Afghanistan and Pakistan Reconstruction Opportunity Zones (ROZs), H.R. 1318/H.R. 1886/H.R. 2410 and S. 496: Issues and Arguments

DTIC Science & Technology

2009-07-09

Qualifying Industrial Zone (QIZ) program under the U.S.-Israel Free Trade Agreement Implementation Act, (P.L. 99-47, as amended by the 1996 West Bank and...cotton apparel items are covered in this category: coats, nightgowns and pajamas , and a few shirts and blouses. • Table A-2 includes textile and

Validity of data in the Danish Colorectal Cancer Screening Database

PubMed Central

Thomsen, Mette Kielsholm; Njor, Sisse Helle; Rasmussen, Morten; Linnemann, Dorte; Andersen, Berit; Baatrup, Gunnar; Friis-Hansen, Lennart Jan; Jørgensen, Jens Christian Riis; Mikkelsen, Ellen Margrethe

2017-01-01

Background In Denmark, a nationwide screening program for colorectal cancer was implemented in March 2014. Along with this, a clinical database for program monitoring and research purposes was established. Objective The aim of this study was to estimate the agreement and validity of diagnosis and procedure codes in the Danish Colorectal Cancer Screening Database (DCCSD). Methods All individuals with a positive immunochemical fecal occult blood test (iFOBT) result who were invited to screening in the first 3 months since program initiation were identified. From these, a sample of 150 individuals was selected using stratified random sampling by age, gender and region of residence. Data from the DCCSD were compared with data from hospital records, which were used as the reference. Agreement, sensitivity, specificity and positive and negative predictive values were estimated for categories of codes “clean colon”, “colonoscopy performed”, “overall completeness of colonoscopy”, “incomplete colonoscopy”, “polypectomy”, “tumor tissue left behind”, “number of polyps”, “lost polyps”, “risk group of polyps” and “colorectal cancer and polyps/benign tumor”. Results Hospital records were available for 136 individuals. Agreement was highest for “colorectal cancer” (97.1%) and lowest for “lost polyps” (88.2%). Sensitivity varied between moderate and high, with 60.0% for “incomplete colonoscopy” and 98.5% for “colonoscopy performed”. Specificity was 92.7% or above, except for the categories “colonoscopy performed” and “overall completeness of colonoscopy”, where the specificity was low; however, the estimates were imprecise. Conclusion A high level of agreement between categories of codes in DCCSD and hospital records indicates that DCCSD reflects the hospital records well. Further, the validity of the categories of codes varied from moderate to high. Thus, the DCCSD may be a valuable data source for future research on colorectal cancer screening. PMID:28255255

Interobserver reproducibility of The Paris System for Reporting Urinary Cytology.

PubMed

Long, Theresa; Layfield, Lester J; Esebua, Magda; Frazier, Shellaine R; Giorgadze, D Tamar; Schmidt, Robert L

2017-01-01

The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application.

Assessment of Interradiologist Agreement Regarding Mammographic Breast Density Classification Using the Fifth Edition of the BI-RADS Atlas.

PubMed

Ekpo, Ernest U; Ujong, Ujong Peter; Mello-Thoms, Claudia; McEntee, Mark F

2016-05-01

The objective of the present study was to assess interradiologist agreement regarding mammographic breast density assessment performed using the rating scale outlined in the fifth edition of the BI-RADS atlas of the American College of Radiology. Breast density assessments of 1000 cases were conducted by five radiologists from the same institution who together had recently undergone retraining in mammographic breast density classification based on the fifth edition of BI-RADS. The readers assigned breast density grades (A-D) on the basis of the BI-RADS classification scheme. Repeat assessment of 100 cases was performed by all readers 1 month after the initial assessment. A weighted kappa was used to calculate intrareader and interreader agreement. Intrareader agreement ranged from a kappa value of 0.86 (95% CI, 0.77-0.93) to 0.89 (95% CI, 0.81-0.95) on a four-category scale (categories A-D) and from 0.89 (95% CI, 0.86-0.92) to 0.94 (95% CI, 0.89-0.97) on a two-category scale (category A-B vs category C-D). Interreader agreement ranged from substantial (κ = 0.76; 95% CI, 0.73-0.78) to almost perfect (κ = 0.87; 95% CI, 0.86-0.89) on a four-category scale, and the overall weighted kappa value was substantial (0.79; 95% CI, 0.78-0.83). Interreader agreement on a two-category scale ranged from a kappa value of 0.85 (95% CI, 0.83-0.86) to 0.91 (95% CI, 0.90-0.92), and the overall weighted kappa was 0.88 (95% CI, 0.87-0.89). Overall, with regard to mammographic breast density classification, radiologists had substantial interreader agreement when a four-category scale was used and almost perfect interreader agreement when a dichotomous scale was used.

Intra- and inter-observer agreement when using a descriptive classification scale for clinical assessment of faecal consistency in growing pigs.

PubMed

Pedersen, Ken Steen; Toft, Nils

2011-03-01

The objective of the current study was to evaluate intra- and inter-observer agreement using a descriptive classification scale with four categories, descriptive text and pictures for assessment of consistency in faecal samples from pigs post weaning. The four consistency categories were score one=firm and shaped, score two=soft and shaped, score three=loose and score four=watery. Five observers from the same veterinary practice examined 100 faecal samples using the scale with four categories. Four of the observers examined the 100 faecal samples twice within the same day. Within observers the difference in proportions for the individual consistency categories between two examinations was on average 0.04 (range: 0-0.10). The mean intra-observer agreement was 0.82 (range: 0.72-0.91) with a mean kappa value of 0.76 (range: 0.61-0.88). For inter-observer agreement overall kappa was 0.64. For the 10 pair-wise comparisons the mean inter-observer agreement was 0.73 (range: 0.61-0.90) with a mean kappa value of 0.64 (range: 0.48-0.87). The difference in proportions for the individual consistency categories was on average 0.08 (range: 0-0.17). In conclusion, the agreement observed for the descriptive classification scale with four categories, descriptive text and pictures may be categorized as a substantial to almost perfect intra-observer agreement and a moderate to almost perfect inter-observer agreement. However, more objective measures than clinical scales may still be needed to improve intra- and inter-observer agreement in research studies. Copyright © 2010 Elsevier B.V. All rights reserved.

Creating Processes Associated with Providing Government Goods and Services Under the Commercial Space Launch Act at Kennedy Space Center

NASA Technical Reports Server (NTRS)

Letchworth, Janet F.

2011-01-01

Kennedy Space Center (KSC) has decided to write its agreements under the Commercial Space Launch Act (CSLA) authority to cover a broad range of categories of support that KSC could provide to our commercial partner. Our strategy was to go through the onerous process of getting the agreement in place once and allow added specificity and final cost estimates to be documented on a separate Task Order Request (TOR). This paper is written from the implementing engineering team's perspective. It describes how we developed the processes associated with getting Government support to our emerging commercial partners, such as SpaceX and reports on our success to date.

Kappa and Rater Accuracy: Paradigms and Parameters.

PubMed

Conger, Anthony J

2017-12-01

Drawing parallels to classical test theory, this article clarifies the difference between rater accuracy and reliability and demonstrates how category marginal frequencies affect rater agreement and Cohen's kappa (κ). Category assignment paradigms are developed: comparing raters to a standard (index) versus comparing two raters to one another (concordance), using both nonstochastic and stochastic category membership. Using a probability model to express category assignments in terms of rater accuracy and random error, it is shown that observed agreement (Po) depends only on rater accuracy and number of categories; however, expected agreement (Pe) and κ depend additionally on category frequencies. Moreover, category frequencies affect Pe and κ solely through the variance of the category proportions, regardless of the specific frequencies underlying the variance. Paradoxically, some judgment paradigms involving stochastic categories are shown to yield higher κ values than their nonstochastic counterparts. Using the stated probability model, assignments to categories were generated for 552 combinations of paradigms, rater and category parameters, category frequencies, and number of stimuli. Observed means and standard errors for Po, Pe, and κ were fully consistent with theory expectations. Guidelines for interpretation of rater accuracy and reliability are offered, along with a discussion of alternatives to the basic model.

43 CFR 2804.19 - How will BLM process my Processing Category 6 application?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false How will BLM process my Processing... process my Processing Category 6 application? (a) For Processing Category 6 applications, you and BLM must enter into a written agreement that describes how BLM will process your application. The final agreement...

43 CFR 2804.19 - How will BLM process my Processing Category 6 application?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false How will BLM process my Processing... process my Processing Category 6 application? (a) For Processing Category 6 applications, you and BLM must enter into a written agreement that describes how BLM will process your application. The final agreement...

Interobserver agreement on Poser's and the new McDonald's diagnostic criteria for multiple sclerosis.

PubMed

Zipoli, V; Portaccio, E; Siracusa, G; Pracucci, G; Sorbi, S; Amato, M P

2003-10-01

We assessed the interobserver agreement on the diagnosis of multiple sclerosis (MS) in a study sample consisting of 41 MS (15 relapsing remitting, two secondary progressive, five primary progressive and 19 presenting their first clinical attack) and three non-MS cases. Clinical and paraclinical information was recorded in standardized forms. Four neurologists were asked to make a diagnosis using Poser's and McDonald's criteria and to assess MRI scans according to the McDonald's guidelines. In terms of the kappa statistic (kappa), we found a moderate agreement on the overall diagnosis using both Poser's and McDonald's criteria (kappa, respectively 0.57 and 0.52). As for distinct diagnostic categories, we observed a moderate to substantial agreement for the three McDonald categories (range of kappa values 0.49-0.64) and a fair to substantial agreement for the nine Poser categories (range of kappa values 0.37-0.67). Taking into account clinical information, the agreement on dissemination over time was substantially higher (kappa = 0.69) than that found on dissemination over space (kappa = 0.46). In contrast, for MRI assessment, the agreement for spatial dissemination was substantial (kappa = 0.74) compared with the fair agreement (kappa = 0.25) yielded by dissemination over time. The new McDonald's criteria yield a good overall diagnostic reliability, and compare favourably with Poser's classification in terms of agreement on distinct diagnostic categories.

Therapeutic drug monitoring of infliximab: performance evaluation of three commercial ELISA kits.

PubMed

Schmitz, Ellen M H; van de Kerkhof, Daan; Hamann, Dörte; van Dongen, Joost L J; Kuijper, Philip H M; Brunsveld, Luc; Scharnhorst, Volkher; Broeren, Maarten A C

2016-07-01

Therapeutic drug monitoring (TDM) of infliximab (IFX, Remicade®) can aid to optimize therapy efficacy. Many assays are available for this purpose. However, a reference standard is lacking. Therefore, we evaluated the analytical performance, agreement and clinically relevant differences of three commercially available IFX ELISA kits on an automated processing system. The kits of Theradiag (Lisa Tracker Infliximab), Progenika (Promonitor IFX) and apDia (Infliximab ELISA) were implemented on an automated processing system. Imprecision was determined by triplicate measurements of patient samples on five days. Agreement was evaluated by analysis of 30 patient samples and four spiked samples by the selected ELISA kits and the in-house IFX ELISA of Sanquin Diagnostics (Amsterdam, The Netherlands). Therapeutic consequences were evaluated by dividing patients into four treatment groups using cut-off levels of 1, 3 and 7 μg/mL and determining assay concordance. Within-run and between-run imprecision were acceptable (≤12% and ≤17%, respectively) within the quantification range of the selected ELISA kits. The apDia assay had the best precision and agreement to target values. Statistically significant differences were found between all assays except between Sanquin Diagnostics and the Lisa Tracker assay. The Promonitor assay measured the lowest IFX concentrations, the apDia assay the highest. When patients were classified in four treatment categories, 70% concordance was achieved. Although all assays are suitable for TDM, significant differences were observed in both imprecision and agreement. Therapeutic consequences were acceptable when patients were divided in treatment categories, but this could be improved by assay standardization.

Comparison of variability in breast density assessment by BI-RADS category according to the level of experience.

PubMed

Eom, Hye-Joung; Cha, Joo Hee; Kang, Ji-Won; Choi, Woo Jung; Kim, Han Jun; Go, EunChae

2018-05-01

Background Only few studies have assessed variability in the results obtained by the readers with different experience levels in comparison with automated volumetric breast density measurements. Purpose To examine the variations in breast density assessment according to BI-RADS categories among readers with different experience levels and to compare it with the results of automated quantitative measurements. Material and Methods Density assignment was done for 1000 screening mammograms by six readers with three different experience levels (breast-imaging experts, general radiologists, and students). Agreement level between the results obtained by the readers and the Volpara automated volumetric breast density measurements was assessed. The agreement analysis using two categories-non-dense and dense breast tissue-was also performed. Results Intra-reader agreement for experts, general radiologists, and students were almost perfect or substantial (k = 0.74-0.95). The agreement between visual assessments of the breast-imaging experts and volumetric assessments by Volpara was substantial (k = 0.77). The agreement was moderate between the experts and general radiologists (k = 0.67) and slight between the students and Volpara (k = 0.01). The agreement for the two category groups (nondense and dense) was almost perfect between the experts and Volpara (k = 0.83). The agreement was substantial between the experts and general radiologists (k = 0.78). Conclusion We observed similar high agreement levels between visual assessments of breast density performed by radiologists and the volumetric assessments. However, agreement levels were substantially lower for the untrained readers.

75 FR 40756 - Implementation Guidance for Physical Protection of Byproduct Material; Category 1 and Category 2...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-14

...-2010-0194] RIN 3150-AI12 Implementation Guidance for Physical Protection of Byproduct Material... licensee or applicant for implementation of proposed 10 CFR part 37, ``Physical Protection of Byproduct... ``Implementation Guidance for 10 CFR part 37 Physical Protection of Byproduct Material, Category 1 and Category 2...

Standardized assessment of tumor-infiltrating lymphocytes in breast cancer: an evaluation of inter-observer agreement between pathologists.

PubMed

Tramm, Trine; Di Caterino, Tina; Jylling, Anne-Marie B; Lelkaitis, Giedrius; Lænkholm, Anne-Vibeke; Ragó, Péter; Tabor, Tomasz P; Talman, Maj-Lis M; Vouza, Emmanouela

2018-01-01

In breast cancer, there is a growing body of evidence that tumor-infiltrating lymphocytes (TILs) may have clinical utility and may be able to direct clinical decisions for subgroups of patients. Clinical utility is, however, not sufficient for warranting the implementation of a new biomarker in the routine practice, and evaluation of the analytical validity is needed, including testing the reproducibility of decentralized assessment of TILs. The aim of this study was to evaluate the inter-observer agreement of TILs assessment using a standardized method, as proposed by the International TILs Working Group 2014, applied to a cohort of breast cancers reflecting an average breast cancer population. Stromal TILs were assessed using full slide sections from 124 breast cancers with varying histology, malignancy grade and ER- and HER2 status. TILs were estimated by nine dedicated breast pathologists using scanned hematoxylin-eosin stainings. TILs results were categorized using various cutoffs, and the inter-observer agreement was evaluated using the intraclass coefficient (ICC), Kappa statistics as well as individual overall agreements with the median value of TILs. Evaluation of TILs led to an ICC of 0.71 (95% CI: 0.65-0.77) corresponding to an acceptable agreement. Kappa values were in the range of 0.38-0.46 corresponding to a fair to moderate agreement. The individual agreements increased, when using only two categories ('high' vs. 'low' TILs) and a cutoff of 50-60%. The results of the present study are in accordance with previous studies, and shows that the proposed methodology for standardized evaluation of TILs renders an acceptable inter-observer agreement. The findings, however, indicate that assessment of TILs needs further refinement, and is in support of the latest St. Gallen Consensus, that routine reporting of TILs for early breast cancer is not ready for implementation in a clinical setting.

Diagnostic performance and reproducibility of T2w based and diffusion weighted imaging (DWI) based PI-RADSv2 lexicon descriptors for prostate MRI.

PubMed

Benndorf, Matthias; Hahn, Felix; Krönig, Malte; Jilg, Cordula Annette; Krauss, Tobias; Langer, Mathias; Dovi-Akué, Philippe

2017-08-01

To examine the diagnostic performance of PI-RADSv2 T2w and diffusion weighted imaging (DWI) based lexicon descriptors, inter-observer agreement for descriptor assignment and diagnostic accuracy of the PI-RADSv2 assessment categories for multiparametric prostate MRI. 176 lesions in 79 consecutive patients are analyzed, lesions are histopathologically verified by MRI-ultrasound fusion biopsy. All lesions are rated according to the PI-RADSv2 lexicon, descriptors for T2w and DWI sequences and resulting assessment categories are assigned by two independent blinded radiologists. We perform receiver-operating-characteristic analysis using the assessment categories. To analyze inter-observer agreement, we calculate weighted kappa values for assessment category assignment and unweighted kappa values for descriptor assignment. PI-RADSv2 assessment categories yield an area under the curve of 0.76/0.74 (radiologist 1/radiologist 2), P >0.05. Weighted kappa for agreement is 0.601 in the peripheral zone and 0.580 in the transition zone. We detect a difference in the cancer rate for PI-RADSv2 category 3 between peripheral zone (32%) and transition zone (12%), P <0.05. We obtain moderate agreement at most for descriptor assignment with kappa values ranging from 0.082 (T2w shape in the transition zone) to 0.407 (T2w signal intensity in the peripheral zone) and 0.493 (ADC pattern in the peripheral zone). Our analysis corroborates typical descriptors for benign/malignant lesions, but also reveals insights into potential pitfalls - T2w wedge shaped lesions in the peripheral zone have a considerable cancer rate, despite being labelled category 2 in the lexicon. Agreement for descriptor assignment in the PI-RADSv2 lexicon is at most moderate in our study. Typical descriptors for benign and malignant lesions are validated, whereas the discriminatory power of some descriptors is challenged. The difference in the cancer rate for PI-RADSv2 category 3 between peripheral zone and transition zone should be considered when management recommendations are linked to assessment categories in the future. Copyright © 2017 Elsevier B.V. All rights reserved.

Log-Linear Modeling of Agreement among Expert Exposure Assessors

PubMed Central

Hunt, Phillip R.; Friesen, Melissa C.; Sama, Susan; Ryan, Louise; Milton, Donald

2015-01-01

Background: Evaluation of expert assessment of exposure depends, in the absence of a validation measurement, upon measures of agreement among the expert raters. Agreement is typically measured using Cohen’s Kappa statistic, however, there are some well-known limitations to this approach. We demonstrate an alternate method that uses log-linear models designed to model agreement. These models contain parameters that distinguish between exact agreement (diagonals of agreement matrix) and non-exact associations (off-diagonals). In addition, they can incorporate covariates to examine whether agreement differs across strata. Methods: We applied these models to evaluate agreement among expert ratings of exposure to sensitizers (none, likely, high) in a study of occupational asthma. Results: Traditional analyses using weighted kappa suggested potential differences in agreement by blue/white collar jobs and office/non-office jobs, but not case/control status. However, the evaluation of the covariates and their interaction terms in log-linear models found no differences in agreement with these covariates and provided evidence that the differences observed using kappa were the result of marginal differences in the distribution of ratings rather than differences in agreement. Differences in agreement were predicted across the exposure scale, with the likely moderately exposed category more difficult for the experts to differentiate from the highly exposed category than from the unexposed category. Conclusions: The log-linear models provided valuable information about patterns of agreement and the structure of the data that were not revealed in analyses using kappa. The models’ lack of dependence on marginal distributions and the ease of evaluating covariates allow reliable detection of observational bias in exposure data. PMID:25748517

Spine Instability Neoplastic Score: agreement across different medical and surgical specialties.

PubMed

Arana, Estanislao; Kovacs, Francisco M; Royuela, Ana; Asenjo, Beatriz; Pérez-Ramírez, Úrsula; Zamora, Javier

2016-05-01

Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature. This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management. Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out. Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included. Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category ("stable," "potentially stable," or "unstable"); and overall agreement with the classification established by tumor board. Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8-13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation. Intra and interobserver agreement on the location of the most affected levels was "almost perfect" (κ>0.94). Intra-observer agreement on the SINS score was "excellent" (ICC=0.77), whereas interobserver agreement was "moderate" (ICC=0.55). Intra-observer agreement in SINS category was "substantial" (k=0.61), whereas interobserver agreement was "moderate" (k=0.42). Overall agreement with the tumor board classification was "substantial" (κ=0.61). Results were similar across specialties, years of experience, and hospital category. Agreement on the assessment of metastatic spine instability is moderate. The SINS can help improve communication among clinicians in oncology care. Copyright © 2015 Elsevier Inc. All rights reserved.

75 FR 47494 - Implementation Guidance for Physical Protection of Byproduct Material; Category 1 and Category 2...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-06

... for Physical Protection of Byproduct Material; Category 1 and Category 2 Quantities of Radioactive... on the draft implementation guidance for proposed 10 CFR part 37 Physical Protection of Byproduct... proposed 10 CFR part 37, Physical Protection of Byproduct Material, specifically Category 1 and Category 2...

International Endometrial Tumor Analysis (IETA) terminology in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm: agreement and reliability study.

PubMed

Sladkevicius, P; Installé, A; Van Den Bosch, T; Timmerman, D; Benacerraf, B; Jokubkiene, L; Di Legge, A; Votino, A; Zannoni, L; De Moor, B; De Cock, B; Van Calster, B; Valentin, L

2018-02-01

To estimate intra- and interrater agreement and reliability with regard to describing ultrasound images of the endometrium using the International Endometrial Tumor Analysis (IETA) terminology. Four expert and four non-expert raters assessed videoclips of transvaginal ultrasound examinations of the endometrium obtained from 99 women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm but without fluid in the uterine cavity. The following features were rated: endometrial echogenicity, endometrial midline, bright edge, endometrial-myometrial junction, color score, vascular pattern, irregularly branching vessels and color splashes. The color content of the endometrial scan was estimated using a visual analog scale graded from 0 to 100. To estimate intrarater agreement and reliability, the same videoclips were assessed twice with a minimum of 2 months' interval. The raters were blinded to their own results and to those of the other raters. Interrater differences in the described prevalence of most IETA variables were substantial, and some variable categories were observed rarely. Specific agreement was poor for variables with many categories. For binary variables, specific agreement was better for absence than for presence of a category. For variables with more than two outcome categories, specific agreement for expert and non-expert raters was best for not-defined endometrial midline (93% and 96%), regular endometrial-myometrial junction (72% and 70%) and three-layer endometrial pattern (67% and 56%). The grayscale ultrasound variable with the best reliability was uniform vs non-uniform echogenicity (multirater kappa (κ), 0.55 for expert and 0.52 for non-expert raters), and the variables with the lowest reliability were appearance of the endometrial-myometrial junction (κ, 0.25 and 0.16) and the nine-category endometrial echogenicity variable (κ, 0.29 and 0.28). The most reliable color Doppler variable was color score (mean weighted κ, 0.77 and 0.69). Intra- and interrater agreement and reliability were similar for experts and non-experts. Inter- and intrarater agreement and reliability when using IETA terminology were limited. This may have implications when assessing the association between a particular ultrasound feature and a specific histological diagnosis, because lack of reproducibility reduces the reliability of the association between a feature and the outcome. Future studies should investigate whether using fewer categories of variable or offering practical training could improve agreement and reliability. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Reliability of psychiatric diagnosis in hospitalized adolescents. Interrater agreement using DSM-III.

PubMed

Strober, M; Green, J; Carlson, G

1981-02-01

To determine the reliability of psychiatric diagnosis in hospitalized adolescents, 95 consecutively admitted patients were diagnosed independently by two experienced clinicians using DSM-III criteria. Diagnostic judgments were based on joint interview of the patient via a structured mental-status examination, nursing observations, and referral materials. Concordance was analyzed by the kappa coefficient. A total of 13 DSM-III categories were used to classify this cohort, with the majority of categories representing traditional syndromes of functional psychopathology. There was complete agreement between the raters for more than three fourths of the patients. Levels of agreement for the categories of schizophrenia and major affective disorder were similar to values obtained in recent studies of adult patients. The results are discussed in relation to historical conceptions of adolescent psychopathology.

High inter-observer agreement of observer-perceived pain assessment in the emergency department.

PubMed

Hangaard, Martin Høhrmann; Malling, Brian; Mogensen, Christian Backer

2018-02-21

Triage is used to prioritize the patients in the emergency department. The majority of the triage systems include the patients' pain score to assess their level of acuity by using a combination of patient reported pain and observer-perceived pain; the latter therefore requires a certain degree of inter-observer agreement. The aim of the present study was to assess the inter-observer agreement of perceived pain among emergency department nurses and to evaluate if it was influenced by predetermined factors like age and gender. A project assistant randomly recruited two nurses, who were not allowed to interact with each other, to assess patient pain intensity on the numeric ranking scale. The project assistant afterwards entered the pain scores in a predesigned electronic questionnaire. We used weighted Fleiss-Cohen (quadratic) kappa statistics, Bland-Altman statistics and logistic regression analysis to assess the inter-observer agreement. One hundred and sixty-two patients were included. They had a median age of 38 years and 45% were females. 30% of the patients were acute surgical patients and 70% acute orthopedic patients. The average time between the pain assessments were 1,7 min. The Bland Altman analysis found a mean difference in pain score of 0.2 and 95% limits of agreement of +/- 3 point. When the NRS scores were translated to commonly used pain categories (no, mild, moderate or severe pain) we found a 70% agreement with a mean difference in categories of 0.05 and 95% limits of agreement of +/- 1 category. Patient age, gender, localization of pain, examination room or presence of a significant other did not affect the inter-observer agreement. We found 70% agreement on pain category between the nurses and it is justified that nurse-perceived pain assessment is used for triage in the emergency department.

Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines.

PubMed

Santo, Susana; Ayres-de-Campos, Diogo; Costa-Santos, Cristina; Schnettler, William; Ugwumadu, Austin; Da Graça, Luís M

2017-02-01

One of the limitations reported with cardiotocography is the modest interobserver agreement observed in tracing interpretation. This study compared agreement, reliability and accuracy of cardiotocography interpretation using the International Federation of Gynecology and Obstetrics, American College of Obstetrics and Gynecology and National Institute for Health and Care Excellence guidelines. A total of 151 tracings were evaluated by 27 clinicians from three centers where International Federation of Gynecology and Obstetrics, American College of Obstetrics and Gynecology and National Institute for Health and Care Excellence guidelines were routinely used. Interobserver agreement was evaluated using the proportions of agreement and reliability with the κ statistic. The accuracy of tracings classified as "pathological/category III" was assessed for prediction of newborn acidemia. For all measures, 95% confidence interval were calculated. Cardiotocography classifications were more distributed with International Federation of Gynecology and Obstetrics (9, 52, 39%) and National Institute for Health and Care Excellence (30, 33, 37%) than with American College of Obstetrics and Gynecology (13, 81, 6%). The category with the highest agreement was American College of Obstetrics and Gynecology category II (proportions of agreement = 0.73, 95% confidence interval 0.70-76), and the ones with the lowest agreement were American College of Obstetrics and Gynecology categories I and III. Reliability was significantly higher with International Federation of Gynecology and Obstetrics (κ = 0.37, 95% confidence interval 0.31-0.43), and National Institute for Health and Care Excellence (κ = 0.33, 95% confidence interval 0.28-0.39) than with American College of Obstetrics and Gynecology (κ = 0.15, 95% confidence interval 0.10-0.21); however, all represent only slight/fair reliability. International Federation of Gynecology and Obstetrics and National Institute for Health and Care Excellence showed a trend towards higher sensitivities in prediction of newborn acidemia (89 and 97%, respectively) than American College of Obstetrics and Gynecology (32%), but the latter achieved a significantly higher specificity (95%). With American College of Obstetrics and Gynecology guidelines there is high agreement in category II, low reliability, low sensitivity and high specificity in prediction of acidemia. With International Federation of Gynecology and Obstetrics and National Institute for Health and Care Excellence guidelines there is higher reliability, a trend towards higher sensitivity, and lower specificity in prediction of acidemia. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Nodule Classification on Low-Dose Unenhanced CT and Standard-Dose Enhanced CT: Inter-Protocol Agreement and Analysis of Interchangeability.

PubMed

Lee, Kyung Hee; Lee, Kyung Won; Park, Ji Hoon; Han, Kyunghwa; Kim, Jihang; Lee, Sang Min; Park, Chang Min

2018-01-01

To measure inter-protocol agreement and analyze interchangeability on nodule classification between low-dose unenhanced CT and standard-dose enhanced CT. From nodule libraries containing both low-dose unenhanced and standard-dose enhanced CT, 80 solid and 80 subsolid (40 part-solid, 40 non-solid) nodules of 135 patients were selected. Five thoracic radiologists categorized each nodule into solid, part-solid or non-solid. Inter-protocol agreement between low-dose unenhanced and standard-dose enhanced images was measured by pooling κ values for classification into two (solid, subsolid) and three (solid, part-solid, non-solid) categories. Interchangeability between low-dose unenhanced and standard-dose enhanced CT for the classification into two categories was assessed using a pre-defined equivalence limit of 8 percent. Inter-protocol agreement for the classification into two categories {κ, 0.96 (95% confidence interval [CI], 0.94-0.98)} and that into three categories (κ, 0.88 [95% CI, 0.85-0.92]) was considerably high. The probability of agreement between readers with standard-dose enhanced CT was 95.6% (95% CI, 94.5-96.6%), and that between low-dose unenhanced and standard-dose enhanced CT was 95.4% (95% CI, 94.7-96.0%). The difference between the two proportions was 0.25% (95% CI, -0.85-1.5%), wherein the upper bound CI was markedly below 8 percent. Inter-protocol agreement for nodule classification was considerably high. Low-dose unenhanced CT can be used interchangeably with standard-dose enhanced CT for nodule classification.

The reliability of axis V of the multiaxial classification scheme.

PubMed

van Goor-Lambo, G

1987-07-01

In a reliability study concerning axis V (abnormal psychosocial situations) of the Multiaxial classification scheme for psychiatric disorders in childhood and adolescence, it was found that the level of agreement in scoring was adequate for only 2 out of 12 categories. A proposal for a modification of axis V was made, including a differentiation and regrouping of the categories and an adjustment of the descriptions in the glossary. With this modification of axis V another reliability study was carried out, in which the level of agreement in scoring was adequate for 12 out of 16 categories.

48 CFR 35.017-1 - Sponsoring agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Sponsoring agreements. 35... CATEGORIES OF CONTRACTING RESEARCH AND DEVELOPMENT CONTRACTING 35.017-1 Sponsoring agreements. (a) In order... mission, and ensure a periodic reevaluation of the FFRDC, a written agreement of sponsorship between the...

48 CFR 35.017-1 - Sponsoring agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Sponsoring agreements. 35... CATEGORIES OF CONTRACTING RESEARCH AND DEVELOPMENT CONTRACTING 35.017-1 Sponsoring agreements. (a) In order... mission, and ensure a periodic reevaluation of the FFRDC, a written agreement of sponsorship between the...

48 CFR 35.017-1 - Sponsoring agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Sponsoring agreements. 35... CATEGORIES OF CONTRACTING RESEARCH AND DEVELOPMENT CONTRACTING 35.017-1 Sponsoring agreements. (a) In order... mission, and ensure a periodic reevaluation of the FFRDC, a written agreement of sponsorship between the...

77 FR 3922 - Rules for Investigations Relating to Global and Bilateral Safeguards Actions, Market Disruption...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-26

... Agreement Implementation Act, section 311(b) of the United States-Colombia Trade Promotion Agreement... Trade Agreement Implementation Act, section 311(b) of the United States-Panama Trade Promotion Agreement Implementation Act, section 311(b) of the United States-Peru Trade Promotion Agreement Implementation Act, and...

46 CFR 501.27 - Delegation to and redelegation by the Director, Bureau of Trade Analysis.

Code of Federal Regulations, 2010 CFR

2010-10-01

... category of agreement or modification includes, for example, the following: a restatement filed to conform... agreement; a correction of typographical or grammatical errors in the text of an agreement; a change in the...

Collecting Evidence to Inform Salt Reduction Policies in Argentina: Identifying Sources of Sodium Intake in Adults from a Population-Based Sample

PubMed Central

Gutierrez, Laura; Romero, Iris B.; Moyano, Daniela L.; Poggio, Rosana; Calandrelli, Matías; Mores, Nora; Rubinstein, Adolfo; Irazola, Vilma

2017-01-01

The maximum content of sodium in selected processed foods (PF) in Argentina was limited by a law enacted in 2013. Data about intake of these and other foods are necessary for policy planning, implementation, evaluation, and monitoring. We examined data from the CESCAS I population-based cohort study to assess the main dietary sources among PF and frequency of discretionary salt use by sex, age, and education attainment, before full implementation of the regulations in 2015. We used a validated 34-item FFQ (Food Frequency Questionnaire) to assess PF intake and discretional salt use. Among 2127 adults in two Argentinean cities, aged 35–76 years, mean salt intake from selected PFs was 4.7 g/day, higher among male and low education subgroups. Categories of foods with regulated maximum limits provided near half of the sodium intake from PFs. Use of salt (always/often) at the table and during cooking was reported by 9% and 73% of the population, respectively, with higher proportions among young people. Reducing salt consumption to the target of 5 g/day may require adjustments to the current regulation (reducing targets, including other food categories), as well as reinforcing strategies such as education campaigns, labeling, and voluntary agreement with bakeries. PMID:28858263

Improvement Research Priorities: USA Survey and Expert Consensus

PubMed Central

Stevens, Kathleen R.; Ovretveit, John

2013-01-01

The purpose of this study was to identify stakeholder views about national priorities for improvement science and build agreement for action in a national improvement and implementation research network in the USA. This was accomplished using three stages of identification and consensus. (1) Topics were identified through a multipronged environmental scan of the literature and initiatives. (2) Based on this scan, a survey was developed, and stakeholders (n = 2,777) were invited to rate the resulting 33-topic, 9-category list, via an online survey. Data from 560 respondents (20% response) were analyzed. (3) An expert panel used survey results to further refine the research priorities through a Rand Delphi process. Priorities identified were within four categories: care coordination and transitions, high-performing clinical systems and microsystems improvement approaches, implementation of evidence-based improvements and best practices, and culture of quality and safety. The priorities identified were adopted by the improvement science research network as the research agenda to guide strategy. The process and conclusions may be of value to quality improvement research funding agencies, governments, and research units seeking to concentrate their resources on improvement topics where research is capable of yielding timely and actionable answers as well as contributing to the knowledge base for improvement. PMID:24024029

7 CFR 993.503 - Size category.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Size category. 993.503 Section 993.503 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... categories listed in § 993.515 and fixes the range or the limits of the various size counts. Effective Date...

Agreement between diagnoses reached by clinical examination and available reference standards: a prospective study of 216 patients with lumbopelvic pain

PubMed Central

Laslett, Mark; McDonald, Barry; Tropp, Hans; Aprill, Charles N; Öberg, Birgitta

2005-01-01

Background The tissue origin of low back pain (LBP) or referred lower extremity symptoms (LES) may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards. Methods We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiotherapists examined consecutive patients with chronic lumbopelvic pain and/or referred LES scheduled to receive the reference standard examinations. When diagnoses were in complete agreement regardless of complexity, "exact" agreement was recorded. When the clinical diagnosis was included within the reference standard diagnoses, "clinical agreement" was recorded. The proportional chance criterion (PCC) statistic was used to estimate agreement on multiple diagnostic possibilities because it accounts for the prevalence of individual categories in the sample. The kappa statistic was used to estimate agreement on six pathoanatomic diagnoses. Results In a sample of chronic LBP patients (n = 216) with high levels of disability and distress, 67% received a patho-anatomic diagnosis based on available reference standards, and 10% had more than one tissue origin of pain identified. For 27 diagnostic categories and combinations, chance clinical agreement (PCC) was estimated at 13%. "Exact" agreement between clinical and reference standard diagnoses was 32% and "clinical agreement" 51%. For six pathoanatomic categories (disc, facet joint, sacroiliac joint, hip joint, nerve root and spinal stenosis), PCC was 33% with actual agreement 56%. There was no overlap of 95% confidence intervals on any comparison. Diagnostic agreement on the six most common patho-anatomic categories produced a kappa of 0.31. Conclusion Clinical diagnoses agree with reference standards diagnoses more often than chance. Using available reference standards, most patients can have a tissue source of pain identified. PMID:15943873

Interobserver and intermodality agreement of standardized algorithms for non-invasive diagnosis of hepatocellular carcinoma in high-risk patients: CEUS-LI-RADS versus MRI-LI-RADS.

PubMed

Schellhaas, Barbara; Hammon, Matthias; Strobel, Deike; Pfeifer, Lukas; Kielisch, Christian; Goertz, Ruediger S; Cavallaro, Alexander; Janka, Rolf; Neurath, Markus F; Uder, Michael; Seuss, Hannes

2018-04-19

We compared the interobserver agreement for the recently introduced contrast-enhanced ultrasound (CEUS)-based algorithm CEUS-LI-RADS (Liver Imaging Reporting and Data System) versus the well-established magnetic resonance imaging (MRI)-LI-RADS for non-invasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients. Focal liver lesions in 50 high-risk patients (mean age 66.2 ± 11.8 years; 39 male) were assessed retrospectively with CEUS and MRI. Two independent observers reviewed CEUS and MRI examinations, separately, classifying observations according to CEUS-LI-RADSv.2016 and MRI-LI-RADSv.2014. Interobserver agreement was assessed with Cohen's kappa. Forty-three lesions were HCCs; two were intrahepatic cholangiocarcinomas; five were benign lesions. Arterial phase hyperenhancement was perceived less frequently with CEUS than with MRI (37/50 / 38/50 lesions = 74%/78% [CEUS; observer 1/observer 2] versus 46/50 / 44/50 lesions = 92%/88% [MRI; observer 1/observer 2]). Washout appearance was observed in 34/50 / 20/50 lesions = 68%/40% with CEUS and 31/50 / 31/50 lesions = 62%/62%) with MRI. Interobserver agreement was moderate for arterial hyperenhancement (ĸ = 0.511/0.565 [CEUS/MRI]) and "washout" (ĸ = 0.490/0.582 [CEUS/MRI]), fair for CEUS-LI-RADS category (ĸ = 0.309) and substantial for MRI-LI-RADS category (ĸ = 0.609). Intermodality agreement was fair for arterial hyperenhancement (ĸ = 0.329), slight to fair for "washout" (ĸ = 0.202) and LI-RADS category (ĸ = 0.218) CONCLUSION: Interobserver agreement is substantial for MRI-LI-RADS and only fair for CEUS-LI-RADS. This is mostly because interobserver agreement in the perception of washout appearance is better in MRI than in CEUS. Further refinement of the LI-RADS algorithms and increasing education and practice may be necessary to improve the concordance between CEUS and MRI for the final LI-RADS categorization. • CEUS-LI-RADS and MRI-LIRADS enable standardized non-invasive diagnosis of HCC in high-risk patients. • With CEUS, interobserver agreement is better for arterial hyperenhancement than for "washout". • Interobserver agreement for major features is moderate for both CEUS and MRI. • Interobserver agreement for LI-RADS category is substantial for MRI, and fair for CEUS. • Interobserver-agreement for CEUS-LI-RADS will presumably improve with ongoing use of the algorithm.

Comparison of subjective and fully automated methods for measuring mammographic density.

PubMed

Moshina, Nataliia; Roman, Marta; Sebuødegård, Sofie; Waade, Gunvor G; Ursin, Giske; Hofvind, Solveig

2018-02-01

Background Breast radiologists of the Norwegian Breast Cancer Screening Program subjectively classified mammographic density using a three-point scale between 1996 and 2012 and changed into the fourth edition of the BI-RADS classification since 2013. In 2015, an automated volumetric breast density assessment software was installed at two screening units. Purpose To compare volumetric breast density measurements from the automated method with two subjective methods: the three-point scale and the BI-RADS density classification. Material and Methods Information on subjective and automated density assessment was obtained from screening examinations of 3635 women recalled for further assessment due to positive screening mammography between 2007 and 2015. The score of the three-point scale (I = fatty; II = medium dense; III = dense) was available for 2310 women. The BI-RADS density score was provided for 1325 women. Mean volumetric breast density was estimated for each category of the subjective classifications. The automated software assigned volumetric breast density to four categories. The agreement between BI-RADS and volumetric breast density categories was assessed using weighted kappa (k w ). Results Mean volumetric breast density was 4.5%, 7.5%, and 13.4% for categories I, II, and III of the three-point scale, respectively, and 4.4%, 7.5%, 9.9%, and 13.9% for the BI-RADS density categories, respectively ( P for trend < 0.001 for both subjective classifications). The agreement between BI-RADS and volumetric breast density categories was k w  = 0.5 (95% CI = 0.47-0.53; P < 0.001). Conclusion Mean values of volumetric breast density increased with increasing density category of the subjective classifications. The agreement between BI-RADS and volumetric breast density categories was moderate.

Consensus-Based Attributes for Identifying Patients With Spasmodic Dysphonia and Other Voice Disorders.

