientation but not in the dorsal orientation or sagittal orientation and did not affect the diagnostic quality of the images. Contrast enhancement did not significantly enhance the visibility of any ocular or orbital structures. Diagnostic CT images of normal ocular and orbital structures can be acquired without the use of general anesthesia in the cat. © 2012 American College of Veterinary Ophthalmologists.

Decision analysis to complete diagnostic research by closing the gap between test characteristics and cost-effectiveness.

PubMed

Schaafsma, Joanna D; van der Graaf, Yolanda; Rinkel, Gabriel J E; Buskens, Erik

2009-12-01

The lack of a standard methodology in diagnostic research impedes adequate evaluation before implementation of constantly developing diagnostic techniques. We discuss the methodology of diagnostic research and underscore the relevance of decision analysis in the process of evaluation of diagnostic tests. Overview and conceptual discussion. Diagnostic research requires a stepwise approach comprising assessment of test characteristics followed by evaluation of added value, clinical outcome, and cost-effectiveness. These multiple goals are generally incompatible with a randomized design. Decision-analytic models provide an important alternative through integration of the best available evidence. Thus, critical assessment of clinical value and efficient use of resources can be achieved. Decision-analytic models should be considered part of the standard methodology in diagnostic research. They can serve as a valid alternative to diagnostic randomized clinical trials (RCTs).

Additional measures do not improve the diagnostic accuracy of the Hospital Admission Risk Profile for detecting downstream quality of life in community-dwelling older people presenting to a hospital emergency department.

PubMed

Grimmer, K; Milanese, S; Beaton, K; Atlas, A

2014-01-01

The Hospital Admission Risk Profile (HARP) instrument is commonly used to assess risk of functional decline when older people are admitted to hospital. HARP has moderate diagnostic accuracy (65%) for downstream decreased scores in activities of daily living. This paper reports the diagnostic accuracy of HARP for downstream quality of life. It also tests whether adding other measures to HARP improves its diagnostic accuracy. One hundred and forty-eight independent community dwelling individuals aged 65 years or older were recruited in the emergency department of one large Australian hospital with a medical problem for which they were discharged without a hospital ward admission. Data, including age, sex, primary language, highest level of education, postcode, living status, requiring care for daily activities, using a gait aid, receiving formal community supports, instrumental activities of daily living in the last week, hospitalization and falls in the last 12 months, and mental state were collected at recruitment. HARP scores were derived from a formula that summed scores assigned to age, activities of daily living, and mental state categories. Physical and mental component scores of a quality of life measure were captured by telephone interview at 1 and 3 months after recruitment. HARP scores are moderately accurate at predicting downstream decline in physical quality of life, but did not predict downstream decline in mental quality of life. The addition of other variables to HARP did not improve its diagnostic accuracy for either measure of quality of life. HARP is a poor predictor of quality of life.

[Quality management and strategic consequences of assessing documentation and coding under the German Diagnostic Related Groups system].

PubMed

Schnabel, M; Mann, D; Efe, T; Schrappe, M; V Garrel, T; Gotzen, L; Schaeg, M

2004-10-01

The introduction of the German Diagnostic Related Groups (D-DRG) system requires redesigning administrative patient management strategies. Wrong coding leads to inaccurate grouping and endangers the reimbursement of treatment costs. This situation emphasizes the roles of documentation and coding as factors of economical success. The aims of this study were to assess the quantity and quality of initial documentation and coding (ICD-10 and OPS-301) and find operative strategies to improve efficiency and strategic means to ensure optimal documentation and coding quality. In a prospective study, documentation and coding quality were evaluated in a standardized way by weekly assessment. Clinical data from 1385 inpatients were processed for initial correctness and quality of documentation and coding. Principal diagnoses were found to be accurate in 82.7% of cases, inexact in 7.1%, and wrong in 10.1%. Effects on financial returns occurred in 16%. Based on these findings, an optimized, interdisciplinary, and multiprofessional workflow on medical documentation, coding, and data control was developed. Workflow incorporating regular assessment of documentation and coding quality is required by the DRG system to ensure efficient accounting of hospital services. Interdisciplinary and multiprofessional cooperation is recognized to be an important factor in establishing an efficient workflow in medical documentation and coding.

Predictors of adequate depression treatment among Medicaid-enrolled adults.

PubMed

Teh, Carrie Farmer; Sorbero, Mark J; Mihalyo, Mark J; Kogan, Jane N; Schuster, James; Reynolds, Charles F; Stein, Bradley D

2010-02-01

To determine whether Medicaid-enrolled depressed adults receive adequate treatment for depression and to identify the characteristics of those receiving inadequate treatment. Claims data from a Medicaid-enrolled population in a large mid-Atlantic state between July 2006 and January 2008. We examined rates and predictors of minimally adequate psychotherapy and pharmacotherapy among adults with a new depression treatment episode during the study period (N=1,098). Many depressed adults received either minimally adequate psychotherapy or pharmacotherapy. Black individuals and individuals who began their depression treatment episode with an inpatient psychiatric stay for depression were markedly less likely to receive minimally adequate psychotherapy and more likely to receive inadequate treatment. Racial minorities and individuals discharged from inpatient treatment for depression are at risk for receiving inadequate depression treatment.

Fuzzy intelligent quality monitoring model for X-ray image processing.

PubMed

Khalatbari, Azadeh; Jenab, Kouroush

2009-01-01

Today's imaging diagnosis needs to adapt modern techniques of quality engineering to maintain and improve its accuracy and reliability in health care system. One of the main factors that influences diagnostic accuracy of plain film X-ray on detecting pathology is the level of film exposure. If the level of film exposure is not adequate, a normal body structure may be interpretated as pathology and vice versa. This not only influences the patient management but also has an impact on health care cost and patient's quality of life. Therefore, providing an accurate and high quality image is the first step toward an excellent patient management in any health care system. In this paper, we study these techniques and also present a fuzzy intelligent quality monitoring model, which can be used to keep variables from degrading the image quality. The variables derived from chemical activity, cleaning procedures, maintenance, and monitoring may not be sensed, measured, or calculated precisely due to uncertain situations. Therefore, the gamma-level fuzzy Bayesian model for quality monitoring of an image processing is proposed. In order to apply the Bayesian concept, the fuzzy quality characteristics are assumed as fuzzy random variables. Using the fuzzy quality characteristics, the newly developed model calculates the degradation risk for image processing. A numerical example is also presented to demonstrate the application of the model.

The study of personality in renal transplant patients: possible predictor of an adequate social adaptation?

PubMed

Pistorio, M L; Veroux, M; Corona, D; Sinagra, N; Giaquinta, A; Zerbo, D; Giacchi, F; Gagliano, M; Tallarita, T; Veroux, P; De Pasquale, C

2013-09-01

This study explored the personality characteristic traits within a sample of renal transplant patients, seeking to obtain predictive index for likely clinical impacts. The personality study was performed using the Structured Clinical Interview Axis II Personality Disorders for Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision in 60 recipients of kidney transplantations from deceased donors. The personality trait that prevailed in the female gender was borderline, while in the male gender it appeared to be predominantly obsessive-compulsive personality trait. The personality study proved to be a good index to predict effects on the level of social adjustment. In this way, patients who have shown pathologic personality traits can be identified early to provide adequate psychologic-psychiatric support and follow-up. Copyright © 2013 Elsevier Inc. All rights reserved.

Diagnostic strategies in nasal congestion

PubMed Central

Krouse, John; Lund, Valerie; Fokkens, Wytske; Meltzer, Eli O

2010-01-01

Nasal congestion is a major symptom of upper respiratory tract disorders, and its characterization an important part of the diagnosis of these illnesses. Patient history and assessment of nasal symptoms are essential components of diagnosis, providing an initial evaluation that may be adequate to rule out serious conditions. However, current congestion medications are not always fully effective. Thus, if symptoms do not respond adequately to therapy, or symptoms suggestive of more serious conditions are present, specialized assessments may be needed. Various techniques are available for diagnosing patients, including those used chiefly by primary care clinicians and those requiring the expertise of otolaryngologists, allergists, and other specialists. Endoscopy remains a mainstay for evaluating nasal blockage and its causes, while modalities such as peak nasal inspiratory flow and acoustic rhinometry are evolving to provide easy-to-use, noninvasive procedures that are sensitive enough to measure small but clinically important abnormalities and therapeutic changes. Several imaging modalities are available to the specialist for severe or unusual cases, as are specialized diagnostic procedures that measure adjunctive features of congestion, such as impaired mucociliary function. PMID:20463824

Diagnostic Assessment and Treatment of Reading Difficulties: A Case Study of Dyslexia

ERIC Educational Resources Information Center

Oviedo, Paula Outon; Gonzalez, Rebeca Abal

2013-01-01

Dyslexia is a specific learning disability in reading and writing, which requires adequate early intervention to prevent future school failure. We describe the diagnostic assessment of a 7-year-old boy labelled "dyslexic", the evaluation of his family, social, medical, developmental, and academic status as a preliminary for the design…

[Definition of low threshold volumes for quality assurance: conceptual and methodological issues involved in the definition and evaluation of thresholds for volume outcome relations in clinical care].

PubMed

Wetzel, Hermann

2006-01-01

In a large number of mostly retrospective association studies, a statistical relationship between volume and quality of health care has been reported. However, the relevance of these results is frequently limited by methodological shortcomings. In this article, criteria for the evidence and definition of thresholds for volume-outcome relations are proposed, e.g. the specification of relevant outcomes for quality indicators, analysis of volume as a continuous variable with an adequate case-mix and risk adjustment, accounting for cluster effects and considering mathematical models for the derivation of cut-off values. Moreover, volume thresholds are regarded as surrogate parameters for the indirect classification of the quality of care, whose diagnostic validity and effectiveness in improving health care quality need to be evaluated in prospective studies.

Radiological safety status and quality assurance audit of medical X-ray diagnostic installations in India.

PubMed

Sonawane, A U; Singh, Meghraj; Sunil Kumar, J V K; Kulkarni, Arti; Shirva, V K; Pradhan, A S

2010-10-01

We conducted a radiological safety and quality assurance (QA) audit of 118 medical X-ray diagnostic machines installed in 45 major hospitals in India. The main objective of the audit was to verify compliance with the regulatory requirements stipulated by the national regulatory body. The audit mainly covered accuracy check of accelerating potential (kVp), linearity of tube current (mA station) and timer, congruence of radiation and optical field, and total filtration; in addition, we also reviewed medical X-ray diagnostic installations with reference to room layout of X-ray machines and conduct of radiological protection survey. A QA kit consisting of a kVp Test-O-Meter (ToM) (Model RAD/FLU-9001), dose Test-O-Meter (ToM) (Model 6001), ionization chamber-based radiation survey meter model Gun Monitor and other standard accessories were used for the required measurements. The important areas where there was noncompliance with the national safety code were: inaccuracy of kVp calibration (23%), lack of congruence of radiation and optical field (23%), nonlinearity of mA station (16%) and timer (9%), improper collimator/diaphragm (19.6%), faulty adjustor knob for alignment of field size (4%), nonavailability of warning light (red light) at the entrance of the X-ray room (29%), and use of mobile protective barriers without lead glass viewing window (14%). The present study on the radiological safety status of diagnostic X-ray installations may be a reasonably good representation of the situation in the country as a whole. The study contributes significantly to the improvement of radiological safety by the way of the steps already taken and by providing a vital feed back to the national regulatory body.

Diagnostic accuracy research in glaucoma is still incompletely reported: An application of Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015.

PubMed

Michelessi, Manuele; Lucenteforte, Ersilia; Miele, Alba; Oddone, Francesco; Crescioli, Giada; Fameli, Valeria; Korevaar, Daniël A; Virgili, Gianni

2017-01-01

Research has shown a modest adherence of diagnostic test accuracy (DTA) studies in glaucoma to the Standards for Reporting of Diagnostic Accuracy Studies (STARD). We have applied the updated 30-item STARD 2015 checklist to a set of studies included in a Cochrane DTA systematic review of imaging tools for diagnosing manifest glaucoma. Three pairs of reviewers, including one senior reviewer who assessed all studies, independently checked the adherence of each study to STARD 2015. Adherence was analyzed on an individual-item basis. Logistic regression was used to evaluate the effect of publication year and impact factor on adherence. We included 106 DTA studies, published between 2003-2014 in journals with a median impact factor of 2.6. Overall adherence was 54.1% for 3,286 individual rating across 31 items, with a mean of 16.8 (SD: 3.1; range 8-23) items per study. Large variability in adherence to reporting standards was detected across individual STARD 2015 items, ranging from 0 to 100%. Nine items (1: identification as diagnostic accuracy study in title/abstract; 6: eligibility criteria; 10: index test (a) and reference standard (b) definition; 12: cut-off definitions for index test (a) and reference standard (b); 14: estimation of diagnostic accuracy measures; 21a: severity spectrum of diseased; 23: cross-tabulation of the index and reference standard results) were adequately reported in more than 90% of the studies. Conversely, 10 items (3: scientific and clinical background of the index test; 11: rationale for the reference standard; 13b: blinding of index test results; 17: analyses of variability; 18; sample size calculation; 19: study flow diagram; 20: baseline characteristics of participants; 28: registration number and registry; 29: availability of study protocol; 30: sources of funding) were adequately reported in less than 30% of the studies. Only four items showed a statistically significant improvement over time: missing data (16), baseline

Non- contacting capacitive diagnostic device

DOEpatents

Ellison, Timothy

2005-07-12

A non-contacting capacitive diagnostic device includes a pulsed light source for producing an electric field in a semiconductor or photovoltaic device or material to be evaluated and a circuit responsive to the electric field. The circuit is not in physical contact with the device or material being evaluated and produces an electrical signal characteristic of the electric field produced in the device or material. The diagnostic device permits quality control and evaluation of semiconductor or photovoltaic device properties in continuous manufacturing processes.

[Diagnostics and surgical treatment of lung cancer in conditions of special thoracal department for patients with purulent lung diseases].

PubMed

Deĭnega, I V; Egorov, V I; Ionov, P M; Akopov, A L

2014-01-01

The authors investigated features of diagnostics and surgical treatment of lung cancer which was complicated by purulent destructive process. The possibilities of radical operative intervention were considered after preliminary adequate treatment of purulent complications in 226 patients. It was noted, that the diagnostic thoracotomy should be used in doubtful cases in order to estimate the resectability of lung cancer.

Does standardised structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets.

PubMed

Ellis, D W; Srigley, J

2016-01-01

Key quality parameters in diagnostic pathology include timeliness, accuracy, completeness, conformance with current agreed standards, consistency and clarity in communication. In this review, we argue that with worldwide developments in eHealth and big data, generally, there are two further, often overlooked, parameters if our reports are to be fit for purpose. Firstly, population-level studies have clearly demonstrated the value of providing timely structured reporting data in standardised electronic format as part of system-wide quality improvement programmes. Moreover, when combined with multiple health data sources through eHealth and data linkage, structured pathology reports become central to population-level quality monitoring, benchmarking, interventions and benefit analyses in public health management. Secondly, population-level studies, particularly for benchmarking, require a single agreed international and evidence-based standard to ensure interoperability and comparability. This has been taken for granted in tumour classification and staging for many years, yet international standardisation of cancer datasets is only now underway through the International Collaboration on Cancer Reporting (ICCR). In this review, we present evidence supporting the role of structured pathology reporting in quality improvement for both clinical care and population-level health management. Although this review of available evidence largely relates to structured reporting of cancer, it is clear that the same principles can be applied throughout anatomical pathology generally, as they are elsewhere in the health system.

Current audiological diagnostics

PubMed Central

Hoth, Sebastian; Baljić, Izet

2017-01-01

Today’s audiological functional diagnostics is based on a variety of hearing tests, whose large number takes account of the variety of malfunctions of a complex sensory organ system and the necessity to examine it in a differentiated manner and at any age of life. The objective is to identify nature and origin of the hearing loss and to quantify its extent as far as necessary to dispose of the information needed to initiate the adequate medical (conservative or operational) treatment or the provision with technical hearing aids or prostheses. Moreover, audiometry provides the basis for the assessment of impairment and handicap as well as for the calculation of the degree of disability. In the present overview, the current state of the method inventory available for practical use is described, starting from basic diagnostics over to complex special techniques. The presentation is systematically grouped in subjective procedures, based on psychoacoustic exploration, and objective methods, based on physical measurements: preliminary hearing tests, pure tone threshold, suprathreshold processing of sound intensity, directional hearing, speech understanding in quiet and in noise, dichotic hearing, tympanogram, acoustic reflex, otoacoustic emissions and auditory evoked potentials. Apart from a few still existing gaps, this method inventory covers the whole spectrum of all clinically relevant functional deficits of the auditory system. PMID:29279727

22 CFR 1006.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Adequate evidence. 1006.900 Section 1006.900 Foreign Relations INTER-AMERICAN FOUNDATION GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT... reasonable belief that a particular act or omission has occurred. ...

22 CFR 1508.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Adequate evidence. 1508.900 Section 1508.900 Foreign Relations AFRICAN DEVELOPMENT FOUNDATION GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT... reasonable belief that a particular act or omission has occurred. ...

VLPs of HCV local isolates for HCV immunoassay diagnostic approach in Indonesia

NASA Astrophysics Data System (ADS)

Prasetyo, Afiono Agung

2017-01-01

Hepatitis C Virus (HCV) infection is a major global disease which often leads to morbidity and mortality. Low survival is related to the lack of adequate diagnostic because HCV infection is frequently asymptomatic and there are no specific diagnostic tests due to the fast transformation of the virus. Here, we investigated the VLPs (virus-like particles) of HCV local isolate as an immunoassay diagnostic approach to detect HCV infection, especially in Indonesia. The core, E1, and E2 of HCV local isolate genes were cloned and molecular analyzed, either as single or in recombinant-VLP form, to determine the molecular and chemical characteristics of each VLPs related to their potential use as an immunoassay detection method for HCV infection. The results indicated the molecular and chemical character of each VLPs are comparable. Conclusion: VLPs of HCV has the potential as an immunoassay diagnostic approach to detect HCV infection.

Asperger syndrome in males over two decades: Quality of life in relation to diagnostic stability and psychiatric comorbidity.

PubMed

Helles, Adam; Gillberg, I Carina; Gillberg, Christopher; Billstedt, Eva

2017-05-01

This study examined objective quality of life (work, academic success, living situation, relationships, support system) and subjective quality of life (Sense of Coherence and Short-Form Health Survey-36) in an adult sample of males ( n = 50, mean age: 30 years) with Asperger syndrome diagnosed in childhood and followed prospectively over two decades. The association between long-term diagnostic stability of an autism spectrum disorder and/or comorbid psychiatric disorders with quality of life was also examined. The results showed great variability as regards quality of life. The subsample that no longer fulfilled an autism spectrum disorder had full-time jobs or studies (10/11), independent living (100%), and reported having two or more friends (100%). In the stable autism spectrum disorder group, 41% had full-time job or studies, 51% lived independently, and 33% reported two or more friends, and a significant minority had specialized employments, lived with support from the government, or had no friends. Academic success was positively correlated with IQ. A majority of the total group scored average Sense of Coherence scores, and the mean for Short-Form Health Survey-36 was above average regarding psychical health and below average regarding mental health. Stability of autism spectrum disorder diagnosis was associated with objective but not subjective quality of life, while psychiatric comorbidity was associated with subjective but not objective quality of life.

22 CFR 208.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Adequate evidence. 208.900 Section 208.900 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

22 CFR 208.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Adequate evidence. 208.900 Section 208.900 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

Assessment of radiological protection systems among diagnostic radiology facilities in North East India.

PubMed

Singh, Thokchom Dewan; Jayaraman, T; Arunkumar Sharma, B

2017-03-01

This study aims to assess the adequacy level of radiological protection systems available in the diagnostic radiology facilities located in three capital cities of North East (NE) India. It further attempts to understand, using a multi-disciplinary approach, how the safety codes/standards in diagnostic radiology framed by the Atomic Energy Regulatory Board (AERB) and the International Atomic Energy Agency (IAEA) to achieve adequate radiological protection in facilities, have been perceived, conceptualized, and applied accordingly in these facilities. About 30 diagnostic radiology facilities were randomly selected from three capitals of states in NE India; namely Imphal (Manipur), Shillong (Meghalaya) and Guwahati (Assam). A semi-structured questionnaire developed based on a multi-disciplinary approach was used for this study. It was observed that radiological practices undertaken in these facilities were not exactly in line with safety codes/standards in diagnostic radiology of the AERB and the IAEA. About 50% of the facilities had registered/licensed x-ray equipment with the AERB. More than 80% of the workers did not use radiation protective devices, although these devices were available in the facilities. About 85% of facilities had no institutional risk management system. About 70% of the facilities did not carry out periodic quality assurance testing of their x-ray equipment or surveys of radiation leakage around the x-ray room, and did not display radiation safety indicators in the x-ray rooms. Workers in these facilities exhibited low risk perception about the risks associated with these practices. The majority of diagnostic radiology facilities in NE India did not comply with the radiological safety codes/standards framed by the AERB and IAEA. The study found inadequate levels of radiological protection systems in the majority of facilities. This study suggests a need to establish firm measures that comply with the radiological safety codes/standards of the

10 CFR 503.35 - Inability to obtain adequate capital.

Code of Federal Regulations, 2010 CFR

2010-01-01

... capital investment, through tariffs, without unreasonably adverse economic effect on its service area... 10 Energy 4 2010-01-01 2010-01-01 false Inability to obtain adequate capital. 503.35 Section 503... New Facilities § 503.35 Inability to obtain adequate capital. (a) Eligibility. Section 212(a)(1)(D) of...

"Something Adequate"? In Memoriam Seamus Heaney, Sister Quinlan, Nirbhaya

ERIC Educational Resources Information Center

Parker, Jan

2014-01-01

Seamus Heaney talked of poetry's responsibility to represent the "bloody miracle", the "terrible beauty" of atrocity; to create "something adequate". This article asks, what is adequate to the burning and eating of a nun and the murderous gang rape and evisceration of a medical student? It considers Njabulo Ndebele's…

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS... belief that a particular act or omission has occurred. ...

Diagnostic performance of serological assays for anti-HBs testing: Results from a quality assessment program.

PubMed

Raven, Stijn; Hautvast, Jeannine; Steenbergen, Jim van; Akkermans, Reinier; Weykamp, Cas; Smits, Francis; Hoebe, Christian; Vossen, Ann

2017-02-01

Post-vaccination testing after hepatitis B vaccination is indispensable to evaluate long-term immunological protection. Using a threshold level of antibodies against hepatitis B surface antigen (anti-HBs) to define serological protection, implies reproducible and valid measurements of different diagnostic assays. In this study we assess the performance of currently used anti-HBs assays. In 2013, 45 laboratories participated in an external quality assessment program using pooled anti-HBs serum samples around the cutoff values 10IU/l and 100IU/l. Laboratories used either Axsym (Abbott Laboratories), Architect (Abbott Laboratories), Access (Beckman-Coulter), ADVIA Centaur anti-HBs2 (Siemens Healthcare Diagnostics), Elecsys, Modular or Cobas (Roche Diagnostics) or Vidas Total Quick (Biomerieux) for anti-HBs titre quantification. We analysed covariance using mixed-model repeated measures. To assess sensitivity/specificity and agreement, a true positive or true negative result was defined as an anti-HBs titre respectively above or below the cutoff value by ≥4 of 6 assays. Different anti-HBs assays were associated with statistically significant (P<0.05) differences in anti-HBs titres in all dilutions. Sensitivity and specificity ranged respectively from 64%-100% and 95%-100%. Agreement between assays around an anti-HBs titre cutoff value of 10IU/l ranged from 93%-100% and was 44% for a cutoff value of 100IU/l. Around a cutoff value of 10IU/l use of the Access assay may result in false-negative results. Concerning the cutoff value of 100IU/l, a sample being classified below or above this cutoff relied heavily on the specific assay used, with both the Architect and the Access resulting in false-negative results. Copyright © 2016 Elsevier B.V. All rights reserved.

Systematic Review of the Diagnostic Accuracy and Therapeutic Effectiveness of Sacroiliac Joint Interventions.

PubMed

Simopoulos, Thomas T; Manchikanti, Laxmaiah; Gupta, Sanjeeva; Aydin, Steve M; Kim, Chong Hwan; Solanki, Daneshvari; Nampiaparampil, Devi E; Singh, Vijay; Staats, Peter S; Hirsch, Joshua A

2015-01-01

The sacroiliac joint is well known as a cause of low back and lower extremity pain. Prevalence estimates are 10% to 25% in patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis based on multiple diagnostic studies and systematic reviews. However, at present there are no definitive management options for treating sacroiliac joint pain. To evaluate the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. A systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. The available literature on diagnostic and therapeutic sacroiliac joint interventions was reviewed. The quality assessment criteria utilized were the Quality Appraisal of Reliability Studies (QAREL) checklist for diagnostic accuracy studies, Cochrane review criteria to assess sources of risk of bias, and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) criteria for randomized therapeutic trials and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for observational therapeutic assessments. The level of evidence was based on a best evidence synthesis with modified grading of qualitative evidence from Level I to Level V. Data sources included relevant literature published from 1966 through March 2015 that were identified through searches of PubMed and EMBASE, manual searches of the bibliographies of known primary and review articles, and all other sources. For the diagnostic accuracy assessment, and for the therapeutic modalities, the primary outcome measure of pain relief and improvement in functional status were utilized. A total of 11 diagnostic accuracy studies and 14 therapeutic studies were included. The evidence for diagnostic accuracy is Level II for dual diagnostic blocks with at least 70% pain relief as the criterion

21 CFR 1404.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

29 CFR 1471.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 4 2011-07-01 2011-07-01 false Adequate evidence. 1471.900 Section 1471.900 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE GOVERNMENTWIDE DEBARMENT... information sufficient to support the reasonable belief that a particular act or omission has occurred. ...

21 CFR 1404.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 9 2014-04-01 2014-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

29 CFR 1471.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 4 2014-07-01 2014-07-01 false Adequate evidence. 1471.900 Section 1471.900 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE GOVERNMENTWIDE DEBARMENT... information sufficient to support the reasonable belief that a particular act or omission has occurred. ...

29 CFR 1471.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 4 2012-07-01 2012-07-01 false Adequate evidence. 1471.900 Section 1471.900 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE GOVERNMENTWIDE DEBARMENT... information sufficient to support the reasonable belief that a particular act or omission has occurred. ...

21 CFR 1404.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 9 2013-04-01 2013-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

21 CFR 1404.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 9 2012-04-01 2012-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

29 CFR 1471.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Adequate evidence. 1471.900 Section 1471.900 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE GOVERNMENTWIDE DEBARMENT... information sufficient to support the reasonable belief that a particular act or omission has occurred. ...

21 CFR 1404.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION... support the reasonable belief that a particular act or omission has occurred. ...

29 CFR 1471.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 4 2013-07-01 2013-07-01 false Adequate evidence. 1471.900 Section 1471.900 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE GOVERNMENTWIDE DEBARMENT... information sufficient to support the reasonable belief that a particular act or omission has occurred. ...

Establishment of local diagnostic reference levels for quality control in intraoral radiography.

PubMed

Izawa, Maki; Harata, Yasuo; Shiba, Noriyoshi; Koizumi, Nobuhide; Ozawa, Tomonori; Takahashi, Nobutoshi; Okumura, Yasuhiko

2017-01-01

To investigate the dosage and imaging conditions for patients undergoing intraoral radiography at Meikai University Hospital and establish assurance and quality control data. Tube voltage, exposure time, and air kinetic energy released per unit mass (air kerma) of three intraoral radiography units were measured. To calculate the patient entrance dose (PED) for each radiograph using Insight film, we extracted data for 1063 patients from their exposure records. The PED was compared with the diagnostic reference level (DRL) from the European Commission and the UK. The tube voltage of the three units was maintained at 60 ± 2 kV. Differences in exposure time were less than 1.7 % for all units. The air kerma rates were well maintained within a 4.2 % error. Based on the patient data, there were no significant differences in the mean exposure times for males and females for all anatomical sites. The mean PED ranged from 1.09 ± 0.31 mGy for the mandibular incisors to 2.42 ± 0.33 mGy for the maxillary molars. The mean PED at the mandibular molars using InSight film was 1.59 ± 0.20 mGy, being less than the recommended value based on the DRL for intraoral radiography in the UK. We concluded that radiographic conditions at the hospital have been properly maintained. This basic quality control data may assist other dental radiation facilities to reduce patient dosage.

Diagnostic air quality model evaluation of source-specific primary and secondary fine particulate carbon.

PubMed

Napelenok, Sergey L; Simon, Heather; Bhave, Prakash V; Pye, Havala O T; Pouliot, George A; Sheesley, Rebecca J; Schauer, James J

2014-01-01

Ambient measurements of 78 source-specific tracers of primary and secondary carbonaceous fine particulate matter collected at four midwestern United States locations over a full year (March 2004-February 2005) provided an unprecedented opportunity to diagnostically evaluate the results of a numerical air quality model. Previous analyses of these measurements demonstrated excellent mass closure for the variety of contributing sources. In this study, a carbon-apportionment version of the Community Multiscale Air Quality (CMAQ) model was used to track primary organic and elemental carbon emissions from 15 independent sources such as mobile sources and biomass burning in addition to four precursor-specific classes of secondary organic aerosol (SOA) originating from isoprene, terpenes, aromatics, and sesquiterpenes. Conversion of the source-resolved model output into organic tracer concentrations yielded a total of 2416 data pairs for comparison with observations. While emission source contributions to the total model bias varied by season and measurement location, the largest absolute bias of -0.55 μgC/m(3) was attributed to insufficient isoprene SOA in the summertime CMAQ simulation. Biomass combustion was responsible for the second largest summertime model bias (-0.46 μgC/m(3) on average). Several instances of compensating errors were also evident; model underpredictions in some sectors were masked by overpredictions in others.

Next Generation Quality: Assessing the Physician in Clinical History Completeness and Diagnostic Interpretations Using Funnel Plots and Normalized Deviations Plots in 3,854 Prostate Biopsies.