PubMed

Ludlow, Christy L; Domangue, Rickie; Sharma, Dinesh; Jinnah, H A; Perlmutter, Joel S; Berke, Gerald; Sapienza, Christine; Smith, Marshall E; Blumin, Joel H; Kalata, Carrie E; Blindauer, Karen; Johns, Michael; Hapner, Edie; Harmon, Archie; Paniello, Randal; Adler, Charles H; Crujido, Lisa; Lott, David G; Bansberg, Stephen F; Barone, Nicholas; Drulia, Teresa; Stebbins, Glenn

2018-06-21

A roadblock for research on adductor spasmodic dysphonia (ADSD), abductor SD (ABSD), voice tremor (VT), and muscular tension dysphonia (MTD) is the lack of criteria for selecting patients with these disorders. To determine the agreement among experts not using standard guidelines to classify patients with ABSD, ADSD, VT, and MTD, and develop expert consensus attributes for classifying patients for research. From 2011 to 2016, a multicenter observational study examined agreement among blinded experts when classifying patients with ADSD, ABSD, VT or MTD (first study). Subsequently, a 4-stage Delphi method study used reiterative stages of review by an expert panel and 46 community experts to develop consensus on attributes to be used for classifying patients with the 4 disorders (second study). The study used a convenience sample of 178 patients clinically diagnosed with ADSD, ABSD, VT MTD, vocal fold paresis/paralysis, psychogenic voice disorders, or hypophonia secondary to Parkinson disease. Participants were aged 18 years or older, without laryngeal structural disease or surgery for ADSD and underwent speech and nasolaryngoscopy video recordings following a standard protocol. Speech and nasolaryngoscopy video recordings following a standard protocol. Specialists at 4 sites classified 178 patients into 11 categories. Four international experts independently classified 75 patients using the same categories without guidelines after viewing speech and nasolaryngoscopy video recordings. Each member from the 4 sites also classified 50 patients from other sites after viewing video clips of voice/laryngeal tasks. Interrater κ less than 0.40 indicated poor classification agreement among rater pairs and across recruiting sites. Consequently, a Delphi panel of 13 experts identified and ranked speech and laryngeal movement attributes for classifying ADSD, ABSD, VT, and MTD, which were reviewed by 46 community specialists. Based on the median attribute rankings, a final attribute list was created for each disorder. When classifying patients without guidelines, raters differed in their classification distributions (likelihood ratio, χ2 = 107.66), had poor interrater agreement, and poor agreement with site categories. For 11 categories, the highest agreement was 34%, with no κ values greater than 0.26. In external rater pairs, the highest κ was 0.23 and the highest agreement was 38.5%. Using 6 categories, the highest percent agreement was 73.3% and the highest κ was 0.40. The Delphi method yielded 18 attributes for classifying disorders from speech and nasolaryngoscopic examinations. Specialists without guidelines had poor agreement when classifying patients for research, leading to a Delphi-based development of the Spasmodic Dysphonia Attributes Inventory for classifying patients with ADSD, ABSD, VT, and MTD for research.

Morphosyntactic Production and Verbal Working Memory: Evidence From Greek Aphasia and Healthy Aging.

PubMed

Fyndanis, Valantis; Arcara, Giorgio; Christidou, Paraskevi; Caplan, David

2018-05-17

The present work investigated whether verbal working memory (WM) affects morphosyntactic production in configurations that do not involve or favor similarity-based interference and whether WM interacts with verb-related morphosyntactic categories and/or cue-target distance (locality). It also explored whether the findings related to the questions above lend support to a recent account of agrammatic morphosyntactic production: Interpretable Features' Impairment Hypothesis (Fyndanis, Varlokosta, & Tsapkini, 2012). A sentence completion task testing production of subject-verb agreement, tense/time reference, and aspect in local and nonlocal conditions and two verbal WM tasks were administered to 8 Greek-speaking persons with agrammatic aphasia (PWA) and 103 healthy participants. The 3 morphosyntactic categories dissociated in both groups (agreement > tense > aspect). A significant interaction emerged in both groups between the 3 morphosyntactic categories and WM. There was no main effect of locality in either of the 2 groups. At the individual level, all 8 PWA exhibited dissociations between agreement, tense, and aspect, and effects of locality were contradictory. Results suggest that individuals with WM limitations (both PWA and healthy older speakers) show dissociations between the production of verb-related morphosyntactic categories. WM affects performance shaping the pattern of morphosyntactic production (in Greek: subject-verb agreement > tense > aspect). The absence of an effect of locality suggests that executive capacities tapped by WM tasks are involved in morphosyntactic processing of demanding categories even when the cue is adjacent to the target. Results are consistent with the Interpretable Features' Impairment Hypothesis (Fyndanis et al., 2012). https://doi.org/10.23641/asha.6024428.

Gender and Number Agreement in the Oral Production of Arabic Heritage Speakers

ERIC Educational Resources Information Center

Albirini, Abdulkafi; Benmamoun, Elabbas; Chakrani, Brahim

2013-01-01

Heritage language acquisition has been characterized by various asymmetries, including the differential acquisition rates of various linguistic areas and the unbalanced acquisition of different categories within a single area. This paper examines Arabic heritage speakers' knowledge of subject-verb agreement versus noun-adjective agreement with the…

Non-Standard Concord and the Marking Hypothesis. Working Papers on Language Universals, No. 11.

ERIC Educational Resources Information Center

Delisle, Gilles L.

In this paper, non-standard types of agreement are examined. Such agreement types are those in which two or more supposedly agreeing categories show discord rather than concord. For example, if a language has noun-adjective agreement, there may, under limited circumstances, be non-standard agreement where the subject is plural and the agreeing…

Comparison Between Digital and Synthetic 2D Mammograms in Breast Density Interpretation.

PubMed

Alshafeiy, Taghreed I; Wadih, Antoine; Nicholson, Brandi T; Rochman, Carrie M; Peppard, Heather R; Patrie, James T; Harvey, Jennifer A

2017-07-01

The purpose of this study was to compare assessments of breast density on synthetic 2D images as compared with digital 2D mammograms. This retrospective study included consecutive women undergoing screening with digital 2D mammography and tomosynthesis during May 2015 with a negative or benign outcome. In separate reading sessions, three radiologists with 5-25 years of clinical experience and 1 year of experience with synthetic 2D mammography read digital 2D and synthetic 2D images and assigned breast density categories according to the 5th edition of BI-RADS. Inter- and intrareader agreement was assessed for each BI-RADS density assessment and combined dense and nondense categories using percent agreement and Cohen kappa coefficient for consensus and all reads. A total of 309 patients met study inclusion criteria. Agreement between consensus BI-RADS density categories assigned for digital and synthetic 2D mammography was 80.3% (95% CI, 75.4-84.5%) with κ = 0.73 (95% CI, 0.66-0.79). For combined dense and nondense categories, agreement reached 91.9% (95% CI, 88.2-94.7%). For consensus readings, similar numbers of patients were shifted between nondense and dense categories (11 and 14, respectively) with the synthetic 2D compared with digital 2D mammography. Interreader differences were apparent; assignment to dense categories was greater with digital 2D mammography for reader 1 (odds ratio [OR], 1.26; p = 0.002), the same for reader 2 (OR, 0.91; p = 0.262), and greater with synthetic 2D mammography for reader 3 (OR, 0.86; p = 0.033). Overall, synthetic 2D mammography is comparable with digital 2D mammography in assessment of breast density, though there is some variability by reader. Practices can readily adopt synthetic 2D mammography without concern that it will affect density assessment and subsequent recommendations for supplemental screening.

Estimating the Relative Sociolinguistic Salience of Segmental Variables in a Dialect Boundary Zone

PubMed Central

Llamas, Carmen; Watt, Dominic; MacFarlane, Andrew E.

2016-01-01

One way of evaluating the salience of a linguistic feature is by assessing the extent to which listeners associate the feature with a social category such as a particular socioeconomic class, gender, or nationality. Such ‘top–down’ associations will inevitably differ somewhat from listener to listener, as a linguistic feature – the pronunciation of a vowel or consonant, for instance – can evoke multiple social category associations, depending upon the dialect in which the feature is embedded and the context in which it is heard. In a given speech community it is reasonable to expect, as a consequence of the salience of the linguistic form in question, a certain level of intersubjective agreement on social category associations. Two metrics we can use to quantify the salience of a linguistic feature are (a) the speed with which the association is made, and (b) the degree to which members of a speech community appear to share the association. Through the use of a new technique, designed as an adaptation of the Implicit Association Test, this paper examines levels of agreement among 40 informants from the Scottish/English border region with respect to the associations they make between four key phonetic variables and the social categories of ‘Scotland’ and ‘England.’ Our findings reveal that the participants exhibit differential agreement patterns across the set of phonetic variables, and that listeners’ responses vary in line with whether participants are members of the Scottish or the English listener groups. These results demonstrate the importance of community-level agreement with respect to the associations that listeners make between social categories and linguistic forms, and as a means of ranking the forms’ relative salience. PMID:27574511

Wheezes, crackles and rhonchi: simplifying description of lung sounds increases the agreement on their classification: a study of 12 physicians' classification of lung sounds from video recordings

PubMed Central

Melbye, Hasse; Garcia-Marcos, Luis; Brand, Paul; Everard, Mark; Priftis, Kostas; Pasterkamp, Hans

2016-01-01

Background The European Respiratory Society (ERS) lung sounds repository contains 20 audiovisual recordings of children and adults. The present study aimed at determining the interobserver variation in the classification of sounds into detailed and broader categories of crackles and wheezes. Methods Recordings from 10 children and 10 adults were classified into 10 predefined sounds by 12 observers, 6 paediatricians and 6 doctors for adult patients. Multirater kappa (Fleiss' κ) was calculated for each of the 10 adventitious sounds and for combined categories of sounds. Results The majority of observers agreed on the presence of at least one adventitious sound in 17 cases. Poor to fair agreement (κ<0.40) was usually found for the detailed descriptions of the adventitious sounds, whereas moderate to good agreement was reached for the combined categories of crackles (κ=0.62) and wheezes (κ=0.59). The paediatricians did not reach better agreement on the child cases than the family physicians and specialists in adult medicine. Conclusions Descriptions of auscultation findings in broader terms were more reliably shared between observers compared to more detailed descriptions. PMID:27158515

Parent-Child Diagnostic Agreement on Anxiety Symptoms with a Structured Diagnostic Interview for Mental Disorders in Children.

PubMed

Popp, Lukka; Neuschwander, Murielle; Mannstadt, Sandra; In-Albon, Tina; Schneider, Silvia

2017-01-01

Objective: In clinical structured diagnostic interviews, diagnoses based on parent and child reports have low to moderate agreement. The aims of the present study are (1) to examine diagnostic agreement on anxiety disorders between parents and children on the levels of current and lifetime diagnostic category and diagnoses focusing in particular on diagnostic criteria and (2) to identify parent- and child-related predictors for diagnostic agreement. Method: The sample consisted of 166 parent-child dyads interviewed with the Structured Diagnostic Interview for Mental Disorders in Children (Kinder-DIPS, Schneider et al., 2009). The children (51.8% girls) were between the ages of 7 and 18 years ( M = 10.94; SD = 2.22). Results: Overall, parent-child agreement on the diagnostic category of anxiety disorder ( k = 0.21; k = 0.22) and the specific anxiety diagnoses (base rate > 10%) of social phobia, specific phobia and separation anxiety disorder ( k = 0.24-0.52; k = 0.19-0.43) and corresponding diagnostic criteria ( k = 0.22-0.67; k = 0.24-0.41) were low to moderate with the highest agreement on separation anxiety disorder ( k > 0.43). Lower maternal depression, and higher social support reported by mother and father were associated with higher parent-child agreement. Maternal depression was indicated as the strongest predictor. Parental sense of competence, parental anxiety, the amount of parent-child interaction and the child's age and gender had no predictive value. Conclusions: Parent-child agreement can be expected to be higher on the level of anxiety criteria compared to specific anxiety diagnoses and diagnostic anxiety category. Psychological strains in the family-especially maternal depression and low social support-lower the parent-child agreement on anxiety symptoms. Child- and relation-related variables (age, gender, amount of time parent(s) and children interact) play no role in the prediction of low parent-child agreement.

Parent-Child Diagnostic Agreement on Anxiety Symptoms with a Structured Diagnostic Interview for Mental Disorders in Children

PubMed Central

Popp, Lukka; Neuschwander, Murielle; Mannstadt, Sandra; In-Albon, Tina; Schneider, Silvia

2017-01-01

Objective: In clinical structured diagnostic interviews, diagnoses based on parent and child reports have low to moderate agreement. The aims of the present study are (1) to examine diagnostic agreement on anxiety disorders between parents and children on the levels of current and lifetime diagnostic category and diagnoses focusing in particular on diagnostic criteria and (2) to identify parent- and child-related predictors for diagnostic agreement. Method: The sample consisted of 166 parent-child dyads interviewed with the Structured Diagnostic Interview for Mental Disorders in Children (Kinder-DIPS, Schneider et al., 2009). The children (51.8% girls) were between the ages of 7 and 18 years (M = 10.94; SD = 2.22). Results: Overall, parent-child agreement on the diagnostic category of anxiety disorder (k = 0.21; k = 0.22) and the specific anxiety diagnoses (base rate > 10%) of social phobia, specific phobia and separation anxiety disorder (k = 0.24–0.52; k = 0.19–0.43) and corresponding diagnostic criteria (k = 0.22–0.67; k = 0.24–0.41) were low to moderate with the highest agreement on separation anxiety disorder (k > 0.43). Lower maternal depression, and higher social support reported by mother and father were associated with higher parent-child agreement. Maternal depression was indicated as the strongest predictor. Parental sense of competence, parental anxiety, the amount of parent-child interaction and the child's age and gender had no predictive value. Conclusions: Parent-child agreement can be expected to be higher on the level of anxiety criteria compared to specific anxiety diagnoses and diagnostic anxiety category. Psychological strains in the family—especially maternal depression and low social support—lower the parent-child agreement on anxiety symptoms. Child- and relation-related variables (age, gender, amount of time parent(s) and children interact) play no role in the prediction of low parent-child agreement. PMID:28396644

Are inspectors' assessments reliable? Ratings of NHS acute hospital trust services in England.

PubMed

Boyd, Alan; Addicott, Rachael; Robertson, Ruth; Ross, Shilpa; Walshe, Kieran

2017-01-01

The credibility of a regulator could be threatened if stakeholders perceive that assessments of performance made by its inspectors are unreliable. Yet there is little published research on the reliability of inspectors' assessments of health care organizations' services. Objectives We investigated the inter-rater reliability of assessments made by inspectors inspecting acute hospitals in England during the piloting of a new regulatory model implemented by the Care Quality Commission (CQC) during 2013 and 2014. Multi-professional teams of inspectors rated service provision on a four-point scale for each of five domains: safety; effectiveness; caring; responsiveness; and leadership. Methods In an online survey, we asked individual inspectors to assign a domain and a rating to each of 10 vignettes of service information extracted from CQC inspection reports. We used these data to simulate the ratings that might be produced by teams of inspectors. We also observed inspection teams in action, and interviewed inspectors and staff from hospitals that had been inspected. Results Levels of agreement varied substantially from vignette to vignette. Characteristics such as professional background explained only a very small part of the variation. Overall, agreement was higher on ratings than on domains, and for groups of inspectors compared with individual inspectors. A number of potential causes of disagreement were identified, such as differences regarding the weight that should be given to contextual factors and general uncertainty about interpreting the rating and domain categories. Conclusion Groups of inspectors produced more reliable assessments than individual inspectors, and there is evidence to support the utility of appropriate discussions between inspectors in improving reliability. The reliability of domain allocations was lower than for ratings. It is important to define categories and rating levels clearly, and to train inspectors in their use. Further research is needed to replicate these results now that the model has been fully implemented, and to understand better the impact that inspector uncertainty and disagreement may have on published CQC ratings.

Graphical aids for visualizing and interpreting patterns in departures from agreement in ordinal categorical observer agreement data.

PubMed

Bangdiwala, Shrikant I

2017-01-01

When studying the agreement between two observers rating the same n units into the same k discrete ordinal categories, Bangdiwala (1985) proposed using the "agreement chart" to visually assess agreement. This article proposes that often it is more interesting to focus on the patterns of disagreement and visually understanding the departures from perfect agreement. The article reviews the use of graphical techniques for descriptively assessing agreement and disagreements, and also reviews some of the available summary statistics that quantify such relationships.

ANALYSIS OF A CLASSIFICATION ERROR MATRIX USING CATEGORICAL DATA TECHNIQUES.

USGS Publications Warehouse

Rosenfield, George H.; Fitzpatrick-Lins, Katherine

1984-01-01

Summary form only given. A classification error matrix typically contains tabulation results of an accuracy evaluation of a thematic classification, such as that of a land use and land cover map. The diagonal elements of the matrix represent the counts corrected, and the usual designation of classification accuracy has been the total percent correct. The nondiagonal elements of the matrix have usually been neglected. The classification error matrix is known in statistical terms as a contingency table of categorical data. As an example, an application of these methodologies to a problem of remotely sensed data concerning two photointerpreters and four categories of classification indicated that there is no significant difference in the interpretation between the two photointerpreters, and that there are significant differences among the interpreted category classifications. However, two categories, oak and cottonwood, are not separable in classification in this experiment at the 0. 51 percent probability. A coefficient of agreement is determined for the interpreted map as a whole, and individually for each of the interpreted categories. A conditional coefficient of agreement for the individual categories is compared to other methods for expressing category accuracy which have already been presented in the remote sensing literature.

7 CFR 993.503 - Size category.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 8 2014-01-01 2014-01-01 false Size category. 993.503 Section 993.503 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA...

7 CFR 993.515 - Size categories.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Size categories. 993.515 Section 993.515 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA...

7 CFR 993.515 - Size categories.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 8 2014-01-01 2014-01-01 false Size categories. 993.515 Section 993.515 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA...

7 CFR 993.515 - Size categories.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 8 2013-01-01 2013-01-01 false Size categories. 993.515 Section 993.515 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA...

7 CFR 993.515 - Size categories.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Size categories. 993.515 Section 993.515 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA...

7 CFR 993.515 - Size categories.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 8 2012-01-01 2012-01-01 false Size categories. 993.515 Section 993.515 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA...

48 CFR 237.7200 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... agreements, i.e., payment by the Government of partial tuition under the off-duty educational program. (b) As... DEFENSE SPECIAL CATEGORIES OF CONTRACTING SERVICE CONTRACTING Educational Service Agreements 237.7200 Scope. (a) This subpart prescribes acquisition procedures for educational services from schools...

48 CFR 237.7200 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... agreements, i.e., payment by the Government of partial tuition under the off-duty educational program. (b) As... DEFENSE SPECIAL CATEGORIES OF CONTRACTING SERVICE CONTRACTING Educational Service Agreements 237.7200 Scope. (a) This subpart prescribes acquisition procedures for educational services from schools...

21 CFR 20.108 - Agreements between the Food and Drug Administration and other departments, agencies, and...

Code of Federal Regulations, 2010 CFR

2010-04-01

... Specific Categories of Records § 20.108 Agreements between the Food and Drug Administration and other... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Agreements between the Food and Drug Administration and other departments, agencies, and organizations. 20.108 Section 20.108 Food and Drugs FOOD AND...

Investigation of rotor blade tip-vortex aerodynamics

NASA Technical Reports Server (NTRS)

Lewellen, W. S.

1971-01-01

Several aspects of the aerodynamics of rotor blade tip vortices are examined. Two particular categories are dealt with; (1) dynamic loads on a blade passing close to or intersecting a trailing vortex, and (2) the response of the trailing vortex core to changes in the flow. Results for both categories are in reasonable agreement with existing data, although lower pressure gradients were obtained than anticipated for category one. A correlation between trailing edge sweep angle at the tip and vortex core size was noted for category two.

Development of a novel regulatory pharmacovigilance prioritisation system: an evaluation of its performance at the UK Medicines and Healthcare products Regulatory Agency.

PubMed

Seabroke, Suzie; Wise, Lesley; Waller, Patrick

2013-10-01

The prioritisation of drug safety issues for further evaluation or regulatory action is critical to ensure that acceptable timelines and appropriate resource allocation are defined to meet public health and regulatory obligations. Our objective was to develop, pilot and implement a novel tool for prioritising pharmacovigilance issues within the Medicines and Healthcare products Regulatory Agency (MHRA). An initial system was developed empirically and then piloted over a 10-month period in the pharmacovigilance signal management meeting at the MHRA that discusses potential pharmacovigilance issues, and determines, through consensus, their priority and a timescale for action. The priority assigned by the tool was compared with the priority decided by collective judgement at the meeting. Once an acceptable level of concordance between the tool and the meeting had been achieved, the finalised tool was implemented into routine use at the MHRA, with an evaluation of its performance conducted after the first year. The Regulatory Pharmacovigilance Prioritisation System (RPPS) tool prioritises pharmacovigilance issues according to the following four broad categories, each with four inputs: strength of evidence, public health implications, agency regulatory obligations and public perceptions. A weighted scoring system links the inputs to a pre-defined number of points where if a threshold is reached then the points are awarded. The overall priority is determined by the sum of all points obtained from each of the inputs. The pilot study included a total of 73 pharmacovigilance issues during the 10-month study period, with an overall exact agreement between the RPPS priority and the collective judgement of the meeting of 60.3 %. Where exact agreement was not obtained, the RPPS generally prioritised the issues slightly higher than the meeting. Over the first year following implementation, the RPPS achieved an overall exact agreement of 82.2 %. Following the pilot study and implementation at the UK MHRA, the RPPS has provided a systematic approach to drug safety issue prioritisation that should help to reduce the subjectivity of reliance on individual judgement.

TQM implementation for the healthcare sector.

PubMed

Chiarini, Andrea; Vagnoni, Emidia

2017-07-03

Purpose The purpose of this paper is to enlarge the debate on total quality management (TQM) implementation in the healthcare sector and to evaluate how and whether leadership can affect TQM implementation. Design/methodology/approach This paper is based on findings from a literature review of TQM and leadership. The authors analysed these findings to categorise causes of a lack of leadership in TQM programme implementations. Findings The authors propose three categories of causes of a lack of leadership in TQM programme implementation. The first cause is well-known: a lack of senior managers' involvement and commitment. The second category is the "combined leadership" that occurs in large healthcare organisations; and the third category is the influence of an external "political leadership" on public healthcare. Research limitations/implications This paper presents researchers with three categories of causes of failure of leadership in TQM implementation that can be investigated. It also encourages reflections from practitioners concerning TQM leadership in the healthcare sector. Practical implications The authors request that practitioners reflect on ways to create or sustain a "monolithic" leadership, especially in large organisations, to ensure a common vision, values and attitude for unitary TQM governance. Originality/value In an original way, this paper analyses and proposes three categories of causes linked to a lack of TQM leadership in the healthcare sector.

Kappa and Rater Accuracy: Paradigms and Parameters

ERIC Educational Resources Information Center

Conger, Anthony J.

2017-01-01

Drawing parallels to classical test theory, this article clarifies the difference between rater accuracy and reliability and demonstrates how category marginal frequencies affect rater agreement and Cohen's kappa. Category assignment paradigms are developed: comparing raters to a standard (index) versus comparing two raters to one another…

Standards for Evaluating Criterion-Referenced Tests.

ERIC Educational Resources Information Center

Walker, Clinton B.

Standards for evaluating criterion-referenced tests are presented. Twenty-one standards, grouped in three categories, are discussed. Category one is defined as measurement properties and is comprised of conceptual validity, including description of the domain, test item agreement with objectives, and item representativeness of the objectives; and…

76 FR 80412 - New Postal Product

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-23

... Service of Filing Functionally Equivalent Inbound Competitive Multi-Service Agreement with a Foreign... application for non-public treatment of certain materials. The Postal Service also provided a redacted copy of... that the Postal Service proposed adding other functionally equivalent agreements as price categories...

An Examination of Strategy Implementation During Abstract Nonlinguistic Category Learning in Aphasia.

PubMed

Vallila-Rohter, Sofia; Kiran, Swathi

2015-08-01

Our purpose was to study strategy use during nonlinguistic category learning in aphasia. Twelve control participants without aphasia and 53 participants with aphasia (PWA) completed a computerized feedback-based category learning task consisting of training and testing phases. Accuracy rates of categorization in testing phases were calculated. To evaluate strategy use, strategy analyses were conducted over training and testing phases. Participant data were compared with model data that simulated complex multi-cue, single feature, and random pattern strategies. Learning success and strategy use were evaluated within the context of standardized cognitive-linguistic assessments. Categorization accuracy was higher among control participants than among PWA. The majority of control participants implemented suboptimal or optimal multi-cue and single-feature strategies by testing phases of the experiment. In contrast, a large subgroup of PWA implemented random patterns, or no strategy, during both training and testing phases of the experiment. Person-to-person variability arises not only in category learning ability but also in the strategies implemented to complete category learning tasks. PWA less frequently developed effective strategies during category learning tasks than control participants. Certain PWA may have impairments of strategy development or feedback processing not captured by language and currently probed cognitive abilities.

Forest land management by satellite: LANDSAT-derived information as input to a forest inventory system. [North Carolina

NASA Technical Reports Server (NTRS)

Williams, D. L.; Haver, G. F. (Principal Investigator)

1976-01-01

The author has identified the following significant results. Analysis of LANDSAT temporal data, specifically the digitally merged winter and summer scenes, provided the best overall classification results. Comparison of temporal classification results with available ground truth reveal a 94% agreement in the delineation of hardwood categories, a 96% agreement for the combined pine category, and a greater than 50% agreement for each individual pine subcategory. For nearly 1000 acres, compared clearcut acreage estimated with LANDSAT digital data differed from company inventory records by only 3%. Through analysis of summer data, pine stands were successfully classified into subcategories based upon the extent of crown closure. Maximum spectral separability of hardwood and pine stands was obtained from the analysis of winter data.

Discrepancies between arterial oxygen saturation and functional oxygen saturation measured with pulse oximetry in very preterm infants.

PubMed

Rosychuk, Rhonda J; Hudson-Mason, Ann; Eklund, Dianne; Lacaze-Masmonteil, Thierry

2012-01-01

Discrepancies between pulse oximetry saturation (SpO(2)) and arterial saturation (SaO(2)) at low blood oxygenation values have been previously reported with significant variations among instruments and studies. Whether pulse oximeters that attenuate motion artifact are less prone to such discrepancies is not well known. To prospectively assess the agreement of the Masimo V4 pulse oximeter within the critical 85-95% SpO(2) target range. For all consecutive babies with gestational age <33 weeks, postnatal age <7 days, and an umbilical arterial line, SpO(2) was measured continuously and SaO(2) analyzed on an as-needed basis. Bland-Altman techniques provided estimates of the difference (D = SaO(2) - SpO(2)), standard deviation (SD), and 95% limits of agreement (D ± 2*SD). There were 1,032 measurements (114 babies) with SpO(2) between 85 and 95%. The 95% limits of agreement were -2.0 ± 5.8, -2.4 ± 9.2, and -1.9 ± 5.3 in the SpO(2) categories 85-95, 85-89, and 91-95%, respectively. For the SpO(2) categories 85-89% and 91-95%, only 52% (53/101) and 59% (523/886) of SpO(2) values, respectively, corresponded to the analogous SaO(2) categories. In the 85-89% SpO(2) category, SaO(2) was lower than 85% in 39 of the 101 (39%) measurements. SaO(2) was lower on average than SpO(2) with an increased bias at lower saturation. The -2.4 ± 9.2 95% limits of agreement for SaO(2) - SpO(2) in the 85-89% SpO(2) category suggest that SpO(2) and SaO(2) are not interchangeable and intermittent SaO(2) assessments are warranted when the targeted SpO(2) is within this range. Copyright © 2011 S. Karger AG, Basel.

Biofeedback in Partial Weight Bearing: Validity of 3 Different Devices.

PubMed

van Lieshout, Remko; Stukstette, Mirelle J; de Bie, Rob A; Vanwanseele, Benedicte; Pisters, Martijn F

2016-11-01

Study Design Controlled laboratory study to assess criterion-related validity, with a cross-sectional within-subject design. Background Patients with orthopaedic conditions have difficulties complying with partial weight-bearing instructions. Technological advances have resulted in biofeedback devices that offer real-time feedback. However, the accuracy of these devices is mostly unknown. Inaccurate feedback can result in incorrect lower-limb loading and may lead to delayed healing. Objectives To investigate validity of peak force measurements obtained using 3 different biofeedback devices under varying levels of partial weight-bearing categories. Methods Validity of 3 biofeedback devices (OpenGo science, SmartStep, and SensiStep) was assessed. Healthy participants were instructed to walk at a self-selected speed with crutches under 3 different weight-bearing conditions, categorized as a percentage range of body weight: 1% to 20%, greater than 20% to 50%, and greater than 50% to 75%. Peak force data from the biofeedback devices were compared with the peak vertical ground reaction force measured with a force plate. Criterion validity was estimated using simple and regression-based Bland-Altman 95% limits of agreement and weighted kappas. Results Fifty-five healthy adults (58% male) participated. Agreement with the gold standard was substantial for the SmartStep, moderate for OpenGo science, and slight for SensiStep (weighted ± = 0.76, 0.58, and 0.19, respectively). For the 1% to 20% and greater than 20% to 50% weight-bearing categories, both the OpenGo science and SmartStep had acceptable limits of agreement. For the weight-bearing category greater than 50% to 75%, none of the devices had acceptable agreement. Conclusion The OpenGo science and SmartStep provided valid feedback in the lower weight-bearing categories, and the SensiStep showed poor validity of feedback in all weight-bearing categories. J Orthop Sports Phys Ther 2016;46(11):-1. Epub 12 Oct 2016. doi:10.2519/jospt.2016.6625.

Measuring Category Intuitiveness in Unconstrained Categorization Tasks

ERIC Educational Resources Information Center

Pothos, Emmanuel M.; Perlman, Amotz; Bailey, Todd M.; Kurtz, Ken; Edwards, Darren J.; Hines, Peter; McDonnell, John V.

2011-01-01

What makes a category seem natural or intuitive? In this paper, an unsupervised categorization task was employed to examine observer agreement concerning the categorization of nine different stimulus sets. The stimulus sets were designed to capture different intuitions about classification structure. The main empirical index of category…

7 CFR 550.22 - Payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... GENERAL ADMINISTRATIVE POLICY FOR NON-ASSISTANCE COOPERATIVE AGREEMENTS Management of Agreements Financial Management § 550.22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of...) The time period covered by the invoice; and (vii) Total dollar amount itemized by budget categories...

48 CFR 237.7204 - Format and clauses for educational service agreements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... educational service agreements. 237.7204 Section 237.7204 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SPECIAL CATEGORIES OF CONTRACTING SERVICE CONTRACTING... practices and procedures for other students of similar accomplishment in that department or field. The...

48 CFR 237.7204 - Format and clauses for educational service agreements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... educational service agreements. 237.7204 Section 237.7204 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SPECIAL CATEGORIES OF CONTRACTING SERVICE CONTRACTING... practices and procedures for other students of similar accomplishment in that department or field. The...

48 CFR 237.7204 - Format and clauses for educational service agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... educational service agreements. 237.7204 Section 237.7204 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SPECIAL CATEGORIES OF CONTRACTING SERVICE CONTRACTING... practices and procedures for other students of similar accomplishment in that department or field. The...

48 CFR 237.7204 - Format and clauses for educational service agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... educational service agreements. 237.7204 Section 237.7204 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SPECIAL CATEGORIES OF CONTRACTING SERVICE CONTRACTING... practices and procedures for other students of similar accomplishment in that department or field. The...

Can glenoid wear be accurately assessed using x-ray imaging? Evaluating agreement of x-ray and magnetic resonance imaging (MRI) Walch classification.

PubMed

Kopka, Michaela; Fourman, Mitchell; Soni, Ashish; Cordle, Andrew C; Lin, Albert

2017-09-01

The Walch classification is the most recognized means of assessing glenoid wear in preoperative planning for shoulder arthroplasty. This classification relies on advanced imaging, which is more expensive and less practical than plain radiographs. The purpose of this study was to determine whether the Walch classification could be accurately applied to x-ray images compared with magnetic resonance imaging (MRI) as the gold standard. We hypothesized that x-ray images cannot adequately replace advanced imaging in the evaluation of glenoid wear. Preoperative axillary x-ray images and MRI scans of 50 patients assessed for shoulder arthroplasty were independently reviewed by 5 raters. Glenoid wear was individually classified according to the Walch classification using each imaging modality. The raters then collectively reviewed the MRI scans and assigned a consensus classification to serve as the gold standard. The κ coefficient was used to determine interobserver agreement for x-ray images and independent MRI reads, as well as the agreement between x-ray images and consensus MRI. The inter-rater agreement for x-ray images and MRIs was "moderate" (κ = 0.42 and κ = 0.47, respectively) for the 5-category Walch classification (A1, A2, B1, B2, C) and "moderate" (κ = 0.54 and κ = 0.59, respectively) for the 3-category Walch classification (A, B, C). The agreement between x-ray images and consensus MRI was much lower: "fair-to-moderate" (κ = 0.21-0.51) for the 5-category and "moderate" (κ = 0.36-0.60) for the 3-category Walch classification. The inter-rater agreement between x-ray images and consensus MRI is "fair-to-moderate." This is lower than the previously reported reliability of the Walch classification using computed tomography scans. Accordingly, x-ray images are inferior to advanced imaging when assessing glenoid wear. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Progress in increasing electronic reporting of laboratory results to public health agencies--United States, 2013.

PubMed

2013-09-27

Electronic reporting of laboratory results to public health agencies can improve public health surveillance for reportable diseases and conditions by making reporting more timely and complete. Since 2010, CDC has provided funding to 57 state, local, and territorial health departments through the Epidemiology and Laboratory Capacity for Infectious Diseases cooperative agreement to assist with improving electronic laboratory reporting (ELR) from clinical and public health laboratories to public health agencies. As part of this agreement, CDC and state and large local health departments are collaborating to monitor ELR implementation in the United States by developing data from each jurisdiction regarding total reporting laboratories, laboratories sending ELR by disease category and message format, and the number of ELR laboratory reports compared with the total number of laboratory reports. At the end of July 2013, 54 of the 57 jurisdictions were receiving at least some laboratory reports through ELR, and approximately 62% of 20 million laboratory reports were being received electronically, compared with 54% in 2012. Continued progress will require collaboration between clinical laboratories, laboratory information management system (LIMS) vendors, and public health agencies.

Atypia on breast core needle biopsies: reproducibility and significance.

PubMed

Darvishian, Farbod; Singh, Baljit; Simsir, Aylin; Ye, Weimin; Cangiarella, Joan F

2009-01-01

This study analyzes the interobserver variability in interpreting atypia on breast core needle biopsies and in each category of atypia calculates the upgrade risk of carcinoma in the subsequent surgical excision. We identified 51 cases of atypia on breast core needle biopsies performed at our institution from January 2003 to August 2006. The atypia was classified into 4 categories: atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), flat epithelial atypia (FEA), and atypia of undetermined significance (AUS). After a tutorial session, these cases were independently reviewed by four pathologists, whose overall multi-rater kappa value for agreement on different categories of atypia was 0.79 (95% CI, 0.69-0.89), which is within the substantial agreement range. The upgrade risk in each category of atypia was as follows: ADH 20% (p = 0.04); ALH 10% (p = 0.6); FEA 16.6% (p = 0.23), and AUS 100% (p = 0.96). Based on our findings, we conclude that follow-up excision should be performed after a diagnosis of ADH. The upgrade risk did not reach statistical significance in ALH or FEA. Although follow-up excision cannot be strongly recommended in ALH and FEA, it should be considered since the upgrade risk is not negligible. Strict adherence to the diagnostic criteria and tutorial sessions can help pathologists to achieve substantial agreement in interpreting atypia on breast core needle biopsies.

78 FR 18877 - Defense Federal Acquisition Regulation Supplement: New Free Trade Agreement With Colombia (DFARS...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-28

... Regulation Supplement (DFARS) to implement the United States-Colombia Trade Promotion Agreement. This Trade Promotion Agreement is a free trade agreement that provides for mutually non-discriminatory treatment of... States-Colombia Trade Promotion Agreement Implementation Act (Pub. L. 112-42) (19 U.S.C. 3805 note). No...

Italy-Japan agreement and discrepancies in diagnosis of superficial gastric lesions.

PubMed

Vindigni, Carla; Marini, Mario; Cevenini, Gabriele; Raffaella Ambrosio, Maria; Onorati, Monica; Frosini, Giorgio; Gotoda, Takuji; Taniguchi, Hirokazu; Tosi, Piero

2010-01-01

The agreement between Italian and Japanese endoscopists and pathologists on endoscopic and histopathological diagnoses of superficial gastric lesions is verified with the use of Paris and Vienna classifications. The correlations between Paris endoscopic types and Vienna histopathological categories is high in both the independent Italian and Japanese evaluations. However, the agreement between Italian and Japanese endoscopists is moderate due to the difficult evaluation of the height of the lesions, in particular when they are mixed. The agreement on the size of the lesions is fairly good. The probability of the same allocation to the Vienna categories of a single case is 87 per cent, disagreements remaining in dysplasia grading, between dysplasia, not only high-grade but also low-grade, and in situ carcinoma, and on cancer invasion of the lamina propria. The results indicate that use of the Paris and Vienna classifications has reduced the discrepancies between Western and Japanese endoscopists and pathologists in the diagnosis of these lesions.

Multimethod latent class analysis

PubMed Central

Nussbeck, Fridtjof W.; Eid, Michael

2015-01-01

Correct and, hence, valid classifications of individuals are of high importance in the social sciences as these classifications are the basis for diagnoses and/or the assignment to a treatment. The via regia to inspect the validity of psychological ratings is the multitrait-multimethod (MTMM) approach. First, a latent variable model for the analysis of rater agreement (latent rater agreement model) will be presented that allows for the analysis of convergent validity between different measurement approaches (e.g., raters). Models of rater agreement are transferred to the level of latent variables. Second, the latent rater agreement model will be extended to a more informative MTMM latent class model. This model allows for estimating (i) the convergence of ratings, (ii) method biases in terms of differential latent distributions of raters and differential associations of categorizations within raters (specific rater bias), and (iii) the distinguishability of categories indicating if categories are satisfyingly distinct from each other. Finally, an empirical application is presented to exemplify the interpretation of the MTMM latent class model. PMID:26441714

Inter-Coder Agreement in One-to-Many Classification: Fuzzy Kappa.

PubMed

Kirilenko, Andrei P; Stepchenkova, Svetlana

2016-01-01

Content analysis involves classification of textual, visual, or audio data. The inter-coder agreement is estimated by making two or more coders to classify the same data units, with subsequent comparison of their results. The existing methods of agreement estimation, e.g., Cohen's kappa, require that coders place each unit of content into one and only one category (one-to-one coding) from the pre-established set of categories. However, in certain data domains (e.g., maps, photographs, databases of texts and images), this requirement seems overly restrictive. The restriction could be lifted, provided that there is a measure to calculate the inter-coder agreement in the one-to-many protocol. Building on the existing approaches to one-to-many coding in geography and biomedicine, such measure, fuzzy kappa, which is an extension of Cohen's kappa, is proposed. It is argued that the measure is especially compatible with data from certain domains, when holistic reasoning of human coders is utilized in order to describe the data and access the meaning of communication.

Medical Evidence Influence on Inpatients and Nurses Pain Ratings Agreement

PubMed Central

Samolsky Dekel, Boaz Gedaliahu; Gori, Alberto; Vasarri, Alessio; Sorella, Maria Cristina; Di Nino, Gianfranco; Melotti, Rita Maria

2016-01-01

Biased pain evaluation due to automated heuristics driven by symptom uncertainty may undermine pain treatment; medical evidence moderators are thought to play a role in such circumstances. We explored, in this cross-sectional survey, the effect of such moderators (e.g., nurse awareness of patients' pain experience and treatment) on the agreement between n = 862 inpatients' self-reported pain and n = 115 nurses' pain ratings using a numerical rating scale. We assessed the mean of absolute difference, agreement (κ-statistics), and correlation (Spearman rank) of inpatients and nurses' pain ratings and analyzed congruence categories' (CCs: underestimation, congruence, and overestimation) proportions and dependence upon pain categories for each medical evidence moderator (χ 2 analysis). Pain ratings agreement and correlation were limited; the CCs proportions were further modulated by the studied moderators. Medical evidence promoted in nurses overestimation of low and underestimation of high inpatients' self-reported pain. Knowledge of the negative influence of automated heuristics driven by symptoms uncertainty and medical-evidence moderators on pain evaluation may render pain assessment more accurate. PMID:27445633

Semiquantitative visual approach to scoring lung cancer treatment response using computed tomography: a pilot study.

PubMed

Gottlieb, Ronald H; Kumar, Prasanna; Loud, Peter; Klippenstein, Donald; Raczyk, Cheryl; Tan, Wei; Lu, Jenny; Ramnath, Nithya

2009-01-01

Our objective was to compare a newly developed semiquantitative visual scoring (SVS) method with the current standard, the Response Evaluation Criteria in Solid Tumors (RECIST) method, in the categorization of treatment response and reader agreement for patients with metastatic lung cancer followed by computed tomography. The 18 subjects (5 women and 13 men; mean age, 62.8 years) were from an institutional review board-approved phase 2 study that evaluated a second-line chemotherapy regimen for metastatic (stages III and IV) non-small cell lung cancer. Four radiologists, blinded to the patient outcome and each other's reads, evaluated the change in the patients' tumor burden from the baseline to the first restaging computed tomographic scan using either the RECIST or the SVS method. We compared the numbers of patients placed into the partial response, the stable disease (SD), and the progressive disease (PD) categories (Fisher exact test) and observer agreement (kappa statistic). Requiring the concordance of 3 of the 4 readers resulted in the RECIST placing 17 (100%) of 17 patients in the SD category compared with the SVS placing 9 (60%) of 15 patients in the partial response, 5 (33%) of the 15 patients in the SD, and 1 (6.7%) of the 15 patients in the PD categories (P < 0.0001). Interobserver agreement was higher among the readers using the SVS method (kappa, 0.54; P < 0.0001) compared with that of the readers using the RECIST method (kappa, -0.01; P = 0.5378). Using the SVS method, the readers more finely discriminated between the patient response categories with superior agreement compared with the RECIST method, which could potentially result in large differences in early treatment decisions for advanced lung cancer.