PubMed

Bonert, Michael; El-Shinnawy, Ihab; Carvalho, Michael; Williams, Phillip; Salama, Samih; Tang, Damu; Kapoor, Anil

2017-01-01

Observational data and funnel plots are routinely used outside of pathology to understand trends and improve performance. Extract diagnostic rate (DR) information from free text surgical pathology reports with synoptic elements and assess whether inter-rater variation and clinical history completeness information useful for continuous quality improvement (CQI) can be obtained. All in-house prostate biopsies in a 6-year period at two large teaching hospitals were extracted and then diagnostically categorized using string matching, fuzzy string matching, and hierarchical pruning. DRs were then stratified by the submitting physicians and pathologists. Funnel plots were created to assess for diagnostic bias. 3,854 prostate biopsies were found and all could be diagnostically classified. Two audits involving the review of 700 reports and a comparison of the synoptic elements with the free text interpretations suggest a categorization error rate of <1%. Twenty-seven pathologists each read >40 cases and together assessed 3,690 biopsies. There was considerable inter-rater variability and a trend toward more World Health Organization/International Society of Urologic Pathology Grade 1 cancers in older pathologists. Normalized deviations plots, constructed using the median DR, and standard error can elucidate associated over- and under-calls for an individual pathologist in relation to their practice group. Clinical history completeness by submitting medical doctor varied significantly (100% to 22%). Free text data analyses have some limitations; however, they could be used for data-driven CQI in anatomical pathology, and could lead to the next generation in quality of care.

Rapid diagnostic tests for malaria

PubMed Central

Daily, Jennifer; Hotte, Nora; Dolkart, Caitlin; Cunningham, Jane; Yadav, Prashant

2015-01-01

Abstract Maintaining quality, competitiveness and innovation in global health technology is a constant challenge for manufacturers, while affordability, access and equity are challenges for governments and international agencies. In this paper we discuss these issues with reference to rapid diagnostic tests for malaria. Strategies to control and eliminate malaria depend on early and accurate diagnosis. Rapid diagnostic tests for malaria require little training and equipment and can be performed by non-specialists in remote settings. Use of these tests has expanded significantly over the last few years, following recommendations to test all suspected malaria cases before treatment and the implementation of an evaluation programme to assess the performance of the malaria rapid diagnostic tests. Despite these gains, challenges exist that, if not addressed, could jeopardize the progress made to date. We discuss recent developments in rapid diagnostic tests for malaria, highlight some of the challenges and provide suggestions to address them. PMID:26668438

Adherence to Standards for Reporting Diagnostic Accuracy in Emergency Medicine Research.

PubMed

Gallo, Lucas; Hua, Nadia; Mercuri, Mathew; Silveira, Angela; Worster, Andrew

2017-08-01

Diagnostic tests are used frequently in the emergency department (ED) to guide clinical decision making and, hence, influence clinical outcomes. The Standards for Reporting of Diagnostic Accuracy (STARD) criteria were developed to ensure that diagnostic test studies are performed and reported to best inform clinical decision making in the ED. The objective was to determine the extent to which diagnostic studies published in emergency medicine journals adhered to STARD 2003 criteria. Diagnostic studies published in eight MEDLINE-listed, peer-reviewed, emergency medicine journals over a 5-year period were reviewed for compliance to STARD criteria. A total of 12,649 articles were screened and 114 studies were included in our study. Twenty percent of these were randomly selected for assessment using STARD 2003 criteria. Adherence to STARD 2003 reporting standards for each criteria ranged from 8.7% adherence (criteria-reporting adverse events from performing index test or reference standard) to 100% (multiple criteria). Just over half of STARD criteria are reported in more than 80% studies. As poorly reported studies may negatively impact their clinical usefulness, it is essential that studies of diagnostic test accuracy be performed and reported adequately. Future studies should assess whether studies have improved compliance with the STARD 2015 criteria amendment. © 2017 by the Society for Academic Emergency Medicine.

Importance of methodology on (99m)technetium dimercapto-succinic acid scintigraphic image quality: imaging pilot study for RIVUR (Randomized Intervention for Children With Vesicoureteral Reflux) multicenter investigation.

PubMed

Ziessman, Harvey A; Majd, Massoud

2009-07-01

We reviewed our experience with (99m)technetium dimercapto-succinic acid scintigraphy obtained during an imaging pilot study for a multicenter investigation (Randomized Intervention for Children With Vesicoureteral Reflux) of the effectiveness of daily antimicrobial prophylaxis for preventing recurrent urinary tract infection and renal scarring. We analyzed imaging methodology and its relation to diagnostic image quality. (99m)Technetium dimercapto-succinic acid imaging guidelines were provided to participating sites. High-resolution planar imaging with parallel hole or pinhole collimation was required. Two core reviewers evaluated all submitted images. Analysis included appropriate views, presence or lack of patient motion, adequate magnification, sufficient counts and diagnostic image quality. Inter-reader agreement was evaluated. We evaluated 70, (99m)technetium dimercapto-succinic acid studies from 14 institutions. Variability was noted in methodology and image quality. Correlation (r value) between dose administered and patient age was 0.780. For parallel hole collimator imaging good correlation was noted between activity administered and counts (r = 0.800). For pinhole imaging the correlation was poor (r = 0.110). A total of 10 studies (17%) were rejected for quality issues of motion, kidney overlap, inadequate magnification, inadequate counts and poor quality images. The submitting institution was informed and provided with recommendations for improving quality, and resubmission of another study was required. Only 4 studies (6%) were judged differently by the 2 reviewers, and the differences were minor. Methodology and image quality for (99m)technetium dimercapto-succinic acid scintigraphy varied more than expected between institutions. The most common reason for poor image quality was inadequate count acquisition with insufficient attention to the tradeoff between administered dose, length of image acquisition, start time of imaging and resulting image

31 CFR 19.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND... sufficient to support the reasonable belief that a particular act or omission has occurred. ...

31 CFR 19.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND... sufficient to support the reasonable belief that a particular act or omission has occurred. ...

34 CFR 85.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Adequate evidence. 85.900 Section 85.900 Education Office of the Secretary, Department of Education GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT... reasonable belief that a particular act or omission has occurred. (Authority: E.O. 12549 (3 CFR, 1986 Comp...

31 CFR 19.900 - Adequate evidence.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND... sufficient to support the reasonable belief that a particular act or omission has occurred. ...

31 CFR 19.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND... sufficient to support the reasonable belief that a particular act or omission has occurred. ...

34 CFR 85.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Adequate evidence. 85.900 Section 85.900 Education Office of the Secretary, Department of Education GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT... reasonable belief that a particular act or omission has occurred. Authority: E.O. 12549 (3 CFR, 1986 Comp., p...

31 CFR 19.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Adequate evidence. 19.900 Section 19.900 Money and Finance: Treasury Office of the Secretary of the Treasury GOVERNMENTWIDE DEBARMENT AND... sufficient to support the reasonable belief that a particular act or omission has occurred. ...

Biomarkers for the differentiation of sepsis and SIRS: the need for the standardisation of diagnostic studies.

PubMed

Hall, T C; Bilku, D K; Al-Leswas, D; Horst, C; Dennison, A R

2011-12-01

Sepsis is a leading cause of death in the critically ill patient. It is a heterogeneous disease and it is frequently difficult to make an unequivocal and expeditious diagnosis. The current 'gold standard' in diagnosing sepsis is the blood culture but this is only available after a significant time delay. Mortality rates from sepsis remain high, however, the introduction of sepsis care bundles in its management has produced significant improvements in patient outcomes. Central to goal-directed resuscitation is the timely and accurate diagnosis of sepsis. The rapid diagnosis and commencement of the appropriate therapies has been shown to reduce the mortality. Biomarkers are already used in clinical practice to aid other more traditional diagnostic tests. In the absence of an adequate gold standard to diagnose sepsis, there has been considerable and growing interest in trying to identify suitable biomarkers. There is currently an unmet need in the medical literature to communicate the importance of the challenges relating to the rapid diagnosis and implementation of goal-directed therapy in sepsis and the underlying concepts that are directing these investigations. This article reviews the more novel biomarkers investigated to differentiate systemic inflammatory response syndrome from sepsis. The biomarkers described reflect the difficulties in making evidence-based recommendations particularly when interpreting studies where the methodology is of poor quality and the results are conflicting. We are reminded of our responsibilities to ensure high quality and standardised study design as articulated by the STAndards for the Reporting of Diagnostic accuracy studies (STARD) initiative.

Quality of routine diagnostic abdominal images generated from a novel detector-based spectral CT scanner: a technical report on a phantom and clinical study.

PubMed

Hojjati, Mojgan; Van Hedent, Steven; Rassouli, Negin; Tatsuoka, Curtis; Jordan, David; Dhanantwari, Amar; Rajiah, Prabhakar

2017-11-01

To evaluate the image quality of routine diagnostic images generated from a novel detector-based spectral detector CT (SDCT) and compare it with CT images obtained from a conventional scanner with an energy-integrating detector (Brilliance iCT), Routine diagnostic (conventional/polyenergetic) images are non-material-specific images that resemble single-energy images obtained at the same radiation, METHODS: ACR guideline-based phantom evaluations were performed on both SDCT and iCT for CT adult body protocol. Retrospective analysis was performed on 50 abdominal CT scans from each scanner. Identical ROIs were placed at multiple locations in the abdomen and attenuation, noise, SNR, and CNR were measured. Subjective image quality analysis on a 5-point Likert scale was performed by 2 readers for enhancement, noise, and image quality. On phantom studies, SDCT images met the ACR requirements for CT number and deviation, CNR and effective radiation dose. In patients, the qualitative scores were significantly higher for the SDCT than the iCT, including enhancement (4.79 ± 0.38 vs. 4.60 ± 0.51, p = 0.005), noise (4.63 ± 0.42 vs. 4.29 ± 0.50, p = 0.000), and quality (4.85 ± 0.32, vs. 4.57 ± 0.50, p = 0.000). The SNR was higher in SDCT than iCT for liver (7.4 ± 4.2 vs. 7.2 ± 5.3, p = 0.662), spleen (8.6 ± 4.1 vs. 7.4 ± 3.5, p = 0.152), kidney (11.1 ± 6.3 vs. 8.7 ± 5.0, p = 0.033), pancreas (6.90 ± 3.45 vs 6.11 ± 2.64, p = 0.303), aorta (14.2 ± 6.2 vs. 11.0 ± 4.9, p = 0.007), but was slightly lower in lumbar-vertebra (7.7 ± 4.2 vs. 7.8 ± 4.5, p = 0.937). The CNR of the SDCT was also higher than iCT for all abdominal organs. Image quality of routine diagnostic images from the SDCT is comparable to images of a conventional CT scanner with energy-integrating detectors, making it suitable for diagnostic purposes.

Assessing Old and New Diagnostic Tests for Gastroesophageal Reflux Disease.

PubMed

Vaezi, Michael F; Sifrim, Daniel

2018-01-01

A detailed critique of objective measurements of gastroesophageal reflux disease (GERD) would improve management of patients suspecting of having reflux, leading to rational selection of treatment and better outcomes. Many diagnostic tests for GERD have been developed over the past decades. We analyze their development, positive- and negative-predictive values, and ability to predict response to treatment. These features are important for development of medical, surgical, and endoscopic therapies for GERD. We discuss the value of available diagnostic tests and review their role in management of patients with persistent reflux symptoms despite adequate medical or surgical treatment. This is becoming a significant health economic problem, due to the widespread use of proton pump inhibitors. GERD is believed to cause nonesophageal symptoms, such as those provoked by ear, nose, throat, or respiratory disorders. We analyze the value of GERD diagnostic tests in evaluation of these troublesome, nonesophageal symptoms. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

An audit of request forms submitted in a multidisciplinary diagnostic center in Lagos.

PubMed

Oyedeji, Olufemi Abiola; Ogbenna, Abiola Ann; Iwuala, Sandra Omozehio

2015-01-01

Request forms are important means of communication between physicians and diagnostic service providers. Pre-analytical errors account for over two thirds of errors encountered in diagnostic service provision. The importance of adequate completion of request forms is usually underestimated by physicians which may result in medical errors or delay in instituting appropriate treatment. The aim of this study was to audit the level of completion of request forms presented at a multidisciplinary diagnostic center. A review of all requests forms for investigations which included radiologic, laboratory and cardiac investigations received between July and December 2011 was performed to assess their level of completeness. The data was entered into a spreadsheet and analyzed. Only 1.3% of the 7,841 request forms reviewed were fully completed. Patient's names, the referring physician's name and gender were the most completed information on the forms evaluated with 99.0%, 99.0% and 90.3% completion respectively. Patient's age was provided in 68.0%, request date in 88.2%, and clinical notes/ diagnosis in 65.9% of the requests. Patient's full address was provided in only 5.6% of requests evaluated. This study shows that investigation request forms are inadequately filled by physicians in our environment. Continuous medical education of physicians on the need for adequate completion of request forms is needed.

Improvements of data quality of the LHD Thomson scattering diagnostics in high-temperature plasma experiments.

PubMed

Yamada, I; Narihara, K; Funaba, H; Hayashi, H; Kohmoto, T; Takahashi, H; Shimozuma, T; Kubo, S; Yoshimura, Y; Igami, H; Tamura, N

2010-10-01

In Large Helical Device (LHD) experiments, an electron temperature (T(e)) more than 15 keV has been observed by the yttrium-aluminum-garnet (YAG) laser Thomson scattering diagnostic. Since the LHD Thomson scattering system has been optimized for the temperature region, 50 eV≤T(e)≤10 keV, the data quality becomes worse in the higher T(e) region exceeding 10 keV. In order to accurately determine T(e) in the LHD high-T(e) experiments, we tried to increase the laser pulse energy by simultaneously firing three lasers. The technique enables us to decrease the uncertainties in the measured T(e). Another signal accumulation method was also tested. In addition, we estimated the influence of high-energy electrons on T(e) obtained by the LHD Thomson scattering system.

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... diagnostic system must monitor reductant quality and tank levels and alert operators to the need to refill... specified in § 1033.110 and an audible alarm. You do not need to separately monitor reductant quality if you include an exhaust NOX sensor (or other sensor) that allows you to determine inadequate reductant quality...

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... diagnostic system must monitor reductant quality and tank levels and alert operators to the need to refill... specified in § 1033.110 and an audible alarm. You do not need to separately monitor reductant quality if you include an exhaust NOX sensor (or other sensor) that allows you to determine inadequate reductant quality...

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... diagnostic system must monitor reductant quality and tank levels and alert operators to the need to refill... specified in § 1033.110 and an audible alarm. You do not need to separately monitor reductant quality if you include an exhaust NOX sensor (or other sensor) that allows you to determine inadequate reductant quality...

Microgravity Combustion Diagnostics Workshop

NASA Technical Reports Server (NTRS)

Santoro, Gilbert J. (Editor); Greenberg, Paul S. (Editor); Piltch, Nancy D. (Editor)

1988-01-01

Through the Microgravity Science and Applications Division (MSAD) of the Office of Space Science and Applications (OSSA) at NASA Headquarters, a program entitled, Advanced Technology Development (ATD) was promulgated with the objective of providing advanced technologies that will enable the development of future microgravity science and applications experimental flight hardware. Among the ATD projects one, Microgravity Combustion Diagnostics (MCD), has the objective of developing advanced diagnostic techniques and technologies to provide nonperturbing measurements of combustion characteristics and parameters that will enhance the scientific integrity and quality of microgravity combustion experiments. As part of the approach to this project, a workshop was held on July 28 and 29, 1987, at the NASA Lewis Research Center. A small group of laser combustion diagnosticians met with a group of microgravity combustion experimenters to discuss the science requirements, the state-of-the-art of laser diagnostic technology, and plan the direction for near-, intermediate-, and long-term programs. This publication describes the proceedings of that workshop.

A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center

PubMed Central

Sindhwani, Geetika; Gupta, Monica; Arora, Sweta; Mishra, Arpita; Bhatt, Jayesh; Arora, Manali; Gehani, Anisha

2017-01-01

Introduction An organization’s transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. Aim To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. Materials and Methods To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP’s), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. Results A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. Conclusion Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety. PMID:28969238

Performance of health laboratories in provision of HIV diagnostic and supportive services in selected districts of Tanzania.

PubMed

Ishengoma, Deus S; Kamugisha, Mathias L; Rutta, Acleus S M; Kagaruki, Gibson B; Kilale, Andrew M; Kahwa, Amos; Kamugisha, Erasmus; Baraka, Vito; Mandara, Celine I; Materu, Godlisten S; Massaga, Julius J; Magesa, Stephen M; Lemnge, Martha M; Mboera, Leonard E G

2017-01-23

Roll-out and implementation of antiretroviral therapy (ART) necessitated many countries in Sub-Saharan Africa to strengthen their national health laboratory systems (NHLSs) to provide high quality HIV diagnostic and supportive services. This study was conducted to assess the performance of health laboratories in provision of HIV diagnostic and supportive services in eight districts (from four regions of Iringa, Mtwara, Tabora and Tanga), after nine years of implementation of HIV/AIDS care and treatment plan in Tanzania. In this cross-sectional study, checklists and observations were utilized to collect information from health facilities (HFs) with care and treatment centres (CTCs) for HIV/AIDS patients; on availability of laboratories, CTCs, laboratory personnel, equipment and reagents. A checklist was also used to collect information on implementation of quality assurance (QA) systems at all levels of the NHLS in the study areas. The four regions had 354 HFs (13 hospitals, 41 Health Centres (HCs) and 300 dispensaries); whereby all hospitals had laboratories and 11 had CTCs while 97.5 and 61.0% of HCs had both laboratories and CTCs, respectively. Of the dispensaries, 36.0 and 15.0% had laboratories and CTCs (mainly in urban areas). Thirty nine HFs (12 hospitals, 21 HCs and six dispensaries) were assessed and 56.4% were located in urban areas. The assessed HFs had 199 laboratory staff of different cadres (laboratory assistants = 35.7%; technicians =32.7%; attendants = 22.6%; and others = 9.1%); with >61% of the staff and 72.3% of the technicians working in urban areas. All laboratories were using rapid diagnostic tests for HIV testing. Over 74% of the laboratories were performing internal quality control and 51.4% were participating in external QA programmes. Regional and district laboratories had all key equipment and harmonization was maintained for Fluorescence-Activated Cell Sorting (FACS) machines. Most of the biochemical (58.0%) and haematological

Funding the Formula Adequately in Oklahoma

ERIC Educational Resources Information Center

Hancock, Kenneth

2015-01-01

This report is a longevity, simulational study that looks at how the ratio of state support to local support effects the number of school districts that breaks the common school's funding formula which in turns effects the equity of distribution to the common schools. After nearly two decades of adequately supporting the funding formula, Oklahoma…

Quantitative analysis of genomic DNA degradation in whole blood under various storage conditions for molecular diagnostic testing.

PubMed

Permenter, Jessalyn; Ishwar, Arjun; Rounsavall, Angie; Smith, Maddie; Faske, Jennifer; Sailey, Charles J; Alfaro, Maria P

2015-12-01

Proper storage of whole blood is crucial for isolating nucleic acids from leukocytes and to ensure adequate performance of downstream assays in the molecular diagnostic laboratory. Short-term and long-term storage recommendations are lacking for successful isolation of genomic DNA (gDNA). Container type (EDTA or heparin), temperature (4 °C and room temperature) and time (1-130 days) were assessed as criterion for sample acceptance policies. The percentage of integrated area (%Ti) between 150 and 10,000 bp from the 2200 TapeStation electropherogram was calculated to measure gDNA degradation. Refrigerated EDTA samples yielded gDNA with low %Ti (high quality). Heparinized samples stored at room temperature yielded gDNA of worst quality. Downstream analysis demonstrated that the quality of the gDNA correlated with the quality of the data; samples with high %Ti generated significantly lower levels of high molecular weight amplicons. Recommendations from these analyses include storing blood samples intended for nucleic acid isolation in EDTA tubes at 4 °C for long term storage (>10 days). gDNA should be extracted within 3 days when blood is stored at room temperature regardless of the container. Finally, refrigerated heparinized samples should not be stored longer than 9 days if expecting high quality gDNA isolates. Laboratories should consider many factors, in addition to the results obtained herein, to update their policies for sample acceptance for gDNA extraction intended for molecular genetic testing. Copyright © 2015 Elsevier Ltd. All rights reserved.

Modeling Canadian Quality Control Test Program for Steroid Hormone Receptors in Breast Cancer: Diagnostic Accuracy Study.

PubMed

Pérez, Teresa; Makrestsov, Nikita; Garatt, John; Torlakovic, Emina; Gilks, C Blake; Mallett, Susan

The Canadian Immunohistochemistry Quality Control program monitors clinical laboratory performance for estrogen receptor and progesterone receptor tests used in breast cancer treatment management in Canada. Current methods assess sensitivity and specificity at each time point, compared with a reference standard. We investigate alternative performance analysis methods to enhance the quality assessment. We used 3 methods of analysis: meta-analysis of sensitivity and specificity of each laboratory across all time points; sensitivity and specificity at each time point for each laboratory; and fitting models for repeated measurements to examine differences between laboratories adjusted by test and time point. Results show 88 laboratories participated in quality control at up to 13 time points using typically 37 to 54 histology samples. In meta-analysis across all time points no laboratories have sensitivity or specificity below 80%. Current methods, presenting sensitivity and specificity separately for each run, result in wide 95% confidence intervals, typically spanning 15% to 30%. Models of a single diagnostic outcome demonstrated that 82% to 100% of laboratories had no difference to reference standard for estrogen receptor and 75% to 100% for progesterone receptor, with the exception of 1 progesterone receptor run. Laboratories with significant differences to reference standard identified with Generalized Estimating Equation modeling also have reduced performance by meta-analysis across all time points. The Canadian Immunohistochemistry Quality Control program has a good design, and with this modeling approach has sufficient precision to measure performance at each time point and allow laboratories with a significantly lower performance to be targeted for advice.

Diagnostic accuracy of scapular physical examination tests for shoulder disorders: a systematic review.

PubMed

Wright, Alexis A; Wassinger, Craig A; Frank, Mason; Michener, Lori A; Hegedus, Eric J

2013-09-01

To systematically review and critique the evidence regarding the diagnostic accuracy of physical examination tests for the scapula in patients with shoulder disorders. A systematic, computerised literature search of PubMED, EMBASE, CINAHL and the Cochrane Library databases (from database inception through January 2012) using keywords related to diagnostic accuracy of physical examination tests of the scapula. The Quality Assessment of Diagnostic Accuracy Studies tool was used to critique the quality of each paper. Eight articles met the inclusion criteria; three were considered to be of high quality. Of the three high-quality studies, two were in reference to a 'diagnosis' of shoulder pain. Only one high-quality article referenced specific shoulder pathology of acromioclavicular dislocation with reported sensitivity of 71% and 41% for the scapular dyskinesis and SICK scapula test, respectively. Overall, no physical examination test of the scapula was found to be useful in differentially diagnosing pathologies of the shoulder.

[Quality assurance in interventional cardiology].

PubMed

Gülker, H

2009-10-01

Quality assurance in clinical studies aiming at approval of pharmaceutical products is submitted to strict rules, controls and auditing regulations. Comparative instruments to ensure quality in diagnostic and therapeutic procedures are not available in interventional cardiology, likewise in other fields of cardiovascular medicine. Quality assurance simply consists of "quality registers" with basic data not externally controlled. Based on the experiences of clinical studies and their long history of standardization it is assumed that these data may be severely flawed thus being inappropriate to set standards for diagnostic and therapeutic strategies. The precondition for quality assurance are quality data. In invasive coronary angiography and intervention medical indications, the decision making process interventional versus surgical revascularization, technical performance and after - care are essential aspects affecting quality of diagnostics and therapy. Quality data are externally controlled data. To collect quality data an appropriate infrastructure is a necessary precondition which is not existent. For an appropriate infrastructure investments have to be done both to build up as well as to sustain the necessary preconditions. As long as there are no infrastructure and no investments there will be no "quality data". There exist simply registers of data which are not proved to be a basis for significant assurance and enhancement in quality in interventional coronary cardiology. Georg Thieme Verlag KG Stuttgart, New York.

Diagnostic yield of 90-kVp low-tube-voltage carotid and intracerebral CT-angiography: effects on radiation dose, image quality and diagnostic performance for the detection of carotid stenosis.

PubMed

Leithner, Doris; Wichmann, Julian L; Mahmoudi, Scherwin; Martin, Simon S; Albrecht, Moritz H; Vogl, Thomas J; Scholtz, Jan-Erik

2018-06-01

To investigate the impact of low-tube-voltage 90-kVp acquisition combined with advanced modeled iterative reconstruction algorithm (Admire) on radiation exposure, image quality, artifacts, and assessment of stenosis in carotid and intracranial CT angiography (CTA). Dual-energy CTA studies of 43 patients performed on a third-generation 192-slice dual-source CT were retrospectively evaluated. Intraindividual comparison of 90-kVp and linearly blended 120-kVp equivalent image series (M_0.6, 60% 90-kVp, 40% Sn-150-kVp) was performed. Contrast-to-noise and signal-to-noise ratios of common carotid artery, internal carotid artery, middle cerebral artery, and basilar artery were calculated. Qualitative image analysis included evaluation of artifacts and suitability for angiographical assessment at shoulder level, carotid bifurcation, siphon, and intracranial by three independent radiologists. Detection and quantification of carotid stenosis were performed. Radiation dose was expressed as dose-length product (DLP). Contrast-to-noise values of all arteries were significantly increased in 90-kVp compared to M_0.6 (p < 0.001). Suitability for angiographical evaluation was rated excellent with low artifacts for all levels in both image series. Both 90-kVp and M_0.6 showed excellent accordance for detection and grading of carotid stenosis with almost perfect interobserver agreement (carotid stenoses in 32 of 129 segments; intraclass correlation coefficient, 0.94). dose-length product was reduced by 40.3% in 90-kVp (110.6 ± 32.1 vs 185.4 ± 47.5 mGy·cm, p < 0.001). 90-kVp carotid and intracranial CTA with Admire provides increased quantitative and similarly good qualitative image quality, while reducing radiation exposure substantially compared to M_0.6. Diagnostic performance for arterial stenosis detection and quantification remained excellent. Advances in knowledge: 90-kVp carotid and intracranial CTA with an advanced iterative reconstruction algorithm results in

An overview of ITER diagnostics (invited)

NASA Astrophysics Data System (ADS)

Young, Kenneth M.; Costley, A. E.; ITER-JCT Home Team; ITER Diagnostics Expert Group

1997-01-01

The requirements for plasma measurements for operating and controlling the ITER device have now been determined. Initial criteria for the measurement quality have been set, and the diagnostics that might be expected to achieve these criteria have been chosen. The design of the first set of diagnostics to achieve these goals is now well under way. The design effort is concentrating on the components that interact most strongly with the other ITER systems, particularly the vacuum vessel, blankets, divertor modules, cryostat, and shield wall. The relevant details of the ITER device and facility design and specific examples of diagnostic design to provide the necessary measurements are described. These designs have to take account of the issues associated with very high 14 MeV neutron fluxes and fluences, nuclear heating, high heat loads, and high mechanical forces that can arise during disruptions. The design work is supported by an extensive research and development program, which to date has concentrated on the effects these levels of radiation might cause on diagnostic components. A brief outline of the organization of the diagnostic development program is given.

Fundamentals of quality and safety in diagnostic radiology.

PubMed

Bruno, Michael A; Nagy, Paul

2014-12-01

The most fundamental aspects of quality and safety in radiology are reviewed, including a brief history of the quality and safety movement as applied to radiology, the overarching considerations of organizational culture, team building, choosing appropriate goals and metrics, and the radiologist's quality "tool kit." Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

Code of Federal Regulations, 2010 CFR

2010-01-01

... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE... adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall provide adequate veterinary care to its animals in compliance with this section: (1) Each research facility shall...

9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

Code of Federal Regulations, 2011 CFR

2011-01-01

... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE... adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall provide adequate veterinary care to its animals in compliance with this section: (1) Each research facility shall...

Pulmonary Infiltrates in Immunosuppressed Patients: Analysis of a Diagnostic Protocol

PubMed Central

Danés, Cristina; González-Martín, Julián; Pumarola, Tomàs; Rañó, Ana; Benito, Natividad; Torres, Antoni; Moreno, Asunción; Rovira, Montserrat; Puig de la Bellacasa, Jorge

2002-01-01

A diagnostic protocol was started to study the etiology of pulmonary infiltrates in immunosuppressed patients. The diagnostic yields of the different techniques were analyzed, with special emphasis on the importance of the sample quality and the role of rapid techniques in the diagnostic strategy. In total, 241 patients with newly developed pulmonary infiltrates within a period of 19 months were included. Noninvasive or invasive evaluation was performed according to the characteristics of the infiltrates. Diagnosis was achieved in 202 patients (84%); 173 patients (72%) had pneumonia, and specific etiologic agents were found in 114 (66%). Bronchoaspirate and bronchoalveolar lavage showed the highest yields, either on global analysis (23 of 35 specimens [66%] and 70 of 134 specimens [52%], respectively) or on analysis of each type of pneumonia. A tendency toward better results with optimal-quality samples was observed, and a statistically significant difference was found in sputum bacterial culture. Rapid diagnostic tests yielded results in 71 of 114 (62.2%) diagnoses of etiological pneumonia. PMID:12037077

Feasibility and quality of nonmydriatic fundus photography in children

PubMed Central

Toffoli, Daniela; Bruce, Beau B.; Lamirel, Cédric; Henderson, Amanda D.; Newman, Nancy J.; Biousse, Valérie

2011-01-01

Purpose Ocular funduscopic examination is difficult in young children and is rarely attempted by nonophthalmologists. Our objective was to determine the feasibility of reliably obtaining high-quality nonmydriatic fundus photographs in children. Methods Nonmydriatic fundus photographs were obtained in both eyes of children seen in a pediatric ophthalmology clinic. Ease of fundus photography was recorded on a 10-point Likert scale (10 = very easy). Quality was graded from 1 to 5 (1, inadequate for any diagnostic purpose; 2, unable to exclude all emergent findings; 3, only able to exclude emergent findings; 4, not ideal, but still able to exclude subtle findings; and 5, ideal quality). The primary outcome measure was image quality by age. Results A total of 878 photographs of 212 children (median age, 6 years; range,1-18 years) were included. Photographs of at least one eye were obtained in 190 children (89.6%) and in both eyes in 181 (85.3%). Median rating for ease of photography was 7. Photographs of some clinical value (grade ≥2) were obtained in 33% of children <3 years and 95% >3 years. High-quality photographs (grade 4 or 5) were obtained in both eyes in 7% of children <3 years, 57% of children ≥3 to <7 years, 85% of children ≥7 to <9 years, and 65% of children ≥9 years. The youngest patient with high-quality photographs in both eyes was 22 months. Conclusions Nonmydriatic fundus photographs of adequate quality can be obtained in children over age 3 and in some children as young as 22 months. PMID:22153402

Diagnostic accuracy of refractometry for assessing bovine colostrum quality: A systematic review and meta-analysis.