A Simulation Tool for the Duties of Computer Specialist Non-Commissioned Officers on a Turkish Air Force Base

DTIC Science & Technology

2009-09-01

Interface IFR Instrument Flight Rules LANTIRN Low-Altitude Navigation and Targeting Infrared for Night MANTIRN Medium Altitude Navigation and...MANTIRN categories, and IFR weather categories. Aside from the category of personnel (computer specialist NCOs rather than pilots), the main...of the node, (2) Adding a description, (3) Implementing event arguments , local variables, and state transitions, (4) Implementing a code that is

An Examination of Strategy Implementation During Abstract Nonlinguistic Category Learning in Aphasia

PubMed Central

Kiran, Swathi

2015-01-01

Purpose Our purpose was to study strategy use during nonlinguistic category learning in aphasia. Method Twelve control participants without aphasia and 53 participants with aphasia (PWA) completed a computerized feedback-based category learning task consisting of training and testing phases. Accuracy rates of categorization in testing phases were calculated. To evaluate strategy use, strategy analyses were conducted over training and testing phases. Participant data were compared with model data that simulated complex multi-cue, single feature, and random pattern strategies. Learning success and strategy use were evaluated within the context of standardized cognitive–linguistic assessments. Results Categorization accuracy was higher among control participants than among PWA. The majority of control participants implemented suboptimal or optimal multi-cue and single-feature strategies by testing phases of the experiment. In contrast, a large subgroup of PWA implemented random patterns, or no strategy, during both training and testing phases of the experiment. Conclusions Person-to-person variability arises not only in category learning ability but also in the strategies implemented to complete category learning tasks. PWA less frequently developed effective strategies during category learning tasks than control participants. Certain PWA may have impairments of strategy development or feedback processing not captured by language and currently probed cognitive abilities. PMID:25908438

Interobserver variability when employing the IUGA/ICS classification system for complications related to prostheses and grafts in female pelvic floor surgery.

PubMed

Gowda, Meghana; Kit, Laura Chang; Stuart Reynolds, W; Wang, Li; Dmochowski, Roger R; Kaufman, Melissa R

2013-10-01

To unify and organize reporting, an International Urogynecological Association (IUGA)/International Continence Society (ICS) expert consortium published terminology guidelines with a classification system for complications related to implants used in female pelvic surgery. We hypothesize that the complexity of the codification system may be a hindrance to precision, especially with decreasing levels of postgraduate expertise. Residents, fellows, and attending physicians were asked to code seven test cases taken from published literature. Category, timing, and site components of the classification system were assessed independently and according to the level of training. Interobserver reliability was calculated as percent agreement and Fleiss' kappa statistic. A total of 24 participants (6 attending physicians, 3 fellows, and 15 residents) were tested. The percent agreement showed significant variation when classified by level of training. In all categories, attending physicians had the greatest percentage agreement and largest kappa. The most agreement was seen when attending physicians classified mesh complications by time, 71% agreement with kappa 0.73 [95% confidence interval (CI) 0.58-0.88]. For the same task, the percentage agreement for fellows was 57%, kappa 0.55 (95% CI 0.23-0.87) and with residents 57%, kappa 0.71([95% CI 0.64-0.78). Interestingly, the site component of the classification system had the least overall agreement and lowest kappa [0%, kappa 0.29 (95% CI 0.26-0.32)] followed by the category component [14%, kappa 0.48 (95% CI 0.46-0.5)]. The IUGA/ICS mesh complication classification system has poor interobserver reliability. This trended downward with decreasing postgraduate level; however, we did not have sufficient statistical power to show an association when stratifying by all training levels. This highlights the complex nature of the classification system in its current form and its limitation for widespread clinical and research application.

Peripheral zone lesions of intermediary risk in multiparametric prostate MRI: Frequency and validation of the PI-RADSv2 risk stratification algorithm based on focal contrast enhancement.

PubMed

Benndorf, Matthias; Waibel, Lorenz; Krönig, Malte; Jilg, Cordula Annette; Langer, Mathias; Krauss, Tobias

2018-02-01

To validate the risk stratification algorithm of the Prostate Imaging Reporting and Data System (PI-RADSv2) for intermediary risk lesions (PI-RADSv2 category 3) in the peripheral zone based on focal contrast enhancement and to compare cancer rates in category 3, upgraded category 4 and category 4 based on markedly low ADC value. We retrospectively analyze 172 consecutive patients undergoing prostate MRI with 315 histopathologically verified lesions. We select all lesions either assigned category 3 or category 4 in the peripheral zone for further analysis. We compare cancer rates with the two-sided chi-squared test. To determine inter-observer agreement about contrast enhancement two blinded radiologists evaluate the subset of category 3 lesions based on the diffusion weighted sequence. The frequency of peripheral PI-RADS 3, upgraded PI-RADS 4 and PI-RADS 4 lesions based on markedly low ADC value is 10.8%, 10.8% and 20.3%, respectively. Cancer rates (significant cancer only) in these subgroups are 8.8% (3/34), 23.5% (8/34) and 40.6% (26/64), P < 0.01. Inter-observer agreement is moderate for evaluation of contrast enhancement with kappa values between 0.46 and 0.5. We demonstrate a trend of increasing cancer rate from PI-RADSv2 category 3 to upgraded category 4 to category 4 based on markedly low ADC value. Peripheral lesions of intermediary risk in the diffusion weighted sequence account for 21.6% of all prostate lesions encountered. Since it is likely that patient management recommendations will be linked to assessment categories in future versions of PI-RADS, cancer rates in upgraded category 4 and category 4 based on markedly low ADC values should be in a similar range. We conclude that in future studies of PI-RADSv2 upgraded category 4 and category 4 based on markedly low ADC value should be reported separately to generate a database for meta-analysis of cancer rates. Copyright © 2017 Elsevier B.V. All rights reserved.

Intonation features of the expression of emotions in Spanish: preliminary study for a prosody assessment procedure.

PubMed

Martínez-Castilla, Pastora; Peppé, Susan

2008-01-01

This study aimed to find out what intonation features reliably represent the emotions of "liking" as opposed to "disliking" in the Spanish language, with a view to designing a prosody assessment procedure for use with children with speech and language disorders. 18 intonationally different prosodic realisations (tokens) of one word (limón) were recorded by one native Spanish speaker. The tokens were deemed representative of two categories of emotion: liking or disliking of the taste "lemon". 30 native Spanish speakers assigned them to the two categories and rated their expressiveness on a six-point scale. For all tokens except two, agreement between judges as to category was highly significant, some tokens attracting 100% agreement. The intonation contours most related to expressiveness levels were: for "liking", an inverted U form contour with exaggerated pitch peak within the tonic syllable; and for "disliking", a flat melodic contour with a slight fall.

Does training improve diagnostic accuracy and inter-rater agreement in applying the Berlin radiographic definition of acute respiratory distress syndrome? A multicenter prospective study.

PubMed

Peng, Jin-Min; Qian, Chuan-Yun; Yu, Xiang-You; Zhao, Ming-Yan; Li, Shu-Sheng; Ma, Xiao-Chun; Kang, Yan; Zhou, Fa-Chun; He, Zhen-Yang; Qin, Tie-He; Yin, Yong-Jie; Jiang, Li; Hu, Zhen-Jie; Sun, Ren-Hua; Lin, Jian-Dong; Li, Tong; Wu, Da-Wei; An, You-Zhong; Ai, Yu-Hang; Zhou, Li-Hua; Cao, Xiang-Yuan; Zhang, Xi-Jing; Sun, Rong-Qing; Chen, Er-Zhen; Du, Bin

2017-01-20

Poor inter-rater reliability in chest radiograph interpretation has been reported in the context of acute respiratory distress syndrome (ARDS), although not for the Berlin definition of ARDS. We sought to examine the effect of training material on the accuracy and consistency of intensivists' chest radiograph interpretations for ARDS diagnosis. We conducted a rater agreement study in which 286 intensivists (residents 41.3%, junior attending physicians 35.3%, and senior attending physician 23.4%) independently reviewed the same 12 chest radiographs developed by the ARDS Definition Task Force ("the panel") before and after training. Radiographic diagnoses by the panel were classified into the consistent (n = 4), equivocal (n = 4), and inconsistent (n = 4) categories and were used as a reference. The 1.5-hour training course attended by all 286 intensivists included introduction of the diagnostic rationale, and a subsequent in-depth discussion to reach consensus for all 12 radiographs. Overall diagnostic accuracy, which was defined as the percentage of chest radiographs that were interpreted correctly, improved but remained poor after training (42.0 ± 14.8% before training vs. 55.3 ± 23.4% after training, p < 0.001). Diagnostic sensitivity and specificity improved after training for all diagnostic categories (p < 0.001), with the exception of specificity for the equivocal category (p = 0.883). Diagnostic accuracy was higher for the consistent category than for the inconsistent and equivocal categories (p < 0.001). Comparisons of pre-training and post-training results revealed that inter-rater agreement was poor and did not improve after training, as assessed by overall agreement (0.450 ± 0.406 vs. 0.461 ± 0.575, p = 0.792), Fleiss's kappa (0.133 ± 0.575 vs. 0.178 ± 0.710, p = 0.405), and intraclass correlation coefficient (ICC; 0.219 vs. 0.276, p = 0.470). The radiographic diagnostic accuracy and inter-rater agreement were poor when the Berlin radiographic definition was used, and were not significantly improved by the training set of chest radiographs developed by the ARDS Definition Task Force. The study was registered at ClinicalTrials.gov (registration number NCT01704066 ) on 6 October 2012.

17 CFR 240.3a67-3 - Definition of “substantial position.”

Code of Federal Regulations, 2014 CFR

2014-04-01

... at the net present value of the unpaid premiums. (ii) Adjustment for netting agreements... value in a major security-based swap category, less the value of the collateral the person has posted in... given major security-based swap category: (i) Determine the dollar value of the aggregate current...

17 CFR 240.3a67-3 - Definition of “substantial position.”

Code of Federal Regulations, 2013 CFR

2013-04-01

... at the net present value of the unpaid premiums. (ii) Adjustment for netting agreements... value in a major security-based swap category, less the value of the collateral the person has posted in... given major security-based swap category: (i) Determine the dollar value of the aggregate current...

Survey on medicinal plants and spices used in Beni-Sueif, Upper Egypt

PubMed Central

2011-01-01

Background This study was conducted to identify medicinal plants and spices used for medicine by the community of Beni-Sueif, Upper Egypt. Methods Ethnobotanical data from local people was collected using direct interviews and a semi-structured questionnaire. Results Forty-eight plant species belonging to twenty-seven families and forty-seven genera were encountered during the study. Their botanical and vernacular names, plant parts used and medicinal uses are given. Results of the study were analyzed using two quantitative tools. The factor informant consensus indicated the agreement in the use of plants and the fidelity level indicated the ratio between the number of informants who independently suggested the use of a species for the same major purpose and the total number of informants who mentioned the plant for any use. The results of the factor informant consensus showed that the cardiovascular category has the greatest agreement, followed by the immunological, gastrointestinal and respiratory categories. The most important species according to their fidelity are: Hibiscus sabdariffa L. for the cardiovascular category; Trigonella foenum-graecum L. for the immunological category; Mentha piperita L. for the gastrointestinal category and Pimpinella anisum L. for the respiratory category. Conclusions Medicinal plants are still used for treatment in Beni-Sueif community despite the availability of prescribed medications. Documentation of this ethnomedicinal knowledge is important. Evaluation of pharmacological activity for the promising medicinal plants is suggested. PMID:21707967

Costing for long-term care: the development of Scottish health service resource utilization groups as a casemix instrument.

PubMed

Urquhart, J; Kennie, D C; Murdoch, P S; Smith, R G; Lennox, I

1999-03-01

to create a casemix measure with a limited number of categories which discriminate in terms of resource use and will assist in the development of a currency for contracting for the provision of health care. nursing staff completed a questionnaire providing clinical data and also gave estimates of relative patient resource use; ward-based costs were collected from appropriate unit managers. National Health Service continuing-care wards in 50 Scottish hospitals. 2783 long-stay patients aged 65 years and over. inter-rater reliability was assessed using 1402 patients; percentage agreement between raters for individual variables varied from 68% for feeding to 97% for clinically complex treatments. Nursing costs gave 62% agreement given categories of high, medium and low. The Scottish health service resource utilization groups (SHRUG) measure was developed using 606 cases, and 67% consistency was achieved for the five categories. The relative weights for the SHRUG categories ranged from 0.56 to 1.41. The five categories explain 35% of variance in costs. the five SHRUG casemix categories show good discrimination in terms of costs. The SHRUG measure compares favourably with diagnosis-related groups in the acute sector and with other casemix instruments for long-term care previously piloted in the UK. SHRUG is a useful measurement instrument in assessing the resource needs of elderly people in long-term care.

Survey on medicinal plants and spices used in Beni-Sueif, Upper Egypt.

PubMed

AbouZid, Sameh F; Mohamed, Abdelhalim A

2011-06-27

This study was conducted to identify medicinal plants and spices used for medicine by the community of Beni-Sueif, Upper Egypt. Ethnobotanical data from local people was collected using direct interviews and a semi-structured questionnaire. Forty-eight plant species belonging to twenty-seven families and forty-seven genera were encountered during the study. Their botanical and vernacular names, plant parts used and medicinal uses are given. Results of the study were analyzed using two quantitative tools. The factor informant consensus indicated the agreement in the use of plants and the fidelity level indicated the ratio between the number of informants who independently suggested the use of a species for the same major purpose and the total number of informants who mentioned the plant for any use. The results of the factor informant consensus showed that the cardiovascular category has the greatest agreement, followed by the immunological, gastrointestinal and respiratory categories. The most important species according to their fidelity are: Hibiscus sabdariffa L. for the cardiovascular category; Trigonella foenum-graecum L. for the immunological category; Mentha piperita L. for the gastrointestinal category and Pimpinella anisum L. for the respiratory category. Medicinal plants are still used for treatment in Beni-Sueif community despite the availability of prescribed medications. Documentation of this ethnomedicinal knowledge is important. Evaluation of pharmacological activity for the promising medicinal plants is suggested.

Teaching implementation science in a new Master of Science Program in Germany: a survey of stakeholder expectations.

PubMed

Ullrich, Charlotte; Mahler, Cornelia; Forstner, Johanna; Szecsenyi, Joachim; Wensing, Michel

2017-04-27

Implementation science in healthcare is an evolving discipline in German-speaking countries. In 2015, the Medical Faculty of the University of Heidelberg, Germany, implemented a two-year full-time Master of Science program Health Services Research and Implementation Science. The curriculum introduces implementation science in the context of a broader program that also covers health services research, healthcare systems, research methods, and generic academic skills. Our aim was to assess the expectations of different stakeholder groups regarding the master's program. An online survey listing desired competencies of prospective graduates was developed and administered to four groups: national experts in the field (including potential employers of graduates), teaching staff, enrolled students, and prospective students (N = 169). Competencies were extracted from the curriculum's module handbook. A five-point Likert scale was used for the assessment of 42 specific items. Data were analyzed descriptively. A total of 83 people participated in the survey (response rate 49%). The online survey showed a strong agreement across the groups concerning the desired competencies of graduates. About two-thirds of the listed competencies (27 items) were felt to be crucial or very important by 80% or more of participants, with little difference between stakeholder groups. Of the eight items specifically related to implementation in practice, six were in this category. Knowledge of implementation strategies (90% very important), knowledge of barriers and enablers of implementation (89%), and knowledge of evidence-based practice (89%) were the top priorities. The master's program is largely orientated towards the desired competencies of graduates according to students, teaching staff, and national experts.

A consensus-based gold standard for the evaluation of mass casualty triage systems.

PubMed

Lerner, E Brooke; McKee, Courtney H; Cady, Charles E; Cone, David C; Colella, M Riccardo; Cooper, Arthur; Coule, Phillip L; Lairet, Julio R; Liu, J Marc; Pirrallo, Ronald G; Sasser, Scott M; Schwartz, Richard; Shepherd, Greene; Swienton, Raymond E

2015-01-01

Accuracy and effectiveness analyses of mass casualty triage systems are limited because there are no gold standard definitions for each of the triage categories. Until there is agreement on which patients should be identified by each triage category, it will be impossible to calculate sensitivity and specificity or to compare accuracy between triage systems. To develop a consensus-based, functional gold standard definition for each mass casualty triage category. National experts were recruited through the lead investigators' contacts and their suggested contacts. Key informant interviews were conducted to develop a list of potential criteria for defining each triage category. Panelists were interviewed in order of their availability until redundancy of themes was achieved. Panelists were blinded to each other's responses during the interviews. A modified Delphi survey was developed with the potential criteria identified during the interview and delivered to all recruited experts. In the early rounds, panelists could add, remove, or modify criteria. In the final rounds edits were made to the criteria until at least 80% agreement was achieved. Thirteen national and local experts were recruited to participate in the project. Six interviews were conducted. Three rounds of voting were performed, with 12 panelists participating in the first round, 12 in the second round, and 13 in the third round. After the first two rounds, the criteria were modified according to respondent suggestions. In the final round, over 90% agreement was achieved for all but one criterion. A single e-mail vote was conducted on edits to the final criterion and consensus was achieved. A consensus-based, functional gold standard definition for each mass casualty triage category was developed. These gold standard definitions can be used to evaluate the accuracy of mass casualty triage systems after an actual incident, during training, or for research.

Nutritional status of children and adolescents based on body mass index: agreement between World Health Organization and International Obesity Task Force

PubMed Central

Cavazzotto, Timothy Gustavo; Brasil, Marcos Roberto; Oliveira, Vinicius Machado; da Silva, Schelyne Ribas; Ronque, Enio Ricardo V.; Queiroga, Marcos Roberto; Serassuelo, Helio

2014-01-01

Objective: To investigate the agreement between two international criteria for classification of children and adolescents nutritional status. Methods: The study included 778 girls and 863 boys aged from six to 13 years old. Body mass and height were measured and used to calculate the body mass index. Nutritional status was classified according to the cut-off points defined by the World Health Organization and the International Obesity Task Force. The agreement was evaluated using Kappa statistic and weighted Kappa. Results: In order to classify the nutritional status, the agreement between the criteria was higher for the boys (Kappa 0.77) compared to girls (Kappa 0.61). The weighted Kappa was also higher for boys (0.85) in comparison to girls (0.77). Kappa index varied according to age. When the nutritional status was classified in only two categories - appropriate (thinness + accentuated thinness + eutrophy) and overweight (overweight + obesity + severe obesity) -, the Kappa index presented higher values than those related to the classification in six categories. Conclusions: A substantial agreement was observed between the criteria, being higher in males and varying according to the age. PMID:24676189

Agreement on underlying causes of infant death between original records and after investigation: analysis of two biennia in the years 2000.

PubMed

dos Santos, Hellen Geremias; de Andrade, Selma Maffei; Silva, Ana Maria Rigo; de Carvalho, Wladithe Organ; Mesas, Arthur Eumann; González, Alberto Durán

2014-01-01

To analyze the agreement between underlying causes of infant deaths obtained from Death Certificates (DC) with those defined after investigation by the Municipal Committee for the Prevention of Maternal and Infant Mortality (CMPMMI), in Londrina, Paraná State, in the biennia 2000-2001 and 2007-2008. DC of infants and records of investigations were obtained from the CMPMMI. The causes of death registered in both sources were coded according to the International Classification of Diseases, tenth revision (ICD-10), and the underlying causes of deaths were selected. Agreement between underlying causes of deaths was verified by Kappa's (k) test and analyzed according to ICD-10 chapters and blocks of categories in both biennia. In 2000/2001, according to ICD-10 chapters, high agreement rates were observed for conditions originated in the perinatal period (k = 0.85) and for external causes (k = 0.84), while, for congenital malformations, there was a substantial agreement (k = 0.71). In 2007/2008, agreement was considered poor for all analyzed chapters. For blocks of categories, high or substantial agreement rates were observed only in the first biennium for "congenital malformations of the circulatory system" (k = 0.78) and for "other external causes of accidental injury" (k = 0.91). A decrease in agreement between the sources during the study period indicates either an improvement in the process of investigation of infant death by the CMPMMI and/or a worsening in the quality of the DC information.

77 FR 13952 - Federal Acquisition Regulation; United States-Korea Free Trade Agreement

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-07

...DoD, GSA, and NASA are issuing an interim rule amending the Federal Acquisition Regulation (FAR) to implement the United States- Korea Free Trade Agreement. The Republic of Korea is already party to the World Trade Organization Government Procurement Agreement, but this trade agreement implements a lower procurement threshold.

A Qualitative Phenomenological Exploration of Teachers' Experience With Nutrition Education.

PubMed

Hall, Elisha; Chai, Weiwen; Albrecht, Julie A

2016-05-03

Background: Nutrition education delivered by classroom teachers has become a popular intervention designed to combat childhood obesity. However, few qualitative studies have explored nutrition education with teachers Purpose: The purpose of this study was to explore how elementary teachers describe their experience with nutrition education. Methods: A qualitative phenomenological approach was used. Semistructured interviews, observations, and document analysis were conducted with 10 teachers who delivered nutrition education in their classrooms. Inductive coding was used to determine invariant constituents, reduce constituents to categories, and cluster categories into themes. Reliability and validity were accomplished through intercoder agreement, audio recording, triangulation, bracketing, and member checking. Results: Results identified 5 core themes related to roles teachers play in nutrition education, the importance placed upon nutrition, motivation for supplementary activities, barriers, and a triadic relationship between students, teachers, and curriculum. Discussion: Findings reveal interactions within the nutrition education experience in which teachers balance barriers with their value of nutrition education and motivation to help students make healthy choices. Translation to Health Education Practice: Health educators should work with classroom teachers at the program design, implementation, and evaluation stages of curriculum development to better address needs and facilitate the delivery of high-quality nutrition education for students.

A Qualitative Phenomenological Exploration of Teachers' Experience With Nutrition Education

PubMed Central

Hall, Elisha; Chai, Weiwen; Albrecht, Julie A.

2016-01-01

Background: Nutrition education delivered by classroom teachers has become a popular intervention designed to combat childhood obesity. However, few qualitative studies have explored nutrition education with teachers Purpose: The purpose of this study was to explore how elementary teachers describe their experience with nutrition education. Methods: A qualitative phenomenological approach was used. Semistructured interviews, observations, and document analysis were conducted with 10 teachers who delivered nutrition education in their classrooms. Inductive coding was used to determine invariant constituents, reduce constituents to categories, and cluster categories into themes. Reliability and validity were accomplished through intercoder agreement, audio recording, triangulation, bracketing, and member checking. Results: Results identified 5 core themes related to roles teachers play in nutrition education, the importance placed upon nutrition, motivation for supplementary activities, barriers, and a triadic relationship between students, teachers, and curriculum. Discussion: Findings reveal interactions within the nutrition education experience in which teachers balance barriers with their value of nutrition education and motivation to help students make healthy choices. Translation to Health Education Practice: Health educators should work with classroom teachers at the program design, implementation, and evaluation stages of curriculum development to better address needs and facilitate the delivery of high-quality nutrition education for students. PMID:27226814

Proposed Requirements-driven User-scenario Development Protocol for the Belmont Forum E-Infrastructure and Data Management Cooperative Research Agreement

NASA Astrophysics Data System (ADS)

Wee, B.; Car, N.; Percivall, G.; Allen, D.; Fitch, P. G.; Baumann, P.; Waldmann, H. C.

2014-12-01

The Belmont Forum E-Infrastructure and Data Management Cooperative Research Agreement (CRA) is designed to foster a global community to collaborate on e-infrastructure challenges. One of the deliverables is an implementation plan to address global data infrastructure interoperability challenges and align existing domestic and international capabilities. Work package three (WP3) of the CRA focuses on the harmonization of global data infrastructure for sharing environmental data. One of the subtasks under WP3 is the development of user scenarios that guide the development of applicable deliverables. This paper describes the proposed protocol for user scenario development. It enables the solicitation of user scenarios from a broad constituency, and exposes the mechanisms by which those solicitations are evaluated against requirements that map to the Belmont Challenge. The underlying principle of traceability forms the basis for a structured, requirements-driven approach resulting in work products amenable to trade-off analyses and objective prioritization. The protocol adopts the ISO Reference Model for Open Distributed Processing (RM-ODP) as a top level framework. User scenarios are developed within RM-ODP's "Enterprise Viewpoint". To harmonize with existing frameworks, the protocol utilizes the conceptual constructs of "scenarios", "use cases", "use case categories", and use case templates as adopted by recent GEOSS Architecture Implementation Project (AIP) deliverables and CSIRO's eReefs project. These constructs are encapsulated under the larger construct of "user scenarios". Once user scenarios are ranked by goodness-of-fit to the Belmont Challenge, secondary scoring metrics may be generated, like goodness-of-fit to FutureEarth science themes. The protocol also facilitates an assessment of the ease of implementing given user scenario using existing GEOSS AIP deliverables. In summary, the protocol results in a traceability graph that can be extended to coordinate across research programmes. If implemented using appropriate technologies and harmonized with existing ontologies, this approach enables queries, sensitivity analyses, and visualization of complex relationships.

Building mutually beneficial partnerships to improve physical activity opportunities through shared-use efforts in under-resourced communities in Los Angeles County.

PubMed

Burbage, Lindsey; Gonzalez, Eloisa; Dunning, Lauren; Simon, Paul; Kuo, Tony

2014-10-01

To evaluate 18 shared-use agreements (SUAs) implemented in Los Angeles County during 2010-2012. SUAs opened school grounds and/or facilities in seven school districts to increase physical activity opportunities for under-resourced communities with high prevalence of obesity. We reviewed the extent to which SUAs addressed school district concerns about cost responsibility, sustainability, and scope. A school site and community partner survey was conducted to inform planning and to facilitate comparisons of the types and range of legal clauses (up to 16) contained in the agreements. We used geographic information systems and 2010 United States Census data to estimate the population reached and the potential benefits of the SUAs. SUAs varied in the degree to which they addressed the three categories of concerns. Eight of the 18 agreements included 13 of the 16 legal clauses. We estimate that these SUAs have the potential to reach nearly 165,000 children (ages 5-19) and more than 500,000 adults (ages 20-64) at a cost of about $0.38 per community member reached. SUAs that include legal clauses to address school concerns about factors such as vandalism, staffing and funding represent a promising strategy for increasing physical activity opportunities in under-resourced neighborhoods where the prevalence of obesity is high. Copyright © 2014 Elsevier Inc. All rights reserved.

Institutional arrangements for the reduction of proliferation risks formulation, evaluation, and implementation of institutional concepts. Appendices

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

Not Available

The purpose of this supporting analysis is to provide a foundation for developing a model, an international or multinational institution capable of accomodating the back end of the fuel cycle, while meeting US nonproliferation goals. The analysis is based on a review of selected, defunct and extant institutions which, although not necessarily concerned with nonproliferation, have faced a trade-off between acceptability and effectiveness in meeting their objectives. Discussion of the various institutions is divided into three categories: international organizations, multinational consortia, and cartels or producer associations. Examples of international organizations include the International Seabed Authority, Intelsat, the United Nations andmore » the International Atomic Energy Agency (IAEA). The International Seabed Authority is discussed. Multinational consortia are organizations that have been developed primarily to meet common commercial objectives. Membership includes at least three member nations. Examples include the Scandinavian Airline System (SAS), URENCO, Unilever, Royal Dutch Shell, Eurochemic, Eurodif, Euratom, European Coal and Steel Community, and Serena. Cartels or producer associations are multinational agreements that restrict market forces; viz, production, market share, customers or prices. Examples include the Intergovernmental Council of Copper Exporting Countries (CIPEC), the Organization of Petroleum Exporting Countries (OPEC), and the Fifth International Tin Agreement (ITA), as well as agreements governing diamonds and uranium, bauxite and coffee. OPEC, CIPEC and ITA are discussed.« less

Evaluation of Data on Live Birth Certificates from the Information System on Live Births (SINASC) in Campinas, São Paulo, 2009☆

PubMed Central

Gabriel, Guilherme Paiva; Chiquetto, Letícia; Morcillo, André Moreno; Ferreira, Maria do Carmo; Bazan, Ivan Gilberto M.; Daolio, Luísa Dias; Lemos, Jéssica J. Rocha; Carniel, Emília de Faria

2014-01-01

Objective: To assess the completeness and reliability of the Information System on Live Births (Sinasc) data. Methods: A cross-sectional analysis of the reliability and completeness of Sinasc's data was performed using a sample of Live Birth Certificate (LBC) from 2009, related to births from Campinas, Southeast Brazil. For data analysis, hospitals were grouped according to category of service (Unified National Health System, private or both), 600 LBCs were randomly selected and the data were collected in LBC-copies through mothers and newborns' hospital records and by telephone interviews. The completeness of LBCs was evaluated, calculating the percentage of blank fields, and the LBCs agreement comparing the originals with the copies was evaluated by Kappa and intraclass correlation coefficients. Results: The percentage of completeness of LBCs ranged from 99.8%-100%. For the most items, the agreement was excellent. However, the agreement was acceptable for marital status, maternal education and newborn infants' race/color, low for prenatal visits and presence of birth defects, and very low for the number of deceased children. Conclusion: The results showed that the municipality Sinasc is reliable for most of the studied variables. Investments in training of the professionals are suggested in an attempt to improve system capacity to support planning and implementation of health activities for the benefit of maternal and child population. PMID:25479847

21 CFR 20.114 - Data and information submitted pursuant to cooperative quality assurance agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Data and information submitted pursuant to cooperative quality assurance agreements. 20.114 Section 20.114 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PUBLIC INFORMATION Availability of Specific Categories of...

Some Paradoxical Results for the Quadratically Weighted Kappa

ERIC Educational Resources Information Center

Warrens, Matthijs J.

2012-01-01

The quadratically weighted kappa is the most commonly used weighted kappa statistic for summarizing interrater agreement on an ordinal scale. The paper presents several properties of the quadratically weighted kappa that are paradoxical. For agreement tables with an odd number of categories "n" it is shown that if one of the raters uses the same…

Early Acquisition of Gender Agreement in the Spanish Noun Phrase: Starting Small

ERIC Educational Resources Information Center

Mariscal, Sonia

2009-01-01

Nativist and constructivist accounts differ in their characterization of children's knowledge of grammatical categories. In this paper we present research on the process of acquisition of a particular grammatical system, gender agreement in the Spanish noun phrase, in children under three years of age. The design of the longitudinal study employed…

Breast Density Estimation with Fully Automated Volumetric Method: Comparison to Radiologists' Assessment by BI-RADS Categories.

PubMed

Singh, Tulika; Sharma, Madhurima; Singla, Veenu; Khandelwal, Niranjan

2016-01-01

The objective of our study was to calculate mammographic breast density with a fully automated volumetric breast density measurement method and to compare it to breast imaging reporting and data system (BI-RADS) breast density categories assigned by two radiologists. A total of 476 full-field digital mammography examinations with standard mediolateral oblique and craniocaudal views were evaluated by two blinded radiologists and BI-RADS density categories were assigned. Using a fully automated software, mean fibroglandular tissue volume, mean breast volume, and mean volumetric breast density were calculated. Based on percentage volumetric breast density, a volumetric density grade was assigned from 1 to 4. The weighted overall kappa was 0.895 (almost perfect agreement) for the two radiologists' BI-RADS density estimates. A statistically significant difference was seen in mean volumetric breast density among the BI-RADS density categories. With increased BI-RADS density category, increase in mean volumetric breast density was also seen (P < 0.001). A significant positive correlation was found between BI-RADS categories and volumetric density grading by fully automated software (ρ = 0.728, P < 0.001 for first radiologist and ρ = 0.725, P < 0.001 for second radiologist). Pairwise estimates of the weighted kappa between Volpara density grade and BI-RADS density category by two observers showed fair agreement (κ = 0.398 and 0.388, respectively). In our study, a good correlation was seen between density grading using fully automated volumetric method and density grading using BI-RADS density categories assigned by the two radiologists. Thus, the fully automated volumetric method may be used to quantify breast density on routine mammography. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Inter-Coder Agreement in One-to-Many Classification: Fuzzy Kappa

PubMed Central

Kirilenko, Andrei P.; Stepchenkova, Svetlana

2016-01-01

Content analysis involves classification of textual, visual, or audio data. The inter-coder agreement is estimated by making two or more coders to classify the same data units, with subsequent comparison of their results. The existing methods of agreement estimation, e.g., Cohen’s kappa, require that coders place each unit of content into one and only one category (one-to-one coding) from the pre-established set of categories. However, in certain data domains (e.g., maps, photographs, databases of texts and images), this requirement seems overly restrictive. The restriction could be lifted, provided that there is a measure to calculate the inter-coder agreement in the one-to-many protocol. Building on the existing approaches to one-to-many coding in geography and biomedicine, such measure, fuzzy kappa, which is an extension of Cohen’s kappa, is proposed. It is argued that the measure is especially compatible with data from certain domains, when holistic reasoning of human coders is utilized in order to describe the data and access the meaning of communication. PMID:26933956

77 FR 56739 - Federal Acquisition Regulation; United States-Korea Free Trade Agreement

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-13

...DoD, GSA, and NASA are adopting as final, without change, an interim rule amending the Federal Acquisition Regulation (FAR) to implement the United States-Korea Free Trade Agreement. The Republic of Korea is already party to the World Trade Organization Government Procurement Agreement, but this trade agreement implements a lower procurement threshold.

Why are some evidence-based care recommendations in chronic obstructive pulmonary disease better implemented than others? Perspectives of medical practitioners

PubMed Central

Johnston, Kylie N; Young, Mary; Grimmer-Somers, Karen A; Antic, Ral; Frith, Peter A

2011-01-01

Background Clinical guidelines for management of patients with chronic obstructive pulmonary disease (COPD) include recommendations based on high levels of evidence, but gaps exist in their implementation. The aim of this study was to examine the perspectives of medical practitioners regarding implementation of six high-evidence recommendations for the management of people with COPD. Methods Semi-structured interviews were conducted with medical practitioners involved with care of COPD patients in hospital and general practice. Interviews sought medical practitioners’ experience regarding implementation of smoking cessation, influenza vaccination, pulmonary rehabilitation, guideline-based medications, long-term oxygen therapy for hypoxemia and plan and advice for future exacerbations. Interviews were audiotaped, transcribed verbatim and analyzed using content analysis. Results Nine hospital-based medical practitioners and seven general practitioners participated. Four major categories were identified which impacted on implementation of the target recommendations in the care of patients with COPD: (1) role clarity of the medical practitioner; (2) persuasive communication with the patient; (3) complexity of behavioral change required; (4) awareness and support available at multiple levels. For some recommendations, strength in all four categories provided significant enablers supporting implementation. However, with regard to pulmonary rehabilitation and plans and advice for future exacerbations, all identified categories that presented barriers to implementation. Conclusion This study of medical practitioner perspectives has indicated areas where significant barriers to the implementation of key evidence-based recommendations in COPD management persist. Developing strategies to target the identified categories provides an opportunity to achieve greater implementation of those high-evidence recommendations in the care of people with COPD. PMID:22259242

Application of Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2): Interobserver Agreement and Positive Predictive Value for Localization of Intermediate- and High-Grade Prostate Cancers on Multiparametric Magnetic Resonance Imaging.

PubMed

Chen, Frank; Cen, Steven; Palmer, Suzanne

2017-09-01

To evaluate interobserver agreement with the use of and the positive predictive value (PPV) of Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) for the localization of intermediate- and high-grade prostate cancers on multiparametric magnetic resonance imaging (mpMRI). In this retrospective, institutional review board-approved study, 131 consecutive patients who had mpMRI followed by transrectal ultrasound-MR imaging fusion-guided biopsy of the prostate were included. Two readers who were blinded to initial mpMRI reports, clinical data, and pathologic outcomes reviewed the MR images, identified all prostate lesions, and scored each lesion based on the PI-RADS v2. Interobserver agreement was assessed by intraclass correlation coefficient (ICC), and PPV was calculated for each PI-RADS category. PI-RADS v2 was found to have a moderate level of interobserver agreement between two readers of varying experience, with ICC of 0.74, 0.72, and 0.67 for all lesions, peripheral zone lesions, and transitional zone lesions, respectively. Despite only moderate interobserver agreement, the calculated PPV in the detection of intermediate- and high-grade prostate cancers for each PI-RADS category was very similar between the two readers, with approximate PPV of 0%, 12%, 64%, and 87% for PI-RADS categories 2, 3, 4, and 5, respectively. In our study, PI-RADS v2 has only moderate interobserver agreement, a similar finding in studies of the original PI-RADS and in initial studies of PI-RADS v2. Despite this, PI-RADS v2 appears to be a useful system to predict significant prostate cancer, with PI-RADS scores correlating well with the likelihood of intermediate- and high-grade cancers. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Prediction scores do not correlate with clinically adjudicated categories of pulmonary embolism in critically ill patients.

PubMed

Katsios, Christina; Donadini, Marco; Meade, Maureen; Mehta, Sangeeta; Hall, Richard; Granton, John; Kutsogiannis, Jim; Dodek, Peter; Heels-Ansdell, Diane; McIntyre, Lauralynn; Vlahakis, Nikolas; Muscedere, John; Friedrich, Jan; Fowler, Robert; Skrobik, Yoanna; Albert, Martin; Cox, Michael; Klinger, James; Nates, Joseph; Bersten, Andrew; Doig, Chip; Zytaruk, Nicole; Crowther, Mark; Cook, Deborah J

2014-01-01

Prediction scores for pretest probability of pulmonary embolism (PE) validated in outpatient settings are occasionally used in the intensive care unit (ICU). To evaluate the correlation of Geneva and Wells scores with adjudicated categories of PE in ICU patients. In a randomized trial of thromboprophylaxis, patients with suspected PE were adjudicated as possible, probable or definite PE. Data were then retrospectively abstracted for the Geneva Diagnostic PE score, Wells, Modified Wells and Simplified Wells Diagnostic scores. The chance-corrected agreement between adjudicated categories and each score was calculated. ANOVA was used to compare values across the three adjudicated PE categories. Among 70 patients with suspected PE, agreement was poor between adjudicated categories and Geneva pretest probabilities (kappa=0.01 [95% CI -0.0643 to 0.0941]) or Wells pretest probabilities (kappa=-0.03 [95% CI -0.1462 to 0.0914]). Among four possible, 16 probable and 50 definite PEs, there were no significant differences in Geneva scores (possible = 4.0, probable = 4.7, definite = 4.5; P=0.90), Wells scores (possible = 2.8, probable = 4.9, definite = 4.1; P=0.37), Modified Wells (possible = 2.0, probable = 3.4, definite = 2.9; P=0.34) or Simplified Wells (possible = 1.8, probable = 2.8, definite = 2.4; P=0.30). Pretest probability scores developed outside the ICU do not correlate with adjudicated PE categories in critically ill patients. Research is needed to develop prediction scores for this population.

Dissociative semantic breakdown in Alzheimer's disease: evidence from multiple category fluency test.

PubMed

Ting, Simon Kang Seng; Hameed, Shahul; Earnest, Arul; Tan, Eng-King

2013-07-01

Category-specific semantic dissociation particularly in terms of biological and non-biological dichotomy has been described in Alzheimer's disease (AD). We re-examine above finding by performing multiple superordinate category verbal fluency test in AD patients. We analyze the baseline neuropsychological assessment performance of food and animal fluency test of AD patients from a tertiary hospital that collected prospectively over 5 years period and correlation was calculated by Kappa test. The analysis is stratified according to literacy level (primary: 0-6 years education and secondary: >6 years education) and disease severity (MMSE score: mild 19-24, moderate 13-18 and severe <13). A total of 296 AD patients were analyzed and only fair to moderate agreement between food and animal category fluency test was found especially in the mild AD cases (primary: kappa 0.42; secondary: kappa 0.40). Kappa agreement level increases when disease progress especially in the secondary education group. Food category, which is a more relevant semantic knowledge to Singapore population, is generally more affected. Higher educated subjects appeared to have less semantic dissociation effect when disease progress. Despite less primed in daily life, biological category of semantic knowledge appears to be affected less during AD process in highly urbanized Singapore society. Brain appears to have special protective mechanism towards living things. However, education level seems have a modulation effect towards the biological protective mechanism. Copyright © 2012 Elsevier B.V. All rights reserved.

Imputation of adverse drug reactions: Causality assessment in hospitals

PubMed Central

Mastroianni, Patricia de Carvalho

2017-01-01

Background & objectives Different algorithms have been developed to standardize the causality assessment of adverse drug reactions (ADR). Although most share common characteristics, the results of the causality assessment are variable depending on the algorithm used. Therefore, using 10 different algorithms, the study aimed to compare inter-rater and multi-rater agreement for ADR causality assessment and identify the most consistent to hospitals. Methods Using ten causality algorithms, four judges independently assessed the first 44 cases of ADRs reported during the first year of implementation of a risk management service in a medium complexity hospital in the state of Sao Paulo (Brazil). Owing to variations in the terminology used for causality, the equivalent imputation terms were grouped into four categories: definite, probable, possible and unlikely. Inter-rater and multi-rater agreement analysis was performed by calculating the Cohen´s and Light´s kappa coefficients, respectively. Results None of the algorithms showed 100% reproducibility in the causal imputation. Fair inter-rater and multi-rater agreement was found. Emanuele (1984) and WHO-UMC (2010) algorithms showed a fair rate of agreement between the judges (k = 0.36). Interpretation & conclusions Although the ADR causality assessment algorithms were poorly reproducible, our data suggest that WHO-UMC algorithm is the most consistent for imputation in hospitals, since it allows evaluating the quality of the report. However, to improve the ability of assessing the causality using algorithms, it is necessary to include criteria for the evaluation of drug-related problems, which may be related to confounding variables that underestimate the causal association. PMID:28166274

Evaluation of the Minnesota Easy Culture System II Bi-Plate and Tri-Plate for identification of common mastitis pathogens in milk.