PubMed

Buczinski, S; Vandeweerd, J M

2016-09-01

Provision of good quality colostrum [i.e., immunoglobulin G (IgG) concentration ≥50g/L] is the first step toward ensuring proper passive transfer of immunity for young calves. Precise quantification of colostrum IgG levels cannot be easily performed on the farm. Assessment of the refractive index using a Brix scale with a refractometer has been described as being highly correlated with IgG concentration in colostrum. The aim of this study was to perform a systematic review of the diagnostic accuracy of Brix refractometry to diagnose good quality colostrum. From 101 references initially obtain ed, 11 were included in the systematic review meta-analysis representing 4,251 colostrum samples. The prevalence of good colostrum samples with IgG ≥50g/L varied from 67.3 to 92.3% (median 77.9%). Specific estimates of accuracy [sensitivity (Se) and specificity (Sp)] were obtained for different reported cut-points using a hierarchical summary receiver operating characteristic curve model. For the cut-point of 22% (n=8 studies), Se=80.2% (95% CI: 71.1-87.0%) and Sp=82.6% (71.4-90.0%). Decreasing the cut-point to 18% increased Se [96.1% (91.8-98.2%)] and decreased Sp [54.5% (26.9-79.6%)]. Modeling the effect of these Brix accuracy estimates using a stochastic simulation and Bayes theorem showed that a positive result with the 22% Brix cut-point can be used to diagnose good quality colostrum (posttest probability of a good colostrum: 94.3% (90.7-96.9%). The posttest probability of good colostrum with a Brix value <18% was only 22.7% (12.3-39.2%). Based on this study, the 2 cut-points could be alternatively used to select good quality colostrum (sample with Brix ≥22%) or to discard poor quality colostrum (sample with Brix <18%). When sample results are between these 2 values, colostrum supplementation should be considered. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

The Development of a Dental Diagnostic Terminology

PubMed Central

Kalenderian, Elsbeth; Ramoni, Rachel L.; White, Joel M.; Schoonheim-Klein, Meta E.; Stark, Paul C.; Kimmes, Nicole S.; Zeller, Gregory G.; Willis, George P.; Walji, Muhammad F.

2011-01-01

There is no commonly accepted standardized terminology for oral diagnoses. The purpose of this article is to report the development of a standardized dental diagnostic terminology by a work group of dental faculty members. The work group developed guiding principles for decision making and adhered to principles of terminology development. The members used an iterative process to develop a terminology incorporating concepts represented in the Toronto/University of California, San Francisco/Creighton University and International Classification of Diseases (ICD)-9/10 codes and periodontal and endodontic diagnoses. Domain experts were consulted to develop a final list of diagnostic terms. A structure was developed, consisting of thirteen categories, seventy-eight subcategories, and 1,158 diagnostic terms, hierarchically organized and mappable to other terminologies and ontologies. Use of this standardized diagnostic terminology will reinforce the diagnosis-treatment link and will facilitate clinical research, quality assurance, and patient communication. Future work will focus on implementation and approaches to enhance the validity and reliability of diagnostic term utilization. PMID:21205730

Investigating the Link Between Radiologists Gaze, Diagnostic Decision, and Image Content

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tourassi, Georgia; Voisin, Sophie; Paquit, Vincent C

2013-01-01

Objective: To investigate machine learning for linking image content, human perception, cognition, and error in the diagnostic interpretation of mammograms. Methods: Gaze data and diagnostic decisions were collected from six radiologists who reviewed 20 screening mammograms while wearing a head-mounted eye-tracker. Texture analysis was performed in mammographic regions that attracted radiologists attention and in all abnormal regions. Machine learning algorithms were investigated to develop predictive models that link: (i) image content with gaze, (ii) image content and gaze with cognition, and (iii) image content, gaze, and cognition with diagnostic error. Both group-based and individualized models were explored. Results: By poolingmore » the data from all radiologists machine learning produced highly accurate predictive models linking image content, gaze, cognition, and error. Merging radiologists gaze metrics and cognitive opinions with computer-extracted image features identified 59% of the radiologists diagnostic errors while confirming 96.2% of their correct diagnoses. The radiologists individual errors could be adequately predicted by modeling the behavior of their peers. However, personalized tuning appears to be beneficial in many cases to capture more accurately individual behavior. Conclusions: Machine learning algorithms combining image features with radiologists gaze data and diagnostic decisions can be effectively developed to recognize cognitive and perceptual errors associated with the diagnostic interpretation of mammograms.« less

Adequate Initial Antidepressant Treatment Among Patients With Chronic Obstructive Pulmonary Disease in a Cohort of Depressed Veterans

PubMed Central

Pirraglia, Paul A.; Charbonneau, Andrea; Kader, Boris; Berlowitz, Dan R.

2006-01-01

Objective: Depression is common among patients with chronic obstructive pulmonary disease (COPD). Patients with COPD may be more likely to have inadequate treatment with antidepressant medications. We tested the hypothesis that depressed patients with COPD have lower odds of adequate duration of antidepressant therapy in the first 3 months of treatment compared to those without COPD. Method: Using administrative and centralized pharmacy data from 14 northeastern Veterans Affairs Medical Centers, we identified 778 veterans with depression (ICD-9-CM codes 296.2x, 296.3x, and 311.xx) who were in the acute phase of antidepressant treatment from June 1, 1999, through August 31, 1999. Within this group, we identified those patients with COPD (23%). An adequate duration of antidepressant treatment was defined as ≥ 80% of days on an antidepressant. We used multivariable logistic regression models to determine the adjusted odds of adequate acute phase antidepressant treatment duration. Results: Those patients with COPD had markedly lower odds of adequate acute phase treatment duration (odds ratio = 0.67, 95% CI = 0.47 to 0.96); this was not observed with other medical diagnoses such as coronary heart disease, diabetes mellitus, or osteoarthritis. Conclusions: The first few months of treatment appears to be a critical period for depressed patients with COPD who are started on antidepressants. The causes for early antidepressant treatment inadequacy among patients with COPD require further investigation. More intensive efforts may be necessary early in the course of treatment to assure high-quality pharmacologic therapy of depressed patients with COPD. PMID:16862230

Measures to Improve Diagnostic Safety in Clinical Practice

PubMed Central

Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

2016-01-01

Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of “diagnostic safety” related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety, and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm. PMID:27768655

A risk index for pediatric patients undergoing diagnostic imaging with 99mTc-dimercaptosuccinic acid that accounts for body habitus

NASA Astrophysics Data System (ADS)

O'Reilly, Shannon E.; Plyku, Donika; Sgouros, George; Fahey, Frederic H.; Treves, S. Ted; Frey, Eric C.; Bolch, Wesley E.

2016-03-01

Published guidelines for administered activity to pediatric patients undergoing diagnostic nuclear medicine imaging are currently obtained through expert consensus of the minimum values as a function of body weight as required to yield diagnostic quality images. We have previously shown that consideration of body habitus is also important in obtaining diagnostic quality images at the lowest administered activity. The objective of this study was to create a series of computational phantoms that realistically portray the anatomy of the pediatric patient population which can be used to develop and validate techniques to minimize radiation dose while maintaining adequate image quality. To achieve this objective, we have defined an imaging risk index that may be used in future studies to develop pediatric patient dosing guidelines. A population of 48 hybrid phantoms consisting of non-uniform B-spline surfaces and polygon meshes was generated. The representative ages included the newborn, 1 year, 5 year, 10 year and 15 year male and female. For each age, the phantoms were modeled at their 10th, 50th, and 90th height percentile each at a constant 50th weight percentile. To test the impact of kidney size, the newborn phantoms were modeled with the following three kidney volumes:  -15%, average, and  +15%. To illustrate the impact of different morphologies on dose optimization, we calculated the effective dose for each phantom using weight-based 99mTc-DMSA activity administration. For a given patient weight, body habitus had a considerable effect on effective dose. Substantial variations were observed in the risk index between the 10th and 90th percentile height phantoms from the 50th percentile phantoms for a given age, with the greatest difference being 18%. There was a dependence found between kidney size and risk of radiation induced kidney cancer, with the highest risk indices observed in newborns with the smallest kidneys. Overall, the phantoms and techniques

The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children.

PubMed

Jaiswal, Nidhi; Melse-Boonstra, Alida; Sharma, Surjeet Kaur; Srinivasan, Krishnamachari; Zimmermann, Michael B

2015-02-01

To compare the iodine status of pregnant women and their children who were sharing all meals in Bangalore, India. A cross-sectional study evaluating demographic characteristics, household salt iodine concentration and salt usage patterns, urinary iodine concentrations (UIC) in women and children, and maternal thyroid volume (ultrasound). Antenatal clinic of an urban tertiary-care hospital, which serves a low-income population. Healthy pregnant women in all trimesters, aged 18-35 years, who had healthy children aged 3-15 years. Median (range) iodine concentrations of household powdered and crystal salt were 55·9 (17·2-65·9) ppm and 18·9 (2·2-68·2) ppm, respectively. The contribution of iodine-containing supplements and multi-micronutrient powders to iodine intake in the families was negligible. Adequately iodized salt, together with small amounts of iodine in local foods, were providing adequate iodine during pregnancy: (i) the overall median (range) UIC in women was 172 (5-1024) µg/l; (ii) the median UIC was >150 µg/l in all trimesters; and (iii) thyroid size was not significantly different across trimesters. At the same time, the median (range) UIC in children was 220 (10-782) µg/l, indicating more-than-adequate iodine intake at this age. Median UIC was significantly higher in children than in their mothers (P=0·008). In this selected urban population of southern India, the iodized salt programme provides adequate iodine to women throughout pregnancy, at the expense of higher iodine intake in their children. Thus we suggest that the current cut-off for median UIC in children indicating more-than-adequate intake, recommended by the WHO/UNICEF/International Council for the Control of Iodine Deficiency Disorders may, need to be reconsidered.

[Quality assurance in diagnostic radiology using an automated system. Experience and results].

PubMed

Princivalli, M; Stea, L; Ordóñez, P L; Bussoli, L; Marchetti, C

1995-05-01

The authors report their personal experience with the use of an integrated quality control system in the radiology department. The system we used was the RTI DIGI-X Plus, a Swedish-made product, allowing a wide range of parameters to be measured on diagnostic X-ray units for general radiography, mammography and fluoroscopy. Data can be retrieved with a minimum number of measurements. The "oRTIgo" software improves the quality assurance system and ensures document compliance with international recommendations. The equipment consists of a detector unit, a processor and a display unit. The detector consists of a rotating holder with 12 combinations of metal filters of various thickness mounted in front of two photo-diodes covered with identical X-ray intensifying gadoliniumoxysulfide screens. This unit is connected to a data acquisition system controlled by a microcomputer. Peak tube voltage and total tube filtration are derived from the ratio of detector signals. The relationship between this ratio and the measured quantity is determined by a calibration procedure. Furthermore, exposure time "mAs" value, "mAs" linearity and exposure (or kerma in air) can be measured. Digital storage can be performed and input signals displayed. A serial interface is used to communicate with a PC for QC management purposes. An error propagation model is used to determine the inaccuracy of peak tube voltage measurements. With the DIGI-X Plus system, measurements can be carried out in a shorter time and the stored data reprocessed later on. After QA testing on 20 X-ray units in the radiology department, in vivo doses were measured using a TLD Harshaw 100 on 46 randomly selected patients undergoing chest examinations. The results are reported and analyzed following the NRPB protocol and show high agreement with the recommended values.

Implementation of test for quality assurance in nuclear medicine gamma camera

NASA Astrophysics Data System (ADS)

Moreno, A. Montoya; Laguna, A. Rodríguez; Zamudio, Flavio E. Trujillo

2012-10-01

In nuclear medicine (NM) over 90% of procedures are performed for diagnostic purposes. To ensure adequate diagnostic quality of images and the optimization of the doses received by patients originated from the radioactive material is essential for regular monitoring and equipment performance through a quality assurance program (QAP). The QAP consists of 15 proposed performance tomographic and not tomographic gamma camera (GC) tests, and is based on recommendations of international organizations. We describe some results of the performance parameters of QAP applied to a GC model e.cam Siemens, of the Department of NM of the National Cancer Institute of Mexico (INCan). The results were: (1) The average intrinsic spatial resolution (Rin) was 4.67 ± 0.25 mm at the limit of acceptance criterion of 4.4 mm. (2) The sensitivity extrinsic (Sext), with maximum variations of 1.8% (less than 2% which is the criterion of acceptance). (3) Rotational Uniformity (Urot), with values of integral uniformity (IU) in the useful field of view detector (UFOV), with maximum percentage change of 0.97% and monthly variations equal angles, ranging from 0.13 to 0.99% less than 1%. (4) The displacement of the center of rotation (DCOR), indicated a maximum deviation of 0.155 ± 0.039 mm less than 4.795 mm, an absolute deviation of less than 0.5 where pixel 0.085 pixel is suggested, the criteria are assigned to low-energy collimator high resolution. (5) In tomographic uniformity (Utomo), UI values (%) and percentage noise level (rms%) were 7.54 ± 1.53 and 4.18 ± 1.69 which are consistent with the limits of acceptance of 7.0-12.0% and 3.0-6.0% respectively. The smallest cold sphere has a diameter of 11.4 mm. The implementation of a QAP allows for high quality diagnostic images, optimization of the doses given to patients, a reduction of exposure to occupationally exposed workers (POE, by its Spanish acronym), and generally improves the productivity of the service. This proposal can be used to

Implementation of test for quality assurance in nuclear medicine gamma camera

DOE Office of Scientific and Technical Information (OSTI.GOV)

Montoya Moreno, A.; Rodriguez Laguna, A.; Trujillo Zamudio, Flavio E

2012-10-23

In nuclear medicine (NM) over 90% of procedures are performed for diagnostic purposes. To ensure adequate diagnostic quality of images and the optimization of the doses received by patients originated from the radioactive material is essential for regular monitoring and equipment performance through a quality assurance program (QAP). The QAP consists of 15 proposed performance tomographic and not tomographic gamma camera (GC) tests, and is based on recommendations of international organizations. We describe some results of the performance parameters of QAP applied to a GC model e.cam Siemens, of the Department of NM of the National Cancer Institute of Mexicomore » (INCan). The results were: (1) The average intrinsic spatial resolution (R{sub in}) was 4.67 {+-} 0.25 mm at the limit of acceptance criterion of 4.4 mm. (2) The sensitivity extrinsic (S{sub ext}), with maximum variations of 1.8% (less than 2% which is the criterion of acceptance). (3) Rotational Uniformity (U{sub rot}), with values of integral uniformity (IU) in the useful field of view detector (UFOV), with maximum percentage change of 0.97% and monthly variations equal angles, ranging from 0.13 to 0.99% less than 1%. (4) The displacement of the center of rotation (DCOR), indicated a maximum deviation of 0.155 {+-} 0.039 mm less than 4.795 mm, an absolute deviation of less than 0.5 where pixel 0.085 pixel is suggested, the criteria are assigned to low-energy collimator high resolution. (5) In tomographic uniformity (U{sub tomo}), UI values (%) and percentage noise level (rms%) were 7.54 {+-} 1.53 and 4.18 {+-} 1.69 which are consistent with the limits of acceptance of 7.0-12.0% and 3.0-6.0% respectively. The smallest cold sphere has a diameter of 11.4 mm. The implementation of a QAP allows for high quality diagnostic images, optimization of the doses given to patients, a reduction of exposure to occupationally exposed workers (POE, by its Spanish acronym), and generally improves the productivity of

Indexing of Diagnostic Accuracy Studies in MEDLINE and EMBASE

PubMed Central

Wilczynski, Nancy L.; Haynes, R. Brian

2007-01-01

Background: STAndards for Reporting of Diagnostic Accuracy (STARD) were published in 2003 and endorsed by some journals but not others. Objective: To determine whether the quality of indexing of diagnostic accuracy studies in MEDLINE and EMBASE has improved since the STARD statement was published. Design: Evaluate the change in the mean number of “accurate index terms” assigned to diagnostic accuracy studies, comparing STARD (endorsing) and non-STARD (non-endorsing) journals, for 2 years before and after STARD publication. Results: In MEDLINE, no differences in indexing quality were found for STARD and non-STARD journals before or after the STARD statement was published in 2003. In EMBASE, indexing in STARD journals improved compared with non-STARD journals (p = 0.02). However, articles in STARD journals had half the number of accurate indexing terms as articles in non-STARD journals, both before and after STARD statement publication (p < 0.001). PMID:18693947

Clinical image quality evaluation for panoramic radiography in Korean dental clinics

PubMed Central

Choi, Bo-Ram; Choi, Da-Hye; Huh, Kyung-Hoe; Yi, Won-Jin; Heo, Min-Suk; Choi, Soon-Chul; Bae, Kwang-Hak

2012-01-01

Purpose The purpose of this study was to investigate the level of clinical image quality of panoramic radiographs and to analyze the parameters that influence the overall image quality. Materials and Methods Korean dental clinics were asked to provide three randomly selected panoramic radiographs. An oral and maxillofacial radiology specialist evaluated those images using our self-developed Clinical Image Quality Evaluation Chart. Three evaluators classified the overall image quality of the panoramic radiographs and evaluated the causes of imaging errors. Results A total of 297 panoramic radiographs were collected from 99 dental hospitals and clinics. The mean of the scores according to the Clinical Image Quality Evaluation Chart was 79.9. In the classification of the overall image quality, 17 images were deemed 'optimal for obtaining diagnostic information,' 153 were 'adequate for diagnosis,' 109 were 'poor but diagnosable,' and nine were 'unrecognizable and too poor for diagnosis'. The results of the analysis of the causes of the errors in all the images are as follows: 139 errors in the positioning, 135 in the processing, 50 from the radiographic unit, and 13 due to anatomic abnormality. Conclusion Panoramic radiographs taken at local dental clinics generally have a normal or higher-level image quality. Principal factors affecting image quality were positioning of the patient and image density, sharpness, and contrast. Therefore, when images are taken, the patient position should be adjusted with great care. Also, standardizing objective criteria of image density, sharpness, and contrast is required to evaluate image quality effectively. PMID:23071969

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders.

PubMed

Mashamba-Thompson, Tivani P; Jama, Ngcwalisa A; Sartorius, Benn; Drain, Paul K; Thompson, Rowan M

2017-01-08

Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients' needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

PubMed Central

Mashamba-Thompson, Tivani P.; Jama, Ngcwalisa A.; Sartorius, Benn; Drain, Paul K.; Thompson, Rowan M.

2017-01-01

Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics. PMID:28075337

Methodology and reporting of diagnostic accuracy studies of automated perimetry in glaucoma: evaluation using a standardised approach.

PubMed

Fidalgo, Bruno M R; Crabb, David P; Lawrenson, John G

2015-05-01

To evaluate methodological and reporting quality of diagnostic accuracy studies of perimetry in glaucoma and to determine whether there had been any improvement since the publication of the Standards for Reporting of Diagnostic Accuracy (STARD) guidelines. A systematic review of English language articles published between 1993 and 2013 reporting the diagnostic accuracy of perimetry in glaucoma. Articles were appraised for methodological quality using the 14-item Quality assessment tool for diagnostic accuracy studies (QUADAS) and evaluated for quality of reporting by applying the STARD checklist. Fifty-eight articles were appraised. Overall methodological quality of these studies was moderate with a median number of QUADAS items rated as 'yes' equal to nine (out of a maximum of 14) (IQR 7-10). The studies were often poorly reported; median score of STARD items fully reported was 11 out of 25 (IQR 10-14). A comparison of the studies published in 10-year periods before and after the publication of the STARD checklist in 2003 found quality of reporting had not substantially improved. Methodological and reporting quality of diagnostic accuracy studies of perimetry is sub-optimal and appears not to have improved substantially following the development of the STARD reporting guidance. This observation is consistent with previous studies in ophthalmology and in other medical specialities. © 2015 The Authors Ophthalmic & Physiological Optics © 2015 The College of Optometrists.

Accuracy, image quality, and radiation dose of prospectively ECG-triggered high-pitch dual-source CT angiography in infants and children with complex coarctation of the aorta.

PubMed

Xu, Jian; Zhao, Hongliang; Wang, Xiaoying; Bai, Yuxiang; Liu, Liwen; Liu, Ying; Wei, Mengqi; Li, Jian; Zheng, Minwen

2014-10-01

To evaluate the diagnostic accuracy, image quality, and radiation dose of prospective electrocardiogram (ECG)-triggered high-pitch dual-source computed tomography (DSCT) in infants and young children with complex coarctation of the aorta (CoA). Forty pediatric patients aged < 4 years with suspected CoA underwent prospective ECG-triggered high-pitch DSCT angiography and transthoracic echocardiography (TTE). Surgery and/or conventional cardiac angiography (CCA) were performed in all patients. The diagnostic accuracy of DSCT angiography and TTE was compared to the surgical and/or CCA findings. The causes of misdiagnosis and miss were analyzed, and the advantages and limitation of both imaging modalities were evaluated. Image quality of DSCT was evaluated, and effective radiation dose was calculated. The sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of DSCT in evaluation of complex CoA were 92.37%, 98.51%, 97.32%, 93.57%, and 96.25%, respectively. There was a significant difference in the accuracy between DSCT and TTE (χ² = 9.9, P＜.05). For a total of 80 extracardiac anomalies, the sensitivity (98.8%, 79/80) of DSCT was greater than that of TTE (62.5%; 50 of 80). On the contrary, for 38 cardiac anomalies, the sensitivity (78.9%, 30 of 38) of DSCT was lesser than that of TTE (100%; 38 of 38). The mean score of image quality was 4.27 ± 0.73. The mean effective radiation dose was 0.20 ± 0.09 mSv. Prospective ECG-triggered high-pitch DSCT may be a clinical feasible modality in the evaluation of pediatric patients with complex CoA, providing adequate image quality, high diagnostic accuracy, and low radiation dose. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Image Quality and Diagnostic Performance of a Digital PET Prototype in Patients with Oncologic Diseases: Initial Experience and Comparison with Analog PET.

PubMed

Nguyen, Nghi C; Vercher-Conejero, Jose L; Sattar, Abdus; Miller, Michael A; Maniawski, Piotr J; Jordan, David W; Muzic, Raymond F; Su, Kuan-Hao; O'Donnell, James K; Faulhaber, Peter F

2015-09-01

We report our initial clinical experience for image quality and diagnostic performance of a digital PET prototype scanner with time-of-flight (DigitalTF), compared with an analog PET scanner with time-of-flight (GeminiTF PET/CT). Twenty-one oncologic patients, mean age 58 y, first underwent clinical (18)F-FDG PET/CT on the GeminiTF. The scanner table was then withdrawn while the patient remained on the table, and the DigitalTF was inserted between the GeminiTF PET and CT scanner. The patients were scanned for a second time using the same PET field of view with CT from the GeminiTF for attenuation correction. Two interpreters reviewed the 2 sets of PET/CT images for overall image quality, lesion conspicuity, and sharpness. They counted the number of suggestive (18)F-FDG-avid lesions and provided the TNM staging for the 5 patients referred for initial staging. Standardized uptake values (SUVs) and SUV gradients as a measure of lesion sharpness were obtained. The DigitalTF showed better image quality than the GeminiTF. In a side-by-side comparison using a 5-point scale, lesion conspicuity (4.3 ± 0.6), lesion sharpness (4.3 ± 0.6), and diagnostic confidence (3.4 ± 0.7) were better with DigitalTF than with GeminiTF (P < 0.01). In 52 representative lesions, the lesion maximum SUV was 36% higher with DigitalTF than with GeminiTF, lesion-to-blood-pool SUV ratio was 59% higher, and SUV gradient was 51% higher, with good correlation between the 2 scanners. Lesions less than 1.5 cm showed a greater increase in SUV from GeminiTF to DigitalTF than those lesions 1.5 cm or greater. In 5 of 21 patients, DigitalTF showed an additional 8 suggestive lesions that were not seen using GeminiTF. In the 15 restaging patients, the true-negative rate was 100% and true-positive rate was 78% for both scanners. In the 5 patients for initial staging, DigitalTF led to upstaging in 2 patients and showed the same staging in the other 3 patients, compared with GeminiTF. DigitalTF provides better

[The diagnostic disclosure of dementia: an ethnographic exploration].

PubMed

van Wijngaarden, Els; Broekhuis, Gert; van Leussen, Carolien; Kamper, Ad; The, Anne-Mei

2017-09-01

Giving adequate diagnostic information is considered to be fundamental in dementia care. An important question is how the diagnostic disclosure in dementia actually takes place. The aim of this explorative ethnographic study was therefore to provide insight into the disclosure practice of medical specialists. For this study, 22 interviews performed by seven medical specialists were analyzed.The results of this study show that the observed doctors are direct and explicit in disclosing the diagnosis. Actual (medical) information about the diagnosis and the performed investigations is provided. The main areas for improvement are involving the patient in the conversation, align your language to the lifeworld of the patient and his/her significant other(s), avoiding the use of medical jargon, discussing the consequences of the diagnosis for daily life, and explicitly recognizing the emotional and existential challenges associated with the disclosure. In providing further information, doctors could discuss emotional and existential support more specifically.

Routine internal- and external-quality control data in clinical laboratories for estimating measurement and diagnostic uncertainty using GUM principles.

PubMed

Magnusson, Bertil; Ossowicki, Haakan; Rienitz, Olaf; Theodorsson, Elvar

2012-05-01

Healthcare laboratories are increasingly joining into larger laboratory organizations encompassing several physical laboratories. This caters for important new opportunities for re-defining the concept of a 'laboratory' to encompass all laboratories and measurement methods measuring the same measurand for a population of patients. In order to make measurement results, comparable bias should be minimized or eliminated and measurement uncertainty properly evaluated for all methods used for a particular patient population. The measurement as well as diagnostic uncertainty can be evaluated from internal and external quality control results using GUM principles. In this paper the uncertainty evaluations are described in detail using only two main components, within-laboratory reproducibility and uncertainty of the bias component according to a Nordtest guideline. The evaluation is exemplified for the determination of creatinine in serum for a conglomerate of laboratories both expressed in absolute units (μmol/L) and relative (%). An expanded measurement uncertainty of 12 μmol/L associated with concentrations of creatinine below 120 μmol/L and of 10% associated with concentrations above 120 μmol/L was estimated. The diagnostic uncertainty encompasses both measurement uncertainty and biological variation, and can be estimated for a single value and for a difference. This diagnostic uncertainty for the difference for two samples from the same patient was determined to be 14 μmol/L associated with concentrations of creatinine below 100 μmol/L and 14 % associated with concentrations above 100 μmol/L.

Diagnostic criteria for CRPS I: differences between patient profiles using three different diagnostic sets.

PubMed

Perez, Roberto S G M; Collins, Susan; Marinus, Johan; Zuurmond, Wouter W A; de Lange, Jaap J

2007-11-01

Complex Regional Pain Syndrome type I (CRPS I) is an illness which usually occurs due to major or minor tissue injury to the extremities. Because a unique pathophysiological mechanism for CRPS I has not yet been established, the diagnosis is based on observation and measurement of clinical symptoms and signs. In this study, a comparison was made between three sets of diagnostic criteria (the IASP, Bruehl et al. and Veldman et al.) based on patient reports and physicians' assessments of signs and symptoms associated with CRPS I, in 372 outpatients suspected of having CRPS I. Agreement between CRPS I diagnosis among the three sets was poor (kappa-range: 0.29-0.42), leading to positive CRPS I diagnoses according to Veldman et al.'s criteria in 218 cases (59%), according to the IASP in 268 cases (72%), and according to Bruehl et al. in 129 cases (35%). Significant differences in patient profiles were found between the diagnostic sets for the number of patients reporting continuing disproportionate pain, larger area affected than the initial trauma (both p<0.001), increase of symptoms due to exercise (p=0.009), edema (p=0.015), temperature asymmetry (p=0.015), hyperesthesia, allodynia (both p<0.001) and hyperalgesia (p=0.036). Similarly, significant differences emerged for physicians' observations of hyperesthesia and allodynia (both p<0.001). Highest combined values of sensitivity (SE) and specificity (SP) for the strongest cases of presence (n=108) or absence (n=62) of CRPS I were found for reported hyperesthesia (SE+SP:165%), allodynia (160%), observed color asymmetry (162%), hyperesthesia (157%), temperature asymmetry (154%) and edema (152%). The lack of agreement between the different diagnostic sets for CRPS I and the different clinical profiles that result from it may lead to different therapeutic and study populations, hampering adequate treatment and scientific development for this illness. We propose explicit reference to diagnostic criteria used in studies

Region 8: Colorado Adequate Letter (10/29/2001)

EPA Pesticide Factsheets

This letter from EPA to Colorado Department of Public Health and Environment determined Denvers' particulate matter (PM10) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes.

Optimizing Diagnostic Imaging in the Emergency Department

PubMed Central

Mills, Angela M.; Raja, Ali S.; Marin, Jennifer R.

2015-01-01

While emergency diagnostic imaging use has increased significantly, there is a lack of evidence for corresponding improvements in patient outcomes. Optimizing emergency department (ED) diagnostic imaging has the potential to improve the quality, safety, and outcomes of ED patients, but to date, there have not been any coordinated efforts to further our evidence-based knowledge in this area. The objective of this article is to discuss six aspects of diagnostic imaging in order to provide background information on the underlying framework for the 2015 Academic Emergency Medicine consensus conference, “Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization.” The consensus conference aims to generate a high priority research agenda for emergency diagnostic imaging that will inform the design of future investigations. The six components herein will serve as the group topics for the conference: 1) patient-centered outcomes research; 2) clinical decision rules; 3) training, education, and competency; 4) knowledge translation and barriers to image optimization; 5) use of administrative data; and 6) comparative effectiveness research: alternatives to traditional CT use. PMID:25731864

Optimizing diagnostic imaging in the emergency department.

PubMed

Mills, Angela M; Raja, Ali S; Marin, Jennifer R

2015-05-01

While emergency diagnostic imaging use has increased significantly, there is a lack of evidence for corresponding improvements in patient outcomes. Optimizing emergency department (ED) diagnostic imaging has the potential to improve the quality, safety, and outcomes of ED patients, but to date, there have not been any coordinated efforts to further our evidence-based knowledge in this area. The objective of this article is to discuss six aspects of diagnostic imaging to provide background information on the underlying framework for the 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The consensus conference aims to generate a high priority research agenda for emergency diagnostic imaging that will inform the design of future investigations. The six components herein will serve as the group topics for the conference: 1) patient-centered outcomes research; 2) clinical decision rules; 3) training, education, and competency; 4) knowledge translation and barriers to image optimization; 5) use of administrative data; and 6) comparative effectiveness research: alternatives to traditional CT use. © 2015 by the Society for Academic Emergency Medicine.

Region 1: Connecticut Adequate Letter (6/14/2017)

EPA Pesticide Factsheets

Letter from Office of Ecosystem Protection to Connecticut Department of Energy & Environmental Protection determined submitted 2017 Motor Vehicle Emissions Budgets adequate for transportation conformity purposes, Greater Connecticut area. (March 20, 2017)

MO-F-204-00: Preparing for the ABR Diagnostic and Nuclear Medical Physics Exams

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and

MO-F-204-02: Preparing for Part 2 of the ABR Diagnostic Physics Exam

DOE Office of Scientific and Technical Information (OSTI.GOV)

Szczykutowicz, T.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and

MO-F-204-03: Preparing for Part 3 of the ABR Diagnostic Physics Exam

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zambelli, J.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and

MO-F-204-01: Preparing for Part 1 of the ABR Diagnostic Physics Exam

DOE Office of Scientific and Technical Information (OSTI.GOV)

McKenney, S.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and

WE-D-213-00: Preparing for the ABR Diagnostic and Nuclear Medicine Physics Exams

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging

WE-D-213-01: Preparing for Part 1 of the ABR Diagnostic Physics Exam

DOE Office of Scientific and Technical Information (OSTI.GOV)

Simiele, S.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging

WE-D-213-03: Preparing for Part 3 of the ABR Diagnostic Physics Exam

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bevins, N.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging

WE-D-213-02: Preparing for Part 2 of the ABR Diagnostic Physics Exam

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zambelli, J.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging

Hierarchical mixture of experts and diagnostic modeling approach to reduce hydrologic model structural uncertainty: STRUCTURAL UNCERTAINTY DIAGNOSTICS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moges, Edom; Demissie, Yonas; Li, Hong-Yi

2016-04-01

In most water resources applications, a single model structure might be inadequate to capture the dynamic multi-scale interactions among different hydrological processes. Calibrating single models for dynamic catchments, where multiple dominant processes exist, can result in displacement of errors from structure to parameters, which in turn leads to over-correction and biased predictions. An alternative to a single model structure is to develop local expert structures that are effective in representing the dominant components of the hydrologic process and adaptively integrate them based on an indicator variable. In this study, the Hierarchical Mixture of Experts (HME) framework is applied to integratemore » expert model structures representing the different components of the hydrologic process. Various signature diagnostic analyses are used to assess the presence of multiple dominant processes and the adequacy of a single model, as well as to identify the structures of the expert models. The approaches are applied for two distinct catchments, the Guadalupe River (Texas) and the French Broad River (North Carolina) from the Model Parameter Estimation Experiment (MOPEX), using different structures of the HBV model. The results show that the HME approach has a better performance over the single model for the Guadalupe catchment, where multiple dominant processes are witnessed through diagnostic measures. Whereas, the diagnostics and aggregated performance measures prove that French Broad has a homogeneous catchment response, making the single model adequate to capture the response.« less

30 CFR 74.6 - Quality control.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Quality control. 74.6 Section 74.6 Mineral... of the CMDPSU will be maintained in production through adequate quality control procedures, MSHA and... DUST SAMPLING DEVICES Approval Requirements for Coal Mine Dust Personal Sampler Unit § 74.6 Quality...

Efficient strategies to find diagnostic test accuracy studies in kidney journals.

PubMed

Rogerson, Thomas E; Ladhani, Maleeka; Mitchell, Ruth; Craig, Jonathan C; Webster, Angela C

2015-08-01

Nephrologists looking for quick answers to diagnostic clinical questions in MEDLINE can use a range of published search strategies or Clinical Query limits to improve the precision of their searches. We aimed to evaluate existing search strategies for finding diagnostic test accuracy studies in nephrology journals. We assessed the accuracy of 14 search strategies for retrieving diagnostic test accuracy studies from three nephrology journals indexed in MEDLINE. Two investigators hand searched the same journals to create a reference set of diagnostic test accuracy studies to compare search strategy results against. We identified 103 diagnostic test accuracy studies, accounting for 2.1% of all studies published. The most specific search strategy was the Narrow Clinical Queries limit (sensitivity: 0.20, 95% CI 0.13-0.29; specificity: 0.99, 95% CI 0.99-0.99). Using the Narrow Clinical Queries limit, a searcher would need to screen three (95% CI 2-6) articles to find one diagnostic study. The most sensitive search strategy was van der Weijden 1999 Extended (sensitivity: 0.95; 95% CI 0.89-0.98; specificity 0.55, 95% CI 0.53-0.56) but required a searcher to screen 24 (95% CI 23-26) articles to find one diagnostic study. Bachmann 2002 was the best balanced search strategy, which was sensitive (0.88, 95% CI 0.81-0.94), but also specific (0.74, 95% CI 0.73-0.75), with a number needed to screen of 15 (95% CI 14-17). Diagnostic studies are infrequently published in nephrology journals. The addition of a strategy for diagnostic studies to a subject search strategy in MEDLINE may reduce the records needed to screen while preserving adequate search sensitivity for routine clinical use. © 2015 Asian Pacific Society of Nephrology.

Survey of the prevalence and methodology of quality assurance for B-mode ultrasound image quality among veterinary sonographers.

PubMed

Hoscheit, Larry P; Heng, Hock Gan; Lim, Chee Kin; Weng, Hsin-Yi

2018-05-01

Image quality in B-mode ultrasound is important as it reflects the diagnostic accuracy and diagnostic information provided during clinical scanning. Quality assurance programs for B-mode ultrasound systems/components are comprised of initial quality acceptance testing and subsequent regularly scheduled quality control testing. The importance of quality assurance programs for B-mode ultrasound image quality using ultrasound phantoms is well documented in the human medical and medical physics literature. The purpose of this prospective, cross-sectional, survey study was to determine the prevalence and methodology of quality acceptance testing and quality control testing of image quality for ultrasound system/components among veterinary sonographers. An online electronic survey was sent to 1497 members of veterinary imaging organizations: the American College of Veterinary Radiology, the Veterinary Ultrasound Society, and the European Association of Veterinary Diagnostic Imaging, and a total of 167 responses were received. The results showed that the percentages of veterinary sonographers performing quality acceptance testing and quality control testing are 42% (64/151; 95% confidence interval 34-52%) and 26% (40/156: 95% confidence interval 19-33%) respectively. Of the respondents who claimed to have quality acceptance testing or quality control testing of image quality in place for their ultrasound system/components, 0% have performed quality acceptance testing or quality control testing correctly (quality acceptance testing 95% confidence interval: 0-6%, quality control testing 95% confidence interval: 0-11%). Further education and guidelines are recommended for veterinary sonographers in the area of quality acceptance testing and quality control testing for B-mode ultrasound equipment/components. © 2018 American College of Veterinary Radiology.

Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals

PubMed Central

Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S.

2015-01-01

Background: Iran has a widespread diagnostics and clinical support services (DCSS) network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA) policies in DCSS units. This study explores the extent of application of eleven QA strategies in DCSS units within Iranian hospitals and its association with hospital characteristics. Methods: A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals. Results: The average reported application rate for the QA strategies ranged from 57%-94% in the DCSS units. Most frequently reported were checking drugs expiration dates (94%), pharmacopoeia availability (92%), equipment calibration (87%) and identifying responsibilities (86%). Least reported was external auditing of the DCSS (57%). The clinical chemistry and microbiology laboratories (84%), pharmacies, blood bank services (83%) reported highest average application rates across all questioned QA strategies. Lowest application rates were reported in human tissue banks (50%). There was no significant difference between the reported application rates in DCSS in the general/specialized, teaching/research, nonteaching/research hospitals with the exception of pharmacies and radiology departments. They reported availability of a written QA plan significantly more often in research hospitals. Nearly all QA strategies were reported to be applied significantly more often in the DCSS of Social Security Organization (SSO) and private-for-profit hospitals than in governmental hospitals. Conclusion: There is still room for strengthening the managerial cycle of QA systems and accountability in the DCSS in Iranian hospitals. Getting feedback, change and learning through application of specific QA strategies (eg, external/internal audits) can be improved. Both the effectiveness of QA

Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals.

PubMed

Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S

2015-05-20

Iran has a widespread diagnostics and clinical support services (DCSS) network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA) policies in DCSS units. This study explores the extent of application of eleven QA strategies in DCSS units within Iranian hospitals and its association with hospital characteristics. A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals. The average reported application rate for the QA strategies ranged from 57%-94% in the DCSS units. Most frequently reported were checking drugs expiration dates (94%), pharmacopoeia availability (92%), equipment calibration (87%) and identifying responsibilities (86%). Least reported was external auditing of the DCSS (57%). The clinical chemistry and microbiology laboratories (84%), pharmacies, blood bank services (83%) reported highest average application rates across all questioned QA strategies. Lowest application rates were reported in human tissue banks (50%). There was no significant difference between the reported application rates in DCSS in the general/specialized, teaching/research, nonteaching/research hospitals with the exception of pharmacies and radiology departments. They reported availability of a written QA plan significantly more often in research hospitals. Nearly all QA strategies were reported to be applied significantly more often in the DCSS of Social Security Organization (SSO) and private-for-profit hospitals than in governmental hospitals. There is still room for strengthening the managerial cycle of QA systems and accountability in the DCSS in Iranian hospitals. Getting feedback, change and learning through application of specific QA strategies (eg, external/internal audits) can be improved. Both the effectiveness of QA strategies in practice, and the application of

The reliability of a quality appraisal tool for studies of diagnostic reliability (QAREL).

PubMed

Lucas, Nicholas; Macaskill, Petra; Irwig, Les; Moran, Robert; Rickards, Luke; Turner, Robin; Bogduk, Nikolai

2013-09-09

The aim of this project was to investigate the reliability of a new 11-item quality appraisal tool for studies of diagnostic reliability (QAREL). The tool was tested on studies reporting the reliability of any physical examination procedure. The reliability of physical examination is a challenging area to study given the complex testing procedures, the range of tests, and lack of procedural standardisation. Three reviewers used QAREL to independently rate 29 articles, comprising 30 studies, published during 2007. The articles were identified from a search of relevant databases using the following string: "Reproducibility of results (MeSH) OR reliability (t.w.) AND Physical examination (MeSH) OR physical examination (t.w.)." A total of 415 articles were retrieved and screened for inclusion. The reviewers undertook an independent trial assessment prior to data collection, followed by a general discussion about how to score each item. At no time did the reviewers discuss individual papers. Reliability was assessed for each item using multi-rater kappa (κ). Multi-rater reliability estimates ranged from κ = 0.27 to 0.92 across all items. Six items were recorded with good reliability (κ > 0.60), three with moderate reliability (κ = 0.41 - 0.60), and two with fair reliability (κ = 0.21 - 0.40). Raters found it difficult to agree about the spectrum of patients included in a study (Item 1) and the correct application and interpretation of the test (Item 10). In this study, we found that QAREL was a reliable assessment tool for studies of diagnostic reliability when raters agreed upon criteria for the interpretation of each item. Nine out of 11 items had good or moderate reliability, and two items achieved fair reliability. The heterogeneity in the tests included in this study may have resulted in an underestimation of the reliability of these two items. We discuss these and other factors that could affect our results and make recommendations for the use of QAREL.

QTL analysis of genotype x environment interactions affecting cotton fiber quality.

PubMed

Paterson, A H; Saranga, Y; Menz, M; Jiang, C-X; Wright, R J

2003-02-01

Cotton is unusual among major crops in that large acreages are grown under both irrigated and rainfed conditions, making genotype x environment interactions of even greater importance than usual in designing crop-improvement strategies. We describe the impact of well-watered versus water-limited growth conditions on the genetic control of fiber quality, a complex suite of traits that collectively determine the utility of cotton. Fiber length, length uniformity, elongation, strength, fineness, and color (yellowness) were influenced by 6, 7, 9, 21, 25 and 11 QTLs (respectively) that could be detected in one or more treatments. The genetic control of cotton fiber quality was markedly affected both by general differences between growing seasons ("years") and by specific differences in water management regimes. Seventeen QTLs were detected only in the water-limited treatment while only two were specific to the well-watered treatment, suggesting that improvement of fiber quality under water stress may be even more complicated than improvement of this already complex trait under well-watered conditions. In crops such as cotton with widespread use of both irrigated and rainfed production systems, the need to manipulate larger numbers of genes to confer adequate quality under both sets of conditions will reduce the expected rate of genetic gain. These difficulties may be partly ameliorated by efficiencies gained through identification and use of diagnostic DNA markers, including those identified herein.

Region 9: Nevada Adequate Letter (3/30/2006)

EPA Pesticide Factsheets

This is a letter from Deborah Jordan, Director, to Leo M. Drozdoff regarding Nevada's motor vehicle emissions budgets in the 2005 Truckee Meadows CO Redesignation Request and Maintenance Plan are adequate for transportation conformity decisions.

Region 6: Texas Adequate Letter (6/21/17)

EPA Pesticide Factsheets

Letter from EPA approves Motor Vehicle Emissions Budgets contained in latest revisions to Houston/Galveston/Brazoria (HGB) 2008 8-hour Ozone State Implementation Plan, adequate for transportation conformity purposes and announced in the Federal Register.

Multi-method automated diagnostics of rotating machines

NASA Astrophysics Data System (ADS)

Kostyukov, A. V.; Boychenko, S. N.; Shchelkanov, A. V.; Burda, E. A.

2017-08-01

The automated machinery diagnostics and monitoring systems utilized within the petrochemical plants are an integral part of the measures taken to ensure safety and, as a consequence, the efficiency of these industrial facilities. Such systems are often limited in their functionality due to the specifics of the diagnostic techniques adopted. As the diagnostic techniques applied in each system are limited, and machinery defects can have different physical nature, it becomes necessary to combine several diagnostics and monitoring systems to control various machinery components. Such an approach is inconvenient, since it requires additional measures to bring the diagnostic results in a single view of the technical condition of production assets. In this case, we mean by a production facility a bonded complex of a process unit, a drive, a power source and lines. A failure of any of these components will cause an outage of the production asset, which is unacceptable. The purpose of the study is to test a combined use of vibration diagnostics and partial discharge techniques within the diagnostic systems of enterprises for automated control of the technical condition of rotating machinery during maintenance and at production facilities. The described solutions allow you to control the condition of mechanical and electrical components of rotating machines. It is shown that the functionality of the diagnostics systems can be expanded with minimal changes in technological chains of repair and operation of rotating machinery. Automation of such systems reduces the influence of the human factor on the quality of repair and diagnostics of the machinery.

Understanding diagnostic variability in breast pathology: lessons learned from an expert consensus review panel

PubMed Central

Allison, Kimberly H; Reisch, Lisa M; Carney, Patricia A; Weaver, Donald L; Schnitt, Stuart J; O’Malley, Frances P; Geller, Berta M; Elmore, Joann G

2015-01-01

Aims To gain a better understanding of the reasons for diagnostic variability, with the aim of reducing the phenomenon. Methods and results In preparation for a study on the interpretation of breast specimens (B-PATH), a panel of three experienced breast pathologists reviewed 336 cases to develop consensus reference diagnoses. After independent assessment, cases coded as diagnostically discordant were discussed at consensus meetings. By the use of qualitative data analysis techniques, transcripts of 16 h of consensus meetings for a subset of 201 cases were analysed. Diagnostic variability could be attributed to three overall root causes: (i) pathologist-related; (ii) diagnostic coding/study methodology-related; and (iii) specimen-related. Most pathologist-related root causes were attributable to professional differences in pathologists’ opinions about whether the diagnostic criteria for a specific diagnosis were met, most frequently in cases of atypia. Diagnostic coding/study methodology-related root causes were primarily miscategorizations of descriptive text diagnoses, which led to the development of a standardized electronic diagnostic form (BPATH-Dx). Specimen-related root causes included artefacts, limited diagnostic material, and poor slide quality. After re-review and discussion, a consensus diagnosis could be assigned in all cases. Conclusions Diagnostic variability is related to multiple factors, but consensus conferences, standardized electronic reporting formats and comments on suboptimal specimen quality can be used to reduce diagnostic variability. PMID:24511905

Region 8: Colorado Adequate Letter (1/20/2004)

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This letter from EPA to Colorado Department of Public Health and Environment determined Greeleys' Carbon Monoxide (CO) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes and will be announced in the FR.

Region 4: Tennessee Adequate Letter (9/30/2010)

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This letter acknowledges that the EPA has reviewed Tennessee's Knoxville Area redesignation request and maintenace plan, as well as the motor vehicle emissions budgets (MVEBs) and have determined that these MVEBs are adequate for transportation conformity

Region 9: California Adequate Letter (7/14/2017)

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EPA approves California Air Resources Board Motor Vehicle Emissions Budgets in San Joaquin Valley Unified Air Pollution Control Districts 2016 Plan for 2008 8-Hour Ozone Standard adequate for transportation conformity purposes announced in Federal Register

Region 9: Arizona Adequate Letter (10/14/2003)

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This is a letter from Jack P. Broadben,. Director, to Nancy Wrona and Dennis Smith informing them that Maricopa County's motor vehicle emissions budgets in the 2003 MAGCO Maintenance Plan are adequate for transportation conformity purposes.

[Critical evaluation of current diagnostic classification systems in psychiatry: the case of DSM-5].

PubMed

Luciano, Mario; Sampogna, Gaia; Del Vecchio, Valeria; De Rosa, Corrado; Albert, Umberto; Carrà, Giuseppe; Dell'Osso, Bernardo; Lorenzo, Giorgio Di; Ferrari, Silvia; Martinotti, Giovanni; Nanni, Maria Giulia; Pinna, Federica; Pompili, Maurizio; Volpe, Umberto; Catapano, Francesco; Fiorillo, Andrea

2016-01-01

Since its first edition, the Diagnostic and Statistical manual of Mental disorders (DSM) has had a great impact on the scientific community and the public opinion as well. In 2013, the American Psychiatric Association released the fifth edition of the manual and - as for the previous versions - several criticisms raised. In particular, the persistence of the categorical approach to mental disorders represents one of the main debated topics, as well as the introduction of new diagnostic syndromes, which are not based on an adequate evidences. Moreover, the threshold of diagnostic criteria for many mental disorders has been lowered, with the consequence that the boundaries between "normality" and "pathology" is not so clear. In this paper, we will: 1) report the historical development of the DSM from the publication of its first edition; 2) describe the main changes introduced in the DSM-5; 3) discuss critical elements in the DSM-5. The current debate regarding the validity of diagnostic manuals and its criteria is threatening the psychiatric discipline, but a possible solution should be represented by the integration of diagnostic criteria with the in-depth description of patient's psychopathological experiences.

Diagnostic reasoning strategies and diagnostic success.

PubMed

Coderre, S; Mandin, H; Harasym, P H; Fick, G H

2003-08-01

Cognitive psychology research supports the notion that experts use mental frameworks or "schemes", both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success. Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology. Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success. These findings have significant implications for medical educators. It supports the introduction of "schemes" as a means of enhancing memory organization and improving diagnostic success.

Why patients' disruptive behaviours impair diagnostic reasoning: a randomised experiment.

PubMed

Mamede, Sílvia; Van Gog, Tamara; Schuit, Stephanie C E; Van den Berge, Kees; Van Daele, Paul L A; Bueving, Herman; Van der Zee, Tim; Van den Broek, Walter W; Van Saase, Jan L C M; Schmidt, H G

2017-01-01

Patients who display disruptive behaviours in the clinical encounter (the so-called 'difficult patients') may negatively affect doctors' diagnostic reasoning, thereby causing diagnostic errors. The present study aimed at investigating the mechanisms underlying the negative influence of difficult patients' behaviours on doctors' diagnostic performance. A randomised experiment with 74 internal medicine residents. Doctors diagnosed eight written clinical vignettes that were exactly the same except for the patients' behaviours (either difficult or neutral). Each participant diagnosed half of the vignettes in a difficult patient version and the other half in a neutral version in a counterbalanced design. After diagnosing each vignette, participants were asked to recall the patient's clinical findings and behaviours. Main measurements were: diagnostic accuracy scores; time spent on diagnosis, and amount of information recalled from patients' clinical findings and behaviours. Mean diagnostic accuracy scores (range 0-1) were significantly lower for difficult than neutral patients' vignettes (0.41 vs 0.51; p<0.01). Time spent on diagnosing was similar. Participants recalled fewer clinical findings (mean=29.82% vs mean=32.52%; p<0.001) and more behaviours (mean=25.51% vs mean=17.89%; p<0.001) from difficult than from neutral patients. Difficult patients' behaviours induce doctors to make diagnostic errors, apparently because doctors spend part of their mental resources on dealing with the difficult patients' behaviours, impeding adequate processing of clinical findings. Efforts should be made to increase doctors' awareness of the potential negative influence of difficult patients' behaviours on diagnostic decisions and their ability to counteract such influence. 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/.

Accelerating the Development and Validation of New Value-Based Diagnostics by Leveraging Biobanks.

PubMed

Schneider, Daniel; Riegman, Peter H J; Cronin, Maureen; Negrouk, Anastassia; Moch, Holger; Balling, Rudi; Penault-Llorca, Frederiques; Zatloukal, Kurt; Horgan, Denis

The challenges faced in developing value-based diagnostics has resulted in few of these tests reaching the clinic, leaving many treatment modalities without matching diagnostics to select patients for particular therapies. Many patients receive therapies from which they are unlikely to benefit, resulting in worse outcomes and wasted health care resources. The paucity of value-based diagnostics is a result of the scientific challenges in developing predictive markers, specifically: (1) complex biology, (2) a limited research infrastructure supporting diagnostic development, and (3) the lack of incentives for diagnostic developers to invest the necessary resources. Better access to biospecimens can address some of these challenges. Methodologies developed to evaluate biomarkers from biospecimens archived from patients enrolled in randomized clinical trials offer the greatest opportunity to develop and validate high-value molecular diagnostics. An alternative opportunity is to access high-quality biospecimens collected from large public and private longitudinal observational cohorts such as the UK Biobank, the US Million Veteran Program, the UK 100,000 Genomes Project, or the French E3N cohort. Value-based diagnostics can be developed to work in a range of samples including blood, serum, plasma, urine, and tumour tissue, and better access to these high-quality biospecimens with clinical data can facilitate biomarker research. © 2016 S. Karger AG, Basel.

Genetic variation for agronomic and fiber quality traits in a population derived from high-quality cotton germplasm

USDA-ARS?s Scientific Manuscript database

Genetic improvement of fiber quality is necessary to meet the requirements of processors and users of cotton fiber. To foster genetic improvement of cotton fiber quality, adequate genetic variation for the quantitatively inherited physical properties of cotton is required. Additionally, knowledge of...

Region 5: Wisconsin Adequate Letter (4/16/2015)

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This March 13, 2015 letter from EPA approves Wisconsins Kenosha and Sheboygan counties Early Progress Plan for year 2015 Motor Vehicle Emissions Budgets (MVEBs) for VOC and NOx finding them adequate for transportation conformity purposes and will be announ

Measures to Improve Diagnostic Safety in Clinical Practice.

PubMed

Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

2016-10-20

Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health-care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Selection of adequate site location during early stages of construction project management: A multi-criteria decision analysis approach

NASA Astrophysics Data System (ADS)

Marović, Ivan; Hanak, Tomaš

2017-10-01

In the management of construction projects special attention should be given to the planning as the most important phase of decision-making process. Quality decision-making based on adequate and comprehensive collaboration of all involved stakeholders is crucial in project’s early stages. Fundamental reasons for existence of this problem arise from: specific conditions of construction industry (final products are inseparable from the location i.e. location has a strong influence of building design and its structural characteristics as well as technology which will be used during construction), investors’ desires and attitudes, and influence of socioeconomic and environment aspects. Considering all mentioned reasons one can conclude that selection of adequate construction site location for future investment is complex, low structured and multi-criteria problem. To take into account all the dimensions, the proposed model for selection of adequate site location is devised. The model is based on AHP (for designing the decision-making hierarchy) and PROMETHEE (for pairwise comparison of investment locations) methods. As a result of mixing basis feature of both methods, operational synergies can be achieved in multi-criteria decision analysis. Such gives the decision-maker a sense of assurance, knowing that if the procedure proposed by the presented model has been followed, it will lead to a rational decision, carefully and systematically thought out.

Region 8: Colorado Adequate Letter (8/17/2011)

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This March 4, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Greeley, CO second 10 year Limited Maintenance Plan (LMP) adequate for transportation conformity

Region 8: Colorado Adequate Letter (6/11/2012)

EPA Pesticide Factsheets

This August 9, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Fort Collins, CO second 10 year Limited Maintenance Plan (LMP) adequate for transportation

Using Multitheory Model of Health Behavior Change to Predict Adequate Sleep Behavior.

PubMed

Knowlden, Adam P; Sharma, Manoj; Nahar, Vinayak K

The purpose of this article was to use the multitheory model of health behavior change in predicting adequate sleep behavior in college students. A valid and reliable survey was administered in a cross-sectional design (n = 151). For initiation of adequate sleep behavior, the construct of behavioral confidence (P < .001) was found to be significant and accounted for 24.4% of the variance. For sustenance of adequate sleep behavior, changes in social environment (P < .02), emotional transformation (P < .001), and practice for change (P < .001) were significant and accounted for 34.2% of the variance.

Quality of radiotherapy reporting in randomized controlled trials of prostate cancer.

PubMed

Soon, Yu Yang; Chen, Desiree; Tan, Teng Hwee; Tey, Jeremy

2018-06-07

Good radiotherapy reporting in clinical trials of prostate radiotherapy is important because it will allow accurate reproducibility of radiotherapy treatment and minimize treatment variations that can affect patient outcomes. The aim of our study is to assess the quality of prostate radiotherapy (RT) treatment reporting in randomized controlled trials in prostate cancer. We searched MEDLINE for randomized trials of prostate cancer, published from 1996 to 2016 and included prostate RT as one of the intervention arms. We assessed if the investigators reported the ten criteria adequately in the trial reports: RT dose prescription method; RT dose-planning procedures; organs at risk (OAR) dose constraints; target volume definition, simulation procedures; treatment verification procedures; total RT dose; fractionation schedule; conduct of quality assurance (QA) as well as presence or absence of deviations in RT treatment planning and delivery. We performed multivariate logistic regression to determine the factors that may influence the quality of reporting. We found 59 eligible trials. There was significant variability in the quality of reporting. Target volume definition, total RT dose and fractionation schedule were reported adequately in 97% of included trials. OAR constraints, simulation procedures and presence or absence of deviations in RT treatment planning and delivery were reported adequately in 30% of included trials. Twenty-four trials (40%) reported seven criteria or more adequately. Multivariable logistic analysis showed that trials that published their quality assurance results and cooperative group trials were more likely to have adequate quality in reporting in at least seven criteria. There is significant variability in the quality of reporting on prostate radiotherapy treatment in randomized trials of prostate cancer. We need to have consensus guidelines to standardize the reporting of radiotherapy treatment in randomized trials.

Measurements and Diagnostics of Diamond Films and Coatings

NASA Technical Reports Server (NTRS)

Miyoshi, Kazuhisa; Wu, Richard L. C.

1999-01-01

The commercial potential of chemical-vapor-deposited (CVD) diamond films has been established and a number of applications have been identified through university, industry, and government research studies. This paper discusses the methodologies used for property measurement and diagnostic of CVD diamond films and coatings. Measurement and diagnostic techniques studied include scanning electron microscopy, transmission electron microscopy, atomic force microscopy, stylus profilometry, x-ray diffraction, electron diffraction, Raman spectroscopy, Rutherford backscattering, elastic recoil spectroscopy, and friction examination. Each measurement and diagnostic technique provides unique information. A combination of techniques can provide the technical information required to understand the quality and properties of CVD diamond films, which are important to their application in specific component systems and environments. In this study the combination of measurement and diagnostic techniques was successfully applied to correlate deposition parameters and resultant diamond film composition, crystallinity, grain size, surface roughness, and coefficient of friction.

Quality of Diagnosis and Treatment Plans After Using the 'Diagnostic Guideline for Anxiety and Challenging Behaviours' in People with Intellectual Disabilities: A Comparative Multiple Case Study Design.

PubMed

Pruijssers, Addy; van Meijel, Berno; Maaskant, Marian; Keeman, Noortje; van Achterberg, Theo

2016-07-01

People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This study evaluates the quality of the diagnoses and treatment plans after using a guideline that was developed to support professionals in their diagnostic tasks. A comparative multiple case study with an experimental and control condition, applying deductive analyses of diagnoses and treatment plans. The analyses revealed that the number of diagnostic statements and planned treatment actions in the experimental group was significantly larger and more differentiated than in the control condition. In the control group, consequential harm and protective factors were hardly mentioned in diagnoses and treatment plans. Working with the 'Diagnostic Guideline for Anxiety and CB' leads to improved diagnoses and treatment plans compared with care as usual. © 2015 John Wiley & Sons Ltd.