PubMed

Royster, E; Godden, S; Goulart, D; Dahlke, A; Rapnicki, P; Timmerman, J

2014-01-01

The objective of this study was to validate use of the Minnesota Easy Culture System II Bi-Plate and Tri-Plate (University of Minnesota Laboratory for Udder Health, St. Paul) to identify common mastitis pathogens in milk. A total of 283 quarter and composite milk samples submitted to the University of Minnesota Laboratory for Udder Health during the spring of 2010 were cultured simultaneously using 3 methods: standard laboratory culture (reference method) and the Minnesota Easy Culture System II Bi-Plate and Tri-Plate methods. Bi-Plate and Tri-Plate cultures were incubated for 18 to 24h and interpreted by 2 independent, untrained readers within 5h of each other. An experienced technician completed the standard laboratory culture. For each sample, all 3 study personnel recorded the culture result (yes/no) for each of the following diagnostic categories: no bacterial growth (NG), mixed (2 organisms), contaminated (3 or more organisms), gram-positive (GP), gram-negative (GN), Staphylococcus spp., Streptococcus spp., Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus uberis, Enterococcus spp., Staphylococcus aureus, coagulase-negative staphylococci, Escherichia coli, Klebsiella spp., and other. For each category, the prevalence, sensitivity, specificity, accuracy, and predictive values of a positive and negative test were calculated, and the agreement between readers and between each reader and the laboratory was assessed. Specificity, overall accuracy, and negative predictive values were generally high (>80%) for the Bi-Plate and Tri-Plate for each category. Sensitivity and positive predictive values were intermediate (>60%) or high (>80%) for the broad categories of NG, GP, GN, Staphylococcus spp. and Streptococcus spp., and for Staph. aureus, but were generally lower (<60%) for other more specific categories. Similarly, interreader agreement (kappa value) was moderate to substantial (40-80%) for the broad categories of NG, GP, GN, Staphylococcus spp. and Streptococcus spp., and for Staph. aureus and E. coli, but was lower for other categories. The Tri-Plate had a higher sensitivity, accuracy, and negative predictive value for Streptococcus spp., and higher interreader agreement for some of the more specific categories. Our conclusion was that Bi-Plate and Tri-Plate results will be most reliable when used to classify infections in broad diagnostic categories such NG, GP, or GN. The Bi-Plate and Tri-Plate will have intermediate ability to identify infections as being caused by Staphylococcus spp., Streptococcus spp., or Staph. aureus. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

A survey study of evidence-based medicine training in US and Canadian medical schools

PubMed Central

Blanco, Maria A.; Capello, Carol F.; Dorsch, Josephine L.; Perry, Gerald (Jerry); Zanetti, Mary L.

2014-01-01

Purpose: The authors conducted a survey examining (1) the current state of evidence-based medicine (EBM) curricula in US and Canadian medical schools and corresponding learning objectives, (2) medical educators' and librarians' participation in EBM training, and (3) barriers to EBM training. Methods: A survey instrument with thirty-four closed and open-ended questions was sent to curricular deans at US and Canadian medical schools. The survey sought information on enrollment and class size; EBM learning objectives, curricular activities, and assessment approaches by year of training; EBM faculty; EBM tools; barriers to implementing EBM curricula and possible ways to overcome them; and innovative approaches to EBM education. Both qualitative and quantitative methods were used for data analysis. Measurable learning objectives were categorized using Bloom's taxonomy. Results: One hundred fifteen medical schools (77.2%) responded. Over half (53%) of the 900 reported learning objectives were measurable. Knowledge application was the predominant category from Bloom's categories. Most schools integrated EBM into other curricular activities; activities and formal assessment decreased significantly with advanced training. EBM faculty consisted primarily of clinicians, followed by basic scientists and librarians. Various EBM tools were used, with PubMed and the Cochrane database most frequently cited. Lack of time in curricula was rated the most significant barrier. National agreement on required EBM competencies was an extremely helpful factor. Few schools shared innovative approaches. Conclusions: Schools need help in overcoming barriers related to EBM curriculum development, implementation, and assessment. Implications: Findings can provide a starting point for discussion to develop a standardized competency framework. PMID:25031556

A survey study of evidence-based medicine training in US and Canadian medical schools.

PubMed

Blanco, Maria A; Capello, Carol F; Dorsch, Josephine L; Perry, Gerald; Zanetti, Mary L

2014-07-01

The authors conducted a survey examining (1) the current state of evidence-based medicine (EBM) curricula in US and Canadian medical schools and corresponding learning objectives, (2) medical educators' and librarians' participation in EBM training, and (3) barriers to EBM training. A survey instrument with thirty-four closed and open-ended questions was sent to curricular deans at US and Canadian medical schools. The survey sought information on enrollment and class size; EBM learning objectives, curricular activities, and assessment approaches by year of training; EBM faculty; EBM tools; barriers to implementing EBM curricula and possible ways to overcome them; and innovative approaches to EBM education. Both qualitative and quantitative methods were used for data analysis. Measurable learning objectives were categorized using Bloom's taxonomy. One hundred fifteen medical schools (77.2%) responded. Over half (53%) of the 900 reported learning objectives were measurable. Knowledge application was the predominant category from Bloom's categories. Most schools integrated EBM into other curricular activities; activities and formal assessment decreased significantly with advanced training. EBM faculty consisted primarily of clinicians, followed by basic scientists and librarians. Various EBM tools were used, with PubMed and the Cochrane database most frequently cited. Lack of time in curricula was rated the most significant barrier. National agreement on required EBM competencies was an extremely helpful factor. Few schools shared innovative approaches. Schools need help in overcoming barriers related to EBM curriculum development, implementation, and assessment. Findings can provide a starting point for discussion to develop a standardized competency framework.

43 CFR 2884.12 - What is the processing fee for a grant or TUP application?

Code of Federal Regulations, 2011 CFR

2011-10-01

... changes in the IPD-GDP. See paragraph (c) of this section for update information (1) Applications for new... part). (c) BLM will revise paragraph (b) of this section to update the processing fees for Categories 1... update Category 5 processing fees as specified in the Master Agreement. You also may obtain a copy of the...

43 CFR 2884.12 - What is the processing fee for a grant or TUP application?

Code of Federal Regulations, 2014 CFR

2014-10-01

... changes in the IPD-GDP. See paragraph (c) of this section for update information (1) Applications for new... part). (c) BLM will revise paragraph (b) of this section to update the processing fees for Categories 1... update Category 5 processing fees as specified in the Master Agreement. You also may obtain a copy of the...

43 CFR 2884.12 - What is the processing fee for a grant or TUP application?

Code of Federal Regulations, 2012 CFR

2012-10-01

... changes in the IPD-GDP. See paragraph (c) of this section for update information (1) Applications for new... part). (c) BLM will revise paragraph (b) of this section to update the processing fees for Categories 1... update Category 5 processing fees as specified in the Master Agreement. You also may obtain a copy of the...

43 CFR 2884.12 - What is the processing fee for a grant or TUP application?

Code of Federal Regulations, 2013 CFR

2013-10-01

... changes in the IPD-GDP. See paragraph (c) of this section for update information (1) Applications for new... part). (c) BLM will revise paragraph (b) of this section to update the processing fees for Categories 1... update Category 5 processing fees as specified in the Master Agreement. You also may obtain a copy of the...

Spouses' conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction--a qualitative analysis.

PubMed

Johansson, Ingela; Swahn, Eva; Strömberg, Anna

2008-09-01

Delay from onset of acute myocardial infarction symptoms to the delivery of medical care is a major determinant of prognosis. Although studies have explored patient reasons for delay, there are only limited data concerning experiences of the spouse. Was to describe spouses' conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction. A phenomenographic approach was applied. Fifteen spouses were interviewed <48 h after the partner's hospital admittance. Two categories with underlying sub-categories conceptualised the spouses' experiences. The category being resourceful contained: sharing the experience, having knowledge, understanding the severity, being rational, and consulting others. The category respecting independence contained: accepting the need for control, marital roles and experiences, restraining emotions, and seeking agreement. Our findings suggest that spouses have a strong influence on the course of events. When accepting the partner's need for control through following earlier marital roles and experiences, restraining own emotions and seeking agreement, this seemed to contribute to delay. However, when the spouse was resourceful by sharing the experience, having knowledge, understanding the severity, being rational and consulting others when needed, this seemed to have a positive influence on the pre-hospital time.

Transillumination and HDR Imaging for Proximal Caries Detection.

PubMed

Lederer, A; Kunzelmann, K H; Hickel, R; Litzenburger, F

2018-02-01

The purpose was to develop an in vitro model for the validation of near-infrared transillumination (NIRT) for proximal caries detection, to enhance NIRT with high-dynamic-range imaging (HDRI), and to compare both methods, using micro-computed tomography (µCT) as a reference standard. Both proximal surfaces of 53 healthy or decayed permanent human teeth were examined using the Diagnocam (DC) (KaVo) and NIRT with HDRI (NIRT-HDRI). NIRT was combined with HDRI to improve the diagnostic performance by reducing under- and overexposed image areas. For NIRT-HDRI, an exposure series was captured and merged into a single HDR image. A classification was applied according to lesion depth. All surfaces were assessed twice by 2 trained examiners, and additionally with µCT for validation. The Kappa statistic was used to calculate inter-rater reliability and agreement between DC and NIRT-HDRI. Inter-rater reliability (weighted Kappa, wκ) showed very good agreement for the DC (0.90) and NIRT-HDRI (0.96). The overall agreement (wκ) was almost perfect (0.85). In the individual categories (0 to 4), the agreement (simple Kappa) ranged from almost perfect (category 4) to moderate (1 and 2) to substantial (categories 0 and 3). Sensitivity and specificity of sound surfaces, enamel, and dentin caries ranged from 0.57 to 0.99 and were similar for both methods in the different categories. NIRT-HDRI had a higher sensitivity for sound surfaces and enamel caries, as well as a higher specificity for dentin caries. Regarding the obtained images, HDRI allowed for the detection of caries within a greater range of luminance levels, resulting in a more detailed visualization of structures without under- or overexposure. However, HDRI this did not improve the diagnostics significantly. Distinguishing between a processed demineralized enamel and dentin lesions appears to be a problem specific to NIRT and cannot be balanced using HDRI.

43 CFR 2884.17 - How will BLM process my Processing Category 6 application?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false How will BLM process my Processing...-WAY UNDER THE MINERAL LEASING ACT Applying for MLA Grants or TUPs § 2884.17 How will BLM process my... written agreement that describes how BLM will process your application. The final agreement consists of a...

43 CFR 2884.17 - How will BLM process my Processing Category 6 application?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false How will BLM process my Processing...-WAY UNDER THE MINERAL LEASING ACT Applying for MLA Grants or TUPs § 2884.17 How will BLM process my... written agreement that describes how BLM will process your application. The final agreement consists of a...

Agreement between University of Cincinnati and AAUP, University of Cincinnati Chapter, September 1, 1986 to August 31, 1989.

ERIC Educational Resources Information Center

American Association of Univ. Professors, Washington, DC.

The collective bargaining agreement between the University of Cincinnati and the university chapter of the American Association of University Professors (AAUP) covering the period September 1, 1986 through August 31, 1989 is presented. The 42 articles, grouped into seven categories, cover the following: (1) basic principles (recognition and…

Personality as a Determinate of Response Dimension Scaling for Likert Rating Categories.

ERIC Educational Resources Information Center

Hensley, Wayne E.; Sanford, David L.

A study was designed to evaluate the use of summated rating (Likert) scales of agreement, evaluation, and frequency. The subjects, 58 female and 45 male college students, rank ordered the descriptive adjectives for the areas of agreement, evaluation, and frequency on a scale of 1 to 100. They also completed the Personal Report of Communication…

Counselor-Client Diagnostic Agreement and Perceived Outcomes of Counseling: A Progress Report.

ERIC Educational Resources Information Center

Hurst, James C.; And Others

This study was designed to investigate the effect of congruity of counselor and client diagnoses upon client-perceived success in counseling. The Missouri Diagnostic Classification Plan (MDCP) was used as the basic diagnostic method. Agreement in the 15 categories was related to client-perceived success of counseling. Subjects, all clients at the…

Validation of the "German Inflammatory Bowel Disease Activity Index (GIBDI)": An Instrument for Patient-Based Disease Activity Assessment in Crohn's Disease and Ulcerative Colitis.

PubMed

Hüppe, Angelika; Langbrandtner, Jana; Häuser, Winfried; Raspe, Heiner; Bokemeyer, Bernd

2018-05-09

 Assessment of disease activity in Crohn's disease (CD) and ulcerative colitis (UC) is usually based on the physician's evaluation of clinical symptoms, endoscopic findings, and biomarker analysis. The German Inflammatory Bowel Disease Activity Index for CD (GIBDI CD ) and UC (GIBDI UC ) uses data from patient-reported questionnaires. It is unclear to what extent the GIBDI agrees with the physicians' documented activity indices.  Data from 2 studies were reanalyzed. In both, gastroenterologists had documented disease activity in UC with the partial Mayo Score (pMS) and in CD with the Harvey Bradshaw Index (HBI). Patient-completed GIBDI questionnaires had also been assessed. The analysis sample consisted of 151 UC and 150 CD patients. Kappa coefficients were determined as agreement measurements.  Rank correlations were 0.56 (pMS, GIBDI UC ) and 0.57 (HBI, GIBDI CD ), with p < 0.001. The absolute agreement for 2 categories of disease activity (remission yes/no) was 74.2 % (UC) and 76.6 % (CD), and for 4 categories (none/mild/moderate/severe) 60.3 % (UC) and 61.9 % (CD). The kappa values ranged between 0.47 for UC (2 categories) and 0.58 for CD (4 categories).  There is satisfactory agreement of GIBDI with the physician-documented disease activity indices. GIBDI can be used in health care research without access to assessments of medical practitioners. In clinical practice, the index offers a supplementary source of information. © Georg Thieme Verlag KG Stuttgart · New York.

75 FR 24584 - Request for Nominations for the Industry Trade Advisory Committees (ITACs)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

... and the USTR regarding trade barriers, negotiation of trade agreements, and implementation of existing... trade negotiation objectives adequately reflect U.S. commercial and economic interests. Section 135(a)(1... regarding trade barriers, negotiation of trade agreements, and implementation of existing trade agreements...

77 FR 75407 - Proposed Information Collection; Comment Request; Interim Procedures for Considering Requests...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-20

... States-Panama Trade Promotion Agreement Implementation Act (the ``Act'') [Pub. L. 112-43] implements the... Promotion Agreement (the ``Agreement''). This safeguard mechanism applies when, as a result of the...) all data available to the requestor showing changes in productivity, utilization of capacity...

75 FR 12494 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-16

... Textile Apparel Safeguard Provision of the United States-Oman Free Trade Agreement. OMB Control Number... States-Oman Free Trade Agreement Implementation Act (the ``Act'') implements the textile and apparel safeguard provisions, provided for in Article 3.1 of the United States-Oman Free Trade Agreement (the...

Breast-density assessment with hand-held ultrasound: A novel biomarker to assess breast cancer risk and to tailor screening?

PubMed

Sanabria, Sergio J; Goksel, Orcun; Martini, Katharina; Forte, Serafino; Frauenfelder, Thomas; Kubik-Huch, Rahel A; Rominger, Marga B

2018-03-19

To assess feasibility and diagnostic accuracy of a novel hand-held ultrasound (US) method for breast density assessment that measures the speed of sound (SoS), in comparison to the ACR mammographic (MG) categories. ACR-MG density (a=fatty to d=extremely dense) and SoS-US were assessed in the retromamillary, inner and outer segments of 106 women by two radiographers. A conventional US system was used for SoS-US. A reflector served as timing reference for US signals transmitted through the breasts. Four blinded readers assessed average SoS (m/s), ΔSoS (segment-variation SoS; m/s) and the ACR-MG density. The highest SoS and ΔSoS values of the three segments were used for MG-ACR whole breast comparison. SoS-US breasts were examined in <2 min. Mean SoS values of densities a-d were 1,421 m/s (SD 14), 1,432 m/s (SD 17), 1,448 m/s (SD 20) and 1,500 m/s (SD 31), with significant differences between all groups (p<0.001). The SoS-US comfort scores and inter-reader agreement were significantly better than those for MG (1.05 vs. 2.05 and 0.982 vs. 0.774; respectively). A strong segment correlation between SoS and ACR-MG breast density was evident (r s =0.622, p=<0.001) and increased for full breast classification (r s =0.746, p=<0.001). SoS-US allowed diagnosis of dense breasts (ACR c and d) with sensitivity 86.2 %, specificity 85.2 % and AUC 0.887. Using hand-held SoS-US, radiographers measured breast density without discomfort, readers evaluated measurements with high inter-reader agreement, and SoS-US correlated significantly with ACR-MG breast-density categories. • The novel speed-of-sound ultrasound correlated significantly with mammographic ACR breast density categories. • Radiographers measured breast density without women discomfort or radiation. • SoS-US can be implemented on a standard US machine. • SoS-US shows potential for a quantifiable, cost-effective assessment of breast density.

48 CFR 25.400 - Scope of subpart.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... L. 103-465); (2) Free Trade Agreements (FTA), consisting of— (i) NAFTA (the North American Free Trade Agreement, as approved by Congress in the North American Free Trade Agreement Implementation Act... Implementation Act (Pub. L. 110-138) (19 U.S.C. 3805 note)); (x) Korea FTA (the United States-Korea Free Trade...

48 CFR 25.400 - Scope of subpart.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... L. 103-465); (2) Free Trade Agreements (FTA), consisting of— (i) NAFTA (the North American Free Trade Agreement, as approved by Congress in the North American Free Trade Agreement Implementation Act... Implementation Act (Pub. L. 110-138) (19 U.S.C. 3805 note)); (x) Korea FTA (the United States-Korea Free Trade...

48 CFR 25.400 - Scope of subpart.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... L. 103-465); (2) Free Trade Agreements (FTA), consisting of— (i) NAFTA (the North American Free Trade Agreement, as approved by Congress in the North American Free Trade Agreement Implementation Act... Implementation Act (Pub. L. 110-138) (19 U.S.C. 3805 note)); (x) Korea FTA (the United States-Korea Free Trade...

Developing and testing a street audit tool using Google Street View to measure environmental supportiveness for physical activity.

PubMed

Griew, Pippa; Hillsdon, Melvyn; Foster, Charlie; Coombes, Emma; Jones, Andy; Wilkinson, Paul

2013-08-23

Walking for physical activity is associated with substantial health benefits for adults. Increasingly research has focused on associations between walking behaviours and neighbourhood environments including street characteristics such as pavement availability and aesthetics. Nevertheless, objective assessment of street-level data is challenging. This research investigates the reliability of a new street characteristic audit tool designed for use with Google Street View, and assesses levels of agreement between computer-based and on-site auditing. The Forty Area STudy street VIEW (FASTVIEW) tool, a Google Street View based audit tool, was developed incorporating nine categories of street characteristics. Using the tool, desk-based audits were conducted by trained researchers across one large UK town during 2011. Both inter and intra-rater reliability were assessed. On-site street audits were also completed to test the criterion validity of the method. All reliability scores were assessed by percentage agreement and the kappa statistic. Within-rater agreement was high for each category of street characteristic (range: 66.7%-90.0%) and good to high between raters (range: 51.3%-89.1%). A high level of agreement was found between the Google Street View audits and those conducted in-person across the nine categories examined (range: 75.0%-96.7%). The audit tool was found to provide a reliable and valid measure of street characteristics. The use of Google Street View to capture street characteristic data is recommended as an efficient method that could substantially increase potential for large-scale objective data collection.

Category specific deficits in Alzheimer's disease: fact or artefact?

PubMed

Tippett, Lynette J; Meier, Sandra L; Blackwood, Kirsty; Diaz-Asper, Catherine

2007-10-01

Impairments in semantic memory commonly occur in Alzheimer's Disease (AD) but do these occur along category-specific lines? We administered a confrontation naming task comprising living and nonliving items to 68 individuals with AD and 59 age-matched control participants, in a study designed to address some of the methodological issues affecting investigation of category effects. In Experiment 1, stimuli were matched for familiarity and word frequency and also visual complexity, and the AD group showed a differential deficit in nonliving things. In Experiment 2, however, living and nonliving stimuli were matched for age-of-acquisition, name agreement, word frequency, and naming accuracy of elderly controls and there was no categorical impairment in the AD group. The AD group was subdivided first into mild and moderate AD, and then into normal or impaired overall naming groups and performance was reanalysed, but there was still no significant category deficit in any group. Converging evidence was provided by hierarchical regressions across items, as age-of-acquisition, name agreement and word frequency were significant predictors of naming performance in mild and moderate AD groups, but category was not. In Experiment 3, stimulus items were matched for familiarity and naming accuracy of elderly controls when their performance was off-ceiling, and again no differential effect of category was found. When we reduced slightly how closely matched stimuli were for familiarity we then found a differential impairment in living things in the AD group. When reviewing the changing pattern of results from use of different stimulus sets, we concluded that the main determinant of whether or not a categorical impairment of either sort is found in AD is which stimulus properties are controlled during stimulus selection. We conclude that AD does not generally lead to a selective category loss in semantic knowledge.

Clinical decision-making in atypical and suspicious categories in fine-needle aspiration cytology of the breast.

PubMed

Gipponi, Marco; Fregatti, Piero; Garlaschi, Alessandro; Calabrese, Massimo; Baccini, Paola; Gallo, Maurizio; Murelli, Federica; Margarino, Cecilia; Bobbio, Carolina; Friedman, Daniele

2015-04-01

Fine-needle aspiration cytology (FNAC) is a simple and reliable technique to assess breast lesions, although a definitive differential diagnosis (benignity vs. cancer) is achieved approximately in 60-70% of cases because an inadequate (C1), atypical (C3) or suspicious (C4) category is otherwise reported. A retrospective analysis of 763 cases with C3 or C4 reports was performed to define their positive predictive value (PPV), as well as the practical implications of clinical and imaging findings as for clinical decision-making. FNACs were collected from January 2003 to September 2012 at the Breast Unit of IRCCS "A.O.U. San Martino-IST" Genoa, with each being received later to definitive histology. The PPV for cancer of C3/C4 categories were computed to measure the accuracy of FNAC; moreover, the PPV was also stratified according to clinical, mammography and sonography data alone or by their combination. The PPV of C3 and C4 was 21.1% (80/380) and 84.1 % (322/383), respectively. Within each C3/C4 category, a significant direct correlation (p<0.001) between the suspicion index of clinical, mammography and sonography data and cancer detection rate was always observed. The PPV of C3/C4 stratified by the combination of clinical and imaging findings showed satisfactory values in the C3 category only when there was an agreement between clinical and imaging findings, whereas the PPV of the C4 category was always remarkably high (ranging from 92.3% to 100%). the diagnostic work-up in C4 reports or in patients with a C3 report but with an high suspicion index at clinical or imaging examination should be preferably implemented by means of a core biopsy to optimize the therapeutic planning; given a C3 report with dubious clinical and/or imaging findings, an excisional biopsy (or in alternative vacuum-assisted breast biopsy with complete removal of the nodule) should be preferably performed in order to reach a definitive histological dia gnosis with no further delay. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

48 CFR 239.7407 - Type of contract.

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF DEFENSE SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Telecommunications... use a basic agreement (see FAR 16.702) in conjunction with communication service authorizations. When...

Alternative Methods for Calculating Intercoder Reliability in Content Analysis: Kappa, Weighted Kappa and Agreement Charts Procedures.

ERIC Educational Resources Information Center

Kang, Namjun

If content analysis is to satisfy the requirement of objectivity, measures and procedures must be reliable. Reliability is usually measured by the proportion of agreement of all categories identically coded by different coders. For such data to be empirically meaningful, a high degree of inter-coder reliability must be demonstrated. Researchers in…

Prediction scores do not correlate with clinically adjudicated categories of pulmonary embolism in critically ill patients

PubMed Central

Katsios, CM; Donadini, M; Meade, M; Mehta, S; Hall, R; Granton, J; Kutsiogiannis, J; Dodek, P; Heels-Ansdell, D; McIntyre, L; Vlahakis, N; Muscedere, J; Friedrich, J; Fowler, R; Skrobik, Y; Albert, M; Cox, M; Klinger, J; Nates, J; Bersten, A; Doig, C; Zytaruk, N; Crowther, M; Cook, DJ

2014-01-01

BACKGROUND: Prediction scores for pretest probability of pulmonary embolism (PE) validated in outpatient settings are occasionally used in the intensive care unit (ICU). OBJECTIVE: To evaluate the correlation of Geneva and Wells scores with adjudicated categories of PE in ICU patients. METHODS: In a randomized trial of thromboprophylaxis, patients with suspected PE were adjudicated as possible, probable or definite PE. Data were then retrospectively abstracted for the Geneva Diagnostic PE score, Wells, Modified Wells and Simplified Wells Diagnostic scores. The chance-corrected agreement between adjudicated categories and each score was calculated. ANOVA was used to compare values across the three adjudicated PE categories. RESULTS: Among 70 patients with suspected PE, agreement was poor between adjudicated categories and Geneva pretest probabilities (kappa 0.01 [95% CI −0.0643 to 0.0941]) or Wells pretest probabilities (kappa −0.03 [95% CI −0.1462 to 0.0914]). Among four possible, 16 probable and 50 definite PEs, there were no significant differences in Geneva scores (possible = 4.0, probable = 4.7, definite = 4.5; P=0.90), Wells scores (possible = 2.8, probable = 4.9, definite = 4.1; P=0.37), Modified Wells (possible = 2.0, probable = 3.4, definite = 2.9; P=0.34) or Simplified Wells (possible = 1.8, probable = 2.8, definite = 2.4; P=0.30). CONCLUSIONS: Pretest probability scores developed outside the ICU do not correlate with adjudicated PE categories in critically ill patients. Research is needed to develop prediction scores for this population. PMID:24083302

Reliability of Causality Assessment for Drug, Herbal and Dietary Supplement Hepatoxicity in the Drug-Induced Liver Injury Network (DILIN)

PubMed Central

Hayashi, Paul H.; Barnhart, Huiman X.; Fontana, Robert J.; Chalasani, Naga; Davern, Timothy J.; Talwalkar, Jayant A.; Reddy, K. Rajender; Stolz, Andrew A.; Hoofnagle, Jay H.; Rockey, Don C.

2014-01-01

Background Due to the lack of objective tests to diagnose drug induced liver injury (DILI), causality assessment is a matter of debate. Expert opinion is often used in research and industry but its test-retest reliability is unknown. Aims To determine the test-retest reliability of the expert opinion process used by the Drug-Induced Liver Injury Network (DILIN) Methods Three DILIN hepatologists adjudicate suspected hepatotoxicity cases to 1 of 5 categories representing levels of likelihood of DILI. Adjudication is based on retrospective assessment of gathered case data that includes prospective follow-up information. One hundred randomly selected DILIN cases were re-assessed using the same processes for initial assessment but by 3 different reviewers in 92% of cases. Results The median time between assessments was 938 days (range: 140–2352). Thirty-one cases involved >1 agent. Weighted kappa statistics for overall case and individual agent category agreement were 0.60 (95% CI: 0.50–0.71) and 0.60 (0.52–0.68), respectively. Overall case adjudications were within one category of each other 93% of the time, while 5% differed by 2 categories and 2% differed by 3 categories. Fourteen-percent crossed the 50% threshold of likelihood due to competing diagnoses or atypical timing between drug exposure and injury. Conclusions The DILIN expert opinion causality assessment method has moderate inter-observer reliability but very good agreement within 1 category. A small but important proportion of cases could not be reliably diagnosed as ≥ 50% likely to be DILI. PMID:24661785

78 FR 71869 - Changes To Implement the Hague Agreement Concerning International Registration of Industrial Designs

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-29

... International Registration of Industrial Designs; Proposed Rule #0;#0;Federal Register / Vol. 78 , No. 230... Changes To Implement the Hague Agreement Concerning International Registration of Industrial Designs... Registration of Industrial Designs (``Hague Agreement'') and is to take effect on the entry into force of the...

2 CFR 180.20 - What must a Federal agency do to implement these guidelines?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false What must a Federal agency do to implement these guidelines? 180.20 Section 180.20 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved OMB GUIDELINES TO AGENCIES ON GOVERNMENTWIDE DEBARMENT...

2 CFR 180.30 - Where does a Federal agency implement these guidelines?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Where does a Federal agency implement these guidelines? 180.30 Section 180.30 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved OMB GUIDELINES TO AGENCIES ON GOVERNMENTWIDE DEBARMENT AND...

2 CFR 180.35 - By when must a Federal agency implement these guidelines?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false By when must a Federal agency implement these guidelines? 180.35 Section 180.35 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved OMB GUIDELINES TO AGENCIES ON GOVERNMENTWIDE DEBARMENT...

2 CFR 182.35 - By when must a Federal agency implement the guidance?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false By when must a Federal agency implement the guidance? 182.35 Section 182.35 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL...

PRESENT CONDITION AND MEASURES TO EXPAND OF VOLUNTARY AGREEMENT ON PLASTIC SHOPPING BAGS REDUCTION AT THE PREFECTURAL LEVEL

NASA Astrophysics Data System (ADS)

Mori, Mayuka; Kanaya, Ken

Purpose of this research is to clear present condition and measures to expand of voluntary agreement on plastic shopping bags reduction at the prefectural level. Methods of this research are questionnaire survey to prefectures implementing the agreement and survey by i town page to the number of stores of companies and the number of companies in the prefectures. Findings of this research are as follows: 1. The refusal rate of plastic shopping bags was 10-40% before the implementation of voluntary agreements. And the rate is approximately 70-90% after the implementation. Therefore, before and after the implementation of voluntary agreements, the refusal rate of plastic shopping bags is approximately 40-70% less. 2. It is suggested that the time and number of meetings from proposal to conclusion of the agreement are related in some way, to the ratio of stores participating. On the participation of administration, the ratio of stores participating in the case in which prefecture and cities participate is higher than in the case in which prefecture participates.

33 CFR 151.47 - Category D NLSs other than oil-like Category D NLSs that may be carried under this part.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) POLLUTION VESSELS CARRYING OIL, NOXIOUS LIQUID SUBSTANCES, GARBAGE, MUNICIPAL OR COMMERCIAL WASTE, AND BALLAST WATER Implementation of... Category D NLSs that may be carried under this part. The following is a list of Category D NLSs other than...

Interobserver agreement between primary graders and an expert grader in the Bristol and Weston diabetic retinopathy screening programme: a quality assurance audit.

PubMed

Patra, S; Gomm, E M W; Macipe, M; Bailey, C

2009-08-01

To assess the quality and accuracy of primary grading in the Bristol and Weston diabetic retinopathy screening programme and to set standards for future interobserver agreement reports. A prospective audit of 213 image sets from six fully trained primary graders in the Bristol and Weston diabetic retinopathy screening programme was carried out over a 4-week period. All the images graded by the primary graders were regraded by an expert grader blinded to the primary grading results and the identity of the primary grader. The interobserver agreement between primary graders and the blinded expert grader and the corresponding Kappa coefficient was determined for overall grading, referable, non-referable and ungradable disease. The audit standard was set at 80% for interobserver agreement with a Kappa coefficient of 0.7. The interobserver agreement bettered the audit standard of 80% in all the categories. The Kappa coefficient was substantial (0.7) for the overall grading results and ranged from moderate to substantial (0.59-0.65) for referable, non-referable and ungradable disease categories. The main recommendation of the audit was to provide refresher training for the primary graders with focus on ungradable disease. The audit demonstrated an acceptable level of quality and accuracy of primary grading in the Bristol and Weston diabetic retinopathy screening programme and provided a standard against which future interobserver agreement can be measured for quality assurance within a screening programme. Diabet. Med. 26, 820-823 (2009).

A smartphone application to determine body length for body weight estimation in children: a prospective clinical trial.

PubMed

Wetzel, Oliver; Schmidt, Alexander R; Seiler, Michelle; Scaramuzza, Davide; Seifert, Burkhardt; Spahn, Donat R; Stein, Philipp

2018-06-01

The aim of this study was to test the feasibility and accuracy of a smartphone application to measure the body length of children using the integrated camera and to evaluate the subsequent weight estimates. A prospective clinical trial of children aged 0-<13 years admitted to the emergency department of the University Children's Hospital Zurich. The primary outcome was to validate the length measurement by the smartphone application «Optisizer». The secondary outcome was to correlate the virtually calculated ordinal categories based on the length measured by the app to the categories based on the real length. The third and independent outcome was the comparison of the different weight estimations by physicians, nurses, parents and the app. For all 627 children, the Bland Altman analysis showed a bias of -0.1% (95% CI -0.3-0.2%) comparing real length and length measured by the app. Ordinal categories of real length were in excellent agreement with categories virtually calculated based upon app length (kappa = 0.83, 95% CI 0.79-0.86). Children's real weight was underestimated by physicians (-3.3, 95% CI -4.4 to -2.2%, p < 0.001), nurses (-2.6, 95% CI -3.8 to -1.5%, p < 0.001) and parents (-1.3, 95% CI -1.9 to -0.6%, p < 0.001) but overestimated by categories based upon app length (1.6, 95% CI 0.3-2.8%, p = 0.02) and categories based upon real length (2.3, 95% CI 1.1-3.5%, p < 0.001). Absolute weight differences were lowest, if estimated by the parents (5.4, 95% CI 4.9-5.9%, p < 0.001). This study showed the accuracy of length measurement of children by a smartphone application: body length determined by the smartphone application is in good agreement with the real patient length. Ordinal length categories derived from app-measured length are in excellent agreement with the ordinal length categories based upon the real patient length. The body weight estimations based upon length corresponded to known data and limitations. Precision of body weight estimations by paediatric physicians and nurses were comparable and not different to length based estimations. In this non-emergency setting, parental weight estimation was significantly better than all other means of estimation (paediatric physicians and nurses, length based estimations) in terms of precision and absolute difference.

Toward criteria for pragmatic measurement in implementation research and practice: a stakeholder-driven approach using concept mapping.

PubMed

Powell, Byron J; Stanick, Cameo F; Halko, Heather M; Dorsey, Caitlin N; Weiner, Bryan J; Barwick, Melanie A; Damschroder, Laura J; Wensing, Michel; Wolfenden, Luke; Lewis, Cara C

2017-10-03

Advancing implementation research and practice requires valid and reliable measures of implementation determinants, mechanisms, processes, strategies, and outcomes. However, researchers and implementation stakeholders are unlikely to use measures if they are not also pragmatic. The purpose of this study was to establish a stakeholder-driven conceptualization of the domains that comprise the pragmatic measure construct. It built upon a systematic review of the literature and semi-structured stakeholder interviews that generated 47 criteria for pragmatic measures, and aimed to further refine that set of criteria by identifying conceptually distinct categories of the pragmatic measure construct and providing quantitative ratings of the criteria's clarity and importance. Twenty-four stakeholders with expertise in implementation practice completed a concept mapping activity wherein they organized the initial list of 47 criteria into conceptually distinct categories and rated their clarity and importance. Multidimensional scaling, hierarchical cluster analysis, and descriptive statistics were used to analyze the data. The 47 criteria were meaningfully grouped into four distinct categories: (1) acceptable, (2) compatible, (3) easy, and (4) useful. Average ratings of clarity and importance at the category and individual criteria level will be presented. This study advances the field of implementation science and practice by providing clear and conceptually distinct domains of the pragmatic measure construct. Next steps will include a Delphi process to develop consensus on the most important criteria and the development of quantifiable pragmatic rating criteria that can be used to assess measures.

2 CFR 182.25 - What must a Federal agency address in its implementation of the guidance?

Code of Federal Regulations, 2010 CFR

2010-01-01

... implementation of the guidance? 182.25 Section 182.25 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE...? Each Federal agency's implementing regulation: (a) Must establish drug-free workplace policies and...

Design considerations for community mental health management information systems.

PubMed

Lowe, B H; Sugarman, B

1978-01-01

Many community mental health centers are presently faced with the necessity of implementing a management information system. This article offers guidelines for centers dealing with this situation. Whether a center chooses to adapt an existing system or develop one of its own, careful planning prior to the implementation of the system can help ensure that it will meet the needs of the center and operate successfully. The guidelines are organized into the categories of data considerations, people considerations, and system considerations. The first two categories are of general interest, whereas the last category is more technical in nature.

76 FR 63763 - National Environmental Policy Act Implementing Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-13

...The U.S. Department of Energy (DOE or the Department) is revising its National Environmental Policy Act (NEPA) Implementing Procedures. The majority of the changes are being made to the categorical exclusion provisions. These revisions are intended to better align the Department's regulations, particularly its categorical exclusions, with DOE's current activities and recent experiences, and to update the provisions with respect to current technologies and regulatory requirements. DOE is establishing 20 new categorical exclusions and removing two categorical exclusion categories, one environmental assessment category, and three environmental impact statement categories. Other changes modify and clarify DOE's existing provisions.

[Evaluation of data on live birth certificates from the Information System on Live Births (SINASC) in Campinas, São Paulo, 2009].

PubMed

Gabriel, Guilherme Paiva; Chiquetto, Letícia; Morcillo, André Moreno; Ferreira, Maria do Carmo; Bazan, Ivan Gilberto M; Daolio, Luísa Dias; Lemos, Jéssica J Rocha; Carniel, Emília de Faria

2014-09-01

To assess the completeness and reliability of the Information System on Live Births (Sinasc) data. A cross-sectional analysis of the reliability and completeness of Sinasc's data was performed using a sample of Live Birth Certificate (LBC) from 2009, related to births from Campinas, Southeast Brazil. For data analysis, hospitals were grouped according to category of service (Unified National Health System, private or both), 600 LBCs were randomly selected and the data were collected in LBC-copies through mothers and newborns' hospital records and by telephone interviews. The completeness of LBCs was evaluated, calculating the percentage of blank fields, and the LBCs agreement comparing the originals with the copies was evaluated by Kappa and intraclass correlation coefficients. The percentage of completeness of LBCs ranged from 99.8%-100%. For the most items, the agreement was excellent. However, the agreement was acceptable for marital status, maternal education and newborn infants' race/color, low for prenatal visits and presence of birth defects, and very low for the number of deceased children. The results showed that the municipality Sinasc is reliable for most of the studied variables. Investments in training of the professionals are suggested in an attempt to improve system capacity to support planning and implementation of health activities for the benefit of maternal and child population. Copyright © 2014 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

An empirical review of antimalarial quality field surveys: the importance of characterising outcomes.

PubMed

Grech, James; Robertson, James; Thomas, Jackson; Cooper, Gabrielle; Naunton, Mark; Kelly, Tamsin

2018-01-05

For decades, thousands of people have been dying from malaria infections because of poor-quality medicines (PQMs). While numerous efforts have been initiated to reduce their presence, PQMs are still risking the lives of those seeking treatment. This review addresses the importance of characterising results of antimalarial medicine field surveys based upon the agreement of clearly defined definitions. Medicines found to be of poor quality can be falsified or counterfeit, substandard or degraded. The distinction between these categories is important as each category requires a different countermeasure. To observe the current trends in the reporting of field surveys, a systematic literature search of six academic databases resulted in the quantitative analysis of 61 full-text journal articles. Information including sample size, sampling method, geographical regions, analytical techniques, and characterisation conclusions was observed for each. The lack of an accepted uniform reporting system has resulted in varying, incomplete reports, which may not include important information that helps form effective countermeasures. The programmes influencing medicine quality such as prequalification, procurement services, awareness and education can be supported with the information derived from characterised results. The implementation of checklists such as the Medicine Quality Assessment Reporting Guidelines will further strengthen the battle against poor-quality antimalarials. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of Visual Assessment of Breast Density in BI-RADS 4th and 5th Editions With Automated Volumetric Measurement.

PubMed

Youk, Ji Hyun; Kim, So Jung; Son, Eun Ju; Gweon, Hye Mi; Kim, Jeong-Ah

2017-09-01

The purpose of this study was to compare visual assessments of mammographic breast density by radiologists using BI-RADS 4th and 5th editions in correlation with automated volumetric breast density measurements. A total of 337 consecutive full-field digital mammographic examinations with standard views were retrospectively assessed by two radiologists for mammographic breast density according to BI-RADS 4th and 5th editions. Fully automated measurement of the volume of fibroglandular tissue and total breast and percentage breast density was performed with a commercially available software program. Interobserver and intraobserver agreement was assessed with kappa statistics. The distributions of breast density categories for both editions of BI-RADS were compared and correlated with volumetric data. Interobserver agreement on breast density category was moderate to substantial (κ = 0.58-0.63) with use of BI-RADS 4th edition and substantial (κ = 0.63-0.66) with use of the 5th edition but without significant difference between the two editions. For intraobserver agreement between the two editions, the distributions of density category were significantly different (p < 0.0001), the proportions of dense breast increased, and the proportion of fatty breast decreased with use of the 5th edition compared with the 4th edition (p < 0.0001). All volumetric breast density data, including percentage breast density, were significantly different among density categories (p < 0.0001) and had significant correlation with visual assessment for both editions of BI-RADS (p < 0.01). Assessment using BI-RADS 5th edition revealed a higher proportion of dense breast than assessment using BI-RADS 4th edition. Nevertheless, automated volumetric density assessment had good correlation with visual assessment for both editions of BI-RADS.