Silk-based blood stabilization for diagnostics.

PubMed

Kluge, Jonathan A; Li, Adrian B; Kahn, Brooke T; Michaud, Dominique S; Omenetto, Fiorenzo G; Kaplan, David L

2016-05-24

Advanced personalized medical diagnostics depend on the availability of high-quality biological samples. These are typically biofluids, such as blood, saliva, or urine; and their collection and storage is critical to obtain reliable results. Without proper temperature regulation, protein biomarkers in particular can degrade rapidly in blood samples, an effect that ultimately compromises the quality and reliability of laboratory tests. Here, we present the use of silk fibroin as a solid matrix to encapsulate blood analytes, protecting them from thermally induced damage that could be encountered during nonrefrigerated transportation or freeze-thaw cycles. Blood samples are recovered by simple dissolution of the silk matrix in water. This process is demonstrated to be compatible with a number of immunoassays and provides enhanced sample preservation in comparison with traditional air-drying paper approaches. Additional processing can remediate interactions with conformational structures of the silk protein to further enhance blood stabilization and recovery. This approach can provide expanded utility for remote collection of blood and other biospecimens empowering new modalities of temperature-independent remote diagnostics.

Modeling companion diagnostics in economic evaluations of targeted oncology therapies: systematic review and methodological checklist.

PubMed

Doble, Brett; Tan, Marcus; Harris, Anthony; Lorgelly, Paula

2015-02-01

The successful use of a targeted therapy is intrinsically linked to the ability of a companion diagnostic to correctly identify patients most likely to benefit from treatment. The aim of this study was to review the characteristics of companion diagnostics that are of importance for inclusion in an economic evaluation. Approaches for including these characteristics in model-based economic evaluations are compared with the intent to describe best practice methods. Five databases and government agency websites were searched to identify model-based economic evaluations comparing a companion diagnostic and subsequent treatment strategy to another alternative treatment strategy with model parameters for the sensitivity and specificity of the companion diagnostic (primary synthesis). Economic evaluations that limited model parameters for the companion diagnostic to only its cost were also identified (secondary synthesis). Quality was assessed using the Quality of Health Economic Studies instrument. 30 studies were included in the review (primary synthesis n = 12; secondary synthesis n = 18). Incremental cost-effectiveness ratios may be lower when the only parameter for the companion diagnostic included in a model is the cost of testing. Incorporating the test's accuracy in addition to its cost may be a more appropriate methodological approach. Altering the prevalence of the genetic biomarker, specific population tested, type of test, test accuracy and timing/sequence of multiple tests can all impact overall model results. The impact of altering a test's threshold for positivity is unknown as it was not addressed in any of the included studies. Additional quality criteria as outlined in our methodological checklist should be considered due to the shortcomings of standard quality assessment tools in differentiating studies that incorporate important test-related characteristics and those that do not. There is a need to refine methods for incorporating the characteristics

New and developing diagnostic technologies for urinary tract infections

PubMed Central

Davenport, Michael; Mach, Kathleen E.; Dairiki Shortliffe, Linda M.; Banaei, Niaz; Wang, Tza-Huei; Liao, Joseph C.

2017-01-01

Timely and accurate identification and determination of the antimicrobial susceptibility of uropathogens is central to the management of UTIs. Urine dipsticks are fast and amenable to point-of-care testing, but do not have adequate diagnostic accuracy or provide microbiological diagnosis. Urine culture with antimicrobial susceptibility testing takes 2 3 days and requires a clinical laboratory. The common use of empirical antibiotics has contributed to the rise of multidrug-resistant organisms, reducing treatment options and increasing costs. In addition to improved antimicrobial stewardship and the development of new antimicrobials, novel diagnostics are needed for timely microbial identification and determination of antimicrobial susceptibilities. New diagnostic platforms, including nucleic acid tests and mass spectrometry, have been approved for clinical use and have improved the speed and accuracy of pathogen identification from primary cultures. Optimization for direct urine testing would reduce the time to diagnosis, yet these technologies do not provide comprehensive information on antimicrobial susceptibility. Emerging technologies including biosensors, microfluidics, and other integrated platforms could improve UTI diagnosis via direct pathogen detection from urine samples, rapid antimicrobial susceptibility testing, and point-of-care testing. Successful development and implementation of these technologies has the potential to usher in an era of precision medicine to improve patient care and public health. PMID:28248946

Region 8: Colorado Adequate Letter (6/11/2012)

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This August 11, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Aspen PM10 maintenance plan and the 2023 motor vehicle emissions budget (MVEB) adequate

Region 9: Arizona Adequate Letter (11/1/2001)

EPA Pesticide Factsheets

This is a letter from Jack P. Broadbent, Director, Air Division to Nancy Wrona and James Bourney informing them of the adequacy of Revised MAG 1999 Serious Area Carbon Monoxide Plan and that the MAG CO Plan is adequate for Maricopa County.

English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis.

PubMed

Hoffmeister, A; Mayerle, J; Beglinger, C; Büchler, M W; Bufler, P; Dathe, K; Fölsch, U R; Friess, H; Izbicki, J; Kahl, S; Klar, E; Keller, J; Knoefel, W T; Layer, P; Loehr, M; Meier, R; Riemann, J F; Rünzi, M; Schmid, R M; Schreyer, A; Tribl, B; Werner, J; Witt, H; Mössner, J; Lerch, M M

2015-12-01

Chronic pancreatitis is a disease of the pancreas in which recurrent inflammatory episodes result in replacement of pancreatic parenchyma by fibrous connective tissue. This fibrotic reorganization of the pancreas leads to a progressive exocrine and endocrine pancreatic insufficiency. In addition, characteristic complications arise, such as pseudocysts, pancreatic duct obstructions, duodenal obstruction, vascular complications, obstruction of the bile ducts, malnutrition and pain syndrome. Pain presents as the main symptom of patients with chronic pancreatitis. Chronic pancreatitis is a risk factor for pancreatic carcinoma. Chronic pancreatitis significantly reduces the quality of life and the life expectancy of affected patients. These guidelines were researched and compiled by 74 representatives from 11 learned societies and their intention is to serve evidence-based professional training as well as continuing education. On this basis they shall improve the medical care of affected patients in both the inpatient and outpatient sector. Chronic pancreatitis requires an adequate diagnostic workup and systematic management, given its severity, frequency, chronicity, and negative impact on the quality of life and life expectancy. © Georg Thieme Verlag KG Stuttgart · New York.

[Diagnostic reference levels in interventional radiology].

PubMed

Vañó Carruana, E; Fernández Soto, J M; Sánchez Casanueva, R M; Ten Morón, J I

2013-12-01

This article discusses the diagnostic reference levels for radiation exposure proposed by the International Commission on Radiological Protection (ICRP) to facilitate the application of the optimization criteria in diagnostic imaging and interventional procedures. These levels are normally established as the third quartile of the dose distributions to patients in an ample sample of centers and are supposed to be representative of good practice regarding patient exposure. In determining these levels, it is important to evaluate image quality as well to ensure that it is sufficient for diagnostic purposes. When the values for the dose received by patients are systematically higher or much lower than the reference levels, an investigation should determine whether corrective measures need to be applied. The European and Spanish regulations require the use of these reference values in quality assurance programs. For interventional procedures, the dose area product (or kerma area product) values are usually used as reference values together with the time under fluoroscopy and the total number of images acquired. The most modern imaging devices allow the value of the accumulated dose at the entrance to the patient to be calculated to optimize the distribution of the dose on the skin. The ICRP recommends that the complexity of interventional procedures be taken into account when establishing reference levels. In the future, diagnostic imaging departments will have automatic systems to manage patient dosimetric data; these systems will enable continuous dosage auditing and alerts about individual procedures that might involve doses several times above the reference values. This article also discusses aspects that need to be clarified to take better advantage of the reference levels in interventional procedures. Copyright © 2013 SERAM. Published by Elsevier Espana. All rights reserved.

Improved diagnostics of chronic inflammatory prostatitis.

PubMed

Kulchavenya, E; Azizoff, A; Brizhatyuk, E; Khomyakov, V; Kholtobin, D; Breusoff, A; Naber, K G

2012-12-01

Prostatitis is a prevalent condition that encompasses a large array of clinical symptoms with significant impacts on men's life. The diagnosis and treatment of this disorder presents numerous challenges for urologists, most notably, a lack of specific and effective diagnostic methods. To improve the diagnostics the comparison of classic 4-glass test Meares and Stamey, 2-glass tests and 3-glass test was conducted in 177 men suspicious for chronic prostatitis. Four-glass test is uncomfortable both for patients and doctors, and leads to contamination of urine with prostatic secretion. Two-glass test is insufficiently effective too. Three-glass test (three urine specimens obtained from one continuous micturition stream) gives more adequate results and may be used for screening. Three-glass test as screening test with the option of an additional EPS investigation in those patients the final diagnosis of chronic prostatitis has to be confirmed is more convenient for patients and doctors than the standard M&S 4-glass test and "false-positive" (contaminated with EPS) midstream urine results are avoided thus improving discrimination of urethritis, cystitis and prostatitis. Therefore, we recommend the KE 3-glass test as a new standard for screening patients with signs and symptoms of chronic inflammatory prostatitis.

Advances in sarcoma diagnostics and treatment

PubMed Central

Dancsok, Amanda R; Asleh-Aburaya, Karama; Nielsen, Torsten O

2017-01-01

The heterogeneity of sarcomas with regard to molecular genesis, histology, clinical characteristics, and response to treatment makes management of these rare yet diverse neoplasms particularly challenging. This review encompasses recent developments in sarcoma diagnostics and treatment, including cytotoxic, targeted, epigenetic, and immune therapy agents. In the past year, groups internationally explored the impact of adding mandatory molecular testing to histological diagnosis, reporting some changes in diagnosis and/or management; however, the impact on outcomes could not be adequately assessed. Transcriptome sequencing techniques have brought forward new diagnostic tools for identifying fusions and/or characterizing unclassified entities. Next-generation sequencing and advanced molecular techniques were also applied to identify potential targets for directed and epigenetic therapy, where preclinical studies reported results for agents active within the receptor tyrosine kinase, mTOR, Notch, Wnt, Hedgehog, Hsp90, and MDM2 signaling networks. At the level of clinical practice, modest developments were seen for some sarcoma subtypes in conventional chemotherapy and in therapies targeting the pathways activated by various receptor tyrosine kinases. In the burgeoning field of immune therapy, sarcoma work is in its infancy; however, elaborate protocols for immune stimulation are being explored, and checkpoint blockade agents advance from preclinical models to clinical studies. PMID:27732970

WE-AB-206-00: Diagnostic QA/QC Hands-On Workshop

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. The goal of this ultrasound hands-on workshop is to demonstrate quality control (QC) testing in diagnostic ultrasound and to provide updates in ACR ultrasound accreditation requirements. The first half of this workshop will include two presentations reviewing diagnostic ultrasound QA/QC and ACR ultrasound accreditation requirements. The second half of the workshop will include live demonstrations of basic QC tests. An array of ultrasound testing phantoms and ultrasound scanners will be available for attendees to learn diagnostic ultrasound QC in a hands-on environmentmore » with live demonstrations and on-site instructors. The targeted attendees are medical physicists in diagnostic imaging. Learning Objectives: Gain familiarity with common elements of a QA/QC program for diagnostic ultrasound imaging dentify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools Learn ACR ultrasound accreditation requirements Jennifer Walter is an employee of American College of Radiology on Ultrasound Accreditation.« less

[Results of a study of the diagnostic qualities of brucellosis and tularemic antigenic erythrocytic diagnostica].

PubMed

Tsybin, B P; Taran, I F; Tinker, A I

1975-09-01

The authors elaborated methods of preparation of brucella and tularemia antigenic erythrocytic diagnostic agents which were characterized as highly specific, specific and stable preparations in mass examination of humans and animals at various stages of the vaccinal and infectous processes. The simplicity of obtaining specific antigens intended for the sensitization of formalinized erythrocytes and stability of the results of results of reproduction of the methods of preparation of the antigenic erythrocytic diagnostic agents offered a possibility of recommending the mentioned methods of industrial preparation of the diagnostic agents.

Dosimetric evaluation of Plastic Water Diagnostic-Therapy.

PubMed

Ramaseshan, Ramani; Kohli, Kirpal; Cao, Fred; Heaton, Robert K

2008-04-29

High-precision radiotherapy planning and quality assurance require accurate dosimetric and geometric phantom measurements. Phantom design requires materials with mechanical strength and resilience, and dosimetric properties close to those of water over diagnostic and therapeutic ranges. Plastic Water Diagnostic Therapy (PWDT: CIRS, Norfolk, VA) is a phantom material designed for water equivalence in photon beams from 0.04 MeV to 100 MeV; the material has also good mechanical properties. The present article reports the results of computed tomography (CT) imaging and dosimetric studies of PWDT to evaluate the suitability of the material in CT and therapy energy ranges. We characterized the water equivalence of PWDT in a series of experiments in which the basic dosimetric properties of the material were determined for photon energies of 80 kVp, 100 kVp, 250 kVp, 4 MV, 6 MV, 10 MV, and 18 MV. Measured properties included the buildup and percentage depth dose curves for several field sizes, and relative dose factors as a function of field size. In addition, the PWDT phantom underwent CT imaging at beam qualities ranging from 80 kVp to 140 kVp to determine the water equivalence of the phantom in the diagnostic energy range. The dosimetric quantities measured with PWDT agreed within 1.5% of those determined in water and Solid Water (Gammex rmi, Middleton, WI). Computed tomography imaging of the phantom was found to generate Hounsfield numbers within 0.8% of those generated using water. The results suggest that PWDT material is suitable both for regular radiotherapy quality assurance measurements and for intensity-modulated radiation therapy (IMRT) verification work. Sample IMRT verification results are presented.

Quality control in mutation analysis: the European Molecular Genetics Quality Network (EMQN).

PubMed

Müller, C R

2001-08-01

The demand for clinical molecular genetics testing has steadily grown since its introduction in the 1980s. In order to reach and maintain the agreed quality standards of laboratory medicine, the same internal and external quality assurance (IQA/EQA) criteria have to be applied as for "conventional" clinical chemistry or pathology. In 1996 the European Molecular Genetics Quality Network (EMQN) was established in order to spread QA standards across Europe and to harmonise the existing national activities. EMQN is operated by a central co-ordinator and 17 national partners from 15 EU countries; since 1998 it is being funded by the EU commission for a 3-year period. EMQN promotes QA by two tools: by providing disease-specific best practice meetings (BPM) and EQA schemes. A typical BPM is focussed on one disease or group of related disorders. International experts report on the latest news of gene characterisation and function and the state-of-the-art techniques for mutation detection. Disease-specific EQA schemes are provided by experts in the field. DNA samples are sent out together with mock clinical referrals and a diagnostic question is asked. Written reports must be returned which are marked for genotyping and interpretation. So far, three BPMs have been held and six EQA schemes are in operation at various stages. Although mutation types and diagnostic techniques varied considerably between schemes, the overall technical performance showed a high diagnostic standard. Nevertheless, serious genotyping errors have been occurred in some schemes which underline the necessity of quality assurance efforts. The European Molecular Genetics Quality Network provides a necessary platform for the internal and external quality assurance of molecular genetic testing.

Colonoscopy video quality assessment using hidden Markov random fields

NASA Astrophysics Data System (ADS)

Park, Sun Young; Sargent, Dusty; Spofford, Inbar; Vosburgh, Kirby

2011-03-01

With colonoscopy becoming a common procedure for individuals aged 50 or more who are at risk of developing colorectal cancer (CRC), colon video data is being accumulated at an ever increasing rate. However, the clinically valuable information contained in these videos is not being maximally exploited to improve patient care and accelerate the development of new screening methods. One of the well-known difficulties in colonoscopy video analysis is the abundance of frames with no diagnostic information. Approximately 40% - 50% of the frames in a colonoscopy video are contaminated by noise, acquisition errors, glare, blur, and uneven illumination. Therefore, filtering out low quality frames containing no diagnostic information can significantly improve the efficiency of colonoscopy video analysis. To address this challenge, we present a quality assessment algorithm to detect and remove low quality, uninformative frames. The goal of our algorithm is to discard low quality frames while retaining all diagnostically relevant information. Our algorithm is based on a hidden Markov model (HMM) in combination with two measures of data quality to filter out uninformative frames. Furthermore, we present a two-level framework based on an embedded hidden Markov model (EHHM) to incorporate the proposed quality assessment algorithm into a complete, automated diagnostic image analysis system for colonoscopy video.

13 CFR 107.200 - Adequate capital for Licensees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... operate actively in accordance with your Articles and within the context of your business plan, as... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Adequate capital for Licensees. 107.200 Section 107.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS...

42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417... health care industry. (b) Provision of data. (1) The HMO or CMP must provide adequate cost and... 42 Public Health 3 2012-10-01 2012-10-01 false Adequate financial records, statistical data, and...

42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.568 Adequate... definitions and accounting, statistics, and reporting practices that are widely accepted in the health care... 42 Public Health 3 2010-10-01 2010-10-01 false Adequate financial records, statistical data, and...

42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.568 Adequate... definitions and accounting, statistics, and reporting practices that are widely accepted in the health care... 42 Public Health 3 2011-10-01 2011-10-01 false Adequate financial records, statistical data, and...

Molecular diagnostics for low resource settings

NASA Astrophysics Data System (ADS)

Weigl, Bernhard H.

2010-03-01

As traditional high quality diagnostic laboratories are not widely available or affordable in developing country health care settings, microfluidics-based point-of-care diagnostics may be able to address the need to perform complex assays in under-resourced areas. Many instrument-based as well as non-instrumented microfluidic prototype diagnostics are currently being developed. In addition to various engineering challenges, the greatest remaining issue is the search for truly low-cost disposable manufacturing methods. Diagnostics for global health, and specifically microfluidics and molecular-based low resource diagnostics, have become a very active research area over the last five years, thanks in part to new funding that became available from the Bill and Melinda Gates Foundation, the National Institutes of Health, and other sources. This has led to a number of interesting prototype devices that are now in advanced development or clinical validation. These devices include disposables and instruments that perform multiplexed PCR-based lab-on-a-chips for enteric, febrile, and vaginal diseases, as well as immunoassays for diseases such as malaria, HIV, and various sexually transmitted diseases. More recently, instrument-free diagnostic disposables based on isothermal nucleic acid amplification have been developed as well. Regardless of platform, however, the search for truly low-cost manufacturing methods that would result in cost of goods per disposable of around US1/unit at volume remains a big challenge. This talk will give an overview over existing platform development efforts as well as present some original research in this area at PATH.

Diffusion of Molecular Diagnostic Lung Cancer Tests: A Survey of German Oncologists

PubMed Central

Steffen, Julius Alexander

2014-01-01

This study was aimed at examining the diffusion of diagnostic lung cancer tests in Germany. It was motivated by the high potential of detecting and targeting oncogenic drivers. Recognizing that the diffusion of diagnostic tests is a conditio sine qua non for the success of personalized lung cancer therapies, this study analyzed the diffusion of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tests in Germany. Qualitative and quantitative research strategies were combined in a mixed-method design. A literature review and subsequent Key Opinion Leader interviews identified a set of qualitative factors driving the diffusion process, which were then translated into an online survey. The survey was conducted among a sample of 961 oncologists (11.34% response rate). The responses were analyzed in a multiple linear regression which identified six statistically significant factors driving the diffusion of molecular diagnostic lung cancer tests: reimbursement, attitude towards R&D, information self-assessment, perceived attitudes of colleagues, age and test-pathway strategies. Besides the important role of adequate reimbursement and relevant guidelines, the results of this study suggest that an increasing usage of test-pathway strategies, especially in an office-based setting, can increase the diffusion of molecular diagnostic lung cancer tests in the future. PMID:25562146

Quality of referral: What information should be included in a request for diagnostic imaging when a patient is referred to a clinical radiologist?

PubMed

G Pitman, Alexander

2017-06-01

Referral to a clinical radiologist is the prime means of communication between the referrer and the radiologist. Current Australian and New Zealand government regulations do not prescribe what clinical information should be included in a referral. This work presents a qualitative compilation of clinical radiologist opinion, relevant professional recommendations, governmental regulatory positions and prior work on diagnostic error to synthesise recommendations on what clinical information should be included in a referral. Recommended requirements on what clinical information should be included in a referral to a clinical radiologist are as follows: an unambiguous referral; identity of the patient; identity of the referrer; and sufficient clinical detail to justify performance of the diagnostic imaging examination and to confirm appropriate choice of the examination and modality. Recommended guideline on the content of clinical detail clarifies when the information provided in a referral meets these requirements. High-quality information provided in a referral allows the clinical radiologist to ensure that exposure of patients to medical radiation is justified. It also minimises the incidence of perceptual and interpretational diagnostic error. Recommended requirements and guideline on the clinical detail to be provided in a referral to a clinical radiologist have been formulated for professional debate and adoption. © 2017 The Royal Australian and New Zealand College of Radiologists.

Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

PubMed Central

2011-01-01

Background: New transbronchial needle aspiration (TBNA) technologies have been developed, but their clinical effectiveness and determinants of diagnostic yield have not been quantified. Prospective data are needed to determine risk-adjusted diagnostic yield. Methods: We prospectively enrolled patients undergoing TBNA of mediastinal lymph nodes in the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE) multicenter database and recorded clinical, procedural, and provider information. All clinical decisions, including type of TBNA used (conventional vs endobronchial ultrasound-guided), were made by the attending bronchoscopist. The primary outcome was obtaining a specific diagnosis. Results: We enrolled 891 patients at six hospitals. Most procedures (95%) were performed with ultrasound guidance. A specific diagnosis was made in 447 cases. Unadjusted diagnostic yields were 37% to 54% for different hospitals, with significant between-hospital heterogeneity (P = .0001). Diagnostic yield was associated with annual hospital TBNA volume (OR, 1.003; 95% CI, 1.000-1.006; P = .037), smoking (OR, 1.55; 95% CI, 1.02-2.34; P = .042), biopsy of more than two sites (OR, 0.57; 95% CI, 0.38-0.85; P = .015), lymph node size (reference > 1-2 cm, ≤ 1 cm: OR, 0.51; 95% CI, 0.34-0.77; P = .003; > 2-3 cm: OR, 2.49; 95% CI, 1.61-3.85; P < .001; and > 3 cm: OR, 3.61; 95% CI, 2.17-6.00; P < .001), and positive PET scan (OR, 3.12; 95% CI, 1.39-7.01; P = .018). Biopsy was performed on more and smaller nodes at high-volume hospitals (P < .0001). Conclusions: To our knowledge, this is the first bronchoscopy study of risk-adjusted diagnostic yields on a hospital-level basis. High-volume hospitals were associated with high diagnostic yields. This study also demonstrates the value of procedural registries as a quality improvement tool. A larger number and variety of participating hospitals is needed to verify these results and to further

INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD): development and validation.

PubMed

Juneja, Monica; Mishra, Devendra; Russell, Paul S S; Gulati, Sheffali; Deshmukh, Vaishali; Tudu, Poma; Sagar, Rajesh; Silberberg, Donald; Bhutani, Vinod K; Pinto, Jennifer M; Durkin, Maureen; Pandey, Ravindra M; Nair, M K C; Arora, Narendra K

2014-05-01

To develop and validate INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD). Diagnostic test evaluation by cross sectional design. Four tertiary pediatric neurology centers in Delhi and Thiruvanthapuram, India. Children aged 2-9 years were enrolled in the study. INDT-ASD and Childhood Autism Rating Scale (CARS) were administered in a randomly decided sequence by trained psychologist, followed by an expert evaluation by DSM-IV TR diagnostic criteria (gold standard). Psychometric parameters of diagnostic accuracy, validity (construct, criterion and convergent) and internal consistency. 154 children (110 boys, mean age 64.2 mo) were enrolled. The overall diagnostic accuracy (AUC=0.97, 95% CI 0.93, 0.99; P<0.001) and validity (sensitivity 98%, specificity 95%, positive predictive value 91%, negative predictive value 99%) of INDT-ASD for Autism spectrum disorder were high, taking expert diagnosis using DSM-IV-TR as gold standard. The concordance rate between the INDT-ASD and expert diagnosis for 'ASD group' was 82.52% [Cohen's k=0.89; 95% CI (0.82, 0.97); P=0.001]. The internal consistency of INDT-ASD was 0.96. The convergent validity with CARS (r = 0.73, P= 0.001) and divergent validity with Binet-Kamat Test of intelligence (r = -0.37; P=0.004) were significantly high. INDT-ASD has a 4-factor structure explaining 85.3% of the variance. INDT-ASD has high diagnostic accuracy, adequate content validity, good internal consistency high criterion validity and high to moderate convergent validity and 4-factor construct validity for diagnosis of Autistm spectrum disorder.

Child malnutrition and mortality among families not utilizing adequately iodized salt in Indonesia.

PubMed

Semba, Richard D; de Pee, Saskia; Hess, Sonja Y; Sun, Kai; Sari, Mayang; Bloem, Martin W

2008-02-01

Salt iodization is the main strategy for reducing iodine deficiency disorders worldwide. Characteristics of families not using iodized salt need to be known to expand coverage. The objective was to determine whether families who do not use iodized salt have a higher prevalence of child malnutrition and mortality and to identify factors associated with not using iodized salt. Use of adequately iodized salt (>or =30 ppm), measured by rapid test kits, was assessed between January 1999 and September 2003 in 145 522 and 445 546 families in urban slums and rural areas, respectively, in Indonesia. Adequately iodized salt was used by 66.6% and 67.2% of families from urban slums and rural areas, respectively. Among families who used adequately iodized salt, mortality in neonates, infants, and children aged <5 y was 3.3% compared with 4.2%, 5.5% compared with 7.1%, and 6.9% compared with 9.1%, respectively (P < 0.0001 for all), in urban slums; among families who did not use adequately iodized salt, the respective values were 4.2% compared with 6.3%, 7.1% compared with 11.2%, and 8.5% compared with 13.3% (P < 0.0001 for all) in rural areas. Families not using adequately iodized salt were more likely to have children who were stunted, underweight, and wasted. In multivariate analyses that controlled for potential confounders, low maternal education was the strongest factor associated with not using adequately iodized salt. In Indonesia, nonuse of adequately iodized salt is associated with a higher prevalence of child malnutrition and mortality in neonates, infants, and children aged <5 y. Stronger efforts are needed to expand salt iodization in Indonesia.

Diagnostic decision-making and strategies to improve diagnosis.

PubMed

Thammasitboon, Satid; Cutrer, William B

2013-10-01

A significant portion of diagnostic errors arises through cognitive errors resulting from inadequate knowledge, faulty data gathering, and/or faulty verification. Experts estimate that 75% of diagnostic failures can be attributed to clinician diagnostic thinking failure. The cognitive processes that underlie diagnostic thinking of clinicians are complex and intriguing, and it is imperative that clinicians acquire explicit appreciation and application of different cognitive approaches to make decisions better. A dual-process model that unifies many theories of decision-making has emerged as a promising template for understanding how clinicians think and judge efficiently in a diagnostic reasoning process. The identification and implementation of strategies for decreasing or preventing such diagnostic errors has become a growing area of interest and research. Suggested strategies to decrease diagnostic error incidence include increasing clinician's clinical expertise and avoiding inherent cognitive errors to make decisions better. Implementing Interventions focused solely on avoiding errors may work effectively for patient safety issues such as medication errors. Addressing cognitive errors, however, requires equal effort on expanding the individual clinician's expertise. Providing cognitive support to clinicians for robust diagnostic decision-making serves as the final strategic target for decreasing diagnostic errors. Clinical guidelines and algorithms offer another method for streamlining decision-making and decreasing likelihood of cognitive diagnostic errors. Addressing cognitive processing errors is undeniably the most challenging task in reducing diagnostic errors. While many suggested approaches exist, they are mostly based on theories and sciences in cognitive psychology, decision-making, and education. The proposed interventions are primarily suggestions and very few of them have been tested in the actual practice settings. Collaborative research effort is

Trabecular bone analysis in CT and X-ray images of the proximal femur for the assessment of local bone quality.

PubMed

Fritscher, Karl; Grunerbl, Agnes; Hanni, Markus; Suhm, Norbert; Hengg, Clemens; Schubert, Rainer

2009-10-01

Currently, conventional X-ray and CT images as well as invasive methods performed during the surgical intervention are used to judge the local quality of a fractured proximal femur. However, these approaches are either dependent on the surgeon's experience or cannot assist diagnostic and planning tasks preoperatively. Therefore, in this work a method for the individual analysis of local bone quality in the proximal femur based on model-based analysis of CT- and X-ray images of femur specimen will be proposed. A combined representation of shape and spatial intensity distribution of an object and different statistical approaches for dimensionality reduction are used to create a statistical appearance model in order to assess the local bone quality in CT and X-ray images. The developed algorithms are tested and evaluated on 28 femur specimen. It will be shown that the tools and algorithms presented herein are highly adequate to automatically and objectively predict bone mineral density values as well as a biomechanical parameter of the bone that can be measured intraoperatively.

A mobile health technology platform for quality assurance and quality improvement of malaria diagnosis by community health workers.

PubMed

Laktabai, Jeremiah; Platt, Alyssa; Menya, Diana; Turner, Elizabeth L; Aswa, Daniel; Kinoti, Stephen; O'Meara, Wendy Prudhomme

2018-01-01

Community health workers (CHWs) play an important role in improving access to services in areas with limited health infrastructure or workforce. Supervision of CHWs by qualified health professionals is the main link between this lay workforce and the formal health system. The quality of services provided by lay health workers is dependent on adequate supportive supervision. It is however one of the weakest links in CHW programs due to logistical and resource constraints, especially in large scale programs. Interventions such as point of care testing using malaria rapid diagnostic tests (RDTs) require real time monitoring to ensure diagnostic accuracy. In this study, we evaluated the utility of a mobile health technology platform to remotely monitor malaria RDT (mRDT) testing by CHWs for quality improvement. As part of a large implementation trial involving mRDT testing by CHWs, we introduced the Fionet system composed of a mobile device (Deki Reader, DR) to assist in processing and automated interpretation of mRDTs, which connects to a cloud-based database which captures reports from the field in real time, displaying results in a custom dashboard of key performance indicators. A random sample of 100 CHWs were trained and provided with the Deki Readers and instructed to use it on 10 successive patients. The CHWs interpretation was compared with the Deki Reader's automatic interpretation, with the errors in processing and interpreting the RDTs recorded. After the CHW entered their interpretation on the DR, the DR provided immediate, automated feedback and interpretation based on its reading of the same cassette. The study team monitored the CHW performance remotely and provided additional support. A total of 1251 primary and 113 repeat tests were performed by the 97 CHWs who used the DR. 91.6% of the tests had agreement between the DR and the CHWs. There were 61 (4.9%) processing and 52 (4.2%) interpretation errors among the primary tests. There was a tendency

Peptide supplementation to nutrient-adequate diets enhanced internal egg quality during storage in hens at peak production.

PubMed

Olukosi, Oluyinka A; Xiao, Weiwei; Jia, Jing

2018-03-01

There is paucity of information on the use of dietary peptides in laying hens and its effects on egg production and quality. In the current study, peptide from enzymatic hydrolysis of soybean protein was incorporated into laying hens' diets to investigate its effect on egg production and internal egg quality. There were no treatment effects on egg production (average hen day production was 96%) during the experiment. Final body weight of the hens increased quadratically (P < 0.05) in response to peptide supplementation. There were no significant effects of peptide supplementation on internal egg quality of the fresh eggs. Peptide supplementation tended to increase yolk colour (P < 0.10) in eggs collected at 4 weeks of the study and stored at room temperature for 14 days. For the eggs collected at 8 weeks of the experiment and stored at room temperature for 14 days, peptide supplementation linearly increased (P < 0.05) albumen height, Haugh unit and yolk index but linearly decreased (P < 0.01) yolk width. Peptide supplementation to laying hens at peak production, receiving diets meeting their nutrient requirement, did not improve hen production but positively helped to maintain hens' body weight and egg quality during storage. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Region 6: New Mexico Adequate Letter (8/21/2003)

EPA Pesticide Factsheets

This is a letter from Carl Edlund, Director, to Alfredo Santistevan regarding MVEB's contained in the latest revision to the Albuquerque Carbon Monoxide State Implementation Plan (SIP) are adequate for transportation conformity purposes.

Understanding Your Adequate Yearly Progress (AYP), 2011-2012

ERIC Educational Resources Information Center

Missouri Department of Elementary and Secondary Education, 2011

2011-01-01

The "No Child Left Behind Act (NCLB) of 2001" requires all schools, districts/local education agencies (LEAs) and states to show that students are making Adequate Yearly Progress (AYP). NCLB requires states to establish targets in the following ways: (1) Annual Proficiency Target; (2) Attendance/Graduation Rates; and (3) Participation…

Detection of scabies: A systematic review of diagnostic methods.

PubMed

Leung, Victor; Miller, Mark

2011-01-01

Accurate diagnosis of scabies infection is important for patient treatment and for public health control of scabies epidemics. To systematically review the accuracy and precision of history, physical examination and tests for diagnosing scabies. Using a structured search strategy, Medline and Embase databases were searched for English and French language articles that included a diagnosis of scabies. Studies comparing history, physical examination and/or any diagnostic tests with the reference standard of microscopic visualization of mites, eggs or fecal elements obtained from skin scrapings or biopsies were included for analysis. Data were extracted using standard criteria. History and examination of pruritic dermatoses failed to accurately diagnose scabies infection. Dermatoscopy by a trained practitioner has a positive likelihood ratio of 6.5 (95% CI 4.1 to 10.3) and a negative likelihood ratio of 0.1 (95% CI 0.06 to 0.2) for diagnosing scabies. The accuracy of other diagnostic tests could not be calculated from the data in the literature. In the face of such diagnostic inaccuracy, clinical judgment is still practical in diagnosing scabies. Two tests are used - the burrow ink test and handheld dermatoscopy. The burrow ink test is a simple, rapid, noninvasive test that can be used to screen a large number of patients. Handheld dermatoscopy is an accurate test, but requires special equipment and trained practitioners. Given the morbidity and costs of scabies infection, and that studies to date lack adequate internal and external validity, research to identify or develop accurate diagnostic tests for scabies infection is needed and justifiable.

Measuring quality of life in patients with stress urinary incontinence: is the ICIQ-UI-SF adequate?

PubMed

Kurzawa, Zuzanna; Sutherland, Jason M; Crump, Trafford; Liu, Guiping

2018-05-08

The International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) is a widely used four-item patient-reported outcome (PRO) measure. Evaluations of this instrument are limited, restraining user's confidence in the instrument. This study conducts a comprehensive evaluation of the ICIQ-UI-SF on a sample of urological surgery patients in Canada. One hundred and seventy-seven surgical patients with stress urinary incontinence completed the ICIQ-UI-SF pre-operatively. Methods drawing from confirmatory factor analysis (CFA), measures of reliability, item response theory (IRT), and differential item functioning were applied. Ceiling effects were examined. Ceiling effects were identified. In the CFA, the factor loadings of items one and two differed significantly (p < 0.001) from item three indicating possible multidimensionality. The first two items reflect symptom severity not quality of life. Reliability was moderate as measured by Cronbach's alpha (0.63) and McDonald's coefficient (0.65). The IRT found the instrument does not discriminate between individuals with low incontinence-related quality of life. Due to low/moderate reliability, the ICIQ-UI-SF can be used as a complement to other data or used to report aggregated surgical outcomes among surgical patients. If the primary objective is to measure quality of life, other PROs should be considered.

Are the defined substrate-based methods adequate to determine the microbiological quality of natural recreational waters?

PubMed

Valente, Marta Sofia; Pedro, Paulo; Alonso, M Carmen; Borrego, Juan J; Dionísio, Lídia

2010-03-01

Monitoring the microbiological quality of water used for recreational activities is very important to human public health. Although the sanitary quality of recreational marine waters could be evaluated by standard methods, they are time-consuming and need confirmation. For these reasons, faster and more sensitive methods, such as the defined substrate-based technology, have been developed. In the present work, we have compared the standard method of membrane filtration using Tergitol-TTC agar for total coliforms and Escherichia coli, and Slanetz and Bartley agar for enterococci, and the IDEXX defined substrate technology for these faecal pollution indicators to determine the microbiological quality of natural recreational waters. ISO 17994:2004 standard was used to compare these methods. The IDEXX for total coliforms and E. coli, Colilert, showed higher values than those obtained by the standard method. Enterolert test, for the enumeration of enterococci, showed lower values when compared with the standard method. It may be concluded that more studies to evaluate the precision and accuracy of the rapid tests are required in order to apply them for routine monitoring of marine and freshwater recreational bathing areas. The main advantages of these methods are that they are more specific, feasible and simpler than the standard methodology.

Adaptive statistical iterative reconstruction and Veo: assessment of image quality and diagnostic performance in CT colonography at various radiation doses.

PubMed

Yoon, Min A; Kim, Se Hyung; Lee, Jeong Min; Woo, Hyoun Sik; Lee, Eun Sun; Ahn, Se Jin; Han, Joon Koo

2012-01-01

To evaluate the diagnostic performance of computed tomography (CT) colonography (CTC) reconstructed with different levels of adaptive statistical iterative reconstruction (ASiR, GE Healthcare) and Veo (model-based iterative reconstruction, GE Healthcare) at various tube currents in detection of polyps in porcine colon phantoms. Five porcine colon phantoms with 46 simulated polyps were scanned at different radiation doses (10, 30, and 50 mA s) and were reconstructed using filtered back projection (FBP), ASiR (20%, 40%, and 60%) and Veo. Eleven data sets for each phantom (10-mA s FBP, 10-mA s 20% ASiR, 10-mA s 40% ASiR, 10-mA s 60% ASiR, 10-mA s Veo, 30-mA s FBP, 30-mA s 20% ASiR, 30-mA s 40% ASiR, 30-mA s 60% ASiR, 30-mA s Veo, and 50-mA s FBP) yielded a total of 55 data sets. Polyp detection sensitivity and confidence level of 2 independent observers were evaluated with the McNemar test, the Fisher exact test, and receiver operating characteristic curve analysis. Comparative analyses of overall image quality score, measured image noise, and interpretation time were also performed. Per-polyp detection sensitivities and specificities were highest in 10-mA s Veo, 30-mA s FBP, 30-mA s 60% ASiR, and 50-mA s FBP (sensitivity, 100%; specificity, 100%). The area-under-the-curve values for the overall performance of each data set was also highest (1.000) at 50-mA s FBP, 30-mA s FBP, 30-mA s 60% ASiR, and 10-mA s Veo. Images reconstructed with ASiR showed statistically significant improvement in per-polyp detection sensitivity as the percent level of per-polyp sensitivity increased (10-mA s FBP vs 10-mA s 20% ASiR, P = 0.011; 10-mA s FBP vs 10-mA s 40% ASiR, P = 0.000; 10-mA s FBP vs 10-mA s 60% ASiR, P = 0.000; 10-mA s 20% ASiR vs 40% ASiR, P = 0.034). Overall image quality score was highest at 30-mA s Veo and 50-mA s FBP. The quantitative measurement of the image noise was lowest at 30-mA s Veo and second lowest at 10-mA s Veo. There was a trend of decrease in time

Diagnostic Tests to Support Late-Stage Control Programs for Schistosomiasis and Soil-Transmitted Helminthiases.

PubMed

Hawkins, Kenneth R; Cantera, Jason L; Storey, Helen L; Leader, Brandon T; de Los Santos, Tala

2016-12-01

Global efforts to address schistosomiasis and soil-transmitted helminthiases (STH) include deworming programs for school-aged children that are made possible by large-scale drug donations. Decisions on these mass drug administration (MDA) programs currently rely on microscopic examination of clinical specimens to determine the presence of parasite eggs. However, microscopy-based methods are not sensitive to the low-intensity infections that characterize populations that have undergone MDA. Thus, there has been increasing recognition within the schistosomiasis and STH communities of the need for improved diagnostic tools to support late-stage control program decisions, such as when to stop or reduce MDA. Failure to adequately address the need for new diagnostics could jeopardize achievement of the 2020 London Declaration goals. In this report, we assess diagnostic needs and landscape potential solutions and determine appropriate strategies to improve diagnostic testing to support control and elimination programs. Based upon literature reviews and previous input from experts in the schistosomiasis and STH communities, we prioritized two diagnostic use cases for further exploration: to inform MDA-stopping decisions and post-MDA surveillance. To this end, PATH has refined target product profiles (TPPs) for schistosomiasis and STH diagnostics that are applicable to these use cases. We evaluated the limitations of current diagnostic methods with regards to these use cases and identified candidate biomarkers and diagnostics with potential application as new tools. Based on this analysis, there is a need to develop antigen-detecting rapid diagnostic tests (RDTs) with simplified, field-deployable sample preparation for schistosomiasis. Additionally, there is a need for diagnostic tests that are more sensitive than the current methods for STH, which may include either a field-deployable molecular test or a simple, low-cost, rapid antigen-detecting test.

Designs and adaptive analysis plans for pivotal clinical trials of therapeutics and companion diagnostics.

PubMed

Simon, Richard

2008-06-01

Developments in genomics and biotechnology provide unprecedented opportunities for the development of effective therapeutics and companion diagnostics for matching the right drug to the right patient. Effective co-development involves many new challenges with increased opportunity for success as well as delay and failure. Clinical trial designs and adaptive analysis plans for the prospective design of pivotal trials of new therapeutics and companion diagnostics are reviewed. Effective co-development requires careful prospective planning of the design and analysis strategy for pivotal clinical trials. Randomized clinical trials continue to be important for evaluating the effectiveness of new treatments, but the target populations for analysis should be prospectively specified based on the companion diagnostic. Post hoc analyses of traditionally designed randomized clinical trials are often deeply problematic. Clear separation is generally required of the data used for developing the diagnostic test, including their threshold of positivity, from the data used for evaluating treatment effectiveness in subsets determined by the test. Adaptive analysis can be used to provide flexibility to the analysis but the use of such methods requires careful planning and prospective definition in order to assure that the pivotal trial adequately limits the chance of erroneous conclusions.

30 CFR 74.6 - Quality control.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Quality control. 74.6 Section 74.6 Mineral... control. The applicant shall describe the way in which each lot of components will be sampled and tested... of the CMDPSU will be maintained in production through adequate quality control procedures, MSHA and...

Indoor Air Quality: Maryland Public Schools.

ERIC Educational Resources Information Center

Maryland State Dept. of Education, College Park. Office of Administration and Finance.

Less than adequate indoor air quality in schools can lead to a higher risk of health problems, an increase in student and teacher absenteeism, diminished learning, and even hazardous conditions. An indoor air quality program that addresses the planning, design, maintenance, and operation of public school buildings should be implemented at the…

30 CFR 74.6 - Quality control.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Quality control. 74.6 Section 74.6 Mineral... control. The applicant shall describe the way in which each lot of components will be sampled and tested... of the CMDPSU will be maintained in production through adequate quality control procedures, MSHA and...

30 CFR 74.6 - Quality control.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Quality control. 74.6 Section 74.6 Mineral... control. The applicant shall describe the way in which each lot of components will be sampled and tested... of the CMDPSU will be maintained in production through adequate quality control procedures, MSHA and...

[Bases for adequate complementary feeding in infants and young children].

PubMed

Gil Hernández, A; Uauy Dagach, R; Dalmau Serra, J

2006-11-01

Infants can be exclusively breast fed or formula fed for the first 6 months of life and their nutritional requirements are completely fulfilled. However, from 6 months onwards, human milk is not sufficient to supply all the nutrients necessary for infants and young children. Therefore, adequate supplementary feeding, in terms of both quantity and quality, should be provided. The present article aims to describe the scientific bases for practical recommendations on complementary feeding during infancy and early childhood, which may be useful to pediatricians and should serve to improve the health status of the infant population in Spain. In this sense, the new international recommendations for energy, protein and other nutrient requirements are reviewed. In Spain, the law applicable to manufacturing infant cereals and homogenized infant foods is that published by the European Union in specific directives. However, taking into consideration new advances in knowledge of nutritional requirements, we have considered a number of issues that could be relevant for the manufacture of these foods. Finally, we propose a series of basic principles that should serve as a guide for the complementary feeding of infants (whether breast fed, formula fed, or receiving mixed feeding) and young children. These recommendations are particularly addressed to pediatricians working in primary health services.

[Polish version of the ADOS (autism diagnostic observation schedule-generic)].

PubMed

Chojnicka, Izabela; Płoski, Rafał

2012-01-01

The article presents the Polish version of the autism diagnostic observation schedule-generic (ADOS), which together with the autism diagnostic interview-revised (ADI-R) is cited as the "gold standard" for the diagnosis of autism. The ADOS is a standardised, semistructured observation protocol appropriate for children and adults of differing age and language levels. It is linked to ICD-10 and DSM-IV-TR criteria. The ADOS consists of four modules, ranging from module 1 for nonverbal individuals to module 4 for verbally fluent adults. The adequate inter-rater reliability for items has been established. The protocol has high discriminant validity and distinguishes children with pervasive developmental disorders from children, who are outside of the spectrum. Although it does not enable to distinguish individuals with pervasive developmental disorder, unspecified from individuals with childhood autism. The paper presents subsequent steps of the translation process of the original version into Polish, as well as a chosen adaptation strategy of the Polish version. The ADOS is a very useful tool both for clinical diagnosis and for the scientific purpose diagnosis. In this last case it is extremely important to use a standardised method. Until now, there was no standardised diagnostic tool for autism in Poland.

Predictors for achieving adequate protein and energy intake in nursing home rehabilitation patients.

PubMed

van Zwienen-Pot, J I; Visser, M; Kruizenga, H M

2018-07-01

Adequate energy and protein intake could be essential for contributing significantly to the rehabilitations process. Data on the actual nutritional intake of older nursing home rehabilitation patients have not yet been investigated. To investigate the nutritional intake and predictors for achieving protein and energy requirements on the 14th day of admission in nursing home rehabilitation patients. Fifty-nine patients aged 65+ years newly admitted to nursing home rehabilitation wards were included. Data on potential variables were collected on admission. On the fourteenth day nutritional intake was assessed. Intake was considered 'adequate' if patients had achieved ≥ 1.2 g of protein/kg bodyweight and ≥ 85% of their energy needs according to Harris and Benedict + 30%. Multiple logistic regression analyses were performed to select predictors for adequate intake. Protein and energy intake was assessed in 79 patients [67% female, mean age 82 ± (SD) 8 years, BMI 25 ± 6 kg/m 2 ]. Mean energy intake was 1677 kcal (± 433) and mean protein intake was 68 g (± 20). Fourteen patients (18%) achieved an adequate protein and energy intake. Predictors for adequate intake were use of sip/tube feeding (OR = 7.7; 95% CI = 1.35-44.21), BMI (0.68; 0.53-0.87) and nausea (8.59; 1.42-52.01). Only 18% of older nursing home rehabilitation patients had an adequate protein and energy intake at 14 days after admission. Patients with higher BMI were less likely, while those using sip/tube feeding or feeling nauseous were more likely to achieve an adequate protein and energy intake.

Behavioral interventions to promote adequate sleep among women: protocol for a systematic review and meta-analysis.

PubMed

Vézina-Im, Lydi-Anne; Moreno, Jennette Palcic; Nicklas, Theresa A; Baranowski, Tom

2017-05-11

Short and poor sleep have been associated with adverse health outcomes in adults, such as overweight/obesity and type 2 diabetes, especially among women. Women therefore represent an important target for interventions aimed at improving sleep and such interventions have been advocated to enhance maternal, fetal, and infant health. This systematic review will assess the efficacy or effectiveness of behavioral interventions aimed at promoting adequate sleep among women. The primary outcomes will be changes in sleep duration and/or sleep quality from baseline to post-intervention and to the last available follow-up measured either through self-reports or objectively. Secondary outcomes will be assessing the behavior change techniques that are responsible for the changes in sleep duration and quality among women. Behavioral interventions that are non-pharmacological and target either sleep directly or sleep hygiene behaviors will be included. Randomized controlled trials, quasi-experimental, and one-group pre-post studies will be included, but treated separately in the analyses, given that a limited number of studies on the topic of sleep is expected. MEDLINE/PubMed, PsycINFO, CINAHL, EMBASE, and Proquest Dissertations and Theses will be investigated. There will be no restriction on the year of publication of the articles, but we will include only the ones written in English or French. Two authors will independently assess articles for eligibility and will extract data using a standardized data extraction form that will have been previously pilot-tested. The quality of the studies will be assessed using the Effective Public Health Practice Project tool for quantitative study designs. The intervention procedures will be classified according to the latest validated taxonomy of behavior change techniques. If there is a sufficient number of studies (k > 5), a meta-analysis of the results will be performed with a random-effect model. If the heterogeneity is high (I 2 �

Spatially Resolved MR-Compatible Doppler Ultrasound: Proof of Concept for Triggering of Diagnostic Quality Cardiovascular MRI for Function and Flow Quantification at 3T.

PubMed

Crowe, Lindsey Alexandra; Manasseh, Gibran; Chmielewski, Aneta; Hachulla, Anne-Lise; Speicher, Daniel; Greiser, Andreas; Muller, Hajo; de Perrot, Thomas; Vallee, Jean-Paul; Salomir, Rares

2018-02-01

We demonstrate the use of a magnetic-resonance (MR)-compatible ultrasound (US) imaging probe using spatially resolved Doppler for diagnostic quality cardiovascular MR imaging (MRI) as an initial step toward hybrid US/MR fetal imaging. A newly developed technology for a dedicated MR-compatible phased array ultrasound-imaging probe acquired pulsed color Doppler carotid images, which were converted in near-real time to a trigger signal for cardiac cine and flow quantification MRI. Ultrasound and MR data acquired simultaneously were interference free. Conventional electrocardiogram (ECG) and the proposed spatially resolved Doppler triggering were compared in 10 healthy volunteers. A synthetic "false-triggered" image was retrospectively processed using metric optimized gating (MOG). Images were scored by expert readers, and sharpness, cardiac function and aortic flow were quantified. Four-dimensional (4-D) flow (two volunteers) showed feasibility of Doppler triggering over a long acquisition time. Imaging modalities were compatible. US probe positioning was stable and comfortable. Image quality scores and quantified sharpness were statistically equal for Doppler- and ECG-triggering (p ). ECG-, Doppler-triggered, and MOG ejection fractions were equivalent (p ), with false-triggered values significantly lower (p < 0.0005). Aortic flow showed no difference between ECG- and Doppler-triggered and MOG (p > 0.05). 4-D flow quantification gave consistent results between ECG and Doppler triggering. We report interference-free pulsed color Doppler ultrasound during MR data acquisition. Cardiovascular MRI of diagnostic quality was successfully obtained with pulsed color Doppler triggering. The hardware platform could further enable advanced free-breathing cardiac imaging. Doppler ultrasound triggering is applicable where ECG is compromised due to pathology or interference at higher magnetic fields, and where direct ECG is impossible, i.e., fetal imaging.

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2014 CFR

2014-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2013 CFR

2013-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2012 CFR

2012-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2011 CFR

2011-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

Comparability and Reliability Considerations of Adequate Yearly Progress

ERIC Educational Resources Information Center

Maier, Kimberly S.; Maiti, Tapabrata; Dass, Sarat C.; Lim, Chae Young

2012-01-01

The purpose of this study is to develop an estimate of Adequate Yearly Progress (AYP) that will allow for reliable and valid comparisons among student subgroups, schools, and districts. A shrinkage-type estimator of AYP using the Bayesian framework is described. Using simulated data, the performance of the Bayes estimator will be compared to…

Performance Assessment as a Diagnostic Tool for Science Teachers

NASA Astrophysics Data System (ADS)

Kruit, Patricia; Oostdam, Ron; van den Berg, Ed; Schuitema, Jaap

2018-04-01

Information on students' development of science skills is essential for teachers to evaluate and improve their own education, as well as to provide adequate support and feedback to the learning process of individual students. The present study explores and discusses the use of performance assessments as a diagnostic tool for formative assessment to inform teachers and guide instruction of science skills in primary education. Three performance assessments were administered to more than 400 students in grades 5 and 6 of primary education. Students performed small experiments using real materials while following the different steps of the empirical cycle. The mutual relationship between the three performance assessments is examined to provide evidence for the value of performance assessments as useful tools for formative evaluation. Differences in response patterns are discussed, and the diagnostic value of performance assessments is illustrated with examples of individual student performances. Findings show that the performance assessments were difficult for grades 5 and 6 students but that much individual variation exists regarding the different steps of the empirical cycle. Evaluation of scores as well as a more substantive analysis of students' responses provided insight into typical errors that students make. It is concluded that performance assessments can be used as a diagnostic tool for monitoring students' skill performance as well as to support teachers in evaluating and improving their science lessons.

STARD 2015: An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies.

PubMed

Bossuyt, Patrick M; Reitsma, Johannes B; Bruns, David E; Gatsonis, Constantine A; Glasziou, Paul P; Irwig, Les; Lijmer, Jeroen G; Moher, David; Rennie, Drummond; de Vet, Henrica C W; Kressel, Herbert Y; Rifai, Nader; Golub, Robert M; Altman, Douglas G; Hooft, Lotty; Korevaar, Daniël A; Cohen, Jérémie F

2015-12-01

Incomplete reporting has been identified as a major source of avoidable waste in biomedical research. Essential information is often not provided in study reports, impeding the identification, critical appraisal, and replication of studies. To improve the quality of reporting of diagnostic accuracy studies, the Standards for Reporting of Diagnostic Accuracy Studies (STARD) statement was developed. Here we present STARD 2015, an updated list of 30 essential items that should be included in every report of a diagnostic accuracy study. This update incorporates recent evidence about sources of bias and variability in diagnostic accuracy and is intended to facilitate the use of STARD. As such, STARD 2015 may help to improve completeness and transparency in reporting of diagnostic accuracy studies.

40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 24 2014-07-01 2014-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The pesticides...

40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 25 2013-07-01 2013-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The pesticides...

40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 25 2012-07-01 2012-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The pesticides...

Diagnostic methods for assessing maxillary skeletal and dental transverse deficiencies: A systematic review

PubMed Central

Sawchuk, Dena; Currie, Kris; Vich, Manuel Lagravere; Palomo, Juan Martin

2016-01-01

Objective To evaluate the accuracy and reliability of the diagnostic tools available for assessing maxillary transverse deficiencies. Methods An electronic search of three databases was performed from their date of establishment to April 2015, with manual searching of reference lists of relevant articles. Articles were considered for inclusion if they reported the accuracy or reliability of a diagnostic method or evaluation technique for maxillary transverse dimensions in mixed or permanent dentitions. Risk of bias was assessed in the included articles, using the Quality Assessment of Diagnostic Accuracy Studies tool-2. Results Nine articles were selected. The studies were heterogeneous, with moderate to low methodological quality, and all had a high risk of bias. Four suggested that the use of arch width prediction indices with dental cast measurements is unreliable for use in diagnosis. Frontal cephalograms derived from cone-beam computed tomography (CBCT) images were reportedly more reliable for assessing intermaxillary transverse discrepancies than posteroanterior cephalograms. Two studies proposed new three-dimensional transverse analyses with CBCT images that were reportedly reliable, but have not been validated for clinical sensitivity or specificity. No studies reported sensitivity, specificity, positive or negative predictive values or likelihood ratios, or ROC curves of the methods for the diagnosis of transverse deficiencies. Conclusions Current evidence does not enable solid conclusions to be drawn, owing to a lack of reliable high quality diagnostic studies evaluating maxillary transverse deficiencies. CBCT images are reportedly more reliable for diagnosis, but further validation is required to confirm CBCT's accuracy and diagnostic superiority. PMID:27668196

Region 1: New Hampshire Adequate Letter (8/12/2008)

EPA Pesticide Factsheets

This July 9, 2008 letter from EPA to the New Hampshire Department of Environmental Services, determined the 2009 Motor Vehicle Emissions Budgets (MVEBs) are adequate for transportation conformity purposes and will be announced in the Federal Register (FR).

Region 6: Texas Austin Adequate Letter (11/23/2016)

EPA Pesticide Factsheets

EPA letter approves the Motor Vehicle Emissions Budgets contained in the latest revision to Dallas/Fort Worth 2008 8-hour Ozone State Implementation Plan, finding them adequate for transportation conformity purposes to be announced in the Federal Register.

Automated Bus Diagnostic System Demonstration in New York City

DOT National Transportation Integrated Search

1983-12-01

In response to a growing problem with the quality and efficiency of nationwide bus maintenance practices, an award was granted to the Tri-State Regional Planning Commission for the testing of an automated bus diagnostic system (ABDS). The ABDS was de...

Evaluation of Quality of Lower Limb Arthroplasty Observational Studies Using the Assessment of Quality in Lower Limb Arthroplasty (AQUILA) Checklist.

PubMed

Cowan, James B; Mlynarek, Ryan A; Nelissen, Rob G H H; Pijls, Bart G C W; Gagnier, Joel J

2015-09-01

This study used the assessment of quality in lower limb arthroplasty (AQUILA) checklist to assess the quality of lower limb arthroplasty observational studies. Among 132 studies the mean reporting quality score was 5.4 (SD=1.2) out of 8 possible points. Most studies adequately reported reasons for revisions (98%) and prosthesis brand and fixation (95%) in sufficient detail. Only 3% of studies adequately reported the number of patients unwilling to participate, 15% stated a clear primary research question or hypothesis, 11% reported a worst-case analysis or competing risk analysis for endpoints, and 42% reported more than 5% of patients were lost to follow-up. There is significant room for improvement in the reporting and methodology of lower limb arthroplasty observational studies. Level III. Copyright © 2015 Elsevier Inc. All rights reserved.

Region 1: New Hampshire Adequate Letter (5/29/2012)

EPA Pesticide Factsheets

This April 25, 2012 letter from EPA to the New Hampshire Department of Environmental Services, determined the 2008 and 2022 Motor Vehicle Emissions Budgets (MVEBs) are adequate for transportation conformity purposes and will be announced in the Federal Reg

Region 5: Ohio Columbus Adequate Letter (8/23/2016)

EPA Pesticide Factsheets

Letter from EPA to State of Ohio determined the 2008 8-hour ozone standard plan for years 2020 and 2030 Motor Vehicle Emissions Budgets for volatile organic compounds and nitrogen oxides for Columbus area adequate for transportation conformity purposes.

Particles and microfluidics merged: perspectives of highly sensitive diagnostic detection

PubMed Central

Bale, Shyam Sundhar; Bhushan, Abhinav; Shen, Keyue; Seker, Erkin; Polyak, Boris

2014-01-01

There is a growing need for diagnostic technologies that provide laboratories with solutions that improve quality, enhance laboratory system productivity, and provide accurate detection of a broad range of infectious diseases and cancers. Recent advances in micro- and nanoscience and engineering, in particular in the areas of particles and microfluidic technologies, have advanced the “lab-on-a-chip” concept towards the development of a new generation of point-of-care diagnostic devices that could significantly enhance test sensitivity and speed. In this review, we will discuss many of the recent advances in microfluidics and particle technologies with an eye towards merging these two technologies for application in medical diagnostics. Although the potential diagnostic applications are virtually unlimited, the most important applications are foreseen in the areas of biomarker research, cancer diagnosis, and detection of infectious microorganisms. PMID:25378716

Region 8: Colorado Springs Adequate Letter (8/17/2011)

EPA Pesticide Factsheets

This March 3, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Colorado Springs, CO second 10 year Limited Maintenance Plan (LMP) adequate for transportation

Minimum requirements for adequate nighttime conspicuity of highway signs

DOT National Transportation Integrated Search

1988-02-01

A laboratory and field study were conducted to assess the minimum luminance levels of signs to ensure that they will be detected and identified at adequate distances under nighttime driving conditions. A total of 30 subjects participated in the field...