Electronic 12-Hour Dietary Recall (e-12HR): Comparison of a Mobile Phone App for Dietary Intake Assessment With a Food Frequency Questionnaire and Four Dietary Records.

PubMed

Béjar, Luis María; Reyes, Óscar Adrián; García-Perea, María Dolores

2018-06-15

One of the greatest challenges in nutritional epidemiology is improving upon traditional self-reporting methods for the assessment of habitual dietary intake. The aim of this study was to evaluate the relative validity of a new method known as the current-day dietary recall (or current-day recall), based on a smartphone app called 12-hour dietary recall, for determining the habitual intake of a series of key food and drink groups using a food frequency questionnaire (FFQ) and four dietary records as reference methods. University students over the age of 18 years recorded their consumption of certain groups of food and drink using 12-hour dietary recall for 28 consecutive days. During this 28-day period, they also completed four dietary records on randomly selected days. Once the monitoring period was over, subjects then completed an FFQ. The two methods were compared using the Spearman correlation coefficient (SCC), a cross-classification analysis, and weighted kappa. A total of 87 participants completed the study (64% women, 56/87; 36% men, 31/87). For e-12HR versus FFQ, for all food and drink groups, the average SCC was 0.70. Cross-classification analysis revealed that the average percentage of individuals classified in the exact agreement category was 51.5%; exact agreement + adjacent was 91.8%, and no participant (0%) was classified in the extreme disagreement category. The average weighted kappa was 0.51. For e-12HR versus the four dietary records, for all food and drink groups, the average SCC was 0.63. Cross-classification analysis revealed that the average percentage of individuals classified in the exact agreement category was 47.1%; exact agreement + adjacent was 89.2%; and no participant (0%) was classified in the extreme disagreement category. The average weighted kappa was 0.47. Current-day recall, based on the 12-hour dietary recall app, was found to be in good agreement with the two reference methods (FFQ & four dietary records), demonstrating its potential usefulness for categorizing individuals according to their habitual dietary intake of certain food and drink groups. ©Luis María Béjar, Óscar Adrián Reyes, María Dolores García-Perea. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 15.06.2018.

2 CFR 1.220 - Federal agency implementation of this subtitle.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Federal agency implementation of this subtitle. 1.220 Section 1.220 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements ABOUT TITLE 2 OF THE CODE OF FEDERAL REGULATIONS AND SUBTITLE A Introduction to Subtitle A § 1.220...

2 CFR 1.220 - Federal agency implementation of this subtitle.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 2 Grants and Agreements 1 2012-01-01 2012-01-01 false Federal agency implementation of this subtitle. 1.220 Section 1.220 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements ABOUT TITLE 2 OF THE CODE OF FEDERAL REGULATIONS AND SUBTITLE A Introduction to Subtitle A § 1.220...

2 CFR 1.220 - Federal agency implementation of this subtitle.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Federal agency implementation of this subtitle. 1.220 Section 1.220 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements ABOUT TITLE 2 OF THE CODE OF FEDERAL REGULATIONS AND SUBTITLE A Introduction toSubtitle A § 1.220...

2 CFR 1.220 - Federal agency implementation of this subtitle.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 2 Grants and Agreements 1 2011-01-01 2011-01-01 false Federal agency implementation of this subtitle. 1.220 Section 1.220 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements ABOUT TITLE 2 OF THE CODE OF FEDERAL REGULATIONS AND SUBTITLE A Introduction toSubtitle A § 1.220...

Cohen's Linearly Weighted Kappa Is a Weighted Average of 2 x 2 Kappas

ERIC Educational Resources Information Center

Warrens, Matthijs J.

2011-01-01

An agreement table with [n as an element of N is greater than or equal to] 3 ordered categories can be collapsed into n - 1 distinct 2 x 2 tables by combining adjacent categories. Vanbelle and Albert ("Stat. Methodol." 6:157-163, 2009c) showed that the components of Cohen's weighted kappa with linear weights can be obtained from these n - 1…

Operative volume in the new era: a comparison of resident operative volume before and after implementation of 80-hour work week restrictions.

PubMed

Bruce, Pamela J; Helmer, Stephen D; Osland, Jacqueline S; Ammar, Alex D

2010-01-01

To determine the effect of the 80-hour work week restrictions on general surgery resident operative volume in a large, community-based, university-affiliated, general surgery residency program. We performed a retrospective review of Accreditation Council for Graduate Medical Education (ACGME) operative logs of general surgery residents graduating from a single residency. The control group consisted of the residents graduating in the 3 years prior to the work-hour restriction implementation (2001, 2002, and 2003). Our comparison group consisted of those residents graduating in the first 2 classes whose entire residency was conducted after the implementation of the 80-hour work week (2008 and 2009). Comparisons were made between the control and the comparison groups in the 19 ACGME defined categories, total number of major cases, total number of chief cases, and total number of teaching assist cases. Operative volumes in 13 categories (skin/soft tissue/breast, alimentary tract, abdominal, liver, pancreas, vascular, endocrine, pediatrics, endoscopy, laparoscopic-complex, total chief cases, total major cases, and teaching cases) were not significantly affected by the implementation of the 80-hour work week. One of the 19 categories (laparoscopic-basic) showed a significant increase in operative volume (p < 0.0001). In 4 of the 19 categories (head/neck, operative-trauma, thoracic, and plastics), operative volume was significantly decreased in the post-80-hour work week era (p < 0.05). Nonoperative trauma could not be assessed, as the category did not exist before the work-hour restrictions. Resident operative volume at our institution's general surgery residency program largely has been unaffected by implementation of the 80-hour work week. Residencies in general surgery can be structured in a manner to allow for compliance with duty-hour regulations while maintaining the required operative volume outlined by the ACGME defined categories. Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

An Examination of Strategy Implementation during Abstract Nonlinguistic Category Learning in Aphasia

ERIC Educational Resources Information Center

Vallila-Rohter, Sofia; Kiran, Swathi

2015-01-01

Purpose: Our purpose was to study strategy use during nonlinguistic category learning in aphasia. Method: Twelve control participants without aphasia and 53 participants with aphasia (PWA) completed a computerized feedback-based category learning task consisting of training and testing phases. Accuracy rates of categorization in testing phases…

Immunogenetics of the Elephant Seal

NASA Technical Reports Server (NTRS)

Garza, John Carlos

1999-01-01

The goals of this cooperative agreement fall into three categories: 1) A basic description of Immunogenetic variation in the northern elephant seal genome; 2) A basic genetic map of the northern elephant seal genome; 3). Microevolutionary forces in the northern elephant seal genome. The results described in this report were acquired using funds from this cooperative agreement together with funds from a National Science Foundation Dissertation Improvement Grant.

Agreement between University of Cincinnati and American Association of University Professors, University of Cincinnati Chapter. September 1, 1989 to August 31, 1992.

ERIC Educational Resources Information Center

American Association of Univ. Professors, Washington, DC.

The collective bargaining agreement between the University of Cincinnati and the University of Cincinnati Chapter of the American Association of University Professors (AAUP), for the period September 1, 1989 through August 31, 1992 is presented. The document covers the following topics in 39 articles under the following categories: (1) "Basic…

2 CFR 1.220 - Federal agency implementation of this subtitle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Federal agency implementation of this subtitle. 1.220 Section 1.220 Grants and Agreements ABOUT TITLE 2 OF THE CODE OF FEDERAL REGULATIONS AND SUBTITLE A Introduction toSubtitle A § 1.220 Federal agency implementation of this subtitle. A Federal...

Disrupted behaviour in grammatical morphology in French speakers with autism spectrum disorders.

PubMed

Le Normand, Marie-Thérèse; Blanc, Romuald; Caldani, Simona; Bonnet-Brilhault, Frédérique

2018-01-18

Mixed and inconsistent findings have been reported across languages concerning grammatical morphology in speakers with Autism Spectrum Disorders (ASD). Some researchers argue for a selective sparing of grammar whereas others claim to have identified grammatical deficits. The present study aimed to investigate this issue in 26 participants with ASD speaking European French who were matched on age, gender and SES to 26 participants with typical development (TD). The groups were compared regarding their productivity and accuracy of syntactic and agreement categories using the French MOR part-of-speech tagger available from the CHILDES. The groups significantly differed in productivity with respect to nouns, adjectives, determiners, prepositions and gender markers. Error analysis revealed that ASD speakers exhibited a disrupted behaviour in grammatical morphology. They made gender, tense and preposition errors and they omitted determiners and pronouns in nominal and verbal contexts. ASD speakers may have a reduced sensitivity to perceiving and processing the distributional structure of syntactic categories when producing grammatical morphemes and agreement categories. The theoretical and cross-linguistic implications of these findings are discussed.

An analysis and comparison of LANDSAT-1, Skylab (S-192) and aircraft data for delineation of land-water cover types of the Green Swamp, Florida

NASA Technical Reports Server (NTRS)

Higer, A. L. (Principal Investigator); Coker, A. E.; Schmidt, N. F.; Reed, I. E.

1975-01-01

The author has identified the following significant results. LANDSAT 1 and Skylab (S192) data from the Green Swamp area of central Florida were categorized into five classes: water, cypress, other wetlands, pine, and pasture. These categories were compared with similar categories on a detailed vegetative map made using low altitude aerial photography. Agreement of LANDSAT and Skylab categorized data with the vegetation map was 87 percent and 83 percent respectively. The Green Swamp vegetative categories may be widespread but often consist of numerous small isolated areas, because LANDSAT has a greater resolution than Skylab, it is more favorable for mapping the small vegetative categories.

Providers' perceptions of spinal cord injury pressure ulcer guidelines.

PubMed

Thomason, Susan S; Evitt, Celinda P; Harrow, Jeffrey J; Love, Linda; Moore, D Helen; Mullins, Maria A; Powell-Cope, Gail; Nelson, Audrey L

2007-01-01

Pressure ulcers are a serious complication for people with spinal cord injury (SCI). The Consortium for Spinal Cord Medicine (CSCM) published clinical practice guidelines (CPGs) that provided guidance for pressure ulcer prevention and treatment after SCI. The aim of this study was to assess providers' perceptions for each of the 32 CPG recommendations regarding their agreement with CPGs, degree of CPG implementation, and CPG implementation barriers and facilitators. This descriptive mixed-methods study included both qualitative (focus groups) and quantitative (survey) data collection approaches. The sample (n = 60) included 24 physicians and 36 nurses who attended the 2004 annual national conferences of the American Paraplegia Society or American Association of Spinal Cord Injury Nurses. This sample drew from two sources: a purposive sample from a list of preregistered participants and a convenience sample of conference attendee volunteers. We analyzed quantitative data using descriptive statistics and qualitative data using a coding scheme to capture barriers and facilitators. The focus groups agreed unanimously on the substance of 6 of the 32 recommendations. Nurse and physician focus groups disagreed on the degree of CGP implementation at their sites, with nurses as a group perceiving less progress in implementation of the guideline recommendations. The focus groups identified only one recommendation, complications of surgery, as being fully implemented at their sites. Categories of barriers and facilitators for implementation of CPGs that emerged from the qualitative analysis included (a) characteristics of CPGs: need for research/evidence, (b) characteristics of CPGs: complexity of design and wording, (c) organizational factors, (d) lack of knowledge, and (e) lack of resources. Although generally SCI physicians and nurses agreed with the CPG recommendations as written, they did not feel these recommendations were fully implemented in their respective clinical settings. The focus groups identified multiple barriers to the implementation of the CPGs and suggested several facilitators/solutions to improve implementation of these guidelines in SCI. Participants identified organizational factors and the lack of knowledge as the most substantial systems/issues that created barriers to CPG implementation.

78 FR 77621 - Forum To Discuss Proposed Changes To Implement the Hague Agreement Concerning International...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-24

... Agreement'') and is to take effect on the entry into force of the Hague Agreement with respect to the United States. On November 29, 2013, the Office published a proposed rule in the Federal Register proposing changes to the rules of practice to implement title I of the PLTIA and seeking written comments on the...

[Incidence of melanoma and changes in stage-specific incidence after implementation of skin cancer screening in Schleswig-Holstein].

PubMed

Eisemann, N; Waldmann, A; Katalinic, A

2014-01-01

A pilot project in skin cancer screening (SCREEN) was conducted in Schleswig-Holstein from July 2003 to June 2004. Although the impact of this screening on the stage-specific incidence of melanoma is of great importance for screening evaluation, it remains unknown. In theory, an effective skin cancer screening program should result in a medium-term incidence decrease of melanomas with a prognostically unfavorable stage. This is studied on a population-based level by using cancer registry data. Based on data from the Cancer Registry of Schleswig-Holstein for 1999-2009, stage-specific (T-category of the TNM-classification system) age-standardized incidence rates were calculated. After implementation of the SCREEN project, the incidence of prognostically favorable melanomas (in situ and T1) was higher than before, while the incidence of advanced melanomas (T2, T3, and for women also T4) decreased considerably. The classification of tumor stages changed during the project period, which may have contributed to an artificial decrease of the stages with a poor prognosis. Nevertheless, the results are in agreement with the observed decrease of melanoma mortality in the screening region.

48 CFR 25.400 - Scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Implementation Act (Pub. L. 109-169) (19 U.S.C. 3805 note)); (viii) Oman FTA (the United States-Oman Free Trade Agreement, as approved by Congress in the United States-Oman Free Trade Agreement Implementation Act (Pub. L...

Sparse Representation of Multimodality Sensing Databases for Data Mining and Retrieval

DTIC Science & Technology

2015-04-09

Savarese. Estimating the Aspect Layout of Object Categories, EEE Conference on Computer Vision and Pattern Recognition (CVPR). 19-JUN-12...Time Equivalent (FTE) support provided by this agreement, and total for each category): (a) Graduate Students Liang Mei, 50% FTE, EE : systems...PhD candidate Min Sun, 50% FTE, EE : systems, PhD candidate Yu Xiang, 50% FTE, EE : systems, PhD candidate Dae Yon Jung, 50% FTE, EE : systems, PhD

Innovative system to improve use of patient education materials.

PubMed Central

Smith, J. L.; Levitt, C.; Franco, E. D.

1997-01-01

OBJECTIVE: To evaluate a new storage system for patient education materials. DESIGN: Anonymous surveys before and after implementation of new storage system. SETTING: Family medicine residency teaching centre. PARTICIPANTS: All nurses, staff doctors, and first- and second-year residents in the unit. INTERVENTIONS: Implementation of a new storage system for patient education materials, orientation of all health professionals in the unit to the new system, and periodic distribution of patient education newsletters. MAIN OUTCOME MEASURES: Self-reported use of patient education materials. RESULTS: Response rates were 73% (30 of 41 health professionals) in 1990 and 86% (36 of 42) in 1992. Responses to the first survey on use of 20 categories of patient education materials showed materials were seldom used by most respondents. Back Care, Nutrition, Diabetes, VD/Birth Control, and Pregnancy categories were the most frequently used. In the second survey, more respondents reported using these five categories of pamphlets. Rates of use varied only slightly for the remaining 15 categories. CONCLUSIONS: Health professionals reported more frequent use of certain patient education materials following implementation of a new storage system. PMID:9626424

U.S.-Iraq Agreements: Congressional Oversight Activities and Legislative Response

DTIC Science & Technology

2009-05-15

in creating the planned agreements, from negotiation to implementation, and took action to ensure such involvement. Members proposed numerous...matter experts. This has equipped Congress with information pertinent to deciding what further action can be taken to involve Congress more in the...concerning the negotiation, execution, and early implementation of the agreements; the second describes in detail the actions taken by Congress thus

Inter- and Intraobserver Agreement of 18F-FDG PET/CT Image Interpretation in Patients Referred for Assessment of Cardiac Sarcoidosis.

PubMed

Ohira, Hiroshi; Ardle, Brian Mc; deKemp, Robert A; Nery, Pablo; Juneau, Daniel; Renaud, Jennifer M; Klein, Ran; Clarkin, Owen; MacDonald, Karen; Leung, Eugene; Nair, Girish; Beanlands, Rob; Birnie, David

2017-08-01

Recent studies have reported the usefulness of 18 F-FDG PET in aiding with the diagnosis and management of patients with cardiac sarcoidosis (CS). However, image interpretation of 18 F-FDG PET for CS is sometimes challenging. We sought to investigate the inter- and intraobserver agreement and explore factors that led to important discrepancies between readers. Methods: We studied consecutive patients with no significant coronary artery disease who were referred for assessment of CS. Two experienced readers masked to clinical information, imaging reports, independently reviewed 18 F-FDG PET/CT images. 18 F-FDG PET/CT images were interpreted according to a predefined standard operating procedure, with cardiac 18 F-FDG uptake patterns categorized into 5 patterns: none, focal, focal on diffuse, diffuse, and isolated lateral wall or basal uptake. Overall image assessment was classified as either consistent with active CS or not. Results: One hundred scans were included from 71 patients. Of these, 46 underwent 18 F-FDG PET/CT with a no-restriction diet (no-restriction group), and 54 underwent 18 F-FDG PET/CT with a low-carbohydrate, high-fat and protein-permitted diet (low-carb group). There was agreement of the interpretation category in 74 of 100 scans. The κ-value of agreement among all 5 categories was 0.64, indicating moderate agreement. For overall clinical interpretation, there was agreement in 93 of 100 scans (κ = 0.85). When scans were divided into the preparation groups, there was a trend toward higher agreement in the low-carb group versus the no-restriction group (80% vs. 67%, P = 0.08). Regarding the overall clinical interpretation, there was also a trend toward greater agreement in the low-carb group versus the no-restriction group (96% vs. 89%, P = 0.08). Conclusion : The interobserver agreement of cardiac 18 F-FDG uptake image patterns was moderate. However, agreement was better regarding overall interpretation of CS. Detailed prescan dietary preparation seemed to improve interobserver agreement. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

Interobserver concordance of assessments of dysplasia and blast counts for the diagnosis of patients with cytopenia: From the Japanese central review study.

PubMed

Matsuda, Akira; Kawabata, Hiroshi; Tohyama, Kaoru; Maeda, Tomoya; Araseki, Kayano; Hata, Tomoko; Suzuki, Takahiro; Kayano, Hidekazu; Shimbo, Kei; Usuki, Kensuke; Chiba, Shigeru; Ishikawa, Takayuki; Arima, Nobuyoshi; Nohgawa, Masaharu; Ohta, Akiko; Miyazaki, Yasushi; Nakao, Sinnji; Ozawa, Keiya; Arai, Shunya; Kurokawa, Mineo; Mitani, Kinuko; Takaori-Kondo, Akifumi

2018-06-07

The diagnosis of myelodysplastic syndromes (MDS) is based on morphology and cytogenetics. However, limited information is currently available on the interobserver concordance of the assessment of dysplastic lineages (<10% or ≥10% in bone marrow (BM)). The revised International Prognostic Scoring System (IPSS-R) described a new threshold (2%) for BM blasts. However, the interobserver concordance of the categories (0-≤2% and >2-<5%) has limited data. The purpose of the present study was to investigate the assessment of dysplastic lineages and IPSS-R reproducibility. Our study was divided into two Steps. In each Step, the microscopic examinations were performed separately by two morphologists. Regarding the category of BM blasts ≤2% and >2-<5%, interobserver agreement was more than 'moderate' in all pairs (kappa test: 0.43-0.90). Regarding dysgranulopoiesis (dysG) and dyserythropoiesis (dysE) in BM, interobserver agreement was more than 'moderate' in all pairs (kappa test, dysG: 0.45-0.96, dysE: 0.45-0.81). Regarding the category of dysmegakaryopoiesis (dysMgk) in BM, interobserver agreement was more than moderate in 4 out of 5 pairs (kappa test: 0.58-1.00), and was fair for one pair (kappa test: 0.37). We consider that high interobserver concordance may be possible for the BM blast cell count (≤2% or >2-<5%) and dysplasia (<10% or ≥10%) of each lineage. Copyright © 2018 Elsevier Ltd. All rights reserved.

77 FR 29519 - To Implement the United States-Colombia Trade Promotion Agreement and for Other Purposes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-18

... Proclamation 8332 of December 29, 2008, implemented U.S. tariff commitments under the United States-Oman Free... States Implementing the United States-Oman Free Trade Agreement.'' Annex II to that publication included... to certain goods of Oman under the terms of general note 31 to the HTS, subchapter XVI of chapter 99...

77 FR 3637 - Atlantic Highly Migratory Species; Atlantic Bluefin Tuna Fisheries; General Category Fishery

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-25

.... 110210132-1275-02] RIN 0648-XA948 Atlantic Highly Migratory Species; Atlantic Bluefin Tuna Fisheries... category fishery for large medium and giant Atlantic bluefin tuna (BFT) until the General category reopens...: Regulations implemented under the authority of the Atlantic Tunas Convention Act (16 U.S.C. 971 et seq.) and...

78 FR 11788 - Atlantic Highly Migratory Species; Atlantic Bluefin Tuna Fisheries; General Category Fishery

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-20

.... 120306154-2241-02] RIN 0648-XC506 Atlantic Highly Migratory Species; Atlantic Bluefin Tuna Fisheries... category fishery for large medium and giant Atlantic bluefin tuna (BFT) until the General category reopens... implemented under the authority of the Atlantic Tunas Convention Act (16 U.S.C. 971 et seq.) and the Magnuson...

Thoracic surgeons' perception of frail behavior in videos of standardized patients.

PubMed

Ferguson, Mark K; Thompson, Katherine; Huisingh-Scheetz, Megan; Farnan, Jeanne; Hemmerich, Josh A; Slawinski, Kris; Acevedo, Julissa; Lee, Sang Mee; Rojnica, Marko; Small, Stephen

2014-01-01

Frailty is a predictor of poor outcomes following many types of operations. We measured thoracic surgeons' accuracy in assessing patient frailty using videos of standardized patients demonstrating signs of physical frailty. We compared their performance to that of geriatrics specialists. We developed an anchored scale for rating degree of frailty. Reference categories were assigned to 31 videos of standardized patients trained to exhibit five levels of activity ranging from "vigorous" to "frail." Following an explanation of frailty, thoracic surgeons and geriatrics specialists rated the videos. We evaluated inter-rater agreement and tested differences between ratings and reference categories. The influences of clinical specialty, clinical experience, and self-rated expertise were examined. Inter-rater rank correlation among all participants was high (Kendall's W 0.85) whereas exact agreement (Fleiss' kappa) was only moderate (0.47). Better inter-rater agreement was demonstrated for videos exhibiting extremes of behavior. Exact agreement was better for thoracic surgeons (n = 32) than geriatrics specialists (n = 9; p = 0.045), whereas rank correlation was similar for both groups. More clinical years of experience and self-reported expertise were not associated with better inter-rater agreement. Videos of standardized patients exhibiting varying degrees of frailty are rated with internal consistency by thoracic surgeons as accurately as geriatrics specialists when referenced to an anchored scale. Ratings were less consistent for moderate degrees of frailty, suggesting that physicians require training to recognize early frailty. Such videos may be useful in assessing and teaching frailty recognition.

[Differentiation between moisture lesions and pressure ulcers using photographs in a critical area].

PubMed

Valls-Matarín, Josefa; Del Cotillo-Fuente, Mercedes; Pujol-Vila, María; Ribal-Prior, Rosa; Sandalinas-Mulero, Inmaculada

2016-01-01

To identify difficulties for nurses in differentiating between moisture lesions and pressure ulcers, proper classification of pressure ulcers to assess the adequate classification of the Grupo Nacional para el Estudio y Asesoramiento de Úlceras por Presión y Heridas Crónicas (GNEAUPP) and the degree of agreement in the correct assessment by type and category of injury. Cross-sectional study in a critical area during 2014. All nurses who agreed to participate were included. They performed a questionnaire with 14 photographs validated by experts of moisture lesions or pressure ulcers in the sacral area and buttocks, with 6 possible answers: Pressure ulcer category I, II, III, IV, moisture lesions and unknown. Demographics and knowledge of the classification system of the pressure ulcers were collected according to GNEAUPP. It involved 98% of the population (n=56); 98.2% knew the classification system of the GNEAUPP; 35.2% of moisture lesions were considered as pressure ulcers, most of them as a category II (18.9%). The 14.8% of the pressure ulcers photographs were identified as moisture lesions and 16.1% were classified in another category. The agreement between nurses earned a global Kappa index of .38 (95% CI: .29-.57). There are difficulties differentiating between pressure ulcers and moisture lesions, especially within initial categories. Nurses have the perception they know the pressure ulcers classification, but they do not classify them correctly. The degree of concordance in the diagnosis of skin lesions was low. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

EPA Solicits Proposals for the Field Implementation Meeting Support Cooperative Agreement

EPA Pesticide Factsheets

EPA’s Office of Pesticide Programs is soliciting applications for cooperative agreements to manage a Field Implementation Meetings Support program. EPA expects to provide up to $500,000 annually, depending on the Agency’s budget, for a total of

Category-theoretic models of algebraic computer systems

NASA Astrophysics Data System (ADS)

Kovalyov, S. P.

2016-01-01

A computer system is said to be algebraic if it contains nodes that implement unconventional computation paradigms based on universal algebra. A category-based approach to modeling such systems that provides a theoretical basis for mapping tasks to these systems' architecture is proposed. The construction of algebraic models of general-purpose computations involving conditional statements and overflow control is formally described by a reflector in an appropriate category of algebras. It is proved that this reflector takes the modulo ring whose operations are implemented in the conventional arithmetic processors to the Łukasiewicz logic matrix. Enrichments of the set of ring operations that form bases in the Łukasiewicz logic matrix are found.

48 CFR 239.7411 - Contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... superseded. (d) Use the clause at 252.239-7016, Telecommunications Security Equipment, Devices, Techniques... OF DEFENSE SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Telecommunications... following clauses in solicitations, contracts, and basic agreements for telecommunications services. Modify...

Evaluation of naranjo adverse drug reactions probability scale in causality assessment of drug-induced liver injury.

PubMed

García-Cortés, M; Lucena, M I; Pachkoria, K; Borraz, Y; Hidalgo, R; Andrade, R J

2008-05-01

Causality assessment in hepatotoxicity is challenging. The current standard liver-specific Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method scale is complex and difficult to implement in daily practice. The Naranjo Adverse Drug Reactions Probability Scale is a simple and widely used nonspecific scale, which has not been specifically evaluated in drug-induced liver injury. To compare the Naranjo method with the standard liver-specific Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method scale in evaluating the accuracy and reproducibility of Naranjo Adverse Drug Reactions Probability Scale in the diagnosis of hepatotoxicity. Two hundred and twenty-five cases of suspected hepatotoxicity submitted to a national registry were evaluated by two independent observers and assessed for between-observer and between-scale differences using percentages of agreement and the weighted kappa (kappa(w)) test. A total of 249 ratings were generated. Between-observer agreement was 45% with a kappa(w) value of 0.17 for the Naranjo Adverse Drug Reactions Probability Scale, while there was a higher agreement when using the Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method scale (72%, kappa(w): 0.71). Concordance between the two scales was 24% (kappa(w): 0.15). The Naranjo Adverse Drug Reactions Probability Scale had low sensitivity (54%) and poor negative predictive value (29%) and showed a limited capability to distinguish between adjacent categories of probability. The Naranjo scale lacks validity and reproducibility in the attribution of causality in hepatotoxicity.

7 CFR 1789.158 - Implementation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Borrower funding for consulting services, RUS shall initiate a procurement request for a Consultant to... to develop a Funding Agreement, an Escrow Agreement and an Indemnification Agreement (the “agreements... Borrower to enter into the agreements and to take such other action as is necessary to effect the purposes...

40 CFR 35.3010 - Delegation agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Delegation agreement. 35.3010 Section... agreement. (a) Before execution of the delegation agreement, the Regional Administrator must determine that the unit of the State agency designated to implement the agreement is capable of carrying out the...

40 CFR 35.3010 - Delegation agreement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Delegation agreement. 35.3010 Section... agreement. (a) Before execution of the delegation agreement, the Regional Administrator must determine that the unit of the State agency designated to implement the agreement is capable of carrying out the...

78 FR 6188 - Federal Acquisition Regulation; Free Trade Agreement-Colombia

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-29

... Promotion Agreement. This Trade Promotion Agreement is a free trade agreement (FTA) that provides for... 77 FR 27548 on May 10, 2012, to implement the United States-Colombia Trade Promotion Agreement... and safety effects, distributive impacts, and equity). E.O. 13563 emphasizes the importance of...

Foundations of reusable and interoperable facet models using category theory

PubMed Central

2016-01-01

Faceted browsing has become ubiquitous with modern digital libraries and online search engines, yet the process is still difficult to abstractly model in a manner that supports the development of interoperable and reusable interfaces. We propose category theory as a theoretical foundation for faceted browsing and demonstrate how the interactive process can be mathematically abstracted. Existing efforts in facet modeling are based upon set theory, formal concept analysis, and light-weight ontologies, but in many regards, they are implementations of faceted browsing rather than a specification of the basic, underlying structures and interactions. We will demonstrate that category theory allows us to specify faceted objects and study the relationships and interactions within a faceted browsing system. Resulting implementations can then be constructed through a category-theoretic lens using these models, allowing abstract comparison and communication that naturally support interoperability and reuse. PMID:27942248

Measurement of Latent Variables with Different Rating Scales: Testing Reliability and Measurement Equivalence by Varying the Verbalization and Number of Categories

ERIC Educational Resources Information Center

Menold, Natalja; Tausch, Anja

2016-01-01

Effects of rating scale forms on cross-sectional reliability and measurement equivalence were investigated. A randomized experimental design was implemented, varying category labels and number of categories. The participants were 800 students at two German universities. In contrast to previous research, reliability assessment method was used,…

A comparison of two patient classification instruments in an acute care hospital.

PubMed

Seago, Jean Ann

2002-05-01

Patient classification systems are alternately praised and vilified by staff nurses, nurse managers, and nurse executives. Most nurses agree that substantial resources are used to create or find, implement, manage, and maintain the systems, and that the predictive ability of the instruments is intermittent. The purpose of this study is to compare the predictive validity of two types of patient classification instruments commonly used in acute care hospitals in California. Acute care hospitals in California are required by both the Joint Commission on Accreditation of Healthcare Organizations and California Title 22 to have a reliable and valid patient classification system (PCS). The two general types of systems commonly used are the summative task type PCS and the critical incident or criterion type PCS. There is little to assist nurse executives in deciding which type of PCS to choose. There is modest research demonstrating the validity and reliability of different PCSs but no published data comparing the predictive validity of the different types of systems. The unit of analysis is one patient shift called the study shift. The study shift is defined as the first day shift after the patient has been in the hospital for a full 24 hours. Data were collected using medical record review only. Both types, criterion and summative, of PCS data collection instruments were completed for all patients at both collection points. Each patient had a before and after score for each type of instrument. Three hundred forty-nine medical records for inpatients meeting the inclusion criteria were examined. The average patient age was 76 years, the average length of stay was 6.6 days with an average of 6.7 secondary diagnoses recorded. Fifty-five percent of the sample was female and the most common primary diagnosis was CHF, followed by COPD, CVA, and pneumonia. There was a difference in mean summative predictor score and the mean summative actual score of 1.57 points with the predictor score higher (P =.001; CI =.62--2.5). For the criterion instrument, 68.4% of the predictor criterion scores were in category 2 compared to 65.5% of the actual criterion scores. The criterion predictor agreed with the criterion actual score 45% of the time for category 1 patients, 87.3% of the time for category 2 patients, 77.1% of the time for category 3 patients and 72.7% of the time for category 4 patients, with an overall agreement between predictor and actual criterion scores of 79.9% (Kappa P <.001, indicating agreement is not by chance). The most significant finding of this study is that there are virtually no differences in the predictive ability of summative versus criterion patient classification instruments. Using the same patients, both types of instruments predicted the actual score over 78% of the time.

Folk medicinal use of fauna in Mapimi, Durango, México.

PubMed

Jacobo-Salcedo, Maria del Rosario; Alonso-Castro, Angel Josabad; Zarate-Martinez, Alicia

2011-01-27

To document the use of animal species in traditional medicine from the municipality of Mapimi, Durango, México. Direct interviews were performed in several short visits with inhabitants from the municipality of Mapimi, Durango. The interviews were analyzed with two quantitative tools. The informant consensus factor that estimates the level of agreement between interviewees over which animals to use for each category and the fidelity level which indicates the percentage of informants claiming the use of a certain animal species for the same medicinal purpose. A total of 18 animal species, belonging to 17 families and four taxonomic categories, were reported by interviewees as used for medicinal purposes. Thirteen medicinal species were identified not previously reported. The results of the informant consensus factor showed that the dermatological, diabetes and reproductive categories had the greatest agreement. The most important species according to their fidelity level are: Mephitis macroura and Crotalus atrox. This study demonstrates that many animal species play an important role in healing practices among inhabitants from Mapimi, Durango. Further experiments with medicinal fauna from Mapimi are needed to be carried out to obtain experimental information about their traditional uses, especially with C. atrox. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Analysis of agreement between cardiac risk stratification protocols applied to participants of a center for cardiac rehabilitation

PubMed Central

Santos, Ana A. S.; Silva, Anne K. F.; Vanderlei, Franciele M.; Christofaro, Diego G. D.; Gonçalves, Aline F. L.; Vanderlei, Luiz C. M.

2016-01-01

ABSTRACT Background Cardiac risk stratification is related to the risk of the occurrence of events induced by exercise. Despite the existence of several protocols to calculate risk stratification, studies indicating that there is similarity between these protocols are still unknown. Objective To evaluate the agreement between the existing protocols on cardiac risk rating in cardiac patients. Method The records of 50 patients from a cardiac rehabilitation program were analyzed, from which the following information was extracted: age, sex, weight, height, clinical diagnosis, medical history, risk factors, associated diseases, and the results from the most recent laboratory and complementary tests performed. This information was used for risk stratification of the patients in the protocols of the American College of Sports Medicine, the Brazilian Society of Cardiology, the American Heart Association, the protocol designed by Frederic J. Pashkow, the American Association of Cardiovascular and Pulmonary Rehabilitation, the Société Française de Cardiologie, and the Sociedad Española de Cardiología. Descriptive statistics were used to characterize the sample and the analysis of agreement between the protocols was calculated using the Kappa coefficient. Differences were considered with a significance level of 5%. Results Of the 21 analyses of agreement, 12 were considered significant between the protocols used for risk classification, with nine classified as moderate and three as low. No agreements were classified as excellent. Different proportions were observed in each risk category, with significant differences between the protocols for all risk categories. Conclusion The agreements between the protocols were considered low and moderate and the risk proportions differed between protocols. PMID:27556385

Hydrography synthesis using LANDSAT remote sensing and the SCS models

NASA Technical Reports Server (NTRS)

Ragan, R. M.; Jackson, T. J.

1976-01-01

The land cover requirements of the Soil Conservation Service (SCS) Model used for hydrograph synthesis in urban areas were modified to be LANDSAT compatible. The Curve Numbers obtained with these alternate land cover categories compare well with those obtained in published example problems using the conventional categories. Emergency spillway hydrographs and synthetic flood frequency flows computed for a 21.1 sq. mi. test area showed excellent agreement between the conventional aerial photo-based and the Landsat-based SCS approaches.

On a categorial aspect of knowledge representation

NASA Astrophysics Data System (ADS)

Tataj, Emanuel; Mulawka, Jan; Nieznański, Edward

Adequate representation of data is crucial for modeling any type of data. To faithfully present and describe the relevant section of the world it is necessary to select the method that can easily be implemented on a computer system which will help in further description allowing reasoning. The main objective of this contribution is to present methods of knowledge representation using categorial approach. Next to identify the main advantages for computer implementation. Categorical aspect of knowledge representation is considered in semantic networks realisation. Such method borrows already known metaphysics properties for data modeling process. The potential topics of further development of categorical semantic networks implementations are also underlined.

Diagnostic Accuracy of the FIGO and the 5-Tier Fetal Heart Rate Classification Systems in the Detection of Neonatal Acidemia.

PubMed

Martí Gamboa, Sabina; Giménez, Olga Redrado; Mancho, Jara Pascual; Moros, María Lapresta; Sada, Julia Ruiz; Mateo, Sergio Castan

2017-04-01

Objective  The objective of this study was to determine ability to detect neonatal acidemia and interobserver agreement with the FIGO 3-tier and 5-tier fetal heart rate (FHR) classification systems. Design  This was a case-control study. Setting  This study was set at the University Medical Center. Population  A total of 202 FHR tracings of 102 women who delivered an acidemic fetus (umbilical arterial cord gas pH ≤ 7.10 and BE < - 8) and 100 who delivered a nonacidemic fetus (umbilical arterial cord gas pH > 7.10) were assessed. A subanalysis was performed for those fetuses who suffered severe metabolic acidemia (pH ≤ 7.0 and BE < - 12). Methods  Two reviewers blind to clinical and outcome data classified tracings according to the new 3-tier system proposed by the FIGO and the 5-tier system proposed by Parer and Ikeda. Main Outcome Measures  Sensitivity and specificity for detecting neonatal acidemia and interobserver agreement in classifying FHR tracings into categories of both systems were studied. Results  The 3-tier system showed a greater sensitivity and lower specificity to detect neonatal acidemia (43.6% sensitivity, 82.5% specificity) and severe metabolic acidemia (71.4% sensitivity, 74.0% specificity) compared with the 5-tier system (36.3% sensitivity, 88% specificity and 61.9% sensitivity, 80.1% specificity, respectively). Both systems were compared by area under the receiver-operating characteristic curve, with comparable predictive ability for detecting neonatal acidemia (FIGO-area under the curve [AUC]: 0.63 [95% confidence interval [CI]: 0.57-0.68] and Parer-AUC: 0.62 [95% CI: 0.56-0.67]). Interobserver agreement was moderate for both systems, but performance at each specific category showed a better agreement for the 5-tier system identifying a pathological tracing (orange or red, κ: 0.625 vs. pathological category, κ: 0.538). Conclusion  Both systems presented a comparable ability to predict neonatal acidemia, although the 5-tier system showed a better interobserver agreement identifying pathological tracings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

19 CFR 351.101 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... law the provisions of the following agreements annexed to the Agreement Establishing the World Trade Organization: Agreement on Implementation of Article VI of the General Agreement on Tariffs and Trade 1994... INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE ANTIDUMPING AND COUNTERVAILING DUTIES Scope and...

20 CFR 404.1902 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... administration of a social security system including responsibility for implementing an agreement; the Social... coordination between the social security systems of the countries party to the agreement. The term agreement... system including applicable laws and international social security agreements; the Commissioner of Social...

Development and Testing of the Observational System for Recording Physical Activity in Children: Elementary School

PubMed Central

McIver, Kerry L.; Brown, William H.; Pfeiffer, Karin A.; Dowda, Marsha; Pate, Russell R.

2016-01-01

Purpose This study describes the development and pilot testing of the Observational System for Recording Physical Activity-Elementary School (OSRAC-E) version. Methods This system was developed to observe and document the levels and types of physical activity and physical and social contexts of physical activity in elementary school students during the school day. Inter-observer agreement scores and summary data were calculated. Results All categories had Kappa statistics above 0.80, with the exception of the activity initiator category. Inter-observer agreement scores were 96% or greater. The OSRAC-E was shown to be a reliable observation system that allows researchers to assess physical activity behaviors, the contexts of those behaviors, and the effectiveness of physical activity interventions in the school environment. Conclusion The OSRAC-E can yield data with high interobserver reliability and provide relatively extensive contextual information about physical activity of students in elementary schools. PMID:26889587

Perceptual and associative knowledge in category specific impairment of semantic memory: a study of two cases.

PubMed

Laiacona, M; Barbarotto, R; Capitani, E

1993-12-01

We report two head-injured patients whose knowledge of living things was selectively disrupted. Their semantic knowledge was tested with naming and verbal comprehension tasks and a verbal questionnaire. In all of them there was consistent evidence that knowledge of living things was impaired and that of non-living things was relatively preserved. The living things deficit emerged irrespective of whether the question tapped associative or perceptual knowledge or required visual or non visual information. In all tasks the category effect was still significant after the influence on the performance of the following variables was partialled out: word frequency, concept familiarity, prototypicality, name agreement, image agreement and visual complexity. In the verbal questionnaire dissociations were still significant even after adjustment for the difficulty of questions for normals, that had proven greater for living things. Besides diffuse brain damage, both patients presented with a left posterior temporo-parietal lesion.

Reliability and Usefulness of Intraoperative 3-Dimensional Imaging by Mobile C-Arm With Flat-Panel Detector.

PubMed

Fujimori, Takahito; Iwasaki, Motoki; Nagamoto, Yukitaka; Kashii, Masafumi; Takao, Masaki; Sugiura, Tsuyoshi; Yoshikawa, Hideki

2017-02-01

Reliability and agreement study. To assess the reliability of intraoperative 3-dimensional imaging with a mobile C-arm (3D C-arm) equipped with a flat-panel detector. Pedicle screws are widely used in spinal surgery. Postoperative computed tomography (CT) is the most reliable method to detect screw misplacement. Recent advances in imaging devices have enabled surgeons to acquire 3D images of the spine during surgery. However, the reliability of these imaging devices is not known. A total of 203 screws were used in 22 consecutive patients who underwent surgery for scoliosis. Screw position was read twice with a 3D C-arm and twice with CT in a blinded manner by 2 independent observers. Screw positions were classified into 4 categories at every 2 mm and then into 2 simpler categories of acceptable or unacceptable. The degree of agreement with respect to screw positions between the double readings was evaluated by κ value. With unanimous agreement between 2 observers regarding postoperative CT readings considered the gold standard, the sensitivity of the 3D C-arm for determining screw misplacement was calculated. A total 804 readings were performed. For the 4-category classification, the mean κ value for the 2 interobserver readings was 0.52 for the 3D C-arm and 0.46 for CT. For the 2-category classification, the mean κ value for the 2 interobserver readings was 0.80 for the 3D C-arm and 0.66 for CT. The sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative imaging with the 3D C-arm were 70%, 95%, 44%, and 98%, respectively. With respect to screws with perforation ≥4 mm, the sensitivity was 83%. No revision surgery was performed. Intraoperative imaging with a 3D C-arm was reliable for detecting screw misplacement and helpful in decreasing the rate of revision surgery for screw misplacement.

Vietnam and Britain agree to forced return of Vietnamese boat people in Hong Kong.

PubMed

1991-10-31

On 29 October 1991, the Governments of the United Kingdom and Viet Nam reached an Agreement on the return of certain categories of Vietnamese "boat people," i.e., persons who fled from Viet Nam to Hong Kong. Under the Agreement, Vietnamese who arrive in Hong Kong after the date of the Agreement and who do not qualify for refugee status will be returned first. The determination of such status is to occur within six weeks of their arrival. Later, Vietnamese in Hong Kong who have already failed to qualify for refugee status will be returned. The Agreement follows an Agreement earlier in October to return Vietnamese arriving in Hong Kong who are known as "double backers," i.e., persons who had previously voluntarily been repatriated to Viet Nam only to return to Hong Kong.

Comparison of Standardized Clinical Classification with Fundus Photograph Grading for the assessment of Diabetic Retinopathy and Diabetic Macular Edema Severity

PubMed Central

Gangaputra, Sapna; Lovato, James F.; Hubbard, Larry; Davis, Matthew D; Esser, Barbara A; Ambrosius, Walter T.; Chew, Emily Y.; Greven, Craig; Perdue, Letitia H; Wong, Wai T.; Condren, Audree; Wilkinson, Charles P.; Agrón, Elvira; Adler, Sharon; Danis, Ronald P

2013-01-01

Purpose To compare evaluation by clinical examination with image grading at a reading center (RC) for the classification of diabetic retinopathy (DR) and diabetic macular edema (DME). Methods ACCORD and FIND had similar methods of clinical and fundus photograph evaluation. For analysis purposes the photographic grading scales were condensed to correspond to the clinical scales and agreement between clinicians and reading center classification were compared. Results 6902 eyes of ACCORD participants and 3638 eyes of FIND participants were analyzed for agreement (percent, kappa) on DR on a 5 level scale. Exact agreement between clinicians and RC on DR severity category was 69% in ACCORD and 74% in FIND (Kappa 0.42 and 0.65). Sensitivity of the clinical grading to identify presence of mild nonproliferative retinopathy or worse was 0.53 in ACCORD and 0.84 in FIND. Specificities were 0.97 and 0.96, respectively. DME agreement in 6649 eyes of ACCORD participants and 3366 eyes of FIND participants was similar in both studies (Kappa 0.35 and 0.41). Sensitivities of the clinical grading to identify DME were 0.44 and 0.53 and specificities were 0.99 and 0.94, respectively. Conclusion Our results support the use of clinical information for defining broad severity categories, but not for documenting small to moderate changes in DR over time. PMID:23615341

Classification versus inference learning contrasted with real-world categories.

PubMed

Jones, Erin L; Ross, Brian H

2011-07-01

Categories are learned and used in a variety of ways, but the research focus has been on classification learning. Recent work contrasting classification with inference learning of categories found important later differences in category performance. However, theoretical accounts differ on whether this is due to an inherent difference between the tasks or to the implementation decisions. The inherent-difference explanation argues that inference learners focus on the internal structure of the categories--what each category is like--while classification learners focus on diagnostic information to predict category membership. In two experiments, using real-world categories and controlling for earlier methodological differences, inference learners learned more about what each category was like than did classification learners, as evidenced by higher performance on a novel classification test. These results suggest that there is an inherent difference between learning new categories by classifying an item versus inferring a feature.

Autonomous Flight Rules Concept: User Implementation Costs and Strategies

NASA Technical Reports Server (NTRS)

Cotton, William B.; Hilb, Robert

2014-01-01

The costs to implement Autonomous Flight Rules (AFR) were examined for estimates in acquisition, installation, training and operations. The user categories were airlines, fractional operators, general aviation and unmanned aircraft systems. Transition strategies to minimize costs while maximizing operational benefits were also analyzed. The primary cost category was found to be the avionics acquisition. Cost ranges for AFR equipment were given to reflect the uncertainty of the certification level for the equipment and the extent of existing compatible avionics in the aircraft to be modified.

76 FR 34577 - Wassenaar Arrangement 2010 Plenary Agreements Implementation: Commerce Control List, Definitions...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-14

... DEPARTMENT OF COMMERCE Bureau of Industry and Security 15 CFR Parts 740, 743, and 774 [Docket No. 110124056-1301-02] RIN 0694-AF11 Wassenaar Arrangement 2010 Plenary Agreements Implementation: Commerce Control List, Definitions, Reports; Correction AGENCY: Bureau of Industry and Security, Commerce. ACTION...

77 FR 65366 - Interim Procedures for Considering Requests From the Public for Textile and Apparel Safeguard...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

... Promotion Agreement (``U.S.-Colombia TPA''). Title III, Subtitle B, Section 321 through Section 328 of the United States-Colombia Trade Promotion Agreement Implementation Act (``Implementation Act'') [Pub. L. 112... requester showing changes in productivity, utilization of capacity, inventories, exports, wages, employment...

78 FR 31886 - Interim Procedures for Considering Requests From the Public for Textile and Apparel Safeguard...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-28

... Trade Promotion Agreement (``US-Panama TPA''). Title III, Subtitle B, Section 321 through Section 328 of the United States-Panama Trade Promotion Agreement Implementation Act (``Implementation Act'') [Pub. L... changes in productivity, utilization of capacity, inventories, exports, wages, employment, domestic prices...

77 FR 35938 - Proposed Information Collection; Comment Request; Interim Procedures for Considering Requests...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

... United States-Colombia Trade Promotion Agreement (U.S.-Colombia TPA) AGENCY: International Trade...-Colombia Trade Promotion Agreement Implementation Act (the ``Act'') [Pub. L. 112-42] implements the commercial availability provision provided for in Article 3.3 of the United States-Colombia Trade Promotion...

76 FR 213 - National Environmental Policy Act Implementing Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-03

...The U.S. Department of Energy (DOE or the Department) proposes to amend its existing regulations governing compliance with the National Environmental Policy Act (NEPA). The majority of the changes are proposed for the categorical exclusions provisions contained in its NEPA Implementing Procedures, with a small number of related changes proposed for other provisions. These proposed changes are intended to better align the Department's regulations, particularly its categorical exclusions, with DOE's current activities and recent experiences, and to update the provisions with respect to current technologies and regulatory requirements. DOE proposes to establish 20 new categorical exclusions, and to remove two categorical exclusion categories, one environmental assessment (EA) category, and two environmental impact statement (EIS) categories. Other proposed changes modify and clarify DOE's existing provisions.

Comparative study of qualitative and quantitative methods to determine toxicity level of Aspergillus flavus isolates in maize.

PubMed

Shekhar, Meena; Singh, Nirupma; Dutta, Ram; Kumar, Shrvan; Mahajan, Vinay

2017-01-01

An attempt was made to compare between easy and inexpensive qualitative method (ammonia vapour test) and analytical methods (thin layer chromatography and enzyme-linked immunosorbent assay) for identification of aflatoxigenic isolates of Aspergillus flavus in maize. In this comparative study the toxicity level of A. flavus isolates exhibited 100% agreement among ammonia vapour test, ELISA and TLC for highly toxigenic (>2000 ppb) and toxigenic (501-2000 ppb) isolates while 88.5% agreement observed for least toxic (<20 ppb) isolates. In ammonia vapour test 51% of A. flavus isolates showed creamish or no colour change corresponding to least toxic/atoxic (<20ppb) category estimated by ELISA. Similarly 22% highly toxic isolates exhibited plum red colour, 12% moderately toxic indicated pink colour and 10% toxic isolates showed red colour. However, 11.5% isolates were found to be false positive in cream colour category (least toxic) and 28.5% false negatives in pink colour (moderately toxic) category. The isolates from different agroclimatic zones of maize in India showed high variability for aflatoxin B1 (AFB1) production potential ranging from 0.214-8116.61 ppb. Toxigenic potential of Aspergillus flavus isolates in culture was further validated by inoculating maize grain sample with four different isolates with varied toxin producing ability. With good agreement percentage between cultural and analytical methods the study concludes the ammonia vapour test to be easy, inexpensive, reliable and time saving method that can be used for segregating or pre-screening of contaminated samples from bulk food/feed stock.

22 CFR 161.7 - Categories of actions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Foreign Relations DEPARTMENT OF STATE ENVIRONMENTAL PROTECTION REGULATIONS FOR IMPLEMENTATION OF THE NATIONAL ENVIRONMENTAL POLICY ACT (NEPA) NEPA and Departmental Decisionmaking § 161.7 Categories of actions... the quality of the environment in the United States. The need to prepare formal environmental...

Inadequate communication between patients with unruptured cerebral aneurysms and neurosurgeons.

PubMed

Saito, Makoto; Takahashi, Yoshimitsu; Yoshimura, Yayoi; Shima, Ayako; Morita, Akio; Houkin, Kiyohiro; Nakayama, Takeo; Nozaki, Kazuhiko

2012-01-01

Communication between patients with cerebral aneurysms and consulting neurosurgeons remains unstudied in Japan. The present clinical study surveyed patients with unruptured cerebral aneurysms and their neurosurgeons after explanation of the disease and its treatment options and expected outcomes in clinic visits using a one-page written questionnaire about treatment options and decisions given to patients and their neurosurgeons. The numbers of participating patients and neurosurgeons were 42 and 9, respectively, and 42 paired patient-neurosurgeon responses were obtained. Agreement was quite low (κ = 0.17-0.31 for 6-point Likert scale and κ = 0.44-0.67 for 2 category scale) regarding the "best" treatment for each patient as agreed on by the patient and neurosurgeon. Agreement in the understanding of treatment options and general application was unexpectedly low (κ = 0.12 and 0.01 for 6-point Likert scale and κ = not applicable and -0.03, respectively, for 2 category scale). Agreement tended to be higher between experienced neurosurgeons and patients than non-experienced neurosurgeons and patients. Patients estimated much higher risks of stroke or death after surgical intervention (p < 0.001) or no intervention (p = 0.006) compared with the estimates offered by their neurosurgeons.

Characteristics of Fluency and Speech in Two Families With High Incidences of Stuttering.

PubMed

Stager, Sheila V; Freeman, Frances J; Braun, Allen

2015-10-01

This study presents data from 2 families with high incidence of stuttering, comparing methods of phenotype assignment and exploring the presence of other fluency disorders and corresponding speech characteristics. Three methods for assigning phenotype of stuttering were used: self-identification, family identification, and expert identification. Agreement on which individuals were assigned by each of these methods was studied. Multiple measures of fluency and speech production were obtained. Self-reports and descriptions of blocking rather than self-identification as a person who stutters demonstrated the best agreement with expert identification of stuttering. Family identification showed poor agreement with both expert and self-identification of stuttering. Using binary categories of fluent or stuttering, 90% of individuals in 1 family were classified by expert consensus. Only 70% of the other family could be similarly categorized. Experts required 2 other categories, cluttering and other fluency disorders, to fully characterize dysfluency within this family. These 2 families also demonstrated differences in speech production. Some families with high incidence of stuttering may also have high incidence of other fluency disorders and other speech-production difficulties. This finding may have ramifications for genetic studies, including criteria for defining phenotype and collapsing data across multiple families.

RELIABILITY AND VALIDITY OF SUBJECTIVE ASSESSMENT OF LUMBAR LORDOSIS IN CONVENTIONAL RADIOGRAPHY.

PubMed

Ruhinda, E; Byanyima, R K; Mugerwa, H

2014-10-01

Reliability and validity studies of different lumbar curvature analysis and measurement techniques have been documented however there is limited literature on the reliability and validity of subjective visual analysis. Radiological assessment of lumbar lordotic curve aids in early diagnosis of conditions even before neurologic changes set in. To ascertain the level of reliability and validity of subjective assessment of lumbar lordosis in conventional radiography. A blinded, repeated-measures diagnostic test was carried out on lumbar spine x-ray radiographs. Radiology Department at Joint Clinical Research Centre (JCRC), Mengo-Kampala-Uganda. Seventy (70) lateral lumbar x-ray films were used for this study and were obtained from the archive of JCRC radiology department at Butikiro house, Mengo-Kampala. Poor observer agreement, both inter- and intra-observer, with kappa values of 0.16 was found. Inter-observer agreement was poorer than intra-observer agreement. Kappa values significantly rose when the lumbar lordosis was clustered into four categories without grading each abnormality. The results confirm that subjective assessment of lumbar lordosis has low reliability and validity. Film quality has limited influence on the observer reliability. This study further shows that fewer scale categories of lordosis abnormalities produce better observer reliability.

Multidisciplinary Delphi Development of a Scale to Evaluate Team Function in Obstetric Emergencies: The PETRA Scale.

PubMed

Balki, Mrinalini; Hoppe, David; Monks, David; Cooke, Mary Ellen; Sharples, Lynn; Windrim, Rory

2017-06-01

The objective of this study was to develop a new interdisciplinary teamwork scale, the Perinatal Emergency: Team Response Assessment (PETRA), for the management of obstetric crises, through consensus agreement of obstetric caregivers. This prospective study was performed using expert consensus, based on a Delphi method. The study investigators developed a new PETRA tool, specifically related to obstetric crisis management, based on the existing literature and discussions among themselves. The scale was distributed to a selected panel of experts in the field for the Delphi process. After each round of Delphi, every component of the scale was analyzed quantitatively by the percentage of agreement ratings and each comment reviewed by the blinded investigators. The assessment scale was then modified, with components of less than 80% agreement removed from the scale. The process was repeated on three occasions to reach a consensus and final PETRA scale. Fourteen of 24 invited experts participated in the Delphi process. The original PETRA scale included six categories and 48 items, one global scale item, and a 3-point rubric for rating. The overall percentage agreement by experts in the first, second, and third rounds was 95.0%, 93.2%, and 98.5%, respectively. The final scale after the third round of Delphi consisted of the following seven categories: shared mental model, communication, situational awareness, leadership, followership, workload management, and positive/effective behaviours and attitudes. There were 34 individual items within these categories, each with a 5-point rating rubric (1 = unacceptable to 5 = perfect). Using a structured Delphi method, we established the face and content validity of this assessment scale that focuses on important aspects of interdisciplinary teamwork in the management of obstetric crises. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

Validity of "Hi_Science" as instructional media based-android refer to experiential learning model

NASA Astrophysics Data System (ADS)

Qamariah, Jumadi, Senam, Wilujeng, Insih

2017-08-01

Hi_Science is instructional media based-android in learning science on material environmental pollution and global warming. This study is aimed: (a) to show the display of Hi_Science that will be applied in Junior High School, and (b) to describe the validity of Hi_Science. Hi_Science as instructional media created with colaboration of innovative learning model and development of technology at the current time. Learning media selected is based-android and collaborated with experiential learning model as an innovative learning model. Hi_Science had adapted student worksheet by Taufiq (2015). Student worksheet had very good category by two expert lecturers and two science teachers (Taufik, 2015). This student worksheet is refined and redeveloped in android as an instructional media which can be used by students for learning science not only in the classroom, but also at home. Therefore, student worksheet which has become instructional media based-android must be validated again. Hi_Science has been validated by two experts. The validation is based on assessment of meterials aspects and media aspects. The data collection was done by media assessment instrument. The result showed the assessment of material aspects has obtained the average value 4,72 with percentage of agreement 96,47%, that means Hi_Science on the material aspects is in excellent category or very valid category. The assessment of media aspects has obtained the average value 4,53 with percentage of agreement 98,70%, that means Hi_Science on the media aspects is in excellent category or very valid category. It was concluded that Hi_Science as instructional media can be applied in the junior high school.

Validation of a semi-quantitative job exposure matrix at a Söderberg aluminum smelter.

PubMed

Friesen, M C; Demers, P A; Spinelli, J J; Le, N D

2003-08-01

We tested the validity of a job exposure matrix (JEM) for coal tar pitch volatiles (CTPV) at a Söderberg aluminum smelter. The JEM had been developed by a committee of company hygienists and union representatives for an earlier study of cancer incidence and mortality. Our aim was to test the validity and reliability of the expert-based assignments. Personal CTPV exposure measurements (n = 1879) overlapped 11 yr of the JEM. The arithmetic mean was calculated for 35 job/time period combinations (35% of the exposed work history), categorized using the original exposure intervals, and compared with the expert-based assignments. The expert-based and the measurement-based exposure assignments were only moderately correlated (Spearman's rho = 0.42; weighted kappa = 0.39, CI 0.10-0.69). Only 40% of the expert-based medium category assignments were correctly assigned, with better agreement in the low (84%) and high (100%) categories. Pot operation jobs exhibited better agreement (rho = 0.60) than the maintenance and pot shell repair jobs (rho = 0.25). The mid-point value of the medium category was overestimated by 0.3 mg/m(3). The expert-based exposure assignments may be improved by better characterizing the transitions between exposure categories, by accounting for exposure differences between pot lines and by re-examining the category mid-point values used in calculating the cumulative exposure. Lack of historical exposure measurements often requires reliance on expert knowledge to assess exposure levels. Validating the experts' estimates against available exposure measurements may help to identify weaknesses in the exposure assessment where improvements may be possible, as was shown here.

Detection of flow limitation in obstructive sleep apnea with an artificial neural network.

PubMed

Norman, Robert G; Rapoport, David M; Ayappa, Indu

2007-09-01

During sleep, the development of a plateau on the inspiratory airflow/time contour provides a non-invasive indicator of airway collapsibility. Humans recognize this abnormal contour easily, and this study replicates this with an artificial neural network (ANN) using a normalized shape. Five 10 min segments were selected from each of 18 sleep records (respiratory airflow measured with a nasal cannula) with varying degrees of sleep disordered breathing. Each breath was visually scored for shape, and breaths split randomly into a training and test set. Equally spaced, peak amplitude normalized flow values (representing breath shape) formed the only input to a back propagation ANN. Following training, breath-by-breath agreement of the ANN with the manual classification was tabulated for the training and test sets separately. Agreement of the ANN was 89% in the training set and 70.6% in the test set. When the categories of 'probably normal' and 'normal', and 'probably flow limited' and 'flow limited' were combined, the agreement increased to 92.7% and 89.4% respectively, similar to the intra- and inter-rater agreements obtained by a visual classification of these breaths. On a naive dataset, the agreement of the ANN to visual classification was 57.7% overall and 82.4% when the categories were collapsed. A neural network based only on the shape of inspiratory airflow succeeded in classifying breaths as to the presence/absence of flow limitation. This approach could be used to provide a standardized, reproducible and automated means of detecting elevated upper airway resistance.

Thoracic Surgeons' Perception of Frail Behavior in Videos of Standardized Patients

PubMed Central

Ferguson, Mark K.; Thompson, Katherine; Huisingh-Scheetz, Megan; Farnan, Jeanne; Hemmerich, Josh A.; Slawinski, Kris; Acevedo, Julissa; Lee, Sang Mee; Rojnica, Marko; Small, Stephen

2014-01-01

Background Frailty is a predictor of poor outcomes following many types of operations. We measured thoracic surgeons' accuracy in assessing patient frailty using videos of standarized patients demonstrating signs of physical frailty. We compared their performance to that of geriatrics specialists. Methods We developed an anchored scale for rating degree of frailty. Reference categories were assigned to 31 videos of standarized patients trained to exhibit five levels of activity ranging from “vigorous” to “frail.” Following an explanation of frailty, thoracic surgeons and geriatrics specialists rated the videos. We evaluated inter-rater agreement and tested differences between ratings and reference categories. The influences of clinical specialty, clinical experience, and self-rated expertise were examined. Results Inter-rater rank correlation among all participants was high (Kendall's W 0.85) whereas exact agreement (Fleiss' kappa) was only moderate (0.47). Better inter-rater agreement was demonstrated for videos exhibiting extremes of behavior. Exact agreement was better for thoracic surgeons (n = 32) than geriatrics specialists (n = 9; p = 0.045), whereas rank correlation was similar for both groups. More clinical years of experience and self-reported expertise were not associated with better inter-rater agreement. Conclusions Videos of standarized patients exhibiting varying degrees of frailty are rated with internal consistency by thoracic surgeons as accurately as geriatrics specialists when referenced to an anchored scale. Ratings were less consistent for moderate degrees of frailty, suggesting that physicians require training to recognize early frailty. Such videos may be useful in assessing and teaching frailty recognition. PMID:24892734

Development of an observational measure of healthcare worker hand-hygiene behaviour: the hand-hygiene observation tool (HHOT).

PubMed

McAteer, J; Stone, S; Fuller, C; Charlett, A; Cookson, B; Slade, R; Michie, S

2008-03-01

Previous observational measures of healthcare worker (HCW) hand-hygiene behaviour (HHB) fail to provide adequate standard operating procedures (SOPs), accounts of inter-rater agreement testing or evidence of sensitivity to change. This study reports the development of an observational tool in a way that addresses these deficiencies. Observational categories were developed systematically, guided by a clinical guideline, previous measures and pilot hand-hygiene behaviour observations (HHOs). The measure, a simpler version of the Geneva tool, consists of HHOs (before and after low-risk, high-risk or unobserved contact), HHBs (soap, alcohol hand rub, no action, unknown), and type of HCW. Inter-observer agreement for each category was assessed by observation of 298 HHOs and HHBs by two independent observers on acute elderly and intensive care units. Raw agreement (%) and Kappa were 77% and 0.68 for HHB; 83% and 0.77 for HHO; and 90% and 0.77 for HCW. Inter-observer agreement for overall compliance of a group of HCWs was assessed by observation of 1191 HHOs and HHBs by two pairs of independent observers. Overall agreement was good (intraclass correlation coefficient = 0.79). Sensitivity to change was examined by autoregressive time-series modelling of longitudinal observations for 8 months on the intensive therapy unit during an Acinetobacter baumannii outbreak and subsequent strengthening of infection control measures. Sensitivity to change was demonstrated by a rise in compliance from 80 to 98% with an odds ratio of increased compliance of 7.00 (95% confidence interval: 4.02-12.2) P < 0.001.

19 CFR 12.104g - Specific items or categories designated by agreements or emergency actions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... in the listing. State party Cultural Property Decision No. Bolivia Archaeological and Ethnological Material from Bolivia T.D. 01-86 extended by CBP Dec. 06-26 Cambodia Archaeological Material from Cambodia...

Intra- and inter-observer agreement in MRI assessment of rotator cuff healing using the Sugaya classification 10years after surgery.

PubMed

Niglis, L; Collin, P; Dosch, J-C; Meyer, N; Kempf, J-F

2017-10-01

The long-term outcomes of rotator cuff repair are unclear. Recurrent tears are common, although their reported frequency varies depending on the type and interpretation challenges of the imaging method used. The primary objective of this study was to assess the intra- and inter-observer reproducibility of the MRI assessment of rotator cuff repair using the Sugaya classification 10years after surgery. The secondary objective was to determine whether poor reproducibility, if found, could be improved by using a simplified yet clinically relevant classification. Our hypothesis was that reproducibility was limited but could be improved by simplifying the classification. In a retrospective study, we assessed intra- and inter-observer agreement in interpreting 49 magnetic resonance imaging (MRI) scans performed 10years after rotator cuff repair. These 49 scans were taken at random among 609 cases that underwent re-evaluation, with imaging, for the 2015 SoFCOT symposium on 10-year and 20-year clinical and anatomical outcomes of rotator cuff repair for full-thickness tears. Each of three observers read each of the 49 scans on two separate occasions. At each reading, they assessed the supra-spinatus tendon according to the Sugaya classification in five types. Intra-observer agreement for the Sugaya type was substantial (κ=0.64) but inter-observer agreement was only fair (κ=0.39). Agreement improved when the five Sugaya types were collapsed into two categories (1-2-3 and 4-5) (intra-observer κ=0.74 and inter-observer κ=0.68). Using the Sugaya classification to assess post-operative rotator cuff healing was associated with substantial intra-observer and fair inter-observer agreement. A simpler classification into two categories improved agreement while remaining clinically relevant. II, prospective randomised low-power study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

How to calculate the annual costs of NGO-implemented programmes to support orphans and vulnerable children: a six-step approach

PubMed Central

2011-01-01

Background Information on the costs of implementing programmes designed to provide support of orphans and vulnerable children (OVC) in sub-Saharan Africa and elsewhere is increasingly being requested by donors for programme evaluation purposes. To date, little information exists to document the costs and structure of costs of OVC programmes as actually implemented "on the ground" by local non-governmental organizations (NGOs). This analysis provides a practical, six-step approach that NGOs can incorporate into routine operations to evaluate their costs of implementing their OVC programmes annually. This approach is applied to the Community-Based Care for Orphans and Vulnerable Children (CBCO) Program implemented by BIDII (a Kenyan NGO) in Eastern Province of Kenya. Methods and results The costing methodology involves the following six steps: accessing and organizing the NGO's annual financial report into logical sub-categories; reorganizing the sub-categories into input cost categories to create a financial cost profile; estimating the annual equivalent payment for programme equipment; documenting donations to the NGO for programme implementation; including a portion of NGO organizational costs not attributed to specific programmes; and including the results of Steps 3-5 into an expanded cost profile. Detailed results are provided for the CBCO programme. Conclusions This paper shows through a concrete example how NGOs implementing OVC programmes (and other public health programmes) can organize themselves for data collection and documentation prospectively during the implementation of their OVC programmes so that costing analyses become routine practice to inform programme implementation rather than a painful and flawed retrospective activity. Such information is required if the costs and outcomes achieved by OVC programmes will ever be clearly documented and compared across OVC programmes and other types of programmes (prevention, treatment, etc.). PMID:22182588

How to calculate the annual costs of NGO-implemented programmes to support orphans and vulnerable children: a six-step approach.

PubMed

Larson, Bruce A; Wambua, Nancy

2011-12-19

Information on the costs of implementing programmes designed to provide support of orphans and vulnerable children (OVC) in sub-Saharan Africa and elsewhere is increasingly being requested by donors for programme evaluation purposes. To date, little information exists to document the costs and structure of costs of OVC programmes as actually implemented "on the ground" by local non-governmental organizations (NGOs). This analysis provides a practical, six-step approach that NGOs can incorporate into routine operations to evaluate their costs of implementing their OVC programmes annually. This approach is applied to the Community-Based Care for Orphans and Vulnerable Children (CBCO) Program implemented by BIDII (a Kenyan NGO) in Eastern Province of Kenya. The costing methodology involves the following six steps: accessing and organizing the NGO's annual financial report into logical sub-categories; reorganizing the sub-categories into input cost categories to create a financial cost profile; estimating the annual equivalent payment for programme equipment; documenting donations to the NGO for programme implementation; including a portion of NGO organizational costs not attributed to specific programmes; and including the results of Steps 3-5 into an expanded cost profile. Detailed results are provided for the CBCO programme. This paper shows through a concrete example how NGOs implementing OVC programmes (and other public health programmes) can organize themselves for data collection and documentation prospectively during the implementation of their OVC programmes so that costing analyses become routine practice to inform programme implementation rather than a painful and flawed retrospective activity. Such information is required if the costs and outcomes achieved by OVC programmes will ever be clearly documented and compared across OVC programmes and other types of programmes (prevention, treatment, etc.).

Evaluation of Optical Disk Jukebox Software.

ERIC Educational Resources Information Center

Ranade, Sanjay; Yee, Fonald

1989-01-01

Discusses software that is used to drive and access optical disk jukeboxes, which are used for data storage. Categories of the software are described, user categories are explained, the design of implementation approaches is discussed, and representative software products are reviewed. (eight references) (LRW)

Estimation of rates-across-sites distributions in phylogenetic substitution models.

PubMed

Susko, Edward; Field, Chris; Blouin, Christian; Roger, Andrew J

2003-10-01

Previous work has shown that it is often essential to account for the variation in rates at different sites in phylogenetic models in order to avoid phylogenetic artifacts such as long branch attraction. In most current models, the gamma distribution is used for the rates-across-sites distributions and is implemented as an equal-probability discrete gamma. In this article, we introduce discrete distribution estimates with large numbers of equally spaced rate categories allowing us to investigate the appropriateness of the gamma model. With large numbers of rate categories, these discrete estimates are flexible enough to approximate the shape of almost any distribution. Likelihood ratio statistical tests and a nonparametric bootstrap confidence-bound estimation procedure based on the discrete estimates are presented that can be used to test the fit of a parametric family. We applied the methodology to several different protein data sets, and found that although the gamma model often provides a good parametric model for this type of data, rate estimates from an equal-probability discrete gamma model with a small number of categories will tend to underestimate the largest rates. In cases when the gamma model assumption is in doubt, rate estimates coming from the discrete rate distribution estimate with a large number of rate categories provide a robust alternative to gamma estimates. An alternative implementation of the gamma distribution is proposed that, for equal numbers of rate categories, is computationally more efficient during optimization than the standard gamma implementation and can provide more accurate estimates of site rates.

78 FR 34402 - Final Environmental Impact Statement, Habitat Conservation Plan, and Implementing Agreement...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-07

...-FF03E15000] Final Environmental Impact Statement, Habitat Conservation Plan, and Implementing Agreement, Ni... Environmental Impact Statement (FEIS) associated with an application received from NiSource Inc. (hereafter ``Ni... Endangered Species Act of 1973, as amended (ESA). If issued, the ITP would authorize NiSource to take 10...

76 FR 1137 - Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-07

... COMMITTEE FOR THE IMPLEMENTATION OF TEXTILE AGREEMENTS Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY: Committee for the Implementation of Textile Agreements (CITA). ACTION: Amending the 12-Month Cap...

76 FR 66915 - Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-28

... COMMITTEE FOR THE IMPLEMENTATION OF TEXTILE AGREEMENTS Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY: Committee for the Implementation of Textile Agreements (CITA). ACTION: Amending the 12-Month Cap...

77 FR 59913 - Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-01

... COMMITTEE FOR THE IMPLEMENTATION OF TEXTILE AGREEMENTS Amendment of Limitation of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY: Committee for the Implementation of Textile Agreements (CITA). ACTION: Amending the 12-month cap...

Implementation agreement between the Washington State Department of Ecology and the Washington State Department of Transportation regarding the use of water quality modification general order

DOT National Transportation Integrated Search

1997-04-01

This implementation agreement was adopted by the Washington State Department of Ecology and the Washington State Department of Transportation. It requires that the agencies work together in dealing with short term modifications of water quality requi...

Implementation of a Posted Schedule to Increase Class-Wide Interobserver Agreement Assessment

ERIC Educational Resources Information Center

Doucette, Stefanie; DiGennaro Reed, Florence D.; Reed, Derek D.; Maguire, Helena; Marquardt, Heidi

2012-01-01

The present study investigated the impact of an antecedent intervention in the form of a daily posted schedule on the interobserver agreement (IOA) assessment of educational goals implemented within a classroom at a private school serving individuals with disabilities. During baseline, the percentage of academic goals with interobserver agreement…

Notice of EPA Implementation of the United States Government Policy on Institutional Oversight of Life Sciences Dual Use Research of Concern for Assistance Agreements

EPA Pesticide Factsheets

The purpose of this Notice is to alert institutions of the iDURC Policy’s issuance and to describe EPA’s intended implementation of the iDURC Policy regarding EPA’s research grants and cooperative agreements.

78 FR 48142 - Proposed Information Collection; Comment Request; Procedures for Considering Requests and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-07

... production of the like or directly competitive article(s) of U.S. origin; (4) imports from Peru as a... Provision of the United States-Peru Free Trade Agreement AGENCY: International Trade Administration (ITA... 328 of the United States-Peru Free Trade Agreement Implementation Act (the ``Act'') implements the...

Notification: Northwest Indian Fisheries Commission’s Puget Sound Protection and Restoration Implementation cooperative agreements PA00J32201 and PA00J91201

EPA Pesticide Factsheets

May 27, 2016. The EPA OIG plans to begin preliminary research on the Northwest Indian Fisheries Commission’s (NWIFC’s) Puget Sound Protection and Restoration Implementation cooperative agreements PA00J32201 and PA00J91201.

U.S.-CHINA RADIOLOGICAL SOURCE SECURITY PROJECT: CONTINUING AND EXPANDING BILATERAL COOPERATION

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

Zhu, Zhixuan; Zhou, Qifu; Yang, Yaoyun

2009-10-07

The successful radiological security cooperation between the U.S. and China to secure at-risk sites near venues of the 2008 Beijing Summer Olympics has led to an expanded bilateral nonproliferation cooperation scope. The U.S. Department of Energy’s National Nuclear Security Administration, the Chinese Atomic Energy Authority and the China Ministry of Environmental Protection are continuing joint efforts to secure radiological sources throughout China under the U.S.-China Peaceful Uses of Nuclear Technology (PUNT) Agreement. Joint cooperation activities include physical security upgrades of sites with International Atomic Energy Agency (IAEA) Category 1 radiological sources, packaging, recovery, and storage of high activity transuranic andmore » beta gamma sources, and secure transportation practices for the movement of recovered sources. Expansion of cooperation into numerous provinces within China includes the use of integrated training workshops that will demonstrate methodologies and best practices between U.S. and Chinese radiological source security and recovery experts. The fiscal year 2009 expanded scope of cooperation will be conducted similar to the 2008 Olympic cooperation with the Global Threat Reduction Initiative taking the lead for the U.S., PUNT being the umbrella agreement, and Los Alamos, Sandia, and Oak Ridge National Laboratories operating as technical working groups. This paper outlines the accomplishments of the joint implementation and training efforts to date and discusses the possible impact on future U.S./China cooperation.« less

48 CFR 235.017-1 - Sponsoring agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF DEFENSE SPECIAL CATEGORIES OF CONTRACTING RESEARCH AND DEVELOPMENT CONTRACTING 235.017-1... Institute of Technology, and Software Engineering Institute operated by Carnegie Mellon) may respond to solicitations and announcements for programs which promote research, development, demonstration, or transfer of...

48 CFR 235.017-1 - Sponsoring agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF DEFENSE SPECIAL CATEGORIES OF CONTRACTING RESEARCH AND DEVELOPMENT CONTRACTING 235.017-1... Institute of Technology, and Software Engineering Institute operated by Carnegie Mellon) may respond to solicitations and announcements for programs which promote research, development, demonstration, or transfer of...

Stakeholders' contributions to tailored implementation programs: an observational study of group interview methods.

PubMed

Huntink, Elke; van Lieshout, Jan; Aakhus, Eivind; Baker, Richard; Flottorp, Signe; Godycki-Cwirko, Maciek; Jäger, Cornelia; Kowalczyk, Anna; Szecsenyi, Joachim; Wensing, Michel

2014-12-06

Tailored strategies to implement evidence-based practice can be generated in several ways. In this study, we explored the usefulness of group interviews for generating these strategies, focused on improving healthcare for patients with chronic diseases. Participants included at least four categories of stakeholders (researchers, quality officers, health professionals, and external stakeholders) in five countries. Interviews comprised brainstorming followed by a structured interview and focused on different chronic conditions in each country. We compared the numbers and types of strategies between stakeholder categories and between interview phases. We also determined which strategies were actually used in tailored intervention programs. In total, 127 individuals participated in 25 group interviews across five countries. Brainstorming generated 8 to 120 strategies per group; structured interviews added 0 to 55 strategies. Healthcare professionals and researchers provided the largest numbers of strategies. The type of strategies for improving healthcare practice did not differ systematically between stakeholder groups in four of the five countries. In three out of five countries, all components of the chosen intervention programs were mentioned by the group of researchers. Group interviews with different stakeholder categories produced many strategies for tailored implementation of evidence-based practice, of which the content was largely similar across stakeholder categories.

Proposed Approval of California Air Plan Revision; Yolo-Solano Air Quality Management District; VOC Source Categories; Negative Declarations

EPA Pesticide Factsheets

EPA is taking final action to approve a revision to the YSAQMD portion of the California SIP concerning YSAQMD negative declarations for several VOC source categories included in its RACT State Implementation Plan Analysis.

Residual Risk Assessment for the Ferroalloys Source Category in Support of the September Supplemental Proposal

EPA Pesticide Factsheets

This document contains the methods and the results of baseline risk assessments (i.e., after the implementation of the MACT standard) and the results of the post-control scenario risk assessment performed for the ferroalloys source category.

42 CFR 137.362 - May construction project agreements be amended?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May construction project agreements be amended? 137... of the Secretary in Establishing and Implementing Construction Project Agreements § 137.362 May construction project agreements be amended? Yes, the Self-Governance Tribe, at its discretion, may request the...

The Implementation of Managed Entry Agreements in Central and Eastern Europe: Findings and Implications.

PubMed

Ferrario, Alessandra; Arāja, Diāna; Bochenek, Tomasz; Čatić, Tarik; Dankó, Dávid; Dimitrova, Maria; Fürst, Jurij; Greičiūtė-Kuprijanov, Ieva; Hoxha, Iris; Jakupi, Arianit; Laidmäe, Erki; Löblová, Olga; Mardare, Ileana; Markovic-Pekovic, Vanda; Meshkov, Dmitry; Novakovic, Tanja; Petrova, Guenka; Pomorski, Maciej; Tomek, Dominik; Voncina, Luka; Haycox, Alan; Kanavos, Panos; Vella Bonanno, Patricia; Godman, Brian

2017-12-01

Managed entry agreements (MEAs) are a set of instruments to facilitate access to new medicines. This study surveyed the implementation of MEAs in Central and Eastern Europe (CEE) where limited comparative information is currently available. We conducted a survey on the implementation of MEAs in CEE between January and March 2017. Sixteen countries participated in this study. Across five countries with available data on the number of different MEA instruments implemented, the most common MEAs implemented were confidential discounts (n = 495, 73%), followed by paybacks (n = 92, 14%), price-volume agreements (n = 37, 5%), free doses (n = 25, 4%), bundle and other agreements (n = 19, 3%), and payment by result (n = 10, >1%). Across seven countries with data on MEAs by therapeutic group, the highest number of brand names associated with one or more MEA instruments belonged to the Anatomical Therapeutic Chemical (ATC)-L group, antineoplastic and immunomodulating agents (n = 201, 31%). The second most frequent therapeutic group for MEA implementation was ATC-A, alimentary tract and metabolism (n = 87, 13%), followed by medicines for neurological conditions (n = 83, 13%). Experience in implementing MEAs varied substantially across the region and there is considerable scope for greater transparency, sharing experiences and mutual learning. European citizens, authorities and industry should ask themselves whether, within publicly funded health systems, confidential discounts can still be tolerated, particularly when it is not clear which country and party they are really benefiting. Furthermore, if MEAs are to improve access, countries should establish clear objectives for their implementation and a monitoring framework to measure their performance, as well as the burden of implementation.

Evaluation of Automated Fracture Risk Assessment Based on the Canadian Association of Radiologists and Osteoporosis Canada Assessment Tool.

PubMed

Allin, Sonya; Bleakney, Robert; Zhang, Julie; Munce, Sarah; Cheung, Angela M; Jaglal, Susan

2016-01-01

Fracture risk assessments are not always clearly communicated on bone mineral density (BMD) reports; evidence suggests that structured reporting (SR) tools may improve report clarity. The aim of this study is to compare fracture risk assessments automatically assigned by SR software in accordance with Canadian Association of Radiologists and Osteoporosis Canada (CAROC) recommendations to assessments from experts on narrative BMD reports. Charts for 500 adult patients who recently received a BMD exam were sampled from across University of Toronto's Joint Department of Medical Imaging. BMD measures and clinical details were manually abstracted from charts and were used to create structured reports with assessments generated by a software implementation of CAROC recommendations. CAROC calculations were statistically compared to experts' original assessments using percentage agreement (PA) and Krippendorff's alpha. Canadian FRAX calculations were also compared to experts', where possible. A total of 25 (5.0%) reported assessments did not conform to categorizations recommended by Canadian guidelines. Across the remainder, the Krippendorff's alpha relating software assigned assessments to physicians was high at 0.918; PA was 94.3%. Lower agreement was associated with reports for patients with documented modifying factors (alpha = 0.860, PA = 90.2%). Similar patterns of agreement related expert assessments to FRAX calculations, although statistics of agreement were lower. Categories of disagreement were defined by (1) gray areas in current guidelines, (2) margins of assessment categorizations, (3) dictation/transcription errors, (4) patients on low doses of steroids, and (5) ambiguous documentation of modifying factors. Results suggest that SR software can produce fracture risk assessments that agree with experts on most routine, adult BMD exams. Results also highlight situations where experts tend to diverge from guidelines and illustrate the potential for SR software to (1) reduce variability in, (2) ameliorate errors in, and (3) improve clarity of routine adult BMD exam reports. Copyright © 2016 International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

A qualitative study identifying the cost categories associated with electronic health record implementation in the UK

PubMed Central

Slight, Sarah P; Quinn, Casey; Avery, Anthony J; Bates, David W; Sheikh, Aziz

2014-01-01

Objective We conducted a prospective evaluation of different forms of electronic health record (EHR) systems to better understand the costs incurred during implementation and the factors that can influence these costs. Methods We selected a range of diverse organizations across three different geographical areas in England that were at different stages of implementing three centrally procured applications, that is, iSOFT's Lorenzo Regional Care, Cerner's Millennium, and CSE's RiO. 41 semi-structured interviews were conducted with hospital staff, members of the implementation team, and those involved in the implementation at a national level. Results Four main overarching cost categories were identified: infrastructure (eg, hardware and software), personnel (eg, training team), estates/facilities (eg, space), and other (eg, training materials). Many factors were felt to impact on these costs, with different hospitals choosing varying amounts and types of infrastructure, diverse training approaches for staff, and different software applications to integrate with the new system. Conclusions Improving the quality and safety of patient care through EHR adoption is a priority area for UK and US governments and policy makers worldwide. With cost considered one of the most significant barriers, it is important for hospitals and governments to be clear from the outset of the major cost categories involved and the factors that may impact on these costs. Failure to adequately train staff or to follow key steps in implementation has preceded many of the failures in this domain, which can create new safety hazards. PMID:24523391

Interobserver variation in CD30 immunohistochemistry interpretation; consequences for patient selection for targeted treatment.