Inferential Processing among Adequate and Struggling Adolescent Comprehenders and Relations to Reading Comprehension

PubMed Central

Barth, Amy E.; Barnes, Marcia; Francis, David J.; Vaughn, Sharon; York, Mary

2015-01-01

Separate mixed model analyses of variance (ANOVA) were conducted to examine the effect of textual distance on the accuracy and speed of text consistency judgments among adequate and struggling comprehenders across grades 6–12 (n = 1203). Multiple regressions examined whether accuracy in text consistency judgments uniquely accounted for variance in comprehension. Results suggest that there is considerable growth across the middle and high school years, particularly for adequate comprehenders in those text integration processes that maintain local coherence. Accuracy in text consistency judgments accounted for significant unique variance for passage-level, but not sentence-level comprehension, particularly for adequate comprehenders. PMID:26166946

Image quality stability of whole-body diffusion weighted imaging.

PubMed

Chen, Yun-bin; Hu, Chun-miao; Zhong, Jing; Sun, Fei

2009-06-01

To assess the reproducibility of whole-body diffusion weighted imaging (WB-DWI) technique in healthy volunteers under normal breathing with background body signal suppression. WB-DWI was performed on 32 healthy volunteers twice within two-week period using short TI inversion-recovery diffusion-weighted echo-planar imaging sequence and built-in body coil. The volunteers were scanned across six stations continuously covering the entire body from the head to the feet under normal breathing. The bone apparent diffusion coefficient (ADC) and exponential ADC (eADC) of regions of interest (ROIs) were measured. We analyzed correlation of the results using paired-t-test to assess the reproducibility of the WB-DWI technique. We were successful in collecting and analyzing data of 64 WB-DWI images. There was no significant difference in bone ADC and eADC of 824 ROIs between the paired observers and paired scans (P>0.05). Most of the images from all stations were of diagnostic quality. The measurements of bone ADC and eADC have good reproducibility. WB-DWI technique under normal breathing with background body signal suppression is adequate.

Educational Auditing and Quality Assurance. Occasional Paper No. 4.

ERIC Educational Resources Information Center

Conner, James E.; Lessinger, Leon M.

This paper considers how to respond to new requirements for adequate disclosure of the schools' performance to the public. It proposes the use of three powerful constructs--quality control, quality assurance, and an independent educational accomplishment audit (IEAA). The essential elements of quality control are agreeing on and specifying desired…

Region 8: Colorado Telluride Adequate Letter (8/17/2011)

EPA Pesticide Factsheets

This March 4, 2011 letter from EPA to Chistopher E. Urbina M.D., MPH, Colorado Department of Public Health and Environment states that EPA has found that the Telluride, CO PM10 maintenance plan and the 2021 motor vehicle emisssions budget (MVEB) adequate

Newborns with suspected occult spinal dysraphism: a cost-effectiveness analysis of diagnostic strategies.

PubMed

Medina, L S; Crone, K; Kuntz, K M

2001-12-01

To assess the clinical and economic consequences of different diagnostic strategies in newborns with suspected occult spinal dysraphism. A decision-analytic model was constructed to project the cost and health outcomes of magnetic resonance imaging (MRI), ultrasound (US), plain radiographs, and no imaging in newborns with suspected occult spinal dysraphism. Morbidity and mortality rates of early versus late diagnosis of dysraphism and the sensitivity and specificity of MRI, US, and plain radiographs were obtained from the literature. Cost estimates were obtained from a hospital cost accounting database and from the Medicaid fee schedule. We found that the choice of imaging strategy depends on the underlying risk of occult spinal dysraphism. In low-risk children with intergluteal dimple or newborns of diabetic mothers (pretest probability: 0.3%-0.34%), US was the most effective strategy with an incremental cost-effectiveness ratio of $55 100 per quality-adjusted life year gained. For children with lumbosacral dimples, who have a higher pretest probability of 3.8%, US was less costly and more effective than the other 3 strategies considered. In intermediate-risk newborns with low anorectal malformation (pretest probability: 27%), US was more effective and less costly than radiographs and no imaging. However, MRI was more effective than US at an incremental cost-effectiveness of $1000 per quality-adjusted life year gained. In the high-risk group that included high anorectal malformation, cloacal malformation, and exstrophy (pretest probability: 44%-46%), MRI was actually cost-saving when compared with the other diagnostic strategies. For the intermediate-risk group, we found our analysis to be sensitive to the costs and diagnostic performances (sensitivity and specificity) of MRI and US. Lower MRI cost or greater MRI diagnostic performance improved the cost-effectiveness of the MRI strategy, whereas lower US cost or greater US diagnostic performance worsened the cost

STARD 2015: An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies.

PubMed

Bossuyt, Patrick M; Reitsma, Johannes B; Bruns, David E; Gatsonis, Constantine A; Glasziou, Paul P; Irwig, Les; Lijmer, Jeroen G; Moher, David; Rennie, Drummond; de Vet, Henrica C W; Kressel, Herbert Y; Rifai, Nader; Golub, Robert M; Altman, Douglas G; Hooft, Lotty; Korevaar, Daniël A; Cohen, Jérémie F

2015-12-01

Incomplete reporting has been identified as a major source of avoidable waste in biomedical research. Essential information is often not provided in study reports, impeding the identification, critical appraisal, and replication of studies. To improve the quality of reporting of diagnostic accuracy studies, the Standards for Reporting of Diagnostic Accuracy Studies (STARD) statement was developed. Here we present STARD 2015, an updated list of 30 essential items that should be included in every report of a diagnostic accuracy study. This update incorporates recent evidence about sources of bias and variability in diagnostic accuracy and is intended to facilitate the use of STARD. As such, STARD 2015 may help to improve completeness and transparency in reporting of diagnostic accuracy studies. © 2015 American Association for Clinical Chemistry.

Evidence assessing the diagnostic performance of medical smartphone apps: a systematic review and exploratory meta-analysis

PubMed Central

Buechi, Rahel; Faes, Livia; Bachmann, Lucas M; Thiel, Michael A; Bodmer, Nicolas S; Schmid, Martin K; Job, Oliver; Lienhard, Kenny R

2017-01-01

Objective The number of mobile applications addressing health topics is increasing. Whether these apps underwent scientific evaluation is unclear. We comprehensively assessed papers investigating the diagnostic value of available diagnostic health applications using inbuilt smartphone sensors. Methods Systematic Review—MEDLINE, Scopus, Web of Science inclusive Medical Informatics and Business Source Premier (by citation of reference) were searched from inception until 15 December 2016. Checking of reference lists of review articles and of included articles complemented electronic searches. We included all studies investigating a health application that used inbuilt sensors of a smartphone for diagnosis of disease. The methodological quality of 11 studies used in an exploratory meta-analysis was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool and the reporting quality with the ’STAndards for the Reporting of Diagnostic accuracy studies' (STARD) statement. Sensitivity and specificity of studies reporting two-by-two tables were calculated and summarised. Results We screened 3296 references for eligibility. Eleven studies, most of them assessing melanoma screening apps, reported 17 two-by-two tables. Quality assessment revealed high risk of bias in all studies. Included papers studied 1048 subjects (758 with the target conditions and 290 healthy volunteers). Overall, the summary estimate for sensitivity was 0.82 (95 % CI 0.56 to 0.94) and 0.89 (95 %CI 0.70 to 0.97) for specificity. Conclusions The diagnostic evidence of available health apps on Apple’s and Google’s app stores is scarce. Consumers and healthcare professionals should be aware of this when using or recommending them. PROSPERO registration number 42016033049. PMID:29247099

2012 HIV Diagnostics Conference: the molecular diagnostics perspective.

PubMed

Branson, Bernard M; Pandori, Mark

2013-04-01

2012 HIV Diagnostic Conference Atlanta, GA, USA, 12-14 December 2012. This report highlights the presentations and discussions from the 2012 National HIV Diagnostic Conference held in Atlanta (GA, USA), on 12-14 December 2012. Reflecting changes in the evolving field of HIV diagnostics, the conference provided a forum for evaluating developments in molecular diagnostics and their role in HIV diagnosis. In 2010, the HIV Diagnostics Conference concluded with the proposal of a new diagnostic algorithm which included nucleic acid testing to resolve discordant screening and supplemental antibody test results. The 2012 meeting, picking up where the 2010 meeting left off, focused on scientific presentations that assessed this new algorithm and the role played by RNA testing and new developments in molecular diagnostics, including detection of total and integrated HIV-1 DNA, detection and quantification of HIV-2 RNA, and rapid formats for detection of HIV-1 RNA.

Detection of scabies: A systematic review of diagnostic methods

PubMed Central

Leung, Victor; Miller, Mark

2011-01-01

BACKGROUND: Accurate diagnosis of scabies infection is important for patient treatment and for public health control of scabies epidemics. OBJECTIVE: To systematically review the accuracy and precision of history, physical examination and tests for diagnosing scabies. METHODS: Using a structured search strategy, Medline and Embase databases were searched for English and French language articles that included a diagnosis of scabies. Studies comparing history, physical examination and/or any diagnostic tests with the reference standard of microscopic visualization of mites, eggs or fecal elements obtained from skin scrapings or biopsies were included for analysis. Data were extracted using standard criteria. RESULTS: History and examination of pruritic dermatoses failed to accurately diagnose scabies infection. Dermatoscopy by a trained practitioner has a positive likelihood ratio of 6.5 (95% CI 4.1 to 10.3) and a negative likelihood ratio of 0.1 (95% CI 0.06 to 0.2) for diagnosing scabies. The accuracy of other diagnostic tests could not be calculated from the data in the literature. CONCLUSIONS: In the face of such diagnostic inaccuracy, clinical judgment is still practical in diagnosing scabies. Two tests are used – the burrow ink test and handheld dermatoscopy. The burrow ink test is a simple, rapid, noninvasive test that can be used to screen a large number of patients. Handheld dermatoscopy is an accurate test, but requires special equipment and trained practitioners. Given the morbidity and costs of scabies infection, and that studies to date lack adequate internal and external validity, research to identify or develop accurate diagnostic tests for scabies infection is needed and justifiable. PMID:23205026

New diagnostic reporting format for endometrial cytology based on cytoarchitectural criteria

PubMed Central

Yanoh, K; Norimatsu, Y; Hirai, Y; Takeshima, N; Kamimori, A; Nakamura, Y; Shimizu, K; Kobayashi, T K; Murata, T; Shiraishi, T

2009-01-01

Objective: The aim of this study was to develop a new reporting format for endometrial cytology that would standardize the diagnostic criteria and the terminology used for reporting. Methods: In previous studies, cytoarchitectural criteria were found to be useful for the cytological assessment of endometrial lesions. To apply these criteria, an appropriate cytological specimen is imperative. In this article, the requirements of an adequate endometrial cytological specimen for the new diagnostic criteria are first discussed. Then, the diagnostic criteria, standardized on a combination of conventional and cytoarchitectural criteria, are presented. Third, terminology that could be used, not only for reporting the histopathological diagnosis, but also for providing better guidance for the gynaecologist to determine further clinical action, is introduced. The proposed reporting format was investigated using endometrial cytology of 58 cases that were cytologically underestimated or overestimated compared to the histopathological diagnosis made on the subsequent endometrial biopsy or surgical specimens. Results: Of the 58 cases, 12 were reassessed as being unsatisfactory for evaluation. Among the remaining 46 cases, 25 of the 27 cases, which had been underestimated and subsequently diagnosed as having endometrial carcinoma or a precursor stage on histopathological examination,were reassessed as recommended for endometrial biopsy. On the other hand, 19 cases overestimated by cytology were all reassessed as not requiring biopsy. Conclusions: The reporting format for endometrial cytology proposed in this article may improve diagnostic accuracy and reduce the number of patients managed inappropriately. PMID:18657157

Health-based risk adjustment: is inpatient and outpatient diagnostic information sufficient?

PubMed

Lamers, L M

Adequate risk adjustment is critical to the success of market-oriented health care reforms in many countries. Currently used risk adjusters based on demographic and diagnostic cost groups (DCGs) do not reflect expected costs accurately. This study examines the simultaneous predictive accuracy of inpatient and outpatient morbidity measures and prior costs. DCGs, pharmacy cost groups (PCGs), and prior year's costs improve the predictive accuracy of the demographic model substantially. DCGs and PCGs seem complementary in their ability to predict future costs. However, this study shows that the combination of DCGs and PCGs still leaves room for cream skimming.

9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

Code of Federal Regulations, 2010 CFR

2010-01-01

... veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT... and Adequate Veterinary Care § 2.40 Attending veterinarian and adequate veterinary care (dealers and... veterinary care to its animals in compliance with this section. (1) Each dealer and exhibitor shall employ an...

9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

Code of Federal Regulations, 2011 CFR

2011-01-01

... veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT... and Adequate Veterinary Care § 2.40 Attending veterinarian and adequate veterinary care (dealers and... veterinary care to its animals in compliance with this section. (1) Each dealer and exhibitor shall employ an...

Performance evaluation of rapid diagnostic test for malaria in high malarious districts of Amhara region, Ethiopia.

PubMed

Beyene, Belay Bezabih; Yalew, Woyneshet Gelaye; Demilew, Ermias; Abie, Getent; Tewabe, Tsehaye; Abera, Bayeh

2016-03-01

Malaria is one of the leading public health challenges in Ethiopia. To address this, the Federal Ministry of Ethiopia launched a laboratory diagnosis programme for promoting use of either rapid diagnostic tests (RDTs) or Giemsa microscopy to all suspected malaria cases. This study was conducted to assess the performance of RDT and influencing factors for Giemsa microscopic diagnosis in Amhara region. A cross-sectional study was conducted in 10 high burden malaria districts of Amhara region from 15 May to 15 June 2014. Data were collected using structured questionnaire. Blood samples were collected from 1000 malaria suspected cases in 10 health centers. RDT (SD BIOLINE) and Giemsa microscopy were performed as per standard procedures. Kappa value, logistic regression and chi-square test were used for statistical analysis. The overall positivity rate (PR) of malaria parasites by RDT and Giemsa microscopy was 17.1 and 16.5% respectively. Compared to Giemsa microscopy as "gold standard", RDT showed 83.9% sensitivity and 96% specificity. The level of agreement between first reader and second reader for blood film microscopy was moderate (Kappa value = 0.74). Logistic regression showed that male, under five year of age and having fever more than 24 h prior to malaria diagnosis had statistically significant association with malaria positivity rate for malaria parasites. The overall specificity and negative predictive values of RDT for malaria diagnosis were excellent. However, the sensitivity and positive predictive values of RDT were low. Therefore, in-service training, quality monitoring of RDTs, and adequate laboratory supplies for diagnostic services of malaria would be crucial for effective intervention measures.

[Rating the quality of care offered to women who underwent hysterectomy].

PubMed

Rosales Aujang, Enrique; Jaime Camacho, María de Jesús

2011-08-01

In recent years emerged as a primary need, the evaluation of the services offered to get better quality in them. Health systems are subject to these assessments. To assess the quality of care provided to patients who underwent hysterectomy, since the reference of the family physician, until discharge by the gynecologist. We analyzed the diagnostic results in the short and long-term, patient satisfaction and gynecologist satisfaction, regarding the conditions for offering services. Retrospective study including 118 patients who underwent hysterectomy and were analyzed the following aspects: history, diagnoses and outcomes. Cross-sectional surveys were also conducted to obtain the satisfaction of patients and the physicians who performed the surgeries. The satisfaction of patients was confirmed, in contrast to the opinion of gynecologists who expressed dissatisfaction with the resources they have. There was discrepancy between diagnosis, planned surgery and the procedure performed, however, the clinical results were adequate. At present, any institution should periodically evaluate the services it provides to implement measures and procedures commensurate with their population and resources and invite users to participate in internal decision making and provide the opportunity to become an evaluator to generate a culture of self-improvement and continuous improvement in all involved.

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Emission diagnostics for SCR systems. 1033.112 Section 1033.112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... computer memory all incidents of engine operation with inadequate reductant injection or reductant quality...

Current strategies for the restoration of adequate lordosis during lumbar fusion

PubMed Central

Barrey, Cédric; Darnis, Alice

2015-01-01

Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

The lack of adequate quality assurance/quality control data hinders the assessment of potential forest degradation in a national forest inventory

Treesearch

Thomas Brandeis; Stanley Zarnoch; Christopher Oswalt; Jeffery Stringer

2017-01-01

Hardwood lumber harvested from the temperate broadleaf and mixed broadleaf/conifer forests of the east-central United States is an important economic resource. Forest industry stakeholders in this region have a growing need for accurate, reliable estimates of high-quality wood volume. While lower-graded timber has an increasingly wide array of uses, the forest products...

A diagnostic for quantifying heat flux from a thermite spray

DOE Office of Scientific and Technical Information (OSTI.GOV)

E. P. Nixon; M. L. Pantoya; D. J. Prentice

2010-02-01

Characterizing the combustion behaviors of energetic materials requires diagnostic tools that are often not readily or commercially available. For example, a jet of thermite spray provides a high temperature and pressure reaction that can also be highly corrosive and promote undesirable conditions for the survivability of any sensor. Developing a diagnostic to quantify heat flux from a thermite spray is the objective of this study. Quick response sensors such as thin film heat flux sensors cannot survive the harsh conditions of the spray, but more rugged sensors lack the response time for the resolution desired. A sensor that will allowmore » for adequate response time while surviving the entire test duration was constructed. The sensor outputs interior temperatures of the probes at known locations and utilizes an inverse heat conduction code to calculate heat flux values. The details of this device are discussed and illustrated. Temperature and heat flux measurements of various thermite sprays are reported. Results indicate that this newly designed heat flux sensor provides quantitative data with good repeatability suitable for characterizing energetic material combustion.« less

Diagnostic ultrasound at MACH 20: retroperitoneal and pelvic imaging in space.

PubMed

Jones, J A; Sargsyan, A E; Barr, Y R; Melton, S; Hamilton, D R; Dulchavsky, S A; Whitson, P A

2009-07-01

An operationally available diagnostic imaging capability augments spaceflight medical support by facilitating the diagnosis, monitoring and treatment of medical or surgical conditions, by improving medical outcomes and, thereby, by lowering medical mission impacts and the probability of crew evacuation due to medical causes. Microgravity-related physiological changes occurring during spaceflight can affect the genitourinary system and potentially cause conditions such as urinary retention or nephrolithiasis for which ultrasonography (U/S) would be a useful diagnostic tool. This study describes the first genitourinary ultrasound examination conducted in space, and evaluates image quality, frame rate, resolution requirements, real-time remote guidance of nonphysician crew medical officers and evaluation of on-orbit tools that can augment image acquisition. A nonphysician crew medical officer (CMO) astronaut, with minimal training in U/S, performed a self-examination of the genitourinary system onboard the International Space Station, using a Philips/ATL Model HDI-5000 ultrasound imaging unit located in the International Space Station Human Research Facility. The CMO was remotely guided by voice commands from experienced, earth-based sonographers stationed in Mission Control Center in Houston. The crewmember, with guidance, was able to acquire all of the target images. Real-time and still U/S images received at Mission Control Center in Houston were of sufficient quality for the images to be diagnostic for multiple potential genitourinary applications. Microgravity-based ultrasound imaging can provide diagnostic quality images of the retroperitoneum and pelvis, offering improved diagnosis and treatment for onboard medical contingencies. Successful completion of complex sonographic examinations can be obtained even with minimally trained nonphysician ultrasound operators, with the assistance of ground-based real-time guidance.

Quality Control of Direct Molecular Diagnostics for Methicillin-Resistant Staphylococcus aureus▿

PubMed Central

van Belkum, Alex; Niesters, Hubert G. M.; MacKay, William G.; van Leeuwen, Willem B.

2007-01-01

Ten samples containing various amounts of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S. aureus, methicillin-resistant Staphylococcus epidermidis (MRSE), and combinations thereof were distributed to 51 laboratories for molecular diagnostics testing. Samples containing 102 to 103 MRSA cells were frequently reported to be negative. MRSE samples were scored as negative by all commercial tests but by only two out of three in-house tests. PMID:17581936

Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis.

PubMed

Reiman, Michael P; Goode, Adam P; Hegedus, Eric J; Cook, Chad E; Wright, Alexis A

2013-09-01

Hip Physical Examination (HPE) tests have long been used to diagnose a myriad of intra-and extra-articular pathologies of the hip joint. Useful clinical utility is necessary to support diagnostic imaging and subsequent surgical decision making. Summarise and evaluate the current research and utility on the diagnostic accuracy of HPE tests for the hip joint germane to sports related injuries and pathology. A computer-assisted literature search of MEDLINE, CINHAL and EMBASE databases (January 1966 to January 2012) using keywords related to diagnostic accuracy of the hip joint. This systematic review with meta-analysis utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the search and reporting phases of the study. Der-Simonian and Laird random effects models were used to summarise sensitivities (SN), specificities (SP), likelihood ratios and diagnostic OR. The employed search strategy revealed 25 potential articles, with 10 demonstrating high quality. Fourteen articles qualified for meta-analysis. The meta-analysis demonstrated that most tests possess weak diagnostic properties with the exception of the patellar-pubic percussion test, which had excellent pooled SN 95 (95% CI 92 to 97%) and good specificity 86 (95% CI 78 to 92%). Several studies have investigated pathology in the hip. Few of the current studies are of substantial quality to dictate clinical decision-making. Currently, only the patellar-pubic percussion test is supported by the data as a stand-alone HPE test. Further studies involving high quality designs are needed to fully assess the value of HPE tests for patients with intra- and extra-articular hip dysfunction.

4 CFR 200.14 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2010 CFR

2010-01-01

... identifiable personal data and automated systems shall be adequately trained in the security and privacy of... the security and privacy of such records. (5) The disposal and destruction of identifiable personal....14 Section 200.14 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PRIVACY ACT OF 1974 § 200...

4 CFR 200.14 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2011 CFR

2011-01-01

... identifiable personal data and automated systems shall be adequately trained in the security and privacy of....14 Section 200.14 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PRIVACY ACT OF 1974 § 200... records in which identifiable personal data are processed or maintained, including all reports and output...

Effect of Reduced Tube Voltage on Diagnostic Accuracy of CT Colonography.

PubMed

Futamata, Yoshihiro; Koide, Tomoaki; Ihara, Riku

2017-01-01

The normal tube voltage in computed tomography colonography (CTC) is 120 kV. Some reports indicate that the use of a low tube voltage (lower than 120 kV) technique plays a significant role in reduction of radiation dose. However, to determine whether a lower tube voltage can reduce radiation dose without compromising diagnostic accuracy, an evaluation of images that are obtained while maintaining the volume CT dose index (CTDI vol ) is required. This study investigated the effect of reduced tube voltage in CTC, without modifying radiation dose (i.e. constant CTDI vol ), on image quality. Evaluation of image quality involved the shape of the noise power spectrum, surface profiling with volume rendering (VR), and receiver operating characteristic (ROC) analysis. The shape of the noise power spectrum obtained with a tube voltage of 80 kV and 100 kV was not similar to the one produced with a tube voltage of 120 kV. Moreover, a higher standard deviation was observed on volume-rendered images that were generated using the reduced tube voltages. In addition, ROC analysis revealed a statistically significant drop in diagnostic accuracy with reduced tube voltage, revealing that the modification of tube voltage affects volume-rendered images. The results of this study suggest that reduction of tube voltage in CTC, so as to reduce radiation dose, affects image quality and diagnostic accuracy.

A semi-automated, field-portable microscopy platform for clinical diagnostic applications

NASA Astrophysics Data System (ADS)

Jagannadh, Veerendra Kalyan; Srinivasan, Rajesh; Gorthi, Sai Siva

2015-08-01

Clinical microscopy is a versatile diagnostic platform used for diagnosis of a multitude of diseases. In the recent past, many microfluidics based point-of-care diagnostic devices have been developed, which serve as alternatives to microscopy. However, these point-of-care devices are not as multi-functional and versatile as clinical microscopy. With the use of custom designed optics and microfluidics, we have developed a versatile microscopy-based cellular diagnostic platform, which can be used at the point of care. The microscopy platform presented here is capable of detecting infections of very low parasitemia level (in a very small quantity of sample), without the use of any additional computational hardware. Such a cost-effective and portable diagnostic device, would greatly impact the quality of health care available to people living in rural locations of the world. Apart from clinical diagnostics, it's applicability to field research in environmental microbiology has also been outlined.

ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology.

PubMed

Khong, P-L; Ringertz, H; Donoghue, V; Frush, D; Rehani, M; Appelgate, K; Sanchez, R

2013-04-01

Paediatric patients have a higher average risk of developing cancer compared with adults receiving the same dose. The longer life expectancy in children allows more time for any harmful effects of radiation to manifest, and developing organs and tissues are more sensitive to the effects of radiation. This publication aims to provide guiding principles of radiological protection for referring clinicians and clinical staff performing diagnostic imaging and interventional procedures for paediatric patients. It begins with a brief description of the basic concepts of radiological protection, followed by the general aspects of radiological protection, including principles of justification and optimisation. Guidelines and suggestions for radiological protection in specific modalities - radiography and fluoroscopy, interventional radiology, and computed tomography - are subsequently covered in depth. The report concludes with a summary and recommendations. The importance of rigorous justification of radiological procedures is emphasised for every procedure involving ionising radiation, and the use of imaging modalities that are non-ionising should always be considered. The basic aim of optimisation of radiological protection is to adjust imaging parameters and institute protective measures such that the required image is obtained with the lowest possible dose of radiation, and that net benefit is maximised to maintain sufficient quality for diagnostic interpretation. Special consideration should be given to the availability of dose reduction measures when purchasing new imaging equipment for paediatric use. One of the unique aspects of paediatric imaging is with regards to the wide range in patient size (and weight), therefore requiring special attention to optimisation and modification of equipment, technique, and imaging parameters. Examples of good radiographic and fluoroscopic technique include attention to patient positioning, field size and adequate collimation, use

Cognitive Attributes of Adequate and Inadequate Responders to Reading Intervention in Middle School

ERIC Educational Resources Information Center

Miciak, Jeremy; Stuebing, Karla K.; Vaughn, Sharon; Roberts, Greg; Barth, Amy E.; Fletcher, Jack M.

2014-01-01

No studies have investigated the cognitive attributes of middle school students who are adequate and inadequate responders to Tier 2 reading intervention. We compared students in Grades 6 and 7 representing groups of adequate responders (n = 77) and inadequate responders who fell below criteria in (a) comprehension (n = 54); (b) fluency (n = 45);…

34 CFR 200.14 - Components of Adequate Yearly Progress.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Components of Adequate Yearly Progress. 200.14 Section 200.14 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE DISADVANTAGED...

13 CFR 108.200 - Adequate capital for NMVC Companies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Adequate capital for NMVC Companies. 108.200 Section 108.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Capitalizing A Nmvc Company § 108.200...

Is this the right normalization? A diagnostic tool for ChIP-seq normalization.

PubMed

Angelini, Claudia; Heller, Ruth; Volkinshtein, Rita; Yekutieli, Daniel

2015-05-09

diagnostic plot proposed in this paper can be used to assess how adequate ChIP/Input normalization constants are, and thus it allows the user to choose the most adequate estimate for the analysis.

Gene expression-based molecular diagnostic system for malignant gliomas is superior to histological diagnosis.

PubMed

Shirahata, Mitsuaki; Iwao-Koizumi, Kyoko; Saito, Sakae; Ueno, Noriko; Oda, Masashi; Hashimoto, Nobuo; Takahashi, Jun A; Kato, Kikuya

2007-12-15

Current morphology-based glioma classification methods do not adequately reflect the complex biology of gliomas, thus limiting their prognostic ability. In this study, we focused on anaplastic oligodendroglioma and glioblastoma, which typically follow distinct clinical courses. Our goal was to construct a clinically useful molecular diagnostic system based on gene expression profiling. The expression of 3,456 genes in 32 patients, 12 and 20 of whom had prognostically distinct anaplastic oligodendroglioma and glioblastoma, respectively, was measured by PCR array. Next to unsupervised methods, we did supervised analysis using a weighted voting algorithm to construct a diagnostic system discriminating anaplastic oligodendroglioma from glioblastoma. The diagnostic accuracy of this system was evaluated by leave-one-out cross-validation. The clinical utility was tested on a microarray-based data set of 50 malignant gliomas from a previous study. Unsupervised analysis showed divergent global gene expression patterns between the two tumor classes. A supervised binary classification model showed 100% (95% confidence interval, 89.4-100%) diagnostic accuracy by leave-one-out cross-validation using 168 diagnostic genes. Applied to a gene expression data set from a previous study, our model correlated better with outcome than histologic diagnosis, and also displayed 96.6% (28 of 29) consistency with the molecular classification scheme used for these histologically controversial gliomas in the original article. Furthermore, we observed that histologically diagnosed glioblastoma samples that shared anaplastic oligodendroglioma molecular characteristics tended to be associated with longer survival. Our molecular diagnostic system showed reproducible clinical utility and prognostic ability superior to traditional histopathologic diagnosis for malignant glioma.

Quality in the molecular microbiology laboratory.

PubMed

Wallace, Paul S; MacKay, William G

2013-01-01

In the clinical microbiology laboratory advances in nucleic acid detection, quantification, and sequence analysis have led to considerable improvements in the diagnosis, management, and monitoring of infectious diseases. Molecular diagnostic methods are routinely used to make clinical decisions based on when and how to treat a patient as well as monitor the effectiveness of a therapeutic regime and identify any potential drug resistant strains that may impact on the long term patient treatment program. Therefore, confidence in the reliability of the result provided by the laboratory service to the clinician is essential for patient treatment. Hence, suitable quality assurance and quality control measures are important to ensure that the laboratory methods and service meet the necessary regulatory requirements both at the national and international level. In essence, the modern clinical microbiology laboratory ensures the appropriateness of its services through a quality management system that monitors all aspects of the laboratory service pre- and post-analytical-from patient sample receipt to reporting of results, from checking and upholding staff competency within the laboratory to identifying areas for quality improvements within the service offered. For most European based clinical microbiology laboratories this means following the common International Standard Organization (ISO9001) framework and ISO15189 which sets out the quality management requirements for the medical laboratory (BS EN ISO 15189 (2003) Medical laboratories-particular requirements for quality and competence. British Standards Institute, Bristol, UK). In the United States clinical laboratories performing human diagnostic tests are regulated by the Centers for Medicare and Medicaid Services (CMS) following the requirements within the Clinical Laboratory Improvement Amendments document 1988 (CLIA-88). This chapter focuses on the key quality assurance and quality control requirements within the

Relationship between anxiety level and radiological investigation. Comparison among different diagnostic imaging exams in a prospective single-center study.