PubMed

Koens, Lianne; van de Ven, Peter M; Hijmering, Nathalie J; Kersten, Marie José; Diepstra, Arjan; Chamuleau, Martine; de Jong, Daphne

2018-05-14

CD30 immunohistochemistry (IHC) in malignant lymphoma is used for selection of patients in clinical trials using brentuximab vedotin, an antibody drug-conjugate targeting the CD30 molecule. For reliable implementation in daily practice and meaningful selection of patients for clinical trials, information on technical variation and interobserver reproducibility of CD30 IHC staining is required. We conducted a 3-round reproducibility assessment of CD30 scoring for categorized frequency and intensity, including a technical validation, a "live polling" pre- and post-instruction scoring round, and a web-based round including individual scoring with additional IHC information to mimic daily diagnostic practice. Agreement in all three scoring rounds was poor to fair (κ=0,12 to 0,35 for CD30 positive tumor cell percentage, and κ=0,16 to 0,41 for staining intensity), even when allowing for one category of freedom in percentage of tumor cell positivity (κ=0,30 to 0,61). The first round with CD30 staining performed in 5 independent laboratories showed objective differences in staining intensity. In the second round, about half of the pathologists changed their opinion on CD30 frequency after a discussion on potential pitfalls, highlighting hesitancy in decision-making. Using fictional cut-off points for percentage of tumor cell positivity, agreement was still suboptimal (κ=0,35 to 0,60). Lack of agreement in cases with heterogeneous expression is shown to influence patient eligibility for treatment with brentuximab vedotin both in clinical practice and within the context of clinical trials, and limits the potential predictive value of the relative frequency of CD30 positive neoplastic cells for clinical response. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases

PubMed Central

Fathelrahman, Ahmed I

2009-01-01

Background The main objective of the present study was to evaluate the agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases. Methods Cross-sectional sample of 100 poisoning cases consecutively admitted to the Hospital Pulau Pinang, Malaysia during the period from September 2003 to February 2004 were studied. Data on health and socioeconomic problems were collected both by self-administered questionnaire and from medical records. Agreement between the two sets of data was assessed by calculating the concordance rate, Kappa (k) and PABAK. McNemar statistic was used to test differences between categories. Results Data collected by questionnaire and medical records showed excellent agreement on the "marital status"; good agreements on "chronic illness", "psychiatric illness", and "previous history of poisoning"; and fair agreements on "at least one health problem", and "boy-girl friends problem". PABAK values suggest better agreements' measures. Conclusion There were excellent to good agreements between questionnaire and medical records on the marital status and most of the health problems and fair to poor agreements on the majority of socioeconomic problems. The implications of those findings were discussed. PMID:19751526

Alternative tense and agreement morpheme measures for assessing grammatical deficits during the preschool period.

PubMed

Gladfelter, Allison; Leonard, Laurence B

2013-04-01

P. A. Hadley and H. Short (2005) developed a set of measures designed to assess the emerging diversity and productivity of tense and agreement (T/A) morpheme use by 2-year-olds. The authors extended 2 of these measures to the preschool years to evaluate their utility in distinguishing children with specific language impairment (SLI) from their typically developing (TD) peers. Spontaneous speech samples from 55 children (25 with SLI, 30 TD) at 2 different age levels (4;0-4;6 [years;months] and 5;0-5;6) were analyzed, using a traditional T/A morphology composite that assessed accuracy, and the Hadley and Short measures of Tense Marker Total (assessing diversity of T/A morpheme use) and Productivity Score (assessing productivity of major T/A categories). All 3 measures showed acceptable levels of sensitivity and specificity. In addition, similar differences in levels of productivity across T/A categories were seen in the TD and SLI groups. The Tense Marker Total and Productivity Score measures seem to have considerable utility for preschool-age children, in that they provide information about specific T/A morphemes and major T/A categories that are not distinguished using the traditional composite measure. The findings are discussed within the framework of the gradual morphosyntactic learning account.

Implementing the Framework Agreement in a Small HEI: From Principles to Practice

ERIC Educational Resources Information Center

Barber, David; Clews, Joy; Meeson, Graham; Rose, Ann; Taylor, Claire

2008-01-01

At the time of writing, UK Higher Education Institutions (HEIs) have either completed, or are part way through, implementation of the Framework Agreement (JNCHES 2003). This process was born out of the recommendations of the National Committee of Inquiry into Higher Education (1997) developed by Bett in his report two years later (Bett 1999). …

75 FR 68153 - To Adjust the Rules of Origin Under the United States-Bahrain Free Trade Agreement, Implement...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-04

... Part IV The President Proclamation 8596--To Adjust the Rules of Origin Under the United States... Adjust the Rules of Origin Under the United States-Bahrain Free Trade Agreement, Implement Modifications... the HTS the schedule of duty reductions and rules of origin necessary or appropriate to carry out the...

19 CFR 12.104g - Specific items or categories designated by agreements or emergency actions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 15th century A.D CBP Dec. 07-52. El Salvador Archaeological material representing Prehispanic cultures of El Salvador T.D. 95-20 extended by CBP Dec. 10-01 Guatemala Archaeological material from sites in...

Mental Health Risk Adjustment with Clinical Categories and Machine Learning.

PubMed

Shrestha, Akritee; Bergquist, Savannah; Montz, Ellen; Rose, Sherri

2017-12-15

To propose nonparametric ensemble machine learning for mental health and substance use disorders (MHSUD) spending risk adjustment formulas, including considering Clinical Classification Software (CCS) categories as diagnostic covariates over the commonly used Hierarchical Condition Category (HCC) system. 2012-2013 Truven MarketScan database. We implement 21 algorithms to predict MHSUD spending, as well as a weighted combination of these algorithms called super learning. The algorithm collection included seven unique algorithms that were supplied with three differing sets of MHSUD-related predictors alongside demographic covariates: HCC, CCS, and HCC + CCS diagnostic variables. Performance was evaluated based on cross-validated R 2 and predictive ratios. Results show that super learning had the best performance based on both metrics. The top single algorithm was random forests, which improved on ordinary least squares regression by 10 percent with respect to relative efficiency. CCS categories-based formulas were generally more predictive of MHSUD spending compared to HCC-based formulas. Literature supports the potential benefit of implementing a separate MHSUD spending risk adjustment formula. Our results suggest there is an incentive to explore machine learning for MHSUD-specific risk adjustment, as well as considering CCS categories over HCCs. © Health Research and Educational Trust.

10 CFR 600.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) ASSISTANCE REGULATIONS FINANCIAL ASSISTANCE RULES General § 600.1 Purpose. This part implements... procedures applicable to the award and administration of grants, cooperative agreements, and technology investment agreements. The specific guidance for technology investment agreements is contained in part 603...

Power Purchase Agreements | Climate Neutral Research Campuses | NREL

Science.gov Websites

. Examples of how some research campuses have used PPAs are provided below. Power Purchase Agreements , primarily to implement on-site energy installations. The owner, in this case a research campus, is typically Power Purchase Agreements Research campuses can use power purchase agreements (PPAs), such as

A Bulk Microphysics Parameterization with Multiple Ice Precipitation Categories.

NASA Astrophysics Data System (ADS)

Straka, Jerry M.; Mansell, Edward R.

2005-04-01

A single-moment bulk microphysics scheme with multiple ice precipitation categories is described. It has 2 liquid hydrometeor categories (cloud droplets and rain) and 10 ice categories that are characterized by habit, size, and density—two ice crystal habits (column and plate), rimed cloud ice, snow (ice crystal aggregates), three categories of graupel with different densities and intercepts, frozen drops, small hail, and large hail. The concept of riming history is implemented for conversions among the graupel and frozen drops categories. The multiple precipitation ice categories allow a range of particle densities and fall velocities for simulating a variety of convective storms with minimal parameter tuning. The scheme is applied to two cases—an idealized continental multicell storm that demonstrates the ice precipitation process, and a small Florida maritime storm in which the warm rain process is important.

Statistical Learning of Phonetic Categories: Insights from a Computational Approach

ERIC Educational Resources Information Center

McMurray, Bob; Aslin, Richard N.; Toscano, Joseph C.

2009-01-01

Recent evidence (Maye, Werker & Gerken, 2002) suggests that statistical learning may be an important mechanism for the acquisition of phonetic categories in the infant's native language. We examined the sufficiency of this hypothesis and its implications for development by implementing a statistical learning mechanism in a computational model…

25 CFR 224.83 - What must a tribe do after executing a lease or business agreement, or granting a right-of-way?

Code of Federal Regulations, 2010 CFR

2010-04-01

... THE INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT AND SELF DETERMINATION ACT Implementation of Tribal Energy Resource Agreements Leases, Business...

25 CFR 224.89 - What procedures will the Secretary use to enforce leases, business agreements, or rights-of-way?

Code of Federal Regulations, 2011 CFR

2011-04-01

... OF THE INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT AND SELF DETERMINATION ACT Implementation of Tribal Energy Resource Agreements Violation Or Breach...

25 CFR 224.83 - What must a tribe do after executing a lease or business agreement, or granting a right-of-way?

Code of Federal Regulations, 2011 CFR

2011-04-01

... THE INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT AND SELF DETERMINATION ACT Implementation of Tribal Energy Resource Agreements Leases, Business...

25 CFR 224.89 - What procedures will the Secretary use to enforce leases, business agreements, or rights-of-way?

Code of Federal Regulations, 2010 CFR

2010-04-01

... OF THE INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT AND SELF DETERMINATION ACT Implementation of Tribal Energy Resource Agreements Violation Or Breach...

7 CFR 251.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... following categories: (i) Emergency feeding organizations (including food banks, food pantries and soup... of food or edible commodities, or the products of food or edible commodities, to food pantries, soup... into an agreement with the United States Department of Agriculture under § 251.2(c). (j) Soup kitchen...

Factors Determining the Inter-observer Variability and Diagnostic Accuracy of High-resolution Manometry for Esophageal Motility Disorders.

PubMed

Kim, Ji Hyun; Kim, Sung Eun; Cho, Yu Kyung; Lim, Chul-Hyun; Park, Moo In; Hwang, Jin Won; Jang, Jae-Sik; Oh, Minkyung

2018-01-30

Although high-resolution manometry (HRM) has the advantage of visual intuitiveness, its diagnostic validity remains under debate. The aim of this study was to evaluate the diagnostic accuracy of HRM for esophageal motility disorders. Six staff members and 8 trainees were recruited for the study. In total, 40 patients enrolled in manometry studies at 3 institutes were selected. Captured images of 10 representative swallows and a single swallow in analyzing mode in both high-resolution pressure topography (HRPT) and conventional line tracing formats were provided with calculated metrics. Assessments of esophageal motility disorders showed fair agreement for HRPT and moderate agreement for conventional line tracing (κ = 0.40 and 0.58, respectively). With the HRPT format, the k value was higher in category A (esophagogastric junction [EGJ] relaxation abnormality) than in categories B (major body peristalsis abnormalities with intact EGJ relaxation) and C (minor body peristalsis abnormalities or normal body peristalsis with intact EGJ relaxation). The overall exact diagnostic accuracy for the HRPT format was 58.8% and rater's position was an independent factor for exact diagnostic accuracy. The diagnostic accuracy for major disorders was 63.4% with the HRPT format. The frequency of major discrepancies was higher for category B disorders than for category A disorders (38.4% vs 15.4%; P < 0.001). The interpreter's experience significantly affected the exact diagnostic accuracy of HRM for esophageal motility disorders. The diagnostic accuracy for major disorders was higher for achalasia than distal esophageal spasm and jackhammer esophagus.

Theoretical studies of the transport properties in compound semiconductors

NASA Technical Reports Server (NTRS)

Segall, Benjamin

1994-01-01

This final report is an overview of the work done on Cooperative Agreement NCC 3-55 with the Solid State Technology Branch of the NASA-Lewis Research Center (LeRC). Over the period of time that the agreement was in effect, the principal investigator and, in the last three years, the co-principal investigator worked on a significant number of projects and interacted with members of the Solid State Technology (SST) branch in a number of different ways. For the purpose of this report, these efforts will be divided into five categories: 1) work directly with experimental electrical transport studies conducted by members of the SST branch; 2) theoretical work on electrical transport in compound semiconductors; 3) electronic structure calculations which are relevant to the electrical transport in polytypes of SiC and SiC-AlN alloys; 4) the electronic structure calculations of polar interfaces; and 5) consultative and supportive activities related to experiments and other studies carried out by SST branch members. Work in these categories is briefly discussed.

The neural basis for category-specific knowledge: an fMRI study.

PubMed

Grossman, Murray; Koenig, Phyllis; DeVita, Chris; Glosser, Guila; Alsop, David; Detre, John; Gee, James

2002-04-01

Functional neuroimaging studies of healthy adults have associated different categories of knowledge with distinct activation patterns. The basis for these recruitment patterns has been controversial, due in part to the limited range of categories that has been studied. We used fMRI to monitor regional cortical recruitment patterns while subjects were exposed to printed names of Animals, Implements, and Abstract nouns. Both Implements and Abstract nouns were related to recruitment of left posterolateral temporal cortex and left prefrontal cortex, and Abstract nouns additionally recruited posterolateral temporal and prefrontal regions of the right hemisphere. Animals were associated with activation of ventral-medial occipital cortex in the left hemisphere at a level that approaches significance. These findings are not consistent with the "sensory-motor" model proposed to explain the neural representation of word knowledge. We suggest instead a neural model of semantic memory that reflects the processes common to understanding Implements and Abstract nouns and a selective sensitivity, possibly evolving from adaptive pressures, to the overlapping, intercorrelated visual characteristics of Animals. (C)2002 Elsevier Science (USA).

The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons.

PubMed

Joseph, Bellal; Friese, Randall S; Sadoun, Moutamn; Aziz, Hassan; Kulvatunyou, Narong; Pandit, Viraj; Wynne, Julie; Tang, Andrew; O'Keeffe, Terence; Rhee, Peter

2014-04-01

It is becoming a standard practice that any "positive" identification of a radiographic intracranial injury requires transfer of the patient to a trauma center for observation and repeat head computed tomography (RHCT). The purpose of this study was to define guidelines-based on each patient's history, physical examination, and initial head CT findings-regarding which patients require a period of observation, RHCT, or neurosurgical consultation. In our retrospective cohort analysis, we reviewed the records of 3,803 blunt traumatic brain injury patients during a 4-year period. We classified patients according to neurologic examination results, use of intoxicants, anticoagulation status, and initial head CT findings. We then developed brain injury guidelines (BIG) based on the individual patient's need for observation or hospitalization, RHCT, or neurosurgical consultation. A total of 1,232 patients had an abnormal head CT finding. In the BIG 1 category, no patients worsened clinically or radiographically or required any intervention. BIG 2 category had radiographic worsening in 2.6% of the patients. All patients who required neurosurgical intervention (13%) were in BIG 3. There was excellent agreement between assigned BIG and verified BIG. κ statistic is equal to 0.98. We have proposed BIG based on patient's history, neurologic examination, and findings of initial head CT scan. These guidelines must be used as supplement to good clinical examination while managing patients with traumatic brain injury. Prospective validation of the BIG is warranted before its widespread implementation. Epidemiologic study, level III.

Characteristics of Fluency and Speech in Two Families With High Incidences of Stuttering

PubMed Central

Freeman, Frances J.; Braun, Allen

2015-01-01

Purpose This study presents data from 2 families with high incidence of stuttering, comparing methods of phenotype assignment and exploring the presence of other fluency disorders and corresponding speech characteristics. Method Three methods for assigning phenotype of stuttering were used: self-identification, family identification, and expert identification. Agreement on which individuals were assigned by each of these methods was studied. Multiple measures of fluency and speech production were obtained. Results Self-reports and descriptions of blocking rather than self-identification as a person who stutters demonstrated the best agreement with expert identification of stuttering. Family identification showed poor agreement with both expert and self-identification of stuttering. Using binary categories of fluent or stuttering, 90% of individuals in 1 family were classified by expert consensus. Only 70% of the other family could be similarly categorized. Experts required 2 other categories, cluttering and other fluency disorders, to fully characterize dysfluency within this family. These 2 families also demonstrated differences in speech production. Conclusion Some families with high incidence of stuttering may also have high incidence of other fluency disorders and other speech-production difficulties. This finding may have ramifications for genetic studies, including criteria for defining phenotype and collapsing data across multiple families. PMID:26126023

A Delphi survey to determine how educational interventions for evidence-based practice should be reported: Stage 2 of the development of a reporting guideline

PubMed Central

2014-01-01

Background Undertaking a Delphi exercise is recommended during the second stage in the development process for a reporting guideline. To continue the development for the Guideline for Reporting Evidence-based practice Educational interventions and Teaching (GREET) a Delphi survey was undertaken to determine the consensus opinion of researchers, journal editors and educators in evidence-based practice (EBP) regarding the information items that should be reported when describing an educational intervention for EBP. Methods A four round online Delphi survey was conducted from October 2012 to March 2013. The Delphi panel comprised international researchers, educators and journal editors in EBP. Commencing with an open-ended question, participants were invited to volunteer information considered important when reporting educational interventions for EBP. Over three subsequent rounds participants were invited to rate the importance of each of the Delphi items using an 11 point Likert rating scale (low 0 to 4, moderate 5 to 6, high 7 to 8 and very high >8). Consensus agreement was set a priori as at least 80 per cent participant agreement. Consensus agreement was initially calculated within the four categories of importance (low to very high), prior to these four categories being merged into two (<7 and ≥7). Descriptive statistics for each item were computed including the mean Likert scores, standard deviation (SD), range and median participant scores. Mean absolute deviation from the median (MAD-M) was also calculated as a measure of participant disagreement. Results Thirty-six experts agreed to participate and 27 (79%) participants completed all four rounds. A total of 76 information items were generated across the four survey rounds. Thirty-nine items (51%) were specific to describing the intervention (as opposed to other elements of study design) and consensus agreement was achieved for two of these items (5%). When the four rating categories were merged into two (<7 and ≥7), 18 intervention items achieved consensus agreement. Conclusion This Delphi survey has identified 39 items for describing an educational intervention for EBP. These Delphi intervention items will provide the groundwork for the subsequent consensus discussion to determine the final inclusion of items in the GREET, the first reporting guideline for educational interventions in EBP. PMID:25081371

Toward the Successful Implementation of the North American Free-Trade Agreement: The Integration of Language and Business Studies.

ERIC Educational Resources Information Center

Raffield, Barney T., III

This paper examines the need for the integration of language and business studies to enhance successful implementation of the North American Free Trade Agreement. For college and university graduates to deal effectively with French-Canadian and Mexican business people and consumers, they must be exposed to their languages and their cultures. This…

77 FR 413 - To Modify the Harmonized Tariff Schedule of the United States and for Other Purposes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-04

..., implemented the United States-Oman Free Trade Agreement (USOFTA) with respect to the United States and, pursuant to section 201 of the United States-Oman Free Trade Agreement Implementation Act (the ``USOFTA Act... reductions with respect to Oman set forth in Annex 2-B of the USOFTA. In order to ensure the continuation of...

From the abstract to the concrete - Implementation of an innovative tool in home care.

PubMed

Kajamaa, Anu; Schulz, Klaus-Peter

2018-02-01

Background The implementation of innovations in practice is a critical factor for change and development processes in health and home care. We therefore analyze how an innovative tool - a mobility agreement to maintain physical mobility of home care clients - was implemented in Finnish home care. Methods Our study involves ethnographic research of 13 home care visits, two years after the mobility agreement was implemented. We analyze the emergence of contradictions, the motives of the actors and the use of artifacts supporting or inhibiting the implementation. Two in-depth cases illustrate the implementation of the mobility agreement in home care visits. Findings Our findings show that, first, to achieve practice change and development, the innovation implementation requires the overcoming of contradictions in the implementation process. Second, it calls for the emergence of a shared motive between the actors to transform the abstract concept of an innovation into a concrete practice. Third, artifacts, customary to the clients are important in supporting the implementation process. Fourth, the implementation brings about a modification of the innovation and the adopting social system. Conclusions Innovation implementation should be seen as a transformation process of an abstract concept into a concrete practice, enabled by the actors involved. Concept design and implementation should be closely linked. In health/home care innovation management, the implementation of innovations needs to be understood as a complex collective learning process. Results can be far reaching - in our case leading to change of home care workers' professional understanding and elderly clients' mobility habits.

Revision to Planetary Protection Policy for Mars Missions

NASA Technical Reports Server (NTRS)

DeVincenzi, D. L.; Stabekis, P.; Barengoltz, J.; Morrison, David (Technical Monitor)

1994-01-01

Under existing COSPAR policy adopted in 1984, missions to Mars (landers, probes, and some orbiters) are designated as Category IV missions. As such, the procedures for implementing planetary protection requirements could include trajectory biasing, cleanrooms, bioload reduction, sterilization of hardware, and bioshields, i. e. requirements could be similar to Viking. However, in 1992, a U. S. National Academy of Sciences study recommended that controls on forward contamination of Mars be tied to specific mission objectives. The report recommended that Mars landers with life detection instruments be subject to at least Viking-level sterilization procedures for bioload reduction, while spacecraft (including orbiters) without life detection instruments be subject to at least Viking-level pre sterilization procedures for bioload reduction but need not be sterilized. In light of this, it is proposed that the current policy's Category IV missions and their planetary protection requirements be divided into two subcategories as follows: Category IV A, for missions comprising landers and probes without life detection experiments and some orbiters, which will meet a specified bioburden limit for exposed surfaces; Category IV B, for landers and probes with life detection experiments, which will require complete system sterilization. For Category IV A missions, bioburden specifications will be proposed and implementing procedures discussed. A resolution will be proposed to modify the existing COSPAR policy to reflect these changes. Similar specifications, procedures, and resolution for Category IV B missions will be the subject of a later study.

Causes and remedies for the dominant risk factors in Enterprise System implementation projects: the consultants' perspective.

PubMed

Lech, Przemysław

2016-01-01

The purpose of this research was to investigate the causes of the dominant risk factors, affecting Enterprise System implementation projects and propose remedies for those risk factors from the perspective of implementation consultants. The study used a qualitative research strategy, based on e-mail interviews, semi-structured personal interviews with consultants and participant observation during implementation projects. The main contribution of this paper is that it offers viable indications of how to mitigate the dominant risk factors. These indications were grouped into the following categories: stable project scope, smooth communication supported by the project management, dedicated, competent and decision-making client team, competent and engaged consultant project manager, schedule and budget consistent with the project scope, use of methodology and procedures, enforced and enabled by the project managers, competent and dedicated consultants. A detailed description is provided for each category.

10 CFR 150.17a - Compliance with requirements of US/IAEA Safeguards Agreement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 2 2011-01-01 2011-01-01 false Compliance with requirements of US/IAEA Safeguards... Authority in Agreement States § 150.17a Compliance with requirements of US/IAEA Safeguards Agreement. (a... shall take other action as may be necessary to implement the US/IAEA Safeguards Agreement, as described...

10 CFR 150.17a - Compliance with requirements of US/IAEA Safeguards Agreement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Compliance with requirements of US/IAEA Safeguards... Authority in Agreement States § 150.17a Compliance with requirements of US/IAEA Safeguards Agreement. (a... shall take other action as may be necessary to implement the US/IAEA Safeguards Agreement, as described...

The Spanish Diagnostic Interview Schedule. Reliability and concordance with clinical diagnoses in Puerto Rico.

PubMed

Canino, G J; Bird, H R; Shrout, P E; Rubio-Stipec, M; Bravo, M; Martinez, R; Sesman, M; Guzman, A; Guevara, L M; Costas, H

1987-08-01

A Spanish translation of the Diagnostic Interview Schedule (DIS) was assessed using samples of Puerto Rican patients and community subjects from the San Juan area. Concordance between DIS results from psychiatrists' interviews and from laypersons' interviews was similar to results with the DIS in mainland samples. Comparisons of laypersons' DIS results with psychiatrists' clinical diagnoses yielded generally poorer agreement. Levels of agreement improved when diagnoses were clustered into higher-rank categories. These results raise cultural issues related to the use of the DIS in Puerto Rico.

Senate and INF ratification

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

Jones, D.T.

1992-11-16

The Intermediate-Range Nuclear Forces (INF) Treaty represented one of the first major accomplishments of the post-cold war era. In contrast to all arms control agreements which preceded it, INF resulted in the elimination of a whole category of weapons systems. The author describes and analyzes many issues which impinged on the Senate ratification process and stimulated intense political debate. In addition to national and international security questions, these issues involved constitutional, political, jurisdictional, and bureaucratic factors. The author concludes with lessons and recommendations for more expeditious ratification for future agreements.

Discordance Between Appropriate Use Criteria for Nuclear Myocardial Perfusion Imaging From Different Specialty Societies: A Potential Concern for Health Policy.

PubMed

Winchester, David E; Wolinsky, David; Beyth, Rebecca J; Shaw, Leslee J

2016-05-01

Appropriate use criteria (AUC) assist health care professionals in making decisions about procedures and diagnostic testing. In some cases, multiple AUC exist for a single procedure or test. To date, the extent of agreement between multiple AUC has not been evaluated. To measure discordance between the American College of Cardiology Foundation (ACCF) AUC and the American College of Radiology (ACR) Appropriateness Criteria for gauging the appropriateness of nuclear myocardial perfusion imaging. Retrospective cohort study at an academically affiliated Veterans Affairs medical center. Participants were Veteran patients who underwent nuclear myocardial perfusion imaging between December 2010 and July 2011 with rating of appropriateness by the ACCF and ACR criteria. Analysis was performed in March 2015. The primary outcome was the agreement of appropriateness category as measured by κ statistic. The secondary outcome was a comparison of nuclear myocardial perfusion imaging results and frequency of ischemia across appropriateness categories for the 2 rating methods. Of 67 indications in the ACCF AUC, 35 (52.2%) could not be matched to an ACR rating, 18 (26.9%) had the same appropriateness category, and 14 (20.9%) disagreed on appropriateness. The study cohort comprised 592 individuals. Their mean (SD) age was 62.6 (9.4) years, and 570 of 592 (96.2%) were male. When applied to the patient cohort, 111 patients (18.8%) could not be matched to an ACR rating, 349 patients (59.0%) had the same appropriateness category for the ACR and ACCF methods, and 132 patients (22.3%) were discordant. Overall, the agreement of appropriateness between the 2 methods was poor (κ = 0.34, P < .001). Ischemia was rare among patients rated as "inappropriate" by the ACCF AUC (1 of 39 patients [2.6%]), while ischemia was more common among patients rated as "usually not appropriate" by the ACR Appropriateness Criteria (14 of 80 patients [17.5%]). Substantial discordance may exist between methods for assessing the appropriateness of advanced imaging tests. Discordance in methods may translate into differences in clinically relevant outcomes, such as the detection of myocardial ischemia.

Towards system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in routine practice: Developing simple, intuitive descriptions of ICF categories in the ICF Generic and Rehabilitation Set.

PubMed

Prodinger, Birgit; Reinhardt, Jan D; Selb, Melissa; Stucki, Gerold; Yan, Tiebin; Zhang, Xia; Li, Jianan

2016-06-13

A national, multi-phase, consensus process to develop simple, intuitive descriptions of International Classification of Functioning, Disability and Health (ICF) categories contained in the ICF Generic and Rehabilitation Sets, with the aim of enhancing the utility of the ICF in routine clinical practice, is presented in this study. A multi-stage, national, consensus process was conducted. The consensus process involved 3 expert groups and consisted of a preparatory phase, a consensus conference with consecutive working groups and 3 voting rounds (votes A, B and C), followed by an implementation phase. In the consensus conference, participants first voted on whether they agreed that an initially developed proposal for simple, intuitive descriptions of an ICF category was in fact simple and intuitive. The consensus conference was held in August 2014 in mainland China. Twenty-one people with a background in physical medicine and rehabilitation participated in the consensus process. Four ICF categories achieved consensus in vote A, 16 in vote B, and 8 in vote C. This process can be seen as part of a larger effort towards the system-wide implementation of the ICF in routine clinical and rehabilitation practice to allow for the regular and comprehensive evaluation of health outcomes most relevant for the monitoring of quality of care.

Risk-sharing agreements, present and future

PubMed Central

Gonçalves, Francisco R; Santos, Susana; Silva, Catarina; Sousa, Gabriela

2018-01-01

Risk-sharing agreements between pharmaceutical companies and payers stand out as a recent practice, the use of which has been increasing in the case of innovative medicines, particularly in the field of oncology, which aims to ensure better budgetary control and a lower risk of spending on medicinal products without full evidence of clinical benefit. In this article, the authors discuss the types of existing agreements, as well as those used in Portugal, their advantages, disadvantages and future challenges of implementation, as well as their potential role in access to therapeutic innovation, namely medicines for cancer treatment. For this purpose, a nonsystematic review of indexed and nonconventional literature was carried out. There is a tendency for the risk-sharing agreements established between payers and pharmaceutical companies to include a component of monitoring the use of medicines and outcomes measurement, involving real life data collection. Portugal is no exception and, although most agreements are still financial in nature, there is already a strong desire for other agreements, in particular clinical outcomes based. It is concluded that there is not yet a gold standard methodology in relation to the type of agreements to be practiced. Moreover, its opportunity cost, including the cost of implementation, remains to be scrutinised. However, regardless of the type of agreement, the advantages of adopting these agreements are well known, inevitably related with challenges of implementation. The need for an infrastructure to support information sharing is undisputed and urgent. The future of therapeutic innovation and increased pressure on health budgets will require alternative, more flexible models, personalized reimbursement models that allow alignment of medicines prices with the value they deliver in treating the several diseases. PMID:29743943

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts.

PubMed

Shah, Hemant; Allard, Raymond D; Enberg, Robert; Krishnan, Ganesh; Williams, Patricia; Nadkarni, Prakash M

2012-03-09

A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies.

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts

PubMed Central

2012-01-01

Background A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. Methods In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). Results The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. Conclusions When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies. PMID:22405400

77 FR 11187 - Request for Comments of a Previously Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-24

... similar marketing tools, particularly in international air transportation, had given the Department... name given to a common airline industry marketing practice where, by mutual agreement between.... Arrangements falling into this category are similar to leases of aircraft with crew (wet leases). The...

42 CFR 37.52 - Method of obtaining definitive interpretations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Roentgenographic Examinations Specifications for Interpretation, Classification, and Submission of Chest... described in § 37.51. If there is agreement between the two interpreters as defined in paragraph (b) of this... (with one exception noted below) are within one minor category (ILO Classification 12-point scale) of...

Forms and Formalities: A Resource.

ERIC Educational Resources Information Center

Clarkson, Glenn; Warpinski, Robert

This report provides a selection of examples of National Diffusion Network participant forms utilized between Developer/Demonstrators, State Facilitators, and Local Educational Agencies. They were selected to demonstrate variety and to be a source of ideas for others. Forms are grouped in five categories: needs assessment, adoption agreement,…

78 FR 35319 - Solicitation for a Cooperative Agreement-Curriculum Development: Planning and Implementing...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-12

... DEPARTMENT OF JUSTICE National Institute of Corrections Solicitation for a Cooperative Agreement... Institute of Corrections, U.S. Department of Justice. ACTION: Solicitation for a Cooperative Agreement.... Eligibility of Applicants: An eligible applicant is any public or private agency, educational institution...

26 CFR 601.802 - Cooperative agreements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... STATEMENT OF PROCEDURAL RULES Tax Counseling for the Elderly § 601.802 Cooperative agreements. (a) General. Tax Counseling for the Elderly programs will be administered by sponsor organizations under... agreements. If appropriations to implement the Tax Counseling for the Elderly program are received at a time...

26 CFR 601.802 - Cooperative agreements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... STATEMENT OF PROCEDURAL RULES Tax Counseling for the Elderly § 601.802 Cooperative agreements. (a) General. Tax Counseling for the Elderly programs will be administered by sponsor organizations under... agreements. If appropriations to implement the Tax Counseling for the Elderly program are received at a time...

26 CFR 601.802 - Cooperative agreements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... STATEMENT OF PROCEDURAL RULES Tax Counseling for the Elderly § 601.802 Cooperative agreements. (a) General. Tax Counseling for the Elderly programs will be administered by sponsor organizations under... agreements. If appropriations to implement the Tax Counseling for the Elderly program are received at a time...

26 CFR 601.802 - Cooperative agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... STATEMENT OF PROCEDURAL RULES Tax Counseling for the Elderly § 601.802 Cooperative agreements. (a) General. Tax Counseling for the Elderly programs will be administered by sponsor organizations under... agreements. If appropriations to implement the Tax Counseling for the Elderly program are received at a time...

7 CFR 1599.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... legally binding agreement entered into between FAS and a participant to implement activities under the... FAS to a participant under an agreement. The term may include donated commodities that are used to produce a further processed product for use under the agreement. FAS means the Foreign Agricultural...

7 CFR 1599.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... legally binding agreement entered into between FAS and a participant to implement activities under the... FAS to a participant under an agreement. The term may include donated commodities that are used to produce a further processed product for use under the agreement. FAS means the Foreign Agricultural...

7 CFR 1599.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... legally binding agreement entered into between FAS and a participant to implement activities under the... FAS to a participant under an agreement. The term may include donated commodities that are used to produce a further processed product for use under the agreement. FAS means the Foreign Agricultural...

7 CFR 1599.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... legally binding agreement entered into between FAS and a participant to implement activities under the... FAS to a participant under an agreement. The term may include donated commodities that are used to produce a further processed product for use under the agreement. FAS means the Foreign Agricultural...

7 CFR 1599.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... legally binding agreement entered into between FAS and a participant to implement activities under the... FAS to a participant under an agreement. The term may include donated commodities that are used to produce a further processed product for use under the agreement. FAS means the Foreign Agricultural...

19 CFR 10.761 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Morocco Free Trade Agreement General... applicable to imported goods under the United States-Morocco Free Trade Agreement (the MFTA) signed on June 15, 2004, and under the United States-Morocco Free Trade Agreement Implementation Act (the Act; 118...

19 CFR 10.501 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Singapore Free Trade Agreement General... applicable to imported goods under the United States-Singapore Free Trade Agreement (the SFTA) signed on May 6, 2003, and under the United States-Singapore Free Trade Agreement Implementation Act (the Act; 117...

Policy review: Japan-Philippines Economic Partnership Agreement (JPEPA)--analysis of a failed nurse migration policy.

PubMed

Yagi, Nozomi; Mackey, Tim K; Liang, Bryan A; Gerlt, Lorna

2014-02-01

In 2008, the bilateral Japan-Philippines Economic Partnership Agreement took effect. Contained within this regional free trade agreement are unique provisions allowing exchange of Filipino nurses and healthcare workers to work abroad in Japan. Japan's increasing need for healthcare workers due to its aging demographic and the Philippines need for economic development could have led to shared benefits under the Japan-Philippines Economic Partnership Agreement. However, 4 years following program implementation, results have been disappointing, e.g., only 7% of candidates passing the programs requirements since 2009. These disappointing results represent a policy failure within the current Japan-Philippines Economic Partnership Agreement framework, and point to the need for reform. Hence, amending the current Japan-Philippines Economic Partnership Agreement structure by potentially adopting a USA based approach to licensure examinations and implementing necessary institutional and governance reform measures may be necessary to ensure beneficial healthcare worker migration for both countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

Implementing an Imaginative Unit: Wonders of the Water Cycle

ERIC Educational Resources Information Center

Hrennikoff, Margo

2006-01-01

The grade three curriculum set out by the British Columbia Ministry of Education has four categories for science: Processes of Science, Life Science, Physical Science, and Earth and Space Science. Within each of these categories there are numerous topics to teach. For example, the physical science curriculum requires students to learn about…

Faculty Perceptions of Moving a Face-to-Face Course to Online Instruction

ERIC Educational Resources Information Center

Chiasson, Kari; Terras, Katherine; Smart, Kathy

2015-01-01

This qualitative study explores the experiences of 10 faculty members who developed and taught an online course that they had previously taught in a face-to-face classroom. The categories from the data analysis included planning, implementation, and reflection. Within the categories, eight themes emerged from the data. The themes addressed…

78 FR 24992 - Approval and Promulgation of Air Quality Implementation Plans; District of Columbia; Volatile...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-29

... includes negative declarations for various VOC source categories. EPA is approving the regulation changes and the negative declarations in accordance with the requirements of the Clean Air Act (CAA). DATES... adopt RACT and negative declarations for various VOC source categories. The formal SIP revision was...

Putting Action Back into Action Planning: Experiences of Career Clients

ERIC Educational Resources Information Center

Borgen, William A.; Maglio, Asa-Sophia T.

2007-01-01

This study used the critical incident technique to investigate what helped and hindered unemployed and career-changing people in implementing the action plans they developed while participating in career or employment counseling. Information from interviews with 23 women and 16 men generated 9 categories of helping incidents and 9 categories of…

33 CFR 151.35 - Certificates needed to carry Category D NLS and Category D Oil-like NLS.

Code of Federal Regulations, 2014 CFR

2014-07-01

... GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) POLLUTION VESSELS CARRYING OIL, NOXIOUS LIQUID SUBSTANCES, GARBAGE, MUNICIPAL OR COMMERCIAL WASTE, AND BALLAST WATER Implementation of MARPOL 73/78 and the Protocol on Environmental Protection to the Antarctic Treaty as it Pertains to Pollution from Ships Noxious...

33 CFR 151.35 - Certificates needed to carry Category D NLS and Category D Oil-like NLS.

Code of Federal Regulations, 2012 CFR

2012-07-01

... GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) POLLUTION VESSELS CARRYING OIL, NOXIOUS LIQUID SUBSTANCES, GARBAGE, MUNICIPAL OR COMMERCIAL WASTE, AND BALLAST WATER Implementation of MARPOL 73/78 and the Protocol on Environmental Protection to the Antarctic Treaty as it Pertains to Pollution from Ships Noxious...

33 CFR 151.35 - Certificates needed to carry Category D NLS and Category D Oil-like NLS.

Code of Federal Regulations, 2011 CFR

2011-07-01

... GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) POLLUTION VESSELS CARRYING OIL, NOXIOUS LIQUID SUBSTANCES, GARBAGE, MUNICIPAL OR COMMERCIAL WASTE, AND BALLAST WATER Implementation of MARPOL 73/78 and the Protocol on Environmental Protection to the Antarctic Treaty as it Pertains to Pollution from Ships Noxious...

33 CFR 151.35 - Certificates needed to carry Category D NLS and Category D Oil-like NLS.

Code of Federal Regulations, 2010 CFR

2010-07-01

... GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) POLLUTION VESSELS CARRYING OIL, NOXIOUS LIQUID SUBSTANCES, GARBAGE, MUNICIPAL OR COMMERCIAL WASTE, AND BALLAST WATER Implementation of MARPOL 73/78 and the Protocol on Environmental Protection to the Antarctic Treaty as it Pertains to Pollution from Ships Noxious...

The science of quality improvement implementation: developing capacity to make a difference.

PubMed

Alexander, Jeffrey A; Hearld, Larry R

2011-12-01

Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations. To critically review the empirical research on QI implementation in health care organizations. A literature review of 107 studies that examined the implementation of QI innovations in health care organizations. Studies were classified into 4 groups based on the types of predictors that were assumed to affect implementation (content of QI innovation, organizational processes, internal context, and external context). Internal context and organizational processes were the most frequently studied categories. External context and organizational process categories exhibited the highest rate of positive effects on QI implementation. The review revealed several important gaps in the QI implementation literature. Studies often lacked clear conceptual frameworks to guide the research, which may hinder efforts to compare relationships across studies. Studies also tended to adopt designs that were narrowly focused on independent effects of predictors and did not include holistic frameworks to capture interactions among the many factors involved in implementation. Other design limitations included the use of cross-sectional designs, single-source data collection, and potential selection bias among study participants.

Teaching Scotland's Children: A Report on Progress in Implementing "A Teaching Profession for the 21st Century"

ERIC Educational Resources Information Center

Her Majesty's Inspectorate of Education, 2007

2007-01-01

Published in January 2001, "A Teaching Profession for the 21st Century" (normally referred to in this report as the Teachers' Agreement), set out arrangements for a new salary scale and conditions of employment for teachers. From 2002 to 2006 HMIE carried out a review of the implementation of the Agreement working in partnership with…

Picture gallery: A structured presentation of OAO-2 photometric data supported by UBV, ANS, and TD1 observations

NASA Technical Reports Server (NTRS)

Koornneed, J.; Meade, M. R.; Wesselius, P. R.; Code, A. D.; Vanduinen, R.