PubMed

Lo Re, Giuseppe; De Luca, Rossella; Muscarneri, Filippa; Dorangricchia, Patrizia; Picone, Dario; Vernuccio, Federica; Salerno, Sergio; La Tona, Giuseppe; Pinto, Antonio; Midiri, Massimo; Russo, Antonio; Lagalla, Roberto; Cicero, Giuseppe

2016-10-01

Every patient could feel anxious when he waits in a radiological department to undergo diagnostic exams. The aim of our study is to evaluate the impact of the radiological exams on patient anxiety. We evaluated 343 patients (mean age 54.83 years) who underwent different types of diagnostic exams in the Department of Diagnostic Imaging at our Hospital from April 2013 to August 2014. We administered to patients the State and Trait Anxiety Inventory Test, which detected with high sensitivity both state anxiety and trait anxiety. A team of clinical psychologists and radiologists evaluated the scores obtained. 83 out of 343 patients were excluded because refused to file the questionnaire. 31 % of the patients were submitted to MR, 18 % to breast imaging, 10 % to X-ray, 22 % Computer Tomography and 19 % to ultrasound, as previously described. 41 % of patients were submitted to the examination because of an oncologic disease, while 59 % because of non-oncological disease. Therefore, it was found that high levels of anxiety were present in most (about 91 %) of the patients and the scores varied according to the imaging examination and to the examination's reason: anxiety level was higher in non-oncological patients (54 %) and in patients waiting to undergo to MRI exams (29 %). Our data suggest that the diagnostic exams are stressful events for the patient, also in non-oncological patients. So, it is important to adequate the radiological staff to receive the patient, to inform him and perform exams with emotive involvement with a targeted education. Also, further studies are needed to evaluate the anxiety level and the quality of the images, because the anxiety can result in a somatic disorder with hyperactivity of the autonomic nervous system which may affect the patient's physical examination, causing problems in the evaluation of radiological images making to non-cooperative patient. MRI imaging is the examination that more of all led to an anxious state of

PREFACE: Diagnostics for electrical discharge light sources: pushing the limits Diagnostics for electrical discharge light sources: pushing the limits

NASA Astrophysics Data System (ADS)

Zissis, Georges; Haverlag, Marco

2010-06-01

Light sources play an indispensable role in the daily life of any human being. Quality of life, health and urban security related to traffic and crime prevention depend on light and on its quality. In fact, every day approximately 30 billion electric light sources operate worldwide. These electric light sources consume almost 19% of worldwide electricity production. Finding new ways to light lamps is a challenge where the stakes are scientific, technological, economic and environmental. The production of more efficient light sources is a sustainable solution for humanity. There are many opportunities for not only enhancing the efficiency and reliability of lighting systems but also for improving the quality of light as seen by the end user. This is possible through intelligent use of new technologies, deep scientific understanding of the operating principles of light sources and knowledge of the varied human requirements for different types of lighting in different settings. A revolution in the domain of light source technology is on the way: high brightness light emitting diodes arriving in the general lighting market, together with organic LEDs (OLEDs), are producing spectacular advances. However, unlike incandescence, electrical discharge lamps are far from disappearing from the market. In addition, new generations of discharge lamps based on molecular radiators are becoming a reality. There are still many scientific and technological challenges to be raised in this direction. Diagnostics are important for understanding the fundamental mechanisms taking place in the discharge plasma. This understanding is an absolute necessity for system optimization leading to more efficient and high quality light sources. The studied medium is rather complex, but new diagnostic techniques coupled to innovative ideas and powerful tools have been developed in recent years. This cluster issue of seven papers illustrates these efforts. The selected papers cover all domains, from

Region 9: California Adequate / Inadequate Letter Attachment (5/30/2008)

EPA Pesticide Factsheets

This is a document that states that it has been found adequate for transportation conformitypurposes certain 8-hour ozone and PM2.5 motor vehicleemissions budgets in the 2007 South Coast StateImplementation Plan.

Pre-examination factors affecting molecular diagnostic test results and interpretation: A case-based approach.

PubMed

Payne, Deborah A; Baluchova, Katarina; Peoc'h, Katell H; van Schaik, Ron H N; Chan, K C Allen; Maekawa, Masato; Mamotte, Cyril; Russomando, Graciela; Rousseau, François; Ahmad-Nejad, Parviz

2017-04-01

Multiple organizations produce guidance documents that provide opportunities to harmonize quality practices for diagnostic testing. The International Organization for Standardization ISO 15189 standard addresses requirements for quality in management and technical aspects of the clinical laboratory. One technical aspect addresses the complexities of the pre-examination phase prior to diagnostic testing. The Committee for Molecular Diagnostics of the International Federation for Clinical Chemistry and Laboratory Medicine (also known as, IFCC C-MD) conducted a survey of international molecular laboratories and determined ISO 15189 to be the most referenced guidance document. In this review, the IFCC C-MD provides case-based examples illustrating the value of select pre-examination processes as these processes relate to molecular diagnostic testing. Case-based examples in infectious disease, oncology, inherited disease and pharmacogenomics address the utility of: 1) providing information to patients and users, 2) designing requisition forms, 3) obtaining informed consent and 4) maintaining sample integrity prior to testing. The pre-examination phase requires extensive and consistent communication between the laboratory, the healthcare provider and the end user. The clinical vignettes presented in this paper illustrate the value of applying select ISO 15189 recommendations for general laboratory to the more specialized area of Molecular Diagnostics. Copyright © 2016 Elsevier B.V. All rights reserved.

Adequate nutrient intake can reduce cardiovascular disease risk in African Americans.

PubMed

Reusser, Molly E; DiRienzo, Douglas B; Miller, Gregory D; McCarron, David A

2003-03-01

Cardiovascular disease kills nearly as many Americans each year as the next seven leading causes of death combined. The prevalence of cardiovascular disease and most of its associated risk factors is markedly higher and increasing more rapidly among African Americans than in any other racial or ethnic group. Improving these statistics may be simply a matter of improving diet quality. In recent years, a substantial and growing body of evidence has revealed that dietary patterns complete in all food groups, including nutrient-rich dairy products, are essential for preventing and reducing cardiovascular disease and the conditions that contribute to it. Several cardiovascular risk factors, including hypertension, insulin resistance syndrome, and obesity, have been shown to be positively influenced by dietary patterns that include adequate intake of dairy products. The benefits of nutrient-rich dietary patterns have been specifically tested in randomized, controlled trials emphasizing African American populations. These studies demonstrated proportionally greater benefits for African Americans without evidence of adverse effects such as symptoms of lactose intolerance. As currently promoted for the prevention of certain cancers and osteoporosis, regular consumption of diets that meet recommended nutrient intake levels might also be the most effective approach for reducing cardiovascular disease risk in African Americans.

10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the security and privacy of personal data. (4) The disposal and disposition of identifiable personal... contained in a system of records are adequately trained to protect the security and privacy of such records....114 Section 1304.114 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.114...

Is the Stock of VET Skills Adequate? Assessment Methodologies.

ERIC Educational Resources Information Center

Blandy, Richard; Freeland, Brett

In Australia and elsewhere, four approaches have been used to determine whether stocks of vocational education and training (VET) skills are adequate to meet industry needs. The four methods are as follows: (1) the manpower requirements approach; (2) the international, national, and industry comparisons approach; (3) the labor market analysis…

Dual-Energy Computed Tomography Angiography of the Lower Extremity Runoff: Impact of Noise-Optimized Virtual Monochromatic Imaging on Image Quality and Diagnostic Accuracy.

PubMed

Wichmann, Julian L; Gillott, Matthew R; De Cecco, Carlo N; Mangold, Stefanie; Varga-Szemes, Akos; Yamada, Ricardo; Otani, Katharina; Canstein, Christian; Fuller, Stephen R; Vogl, Thomas J; Todoran, Thomas M; Schoepf, U Joseph

2016-02-01

The aim of this study was to evaluate the impact of a noise-optimized virtual monochromatic imaging algorithm (VMI+) on image quality and diagnostic accuracy at dual-energy computed tomography angiography (CTA) of the lower extremity runoff. This retrospective Health Insurance Portability and Accountability Act-compliant study was approved by the local institutional review board. We evaluated dual-energy CTA studies of the lower extremity runoff in 48 patients (16 women; mean age, 63.3 ± 13.8 years) performed on a third-generation dual-source CT system. Images were reconstructed with standard linear blending (F_0.5), VMI+, and traditional monochromatic (VMI) algorithms at 40 to 120 keV in 10-keV intervals. Vascular attenuation and image noise in 18 artery segments were measured; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Five-point scales were used to subjectively evaluate vascular attenuation and image noise. In a subgroup of 21 patients who underwent additional invasive catheter angiography, diagnostic accuracy for the detection of significant stenosis (≥50% lumen restriction) of F_0.5, 50-keV VMI+, and 60-keV VMI data sets were assessed. Objective image quality metrics were highest in the 40- and 50-keV VMI+ series (SNR: 20.2 ± 10.7 and 19.0 ± 9.5, respectively; CNR: 18.5 ± 10.3 and 16.8 ± 9.1, respectively) and were significantly (all P < 0.001) higher than in the corresponding VMI data sets (SNR: 8.7 ± 4.1 and 10.8 ± 5.0; CNR: 8.0 ± 4.0 and 9.6 ± 4.9) and F_0.5 series (SNR: 10.7 ± 4.4; CNR: 8.3 ± 4.1). Subjective assessment of attenuation was highest in the 40- and 50-keV VMI and VMI+ image series (range, 4.84-4.91), superior to F_0.5 (4.07; P < 0.001). Corresponding subjective noise assessment was superior for 50-keV VMI+ (4.71; all P < 0.001) compared with VMI (2.60) and F_0.5 (4.11). Sensitivity and specificity for detection of 50% or greater stenoses were highest in VMI+ reconstructions (92% and 95

The IHS diagnostic X-ray equipment radiation protection program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Knapp, A.; Byrns, G.; Suleiman, O.

The Indian Health Service (IHS) operates or contracts with Tribal groups to operate 50 hospitals and approximately 165 primary ambulatory care centers. These facilities contain approximately 275 medical and 800 dental diagnostic x-ray machines. IHS environmental health personnel in collaboration with the Food and Drug Administration's (FDA) Center for Devices and Radiological Health (CDRH) developed a diagnostic x-ray protection program including standard survey procedures and menu-driven calculations software. Important features of the program include the evaluation of equipment performance collection of average patient entrance skin exposure (ESE) measurements for selected procedures, and quality assurance. The ESE data, collected using themore » National Evaluation of X-ray Trends (NEXT) protocol, will be presented. The IHS Diagnostic X-ray Radiation Protection Program is dynamic and is adapting to changes in technology and workload.« less

Psychometric Qualities of the German Version of the Posttraumatic Diagnostic Scale (PTDS)

ERIC Educational Resources Information Center

Griesel, Dorothee; Wessa, Michele; Flor, Herta

2006-01-01

In the present study, the psychometric properties of the German version of the Posttraumatic Diagnostic Scale (PTDS; A. Ehlers, R. Steil, H. Winter, & E. B. Foa, 1996) were evaluated in a sample of 143 trauma survivors. To investigate convergent and discriminant validity of this questionnaire, the authors assessed posttraumatic stress disorder…

The role of imaging specialists as authors of systematic reviews on diagnostic and interventional imaging and its impact on scientific quality: report from the EuroAIM Evidence-based Radiology Working Group.

PubMed

Sardanelli, Francesco; Bashir, Humayun; Berzaczy, Dominik; Cannella, Guglielmo; Espeland, Ansgar; Flor, Nicola; Helbich, Thomas; Hunink, Myriam; Malone, Dermot E; Mann, Ritse; Muzzupappa, Claudia; Petersen, Lars J; Riklund, Katrine; Sconfienza, Luca M; Serafin, Zbigniew; Spronk, Sandra; Stoker, Jaap; van Beek, Edwin J R; Vorwerk, Dierk; Di Leo, Giovanni

2014-08-01

To evaluate the inclusion of radiologists or nuclear medicine physicians (imaging specialists) as authors of systematic reviews (SRs) on imaging and imaging-guided diagnostic procedures and to determine the impact of imaging specialists' presence as authors on the overall quality of the reviews. A MEDLINE and EMBASE search was performed for SRs of diagnostic and interventional image-guided procedures that were published from January 2001 to December 2010. SRs about procedures primarily performed by nonimaging specialists were excluded. The inclusion of imaging specialists among the SR authors and the frequency of publication in imaging journals were evaluated. The quality of a subset of 200 SRs (100 most recent SRs with imaging specialists as authors and 100 most recent SRs without imaging specialists as authors) was rated by using a 12-item modified assessment of multiple SRs (AMSTAR) evaluation tool. Spearman, χ(2), and Mann-Whitney statistics were used. From among 3258 retrieved citations, 867 SRs were included in the study. Neuroimaging had the largest number of SRs (28% [241 of 867]), 41% (354 of 867) of SRs concerned diagnostic performance, and 26% (228 of 867) of SRs were published in imaging journals. Imaging specialists were authors (in any position) in 330 (38%) of 867 SRs; they were first authors of 176 SRs and last authors of 161 SRs. SRs with imaging specialists as authors were more often published in imaging journals than in nonimaging journals (54% [179 of 330] vs 9% [49 of 537]; P < .001). The median number of modified AMSTAR quality indicators was nine in SRs with imaging specialists as authors, while that in SRs without imaging specialists as authors was seven (P = .003). Only 38% (330 of 867) of SRs on radiology or nuclear medicine-related imaging published from January 2001 to December 2010 included imaging specialists as authors. However, the inclusion of imaging specialists as authors was associated with a significant increase in the

A Metric and Workflow for Quality Control in the Analysis of Heterogeneity in Phenotypic Profiles and Screens

PubMed Central

Gough, Albert; Shun, Tongying; Taylor, D. Lansing; Schurdak, Mark

2016-01-01

Heterogeneity is well recognized as a common property of cellular systems that impacts biomedical research and the development of therapeutics and diagnostics. Several studies have shown that analysis of heterogeneity: gives insight into mechanisms of action of perturbagens; can be used to predict optimal combination therapies; and to quantify heterogeneity in tumors where heterogeneity is believed to be associated with adaptation and resistance. Cytometry methods including high content screening (HCS), high throughput microscopy, flow cytometry, mass spec imaging and digital pathology capture cell level data for populations of cells. However it is often assumed that the population response is normally distributed and therefore that the average adequately describes the results. A deeper understanding of the results of the measurements and more effective comparison of perturbagen effects requires analysis that takes into account the distribution of the measurements, i.e. the heterogeneity. However, the reproducibility of heterogeneous data collected on different days, and in different plates/slides has not previously been evaluated. Here we show that conventional assay quality metrics alone are not adequate for quality control of the heterogeneity in the data. To address this need, we demonstrate the use of the Kolmogorov-Smirnov statistic as a metric for monitoring the reproducibility of heterogeneity in an SAR screen, describe a workflow for quality control in heterogeneity analysis. One major challenge in high throughput biology is the evaluation and interpretation of heterogeneity in thousands of samples, such as compounds in a cell-based screen. In this study we also demonstrate that three heterogeneity indices previously reported, capture the shapes of the distributions and provide a means to filter and browse big data sets of cellular distributions in order to compare and identify distributions of interest. These metrics and methods are presented as a

Quality of ground water in Idaho

USGS Publications Warehouse

Yee, Johnson J.; Souza, William R.

1987-01-01

The major aquifers in Idaho are categorized under two rock types, sedimentary and volcanic, and are grouped into six hydrologic basins. Areas with adequate, minimally adequate, or deficient data available for groundwater-quality evaluations are described. Wide variations in chemical concentrations in the water occur within individual aquifers, as well as among the aquifers. The existing data base is not sufficient to describe fully the ground-water quality throughout the State; however, it does indicate that the water is generally suitable for most uses. In some aquifers, concentrations of fluoride, cadmium, and iron in the water exceed the U.S. Environmental Protection Agency's drinking-water standards. Dissolved solids, chloride, and sulfate may cause problems in some local areas. Water-quality data are sparse in many areas, and only general statements can be made regarding the areal distribution of chemical constituents. Few data are available to describe temporal variations of water quality in the aquifers. Primary concerns related to special problem areas in Idaho include (1) protection of water quality in the Rathdrum Prairie aquifer, (2) potential degradation of water quality in the Boise-Nampa area, (3) effects of widespread use of drain wells overlying the eastern Snake River Plain basalt aquifer, and (4) disposal of low-level radioactive wastes at the Idaho National Engineering Laboratory. Shortcomings in the ground-water-quality data base are categorized as (1) multiaquifer sample inadequacy, (2) constituent coverage limitations, (3) baseline-data deficiencies, and (4) data-base nonuniformity.

The value of diagnostic information to patients with suspected multiple sclerosis. Rochester-Toronto MRI Study Group.

PubMed

Mushlin, A I; Mooney, C; Grow, V; Phelps, C E

1994-01-01

To determine the value of diagnostic information to patients with suspected multiple sclerosis (MS). Because treatment choices would be only minimally affected by earlier diagnosis for most patients with this clinical problem, this study assessed the "nondecisional" value of diagnosis. Prospective survey of patients before and after diagnostic workup, including imaging with magnetic resonance scanning. We assessed the effect of diagnostic information on patients' sense of well-being, as well as direct measures of the utility of information (using time trade-off and willingness-to-pay techniques). Patients referred from primary care practices for diagnostic workup for suspected MS to neurology clinics and practices. Sixty-eight individuals, mean age 37.5 years, 53 female and 15 male. Thirty-one patients were classified as having "probable MS," and 37 were classified as having "possible MS" by the examining neurologist before workup. Present and future health perception, uncertainty about diagnosis-prognosis, and level of anxiety. Willingness to pay for diagnostic information, quality of life as measured by the time trade-off technique, and psychological state of the patient before and after diagnosis. Diagnostic uncertainty fell significantly as a result of the diagnostic workup. Most patients (59/62) said that they were better off having received diagnostic information. Although anxiety seemed to be reduced by testing, overall anxiety levels did not decrease as much as anticipated. Patients also became less optimistic about their future health after testing. On average, patients were willing to forgo 4.5 quality-adjusted life days to receive an earlier diagnosis and their quality of life after diagnosis improved slightly. Subgroups of patients differed in their response to diagnostic information. Those in whom no definitive diagnosis emerged tend to be more anxious rather than being reassured by the "negative" workup. Individuals with "positive" workups became less

Evaluating online diagnostic decision support tools for the clinical setting.

PubMed

Pryor, Marie; White, David; Potter, Bronwyn; Traill, Roger

2012-01-01

Clinical decision support tools available at the point of care are an effective adjunct to support clinicians to make clinical decisions and improve patient outcomes. We developed a methodology and applied it to evaluate commercially available online clinical diagnostic decision support (DDS) tools for use at the point of care. We identified 11 commercially available DDS tools and assessed these against an evaluation instrument that included 6 categories; general information, content, quality control, search, clinical results and other features. We developed diagnostically challenging clinical case scenarios based on real patient experience that were commonly missed by junior medical staff. The evaluation was divided into 2 phases; an initial evaluation of all identified and accessible DDS tools conducted by the Clinical Information Access Portal (CIAP) team and a second phase that further assessed the top 3 tools identified in the initial evaluation phase. An evaluation panel consisting of senior and junior medical clinicians from NSW Health conducted the second phase. Of the eleven tools that were assessed against the evaluation instrument only 4 tools completely met the DDS definition that was adopted for this evaluation and were able to produce a differential diagnosis. From the initial phase of the evaluation 4 DDS tools scored 70% or more (maximum score 96%) for the content category, 8 tools scored 65% or more (maximum 100%) for the quality control category, 5 tools scored 65% or more (maximum 94%) for the search category, and 4 tools score 70% or more (maximum 81%) for the clinical results category. The second phase of the evaluation was focused on assessing diagnostic accuracy for the top 3 tools identified in the initial phase. Best Practice ranked highest overall against the 6 clinical case scenarios used. Overall the differentiating factor between the top 3 DDS tools was determined by diagnostic accuracy ranking, ease of use and the confidence and

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

PubMed Central

Kapur, Vishesh K.; Auckley, Dennis H.; Chowdhuri, Susmita; Kuhlmann, David C.; Mehra, Reena; Ramar, Kannan; Harrod, Christopher G.

2017-01-01

Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as “good practice statements”, that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. Recommendations: The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation. Recommendations: We recommend that clinical tools, questionnaires and prediction

21 CFR 892.1940 - Radiologic quality assurance instrument.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radiologic quality assurance instrument. 892.1940... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1940 Radiologic quality assurance instrument. (a) Identification. A radiologic quality assurance instrument is a device intended for medical...

Overview of ion source characterization diagnostics in INTF

NASA Astrophysics Data System (ADS)

Bandyopadhyay, M.; Sudhir, Dass; Bhuyan, M.; Soni, J.; Tyagi, H.; Joshi, J.; Yadav, A.; Rotti, C.; Parmar, Deepak; Patel, H.; Pillai, S.; Chakraborty, A.

2016-02-01

INdian Test Facility (INTF) is envisaged to characterize ITER diagnostic neutral beam system and to establish the functionality of its eight inductively coupled RF plasma driver based negative hydrogen ion source and its beamline components. The beam quality mainly depends on the ion source performance and therefore, its diagnostics plays an important role for its safe and optimized operation. A number of diagnostics are planned in INTF to characterize the ion source performance. Negative ions and its cesium contents in the source will be monitored by optical emission spectroscopy (OES) and cavity ring down spectroscopy. Plasma near the extraction region will be studied using standard electrostatic probes. The beam divergence and negative ion stripping losses are planned to be measured using Doppler shift spectroscopy. During initial phase of ion beam characterization, carbon fiber composite based infrared imaging diagnostics will be used. Safe operation of the beam will be ensured by using standard thermocouples and electrical voltage-current measurement sensors. A novel concept, based on plasma density dependent plasma impedance measurement using RF electrical impedance matching parameters to characterize the RF driver plasma, will be tested in INTF and will be validated with OES data. The paper will discuss about the overview of the complete INTF diagnostics including its present status of procurement, experimentation, interface with mechanical systems in INTF, and integration with INTF data acquisition and control systems.

Image quality and diagnostic performance of free-breathing diffusion-weighted imaging for hepatocellular carcinoma.

PubMed

Takayama, Yukihisa; Nishie, Akihiro; Asayama, Yoshiki; Ishigami, Kousei; Kakihara, Daisuke; Ushijima, Yasuhiro; Fujita, Nobuhiro; Shirabe, Ken; Takemura, Atsushi; Honda, Hiroshi

2017-05-18

To retrospectively evaluate the diagnostic performance of free-breathing diffusion-weighted imaging (FB-DWI) with modified imaging parameter settings for detecting hepatocellular carcinomas (HCCs). Fifty-one patients at risk for HCC were scanned with both FB-DWI and respiratory-triggered DWI with the navigator echo respiratory-triggering technique (RT-DWI). Qualitatively, the sharpness of the liver contour, the image noise and the chemical shift artifacts on each DWI with b -values of 1000 s/mm 2 were independently evaluated by three radiologists using 4-point scoring. We compared the image quality scores of each observer between the two DWI methods, using the Wilcoxon signed-rank test. Quantitatively, we compared the signal-to-noise ratios (SNRs) of the liver parenchyma and lesion-to-nonlesion contrast-to-noise ratios (CNRs) after measuring the signal intensity on each DWI with a b-factor of 1000 s/mm 2 . The average SNRs and CNRs between the two DWI methods were compared by the paired t-test. The detectability of HCC on each DWI was also analyzed by three radiologists. The detectability provided by the two DWI methods was compared using McNemar's test. For all observers, the averaged image quality scores of FB-DWI were: Sharpness of the liver contour [observer (Obs)-1, 3.08 ± 0.81; Obs-2, 2.98 ± 0.73; Obs-3, 3.54 ± 0.75], those of the distortion (Obs-1, 2.94 ± 0.50; Obs-2, 2.71 ± 0.70; Obs-3, 3.27 ± 0.53), and the chemical shift artifacts (Obs-1, 3.38 ± 0.60; Obs-2, 3.15 ± 1.07; Obs-3, 3.21 ± 0.85). The averaged image quality scores of RT-DWI were: Sharpness of the liver contour (Obs-1, 2.33 ± 0.65; Obs-2, 2.37 ± 0.74; Obs-3, 2.75 ± 0.81), distortion (Obs-1, 2.81 ± 0.56; Obs-2, 2.25 ± 0.74; Obs-3, 2.96 ± 0.71), and the chemical shift artifacts (Obs-1, 2.92 ± 0.59; Obs-2, 2.21 ± 0.85; Obs-3, 2.77 ± 1.08). All image quality scores of FB-DWI were significantly higher than those of RT-DWI ( P < 0.05). The average SNR of the normal liver parenchyma

Image quality and diagnostic performance of free-breathing diffusion-weighted imaging for hepatocellular carcinoma

PubMed Central

Takayama, Yukihisa; Nishie, Akihiro; Asayama, Yoshiki; Ishigami, Kousei; Kakihara, Daisuke; Ushijima, Yasuhiro; Fujita, Nobuhiro; Shirabe, Ken; Takemura, Atsushi; Honda, Hiroshi

2017-01-01

AIM To retrospectively evaluate the diagnostic performance of free-breathing diffusion-weighted imaging (FB-DWI) with modified imaging parameter settings for detecting hepatocellular carcinomas (HCCs). METHODS Fifty-one patients at risk for HCC were scanned with both FB-DWI and respiratory-triggered DWI with the navigator echo respiratory-triggering technique (RT-DWI). Qualitatively, the sharpness of the liver contour, the image noise and the chemical shift artifacts on each DWI with b-values of 1000 s/mm2 were independently evaluated by three radiologists using 4-point scoring. We compared the image quality scores of each observer between the two DWI methods, using the Wilcoxon signed-rank test. Quantitatively, we compared the signal-to-noise ratios (SNRs) of the liver parenchyma and lesion-to-nonlesion contrast-to-noise ratios (CNRs) after measuring the signal intensity on each DWI with a b-factor of 1000 s/mm2. The average SNRs and CNRs between the two DWI methods were compared by the paired t-test. The detectability of HCC on each DWI was also analyzed by three radiologists. The detectability provided by the two DWI methods was compared using McNemar’s test. RESULTS For all observers, the averaged image quality scores of FB-DWI were: Sharpness of the liver contour [observer (Obs)-1, 3.08 ± 0.81; Obs-2, 2.98 ± 0.73; Obs-3, 3.54 ± 0.75], those of the distortion (Obs-1, 2.94 ± 0.50; Obs-2, 2.71 ± 0.70; Obs-3, 3.27 ± 0.53), and the chemical shift artifacts (Obs-1, 3.38 ± 0.60; Obs-2, 3.15 ± 1.07; Obs-3, 3.21 ± 0.85). The averaged image quality scores of RT-DWI were: Sharpness of the liver contour (Obs-1, 2.33 ± 0.65; Obs-2, 2.37 ± 0.74; Obs-3, 2.75 ± 0.81), distortion (Obs-1, 2.81 ± 0.56; Obs-2, 2.25 ± 0.74; Obs-3, 2.96 ± 0.71), and the chemical shift artifacts (Obs-1, 2.92 ± 0.59; Obs-2, 2.21 ± 0.85; Obs-3, 2.77 ± 1.08). All image quality scores of FB-DWI were significantly higher than those of RT-DWI (P < 0.05). The average SNR of the normal

Integrated diagnostics

NASA Technical Reports Server (NTRS)

Hunthausen, Roger J.

1988-01-01

Recently completed projects in which advanced diagnostic concepts were explored and/or demonstrated are summarized. The projects begin with the design of integrated diagnostics for the Army's new gas turbine engines, and advance to the application of integrated diagnostics to other aircraft subsystems. Finally, a recent project is discussed which ties together subsystem fault monitoring and diagnostics with a more complete picture of flight domain knowledge.

A systematic review of diagnostic criteria for psoriasis in adults and children: evidence from studies with a primary aim to develop or validate diagnostic criteria.

PubMed

Burden-Teh, E; Phillips, R C; Thomas, K S; Ratib, S; Grindlay, D; Murphy, R

2017-11-06

The diagnosis of psoriasis in adults and children is made clinically, for both patient management and the selection of participants in research. Diagnostic criteria provide a structure for clinical assessment, which in turn helps standardize patient recruitment into clinical trials and case definitions in observational studies. The aim of this systematic review was to identify and critically appraise the published studies to date that had a primary research aim to develop or validate diagnostic criteria for psoriasis. A search of Ovid MEDLINE and Ovid Embase was conducted in October 2016. The primary objective was to record the sensitivity and specificity of diagnostic criteria for psoriasis. Secondary objectives included diagnostic recommendations, applicability to children and study characteristics. Diagnostic accuracy studies were critically appraised for risk of bias using the QUADAS-2 tool. Twenty-three studies met the inclusion criteria. None detailed clinical examination-based diagnostic criteria. The included criteria varied from genetic and molecular diagnostic models to skin imaging, histopathology, and questionnaire-based, computer-aided and traditional Chinese medicine criteria. High sensitivity and specificity (> 90%) were reported in many studies. However, the study authors often did not specify how the criteria would be used clinically or in research. This review identified studies with varying risk of bias, and due to each study developing separate criteria meta-analysis was not possible. Clinical examination-based diagnostic criteria are currently lacking for psoriasis. Future research could follow an international collaborative approach and employ study designs allowing high-quality diagnostic accuracy testing. Existing and newly developed criteria require validation. © 2017 British Association of Dermatologists.