1981-01-01

Stellar fluxes for 531 stars in the wavelength range lambda 5500-1330A lambda are presented in the form of graphs. The stars are divided into 52 different categories on the basis of their spectral types and objects within one category are shown together. The agreement between the various ultraviolet photometric systems for early type stars is generally better than 0.10 mag. Stars with known and/or observed variability have been grouped separately. A list of stars with observed photometric properties which are indicative of stellar or interstellar anomalies is also provided.

DSM-III field trials: I. Initial interrater diagnostic reliability.

PubMed

Spitzer, R L; Forman, J B; Nee, J

1979-06-01

The interrater agreement for major diagnostic categories in studies using DSM-I and DSM-II was usually only fair or poor. In phase one of the DSM-III field trials the overall kappa coefficient of agreement for axis I diagnoses of 281 adult patients was .78 for joint interviews and .66 for diagnoses made after separate interviews; for axis II--personality disorders and specific developmental disorders--the coefficients of agreement were .61 and .54. The interrater reliability of DSM--III is, in general, higher than that previously achieved and may be due to changes in the classification itself, the separation of axis I from axis II conditions, the systematic description of the various disorders, and the inclusion of diagnostic criteria.

14 CFR § 1266.104 - Cross-waiver of liability for launch agreements for science or space exploration activities...

Code of Federal Regulations, 2014 CFR

2014-01-01

... agreements for science or space exploration activities unrelated to the International Space Station. § 1266...-WAIVER OF LIABILITY § 1266.104 Cross-waiver of liability for launch agreements for science or space... implement a cross-waiver of liability between the parties to agreements for NASA's science or space...

Design and implementation of a web directory for medical education (WDME): a tool to facilitate research in medical education.

PubMed

Changiz, Tahereh; Haghani, Fariba; Masoomi, Rasoul

2012-01-01

Access to the medical resources on the web is one of current challenges for researchers and medical science educators. The purpose of current project was to design and implement a comprehensive and specific subject/web directory of medical education. First, the categories to be incorporated in the directory were defined through reviewing related directories and obtaining medical education experts' opinions in a focus group. Then, number of sources such as (Meta) search engines, subject directories, databases and library catalogs searched/browsed for selecting and collecting high quality resources. Finally, the website was designed and the resources were entered into the directory. The main categories incorporating WDME resources are: Journals, Organizations, Best Evidence in Medical Education, and Textbooks. Each category is divided into sub-categories and related resources of each category are described shortly within it. The resources in this directory could be accessed both by browsing and keyword searching. WDME is accessible on http://medirectory.org. The innovative Web Directory for Medical Education (WDME) presented in this paper, is more comprehensive than other existing directories, and expandable through user suggestions. It may help medical educators to find their desirable resources more quickly and easily; hence have more informed decisions in education.

Interobserver Agreement for Contrast-Enhanced Ultrasound (CEUS)-Based Standardized Algorithms for the Diagnosis of Hepatocellular Carcinoma in High-Risk Patients.

PubMed

Schellhaas, Barbara; Pfeifer, Lukas; Kielisch, Christian; Goertz, Ruediger Stephan; Neurath, Markus F; Strobel, Deike

2018-06-07

 This pilot study aimed at assessing interobserver agreement with two contrast-enhanced ultrasound (CEUS) algorithms for the diagnosis of hepatocellular carcinoma (HCC) in high-risk patients.  Focal liver lesions in 55 high-risk patients were assessed independently by three blinded observers with two standardized CEUS algorithms: ESCULAP (Erlanger Synopsis of Contrast-Enhanced Ultrasound for Liver Lesion Assessment in Patients at risk) and ACR-CEUS-LI-RADSv.2016 (American College of Radiology CEUS-Liver Imaging Reporting and Data System). Lesions were categorized according to size and ultrasound contrast enhancement in the arterial, portal-venous and late phase. Interobserver agreement for assessment of enhancement pattern and categorization was compared between both CEUS algorithms. Additionally, diagnostic accuracy for the definitive diagnosis of HCC was compared. Histology and/or CE-MRI and follow-up served as reference standards.  55 patients were included in the study (male/female, 44/ 11; mean age: 65.9 years). 90.9 % had cirrhosis. Histological findings were available in 39/55 lesions (70.9 %). Reference standard of the 55 lesions revealed 48 HCCs, 2 intrahepatic cholangiocellular carcinomas (ICCs), and 5 non-HCC-non-ICC lesions. Interobserver agreement was moderate to substantial for arterial phase hyperenhancement (ĸ = 0.53 - 0.67), and fair to moderate for contrast washout in the portal-venous or late phase (ĸ = 0.33 - 0.53). Concerning the CEUS-based algorithms, the interreader agreement was substantial for the ESCULAP category (ĸ = 0.64 - 0.68) and fair for the CEUS-LI-RADS ® category (ĸ = 0.3 - 0.39). Disagreement between observers was mostly due to different perception of washout.  Interobserver agreement is better for ESCULAP than for CEUS-LI-RADS ® . This is mostly due to the fact that perception of contrast washout varies between different observers. However, interobserver agreement is good for arterial phase hyperenhancement, which is the key diagnostic feature for the diagnosis of HCC with CEUS in the cirrhotic liver. © Georg Thieme Verlag KG Stuttgart · New York.

5 CFR 410.309 - Agreements to continue in service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Agreements to continue in service. 410.309 Section 410.309 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS TRAINING Establishing and Implementing Training Programs § 410.309 Agreements to continue in service. (a...

31 CFR 540.305 - HEU Agreements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false HEU Agreements. 540.305 Section 540.305 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... current and future amendments thereto; as well as the related current and future implementing agreements...

31 CFR 540.305 - HEU Agreements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false HEU Agreements. 540.305 Section 540.305 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... current and future amendments thereto; as well as the related current and future implementing agreements...

31 CFR 540.305 - HEU Agreements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false HEU Agreements. 540.305 Section 540.305 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... current and future amendments thereto; as well as the related current and future implementing agreements...

77 FR 31832 - Proposed Information Collection; Comment Request; Procedures for Considering Requests and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-30

... Section 328 of the United States-Colombia Trade Promotion Agreement Implementation Act (the ``Act... of the United States- Colombia Trade Promotion Agreement (the ``Agreement''). This safeguard... directly competitive article; and (5) all data available to the requester showing changes in productivity...

EPA-MassDEP Prevention of Significant Deterioration (PSD) Delegation Agreement

EPA Pesticide Factsheets

In April 2011, an agreement for delegation of the federal PSD program was executed by EPA Region 1 to the MassDEP. This agreement sets forth the terms & conditions according to which the MassDEP agrees to implement and enforce the federal PSD regulations.

78 FR 22843 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-17

... Public for Textile and Apparel Safeguard Actions on Imports from Oman. OMB Control Number: 0625-0266... through Section 328 of the United States-Oman Free Trade Agreement Implementation Act (the ``Act...-Oman Free Trade Agreement (the ``Agreement''). This safeguard mechanism applies when, as a result of...

19 CFR 10.861 - Scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman Free Trade Agreement General Provisions... to imported goods under the United States-Oman Free Trade Agreement (the OFTA) signed on January 19, 2006, and under the United States-Oman Free Trade Agreement Implementation Act (the Act; 120 Stat. 1191...

19 CFR 10.861 - Scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman Free Trade Agreement General Provisions... to imported goods under the United States-Oman Free Trade Agreement (the OFTA) signed on January 19, 2006, and under the United States-Oman Free Trade Agreement Implementation Act (the Act; 120 Stat. 1191...

19 CFR 10.861 - Scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman Free Trade Agreement General Provisions... to imported goods under the United States-Oman Free Trade Agreement (the OFTA) signed on January 19, 2006, and under the United States-Oman Free Trade Agreement Implementation Act (the Act; 120 Stat. 1191...

19 CFR 10.861 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman Free Trade Agreement General Provisions... to imported goods under the United States-Oman Free Trade Agreement (the OFTA) signed on January 19, 2006, and under the United States-Oman Free Trade Agreement Implementation Act (the Act; 120 Stat. 1191...

The German Version of the Manchester Triage System and Its Quality Criteria – First Assessment of Validity and Reliability

PubMed Central

Gräff, Ingo; Goldschmidt, Bernd; Glien, Procula; Bogdanow, Manuela; Fimmers, Rolf; Hoeft, Andreas; Kim, Se-Chan; Grigutsch, Daniel

2014-01-01

Background The German Version of the Manchester Triage System (MTS) has found widespread use in EDs across German-speaking Europe. Studies about the quality criteria validity and reliability of the MTS currently only exist for the English-language version. Most importantly, the content of the German version differs from the English version with respect to presentation diagrams and change indicators, which have a significant impact on the category assigned. This investigation offers a preliminary assessment in terms of validity and inter-rater reliability of the German MTS. Methods Construct validity of assigned MTS level was assessed based on comparisons to hospitalization (general / intensive care), mortality, ED and hospital length of stay, level of prehospital care and number of invasive diagnostics. A sample of 45,469 patients was used. Inter-rater agreement between an expert and triage nurses (reliability) was calculated separately for a subset group of 167 emergency patients. Results For general hospital admission the area under the curve (AUC) of the receiver operating characteristic was 0.749; for admission to ICU it was 0.871. An examination of MTS-level and number of deceased patients showed that the higher the priority derived from MTS, the higher the number of deaths (p<0.0001 / χ2 Test). There was a substantial difference in the 30-day survival among the 5 MTS categories (p<0.0001 / log-rank test).The AUC for the predict 30-day mortality was 0.613. Categories orange and red had the highest numbers of heart catheter and endoscopy. Category red and orange were mostly accompanied by an emergency physician, whereas categories blue and green were walk-in patients. Inter-rater agreement between expert triage nurses was almost perfect (κ = 0.954). Conclusion The German version of the MTS is a reliable and valid instrument for a first assessment of emergency patients in the emergency department. PMID:24586477

Ethnobotanical study of the medicinal plants from Tlanchinol, Hidalgo, México.

PubMed

Andrade-Cetto, Adolfo

2009-02-25

The people in Mexico still depend upon the use of medicinal plants to treat simple health problems, including those who live in regions like Tlanchinol Hidalgo, where it is still possible to find people who speak the pre-Hispanic Nahua language. This area is surrounded by rain forest, which is more or less well conserved, so ethnopharmacological field studies are quite relevant. The cultural knowledge about the use of medicinal plants converge with the richness in the surrounding flora making this region ideal for the selection of traditionally used medicinal plants. To present the results of an ethnopharmacological field survey conducted in the municipality of Tlanchinol Hidalgo, Mexico analyzed with two different quantitative tools, with the aim of selecting the most important species used in traditional medicine. Direct interviews with the people were performed in several short visits to the municipality of Tlanchinol Hidalgo. The plants were collected, and the species were determined. The interviews were analyzed with two quantitative tools. First, the factor informant consensus highlighted the agreement in the use of plants and the fidelity level defined as: the ratio between the number of informants who independently suggested the use of a species for the same major purpose and the total number of informants who mentioned the plant for any use. Furthermore, we analyzed the use-mentions for the plants. The results of the factor informant consensus showed that the gastrointestinal category had the greatest agreement, followed by the respiratory and dermatological categories. The most important species according to their fidelity are: Coleus blumei, Plantago australis and Lippia dulcis for the gastrointestinal category; Borago officinalis, Foeniculum vulgare, and Eucalyptus globulus for the respiratory category; and Ageratum houstonianum and Solanum nigrescens for the dermatological category. As a result of the present study, we recommend the plants listed in Table 2 for further ethnopharmacological studies, especially Lippia dulcis var Mexicana.

Automatically classifying sentences in full-text biomedical articles into Introduction, Methods, Results and Discussion.

PubMed

Agarwal, Shashank; Yu, Hong

2009-12-01

Biomedical texts can be typically represented by four rhetorical categories: Introduction, Methods, Results and Discussion (IMRAD). Classifying sentences into these categories can benefit many other text-mining tasks. Although many studies have applied different approaches for automatically classifying sentences in MEDLINE abstracts into the IMRAD categories, few have explored the classification of sentences that appear in full-text biomedical articles. We first evaluated whether sentences in full-text biomedical articles could be reliably annotated into the IMRAD format and then explored different approaches for automatically classifying these sentences into the IMRAD categories. Our results show an overall annotation agreement of 82.14% with a Kappa score of 0.756. The best classification system is a multinomial naïve Bayes classifier trained on manually annotated data that achieved 91.95% accuracy and an average F-score of 91.55%, which is significantly higher than baseline systems. A web version of this system is available online at-http://wood.ims.uwm.edu/full_text_classifier/.

Evidence-Based School Behavior Assessment of Externalizing Behavior in Young Children.

PubMed

Bagner, Daniel M; Boggs, Stephen R; Eyberg, Sheila M

2010-02-01

This study examined the psychometric properties of the Revised Edition of the School Observation Coding System (REDSOCS). Participants were 68 children ages 3 to 6 who completed parent-child interaction therapy for Oppositional Defiant Disorder as part of a larger efficacy trial. Interobserver reliability on REDSOCS categories was moderate to high, with percent agreement ranging from 47% to 90% (M = 67%) and Cohen's kappa coefficients ranging from .69 to .95 (M = .82). Convergent validity of the REDSOCS categories was supported by significant correlations with the Intensity Scale of the Sutter-Eyberg Student Behavior Inventory-Revised and related subscales of the Conners' Teacher Rating Scale-Revised: Long Version (CTRS-R: L). Divergent validity was indicated by nonsignificant correlations between REDSOCS categories and scales on the CTRS-R: L expected not to relate to disruptive classroom behavior. Treatment sensitivity was demonstrated for two of the three primary REDSOCS categories by significant pre to posttreatment changes. This study provides psychometric support for the designation of REDSOCS as an evidence-based assessment procedure for young children.

Discovering Peripheral Arterial Disease Cases from Radiology Notes Using Natural Language Processing

PubMed Central

Savova, Guergana K.; Fan, Jin; Ye, Zi; Murphy, Sean P.; Zheng, Jiaping; Chute, Christopher G.; Kullo, Iftikhar J.

2010-01-01

As part of the Electronic Medical Records and Genomics Network, we applied, extended and evaluated an open source clinical Natural Language Processing system, Mayo’s Clinical Text Analysis and Knowledge Extraction System, for the discovery of peripheral arterial disease cases from radiology reports. The manually created gold standard consisted of 223 positive, 19 negative, 63 probable and 150 unknown cases. Overall accuracy agreement between the system and the gold standard was 0.93 as compared to a named entity recognition baseline of 0.46. Sensitivity for the positive, probable and unknown cases was 0.93–0.96, and for the negative cases was 0.72. Specificity and negative predictive value for all categories were in the 90’s. The positive predictive value for the positive and unknown categories was in the high 90’s, for the negative category was 0.84, and for the probable category was 0.63. We outline the main sources of errors and suggest improvements. PMID:21347073

A System for Rapidly and Accurately Collecting Patients’ Race and Ethnicity

PubMed Central

Baker, David W.; Cameron, Kenzie A.; Feinglass, Joseph; Thompson, Jason A.; Georgas, Patricia; Foster, Shawn; Pierce, Deborah; Hasnain-Wynia, Romana

2006-01-01

Objectives. We assessed the feasibility of collecting race/ethnicity data from patients using their own preferred racial/ethnic terms. Methods. The 424 patients described their race/ethnicity using their own categories, and we compared their descriptions with their responses to the questions (1) “Do you consider yourself Latino or Hispanic?” and (2) “Which category best describes your race?” (7 response options in our computer interview). We also determined patients’ preferences between the 2 approaches. Results.seconds. Rates of missing values and categorization as “other” race were lower than with the closed questions. Agreement between racial/ethnic categorization with open-ended and closed responses was 93% (κ =0.88). Latino/Hispanic and multiracial/multiethnic individuals were more likely to prefer using their own categories to describe their race/ethnicity. Conclusions. Collecting race/ethnicity data using patients’ own racial/ethnic categories is feasible with the use of computerized systems to capture verbatim responses and results in lower rates of missing and unusable data than do standard questions. PMID:16449590

Can a quality improvement project impact maternal and child health outcomes at scale in northern Ghana?

PubMed

Singh, Kavita; Brodish, Paul; Speizer, Ilene; Barker, Pierre; Amenga-Etego, Issac; Dasoberi, Ireneous; Kanyoke, Ernest; Boadu, Eric A; Yabang, Elma; Sodzi-Tettey, Sodzi

2016-06-16

Quality improvement (QI) interventions are becoming more common in low- and middle-income countries, yet few studies have presented impact evaluations of these approaches. In this paper, we present an impact evaluation of a scale-up phase of 'Project Fives Alive!', a QI intervention in Ghana that aims to improve maternal and child health outcomes. 'Project Fives Alive!' employed a QI methodology to recognize barriers to care-seeking and care provision at the facility level and then to identify, test and implement simple and low-cost local solutions that address the barriers. A quasi-experimental design, multivariable interrupted time series analysis, with data coming from 744 health facilities and controlling for potential confounding factors, was used to study the effect of the project. The key independent variables were the change categories (interventions implemented) and implementation phase - Wave 2a (early phase) versus Wave 2b (later phase). The outcomes studied were early antenatal care (ANC), skilled delivery, facility-level under-five mortality and attendance of underweight infants at child welfare clinics. We stratified the analysis by facility type, namely health posts, health centres and hospitals. Several of the specific change categories were significantly associated with improved outcomes. For example, three of five change categories (early ANC, four or more ANC visits and skilled delivery/immediate postnatal care (PNC)) for health posts and two of five change categories (health education and triage) for hospitals were associated with increased skilled delivery. These change categories were associated with increases in skilled delivery varying from 28% to 58%. PNC changes for health posts and health centres were associated with greater attendance of underweight infants at child welfare clinics. The triage change category was associated with increased early antenatal care in hospitals. Intensity, the number of change categories tested, was associated with increased skilled delivery in health centres and reduced under-five mortality in hospitals. Using an innovative evaluation technique we determined that 'Project Fives Alive!' demonstrated impact at scale for the outcomes studied. The QI approach used by this project should be considered by other low- and middle-income countries in their efforts to improve maternal and child health.

Preventive services recommendations for adults in primary care settings: agreement between Canada, France and the USA--a systematic review.

PubMed

Gelly, Julien; Mentre, France; Nougairede, Michel; Duval, Xavier

2013-07-01

To analyze the level of agreement between recommendations on preventive services developed by Canada, France and the USA. We gathered recommendations on primary and secondary preventive services to adults up to November 3rd, 2011 from Canadian and US Task Forces, and equivalent French agencies. We excluded recommendations on immunization, long-term diseases or pregnancy. Among 250 recommendations, 84 (34%) issued by a single country could not be compared; 43 (26%) of the remaining 166 were in strong agreement (strictly identical grades between advising countries); 25 of 43 resulted in a proposal to be implemented in clinical practice, two others not to be implemented in clinical practice and 16 were indeterminate about implementation. Strong agreement was more frequent for recommendations concerning history-taking and physical examination than for those concerning interventions (odds ratio (OR)=11.3, 95%CI: 1.6-241.2; p=0.04), and for recommendations concerning a high-risk population than for those concerning the general population (OR=3.1, 95%CI: 1.4-7.0; p=0.006). Agreement did not differ either according to maximum time range between recommendations' publication or according to the advising country. Agreement between recommendations is low particularly on those concerning non-clinical preventive services or non-high-risk individuals. Copyright © 2013 Elsevier Inc. All rights reserved.

Behavior States Are Real and Observable.

ERIC Educational Resources Information Center

Guess, Doug; Roberts, Sally; Rues, Jane

2000-01-01

This article critiques the research methodology used by Mudford, Hogg, and Roberts (1999) that resulted in a failure to achieve inter-observer agreement on adults with mental retardation when using an experimental, 13-category behavior state code. Arguments are provided on why their videotape study does not meet requirements of acceptable…

46 CFR 310.65 - Graduation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Graduation. 310.65 Section 310.65 Shipping MARITIME... Midshipmen at the United States Merchant Marine Academy § 310.65 Graduation. (a) Classes enrolled prior to... agreement to serve in one of the following categories immediately after graduation: (i) Sail on his or her...

46 CFR 310.65 - Graduation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Graduation. 310.65 Section 310.65 Shipping MARITIME... Midshipmen at the United States Merchant Marine Academy § 310.65 Graduation. (a) Classes enrolled prior to... agreement to serve in one of the following categories immediately after graduation: (i) Sail on his or her...

46 CFR 310.65 - Graduation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Graduation. 310.65 Section 310.65 Shipping MARITIME... Midshipmen at the United States Merchant Marine Academy § 310.65 Graduation. (a) Classes enrolled prior to... agreement to serve in one of the following categories immediately after graduation: (i) Sail on his or her...

11 CFR 9008.51 - Registration and reports.

Code of Federal Regulations, 2013 CFR

2013-01-01

... convention under 11 CFR 9008.52(b), a list of the categories of facilities and services the government agency... first report due under paragraph (b) of this section after the contract or agreement or modification is executed. (b) Post-convention and quarterly reports by host committees and municipal funds; content and...

11 CFR 9008.51 - Registration and reports.

Code of Federal Regulations, 2014 CFR

2014-01-01

... convention under 11 CFR 9008.52(b), a list of the categories of facilities and services the government agency... first report due under paragraph (b) of this section after the contract or agreement or modification is executed. (b) Post-convention and quarterly reports by host committees and municipal funds; content and...

Educational Leave in Europe. Policy Paper No. 83-C3.

ERIC Educational Resources Information Center

Schutze, Hans G.

This paper provides a description of and rationale for paid educational leave policies in Western Europe by examining three basic categories: general leave provisions provided by law, legal provisions for specific groups, and provisions for educational leave in collective bargaining agreements. Five countries presently have general leave…

Most and Least Helpful Events in Three Supervision Modalities

ERIC Educational Resources Information Center

Fickling, Melissa J.; Borders, L. DiAnne; Mobley, Keith A.; Wester, Kelly

2017-01-01

The authors conducted a content analysis of supervisors' (n = 10) and supervisees' (n = 31) descriptions (n = 707) of most and least helpful significant events in individual, group, and triadic supervision across 1 semester. Categories by group for each modality and areas of agreement and disagreement are highlighted.

Commercialism@School.com: The Third Annual Report on Trends in Schoolhouse Commercialism.

ERIC Educational Resources Information Center

Molnar, Alex; Morales, Jennifer

This report details the seven categories tracked by the Center for the Analysis of Commercialism in Education (CACE) between 1990 and 1999-2000: sponsorship of programs and activities, exclusive agreements, incentive programs, appropriation of space, sponsored educational materials, electronic marketing, and privatization. The 1999-2000 report…

Comparison of Categorical Assignments of the BSRI and the PAQ.

ERIC Educational Resources Information Center

Gaa, John P.; Liberman, Dov

The degree of agreement between the Bem Sex Role Inventory (BSRI) and the Personality Attributes Questionnaire (PAQ) in assigning sex role categories was investigated by administering both instruments to undergraduate education majors. As a result of scoring, subjects were classified as androgynous, masculine, feminine, or undifferentiated. It was…

12 CFR 721.3 - What categories of activities are preapproved as incidental powers necessary or requisite to...

Code of Federal Regulations, 2011 CFR

2011-01-01

..., employees and data processing. (e) Financial counseling services. Financial counseling services means advice..., debt suspension agreements, letters of credit and leases. (h) Marketing activities. Marketing... and services you offer to your members. Marketing activities may include advertising and other...

40 CFR 63.7570 - Who implements and enforces this subpart?

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants for Industrial, Commercial, and Institutional Boilers and Process Heaters Other Requirements and Information § 63.7570 Who implements and...

40 CFR 63.368 - Implementation and enforcement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Implementation and enforcement. 63.368 Section 63.368 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES Ethylene Oxide...

Reproducibility of the index of orthognathic functional treatment need scores derived from plaster study casts and their three-dimensional digital equivalents: a pilot study.

PubMed

McCrory, Emma; McGuinness, Niall Jp; Ulhaq, Aman

2018-06-01

To determine the reproducibility of Index of Orthognathic Functional Treatment Need (IOFTN) scores derived from plaster casts and their three-dimensional (3D) digital equivalents. Pilot study, prospective analytical. UK hospital orthodontic department. Thirty casts and their digital equivalents, representing the pre-treatment malocclusions of patients requiring orthodontic-orthognathic surgical treatment, were scored by four clinicians using IOFTN. Casts were scanned using a 3Shape digital scanner and 3D models produced using OrthoAnalyzer TM (3Shape Ltd, Copenhagen, Denmark). Examiners independently determined the IOFTN scores for the casts and digital models, to test their inter- and intra-operator reliability using weighted Kappa scores. Intra-operator agreement with IOFTN major categories (1-5: treatment need) was very good for plaster casts (0.83-0.98) and good-very good for digital models (0.78-0.83). Inter-operator agreement was moderate-very good for casts (0.58-0.82) and good-very good for digital models (0.65-0.92). Intra-operator agreement with IOFTN sub-categories (1-14: feature of malocclusion) was good-very good for casts (0.70-0.97) and digital models (0.80-0.94). Inter-operator agreement was moderate-good for casts (0.53-0.77); and moderate-very good for the digital models (0.58-0.90). Digital models are an acceptable alternative to plaster casts for examining the malocclusion of patients requiring combined orthodontic-orthognathic surgical treatment and determining treatment need.

Predictors of parent-child agreement on child anxiety diagnoses on the ADIS-IV-C/P.

PubMed

Hamblin, Rebecca J; Salloum, Alison; Andel, Ross; Nadeau, Joshua M; McBride, Nicole M; Lewin, Adam B; Storch, Eric A

2016-11-30

Diagnostic agreement between parents' and children's reports on children's anxiety problems is notoriously poor; however, very few investigations have examined specific predictors of inter-rater agreement on child anxiety diagnoses. This study examined predictors of categories of parent and child diagnostic endorsement on the Anxiety Disorders Interview Schedule for Children-IV. One hundred eight children (ages 7-13) and their parents completed structured diagnostic interviews for non-OCD/PTSD anxiety diagnoses and paper and pencil measures of functioning and impairment in a variety of domains. Parent-child agreement was statistically significant for social phobia and separation anxiety disorder, but was overall poor for all anxiety diagnoses. Externalizing disorder status, family accommodation frequency, and child rated impairment in various domains differentially predicted informant discrepancies for different anxiety disorders. These data are among the first to suggest variables that may explain parent-child concordance. Copyright © 2016. Published by Elsevier Ireland Ltd.

Creating objects and object categories for studying perception and perceptual learning.

PubMed

Hauffen, Karin; Bart, Eugene; Brady, Mark; Kersten, Daniel; Hegdé, Jay

2012-11-02

In order to quantitatively study object perception, be it perception by biological systems or by machines, one needs to create objects and object categories with precisely definable, preferably naturalistic, properties. Furthermore, for studies on perceptual learning, it is useful to create novel objects and object categories (or object classes) with such properties. Many innovative and useful methods currently exist for creating novel objects and object categories (also see refs. 7,8). However, generally speaking, the existing methods have three broad types of shortcomings. First, shape variations are generally imposed by the experimenter, and may therefore be different from the variability in natural categories, and optimized for a particular recognition algorithm. It would be desirable to have the variations arise independently of the externally imposed constraints. Second, the existing methods have difficulty capturing the shape complexity of natural objects. If the goal is to study natural object perception, it is desirable for objects and object categories to be naturalistic, so as to avoid possible confounds and special cases. Third, it is generally hard to quantitatively measure the available information in the stimuli created by conventional methods. It would be desirable to create objects and object categories where the available information can be precisely measured and, where necessary, systematically manipulated (or 'tuned'). This allows one to formulate the underlying object recognition tasks in quantitative terms. Here we describe a set of algorithms, or methods, that meet all three of the above criteria. Virtual morphogenesis (VM) creates novel, naturalistic virtual 3-D objects called 'digital embryos' by simulating the biological process of embryogenesis. Virtual phylogenesis (VP) creates novel, naturalistic object categories by simulating the evolutionary process of natural selection. Objects and object categories created by these simulations can be further manipulated by various morphing methods to generate systematic variations of shape characteristics. The VP and morphing methods can also be applied, in principle, to novel virtual objects other than digital embryos, or to virtual versions of real-world objects. Virtual objects created in this fashion can be rendered as visual images using a conventional graphical toolkit, with desired manipulations of surface texture, illumination, size, viewpoint and background. The virtual objects can also be 'printed' as haptic objects using a conventional 3-D prototyper. We also describe some implementations of these computational algorithms to help illustrate the potential utility of the algorithms. It is important to distinguish the algorithms from their implementations. The implementations are demonstrations offered solely as a 'proof of principle' of the underlying algorithms. It is important to note that, in general, an implementation of a computational algorithm often has limitations that the algorithm itself does not have. Together, these methods represent a set of powerful and flexible tools for studying object recognition and perceptual learning by biological and computational systems alike. With appropriate extensions, these methods may also prove useful in the study of morphogenesis and phylogenesis.

How did the Master Settlement Agreement change tobacco industry expenditures for cigarette advertising and promotions?

PubMed

Pierce, John P; Gilpin, Elizabeth A

2004-07-01

The 1998 multistate Master Settlement Agreement (MSA) with the tobacco industry restricted cigarette advertising and promotions. The MSA monetary settlement was also associated with an average cigarette price increase of U.S.$1.19/pack between 1998 and 2001 to fund, in part, industry payments to the states. We examined Federal Trade Commission reports on how the tobacco industry spends its cigarette advertising and promotional dollars to see if changes expected as a result of the MSA occurred. Expected changes included reduced total expenditures and reductions for outdoor advertising, specialty promotional items identified with a brand (e.g., caps, t-shirts, lighters), and public entertainment. However, tobacco industry spending for advertising and promotions increased 96% between 1995 and 2001, with large increases in 1998 and 1999, as the MSA took effect. Between 1997 and 2001, outdoor advertising declined 98%, expenditures for specialty promotional items decreased 41%, although public entertainment increased 45%. However, in 2001, these categories represented only a small fraction of the total budget. Expenditures for retail-value-added increased 344% between 1997 and 2001 (to 42.5% of total), perhaps to mitigate increased cigarette prices. In 2001, the incentives-to-merchants and retail-value-added categories comprised more than 80% of total expenditures. To adequately monitor tobacco industry expenditures as they adapt to the MSA and other tobacco control efforts, more refined reporting categories are essential.

Accuracy of recorded tumor, node, and metastasis stage in a comprehensive cancer center.

PubMed

Brierley, James D; Catton, Pamela A; O'Sullivan, Brian; Dancey, Janet E; Dowling, Anthony J; Irish, Jonathan C; McGowan, Thomas S; Sturgeon, Jeremy F G; Swallow, Carol J; Rodrigues, George B; Panzarella, Tony

2002-01-15

The benefits of recording the tumor, node, and metastasis (TNM) stages of cancer patients are well accepted, but little is known about how accurately this is performed. An audit was performed to determine the accuracy of recorded stage and to act as a baseline before the implementation of an education program. All new patient referrals to Princess Margaret Hospital between July 1 and August 31, 1997, were reviewed. An audit panel composed of five health record technicians (HRTs) and 10 doctors was assembled. Each auditor reviewed 10% of the health record. If there was a discrepancy between the stage in the health record and the auditor stage, then the final stage was determined by the audit committee. Analysis of the agreement between the health record, the physician auditor, the HRT auditor, and the final stage was performed. A total of 855 patients were referred with a new diagnosis of a malignancy for which there was a TNM stage system; 833 patients (97.4%) had a stage assigned. There was agreement between the health record stage and final stage in 80% (95% confidence interval [CI], 77% to 82%) of cases for clinical stage, compared with 90% (95% CI, 87% to 92%) for pathologic stage. Of the major site groups, lung was the least accurately recorded. The most common major discrepancies were due to the recording of X when a definite category could be assigned. This audit demonstrates the importance of staging and provides impetus to develop staging guidelines and education programs.

30 CFR 914.30 - State-Federal Cooperative Agreement.

Code of Federal Regulations, 2014 CFR

2014-07-01

....C. 4321 et seq., and implementing regulations, including 40 CFR part 1500. 4. The Endangered Species.... Authority This Agreement is authorized by section 523(c) of the Surface Mining Control and Reclamation Act.... Article II: Effective Date After being signed by the Secretary and the Governor, this Agreement will take...

30 CFR 914.30 - State-Federal Cooperative Agreement.

Code of Federal Regulations, 2011 CFR

2011-07-01

....C. 4321 et seq., and implementing regulations, including 40 CFR part 1500. 4. The Endangered Species.... Authority This Agreement is authorized by section 523(c) of the Surface Mining Control and Reclamation Act.... Article II: Effective Date After being signed by the Secretary and the Governor, this Agreement will take...

30 CFR 914.30 - State-Federal Cooperative Agreement.

Code of Federal Regulations, 2012 CFR

2012-07-01

....C. 4321 et seq., and implementing regulations, including 40 CFR part 1500. 4. The Endangered Species.... Authority This Agreement is authorized by section 523(c) of the Surface Mining Control and Reclamation Act.... Article II: Effective Date After being signed by the Secretary and the Governor, this Agreement will take...

30 CFR 914.30 - State-Federal Cooperative Agreement.

Code of Federal Regulations, 2013 CFR

2013-07-01

....C. 4321 et seq., and implementing regulations, including 40 CFR part 1500. 4. The Endangered Species.... Authority This Agreement is authorized by section 523(c) of the Surface Mining Control and Reclamation Act.... Article II: Effective Date After being signed by the Secretary and the Governor, this Agreement will take...

30 CFR 914.30 - State-Federal Cooperative Agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

....C. 4321 et seq., and implementing regulations, including 40 CFR part 1500. 4. The Endangered Species.... Authority This Agreement is authorized by section 523(c) of the Surface Mining Control and Reclamation Act.... Article II: Effective Date After being signed by the Secretary and the Governor, this Agreement will take...

25 CFR 224.84 - When may a tribe grant a right-of-way?

Code of Federal Regulations, 2011 CFR

2011-04-01

....84 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT AND SELF DETERMINATION ACT Implementation of Tribal Energy Resource Agreements Leases, Business Agreements, and Rights-Of-Way Under A Tera § 224.84...

25 CFR 224.84 - When may a tribe grant a right-of-way?

Code of Federal Regulations, 2010 CFR

2010-04-01

....84 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT AND SELF DETERMINATION ACT Implementation of Tribal Energy Resource Agreements Leases, Business Agreements, and Rights-Of-Way Under A Tera § 224.84...

2 CFR 176.20 - Agency responsibilities (general).

Code of Federal Regulations, 2012 CFR

2012-01-01

... 2 Grants and Agreements 1 2012-01-01 2012-01-01 false Agency responsibilities (general). 176.20 Section 176.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements... enforcement or termination action in accordance with 2 CFR 215.62 or the agency's implementation of the OMB...

2 CFR 176.20 - Agency responsibilities (general).

Code of Federal Regulations, 2013 CFR

2013-01-01

... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Agency responsibilities (general). 176.20 Section 176.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements... enforcement or termination action in accordance with 2 CFR 215.62 or the agency's implementation of the OMB...

2 CFR 176.20 - Agency responsibilities (general).

Code of Federal Regulations, 2014 CFR

2014-01-01

... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Agency responsibilities (general). 176.20 Section 176.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements... enforcement or termination action in accordance with 2 CFR 215.62 or the agency's implementation of the OMB...

2 CFR 176.20 - Agency responsibilities (general).

Code of Federal Regulations, 2011 CFR

2011-01-01

... 2 Grants and Agreements 1 2011-01-01 2011-01-01 false Agency responsibilities (general). 176.20 Section 176.20 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements... enforcement or termination action in accordance with 2 CFR 215.62 or the agency's implementation of the OMB...

2 CFR 182.20 - What must a Federal agency do to implement the guidance?

Code of Federal Regulations, 2010 CFR

2010-01-01

... the guidance? 182.20 Section 182.20 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE... cooperative agreements or makes other financial assistance awards that are subject to the drug-free workplace...

2 CFR 182.30 - Where does a Federal agency implement the guidance?

Code of Federal Regulations, 2010 CFR

2010-01-01

... guidance? 182.30 Section 182.30 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL... grants or cooperative agreements or makes other financial assistance awards that are subject to the drug...

78 FR 65221 - Defense Federal Acquisition Regulation Supplement: New Free Trade Agreement-Panama (DFARS Case...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

... Supplement (DFARS) to implement the United States--Panama Trade Promotion Agreement. This Trade Promotion...--Panama Trade Promotion Agreement. No respondents submitted public comments in response to the interim... effects, distributive impacts, and equity). E.O. 13563 emphasizes the importance of quantifying both costs...

Inter-observer agreement improves with PERCIST 1.0 as opposed to qualitative evaluation in non-small cell lung cancer patients evaluated with F-18-FDG PET/CT early in the course of chemo-radiotherapy.

PubMed

Fledelius, Joan; Khalil, Azza; Hjorthaug, Karin; Frøkiær, Jørgen

2016-12-01

The purpose of this study is to determine whether a qualitative approach or a semi-quantitative approach provides the most robust method for early response evaluation with 2'-deoxy-2'-[(18)F]fluoro-D-glucose (F-18-FDG) positron emission tomography combined with whole body computed tomography (PET/CT) in non-small cell lung cancer (NSCLC). In this study eight Nuclear Medicine consultants analyzed F-18-FDG PET/CT scans from 35 patients with locally advanced NSCLC. Scans were performed at baseline and after 2 cycles of chemotherapy. Each observer used two different methods for evaluation: (1) PET response criteria in solid tumors (PERCIST) 1.0 and (2) a qualitative approach. Both methods allocate patients into one of four response categories (complete and partial metabolic response (CMR and PMR) and stable and progressive metabolic disease (SMD and PMD)). The inter-observer agreement was evaluated using Fleiss' kappa for multiple raters, Cohens kappa for comparison of the two methods, and intraclass correlation coefficients (ICC) for comparison of lean body mass corrected standardized uptake value (SUL) peak measurements. The agreement between observers when determining the percentage change in SULpeak was "almost perfect", with ICC = 0.959. There was a strong agreement among observers allocating patients to the different response categories with a Fleiss kappa of 0.76 (0.71-0.81). In 22 of the 35 patients, complete agreement was observed with PERCIST 1.0. The agreement was lower when using the qualitative method, moderate, having a Fleiss kappa of 0.60 (0.55-0.64). Complete agreement was achieved in only 10 of the 35 patients. The difference between the two methods was statistically significant (p < 0.005) (chi-squared). Comparing the two methods for each individual observer showed Cohen's kappa values ranging from 0.64 to 0.79, translating into a strong agreement between the two methods. PERCIST 1.0 provides a higher overall agreement between observers than the qualitative approach in categorizing early treatment response in NSCLC patients. The inter-observer agreement is in fact strong when using PERCIST 1.0 even when the level of instruction is purposely kept to a minimum in order to mimic the everyday situation. The variability is largely owing to the subjective elements of the method.

78 FR 19602 - Approval and Promulgation of Implementation Plans and Operating Permits Program; State of Missouri

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

... of VOC. The SIP revision also corrects two asbestos method subpart references. This revision also...-6.020(c) for Category I nonfriable asbestos containing material (ACM), and Category II nonfriable... Reference Tables (2)(C)3 and (2)(C)4 dated November 30, 2010. Although asbestos is not regulated under the...

Risk-Category Transition Patterns for Students in Grades 2 to 4. Research Brief 7

ERIC Educational Resources Information Center

Park, Bitnara Jasmine

2013-01-01

Early identification of students who are at-risk for reading difficulties (RD) is critical for successful and effective RTI implementation. A large group of students were followed for three years (grades 2 to 4) to investigate transition patterns of risk-categories across three years. Results indicated that although students identified at…

75 FR 41424 - Fisheries of the Exclusive Economic Zone Off Alaska; Skates Management in the Groundfish...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

... and AMs must be implemented by January 1, 2011. Skate, shark, sculpin, and octopus groups are currently managed as a complex in the ``other species'' category in the BSAI. In the GOA, shark, sculpin...'' category combines the management of short-lived invertebrates (squids and octopuses) with long-lived fish...

Mammographic image quality in relation to positioning of the breast: A multicentre international evaluation of the assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment.

PubMed

Taylor, K; Parashar, D; Bouverat, G; Poulos, A; Gullien, R; Stewart, E; Aarre, R; Crystal, P; Wallis, M

2017-11-01

Optimum mammography positioning technique is necessary to maximise cancer detection. Current criteria for mammography appraisal lack reliability and validity with a need to develop a more objective system. We aimed to establish current international practice in assessing image quality (IQ), of screening mammograms then develop and validate a reproducible assessment tool. A questionnaire sent to centres in countries undertaking population screening identified practice, participants for an expert panel (EP) of radiologists/radiographers and a testing panel (TP) of radiographers. The EP developed category criteria and descriptors using a modified Delphi process to agree definitions. The EP scored 12 screening mammograms to test agreement then a main set of 178 cases. Weighted scores were derived for each descriptor enabling calculation of numerical parameters for each new category. The TP then scored the main set. Statistical analysis included ANOVA, t-tests and Kendall's coefficient. 11 centres in 8 countries responded forming an EP of 7 members and TP of 44 members. The EP showed moderate agreement when the scoring the mini test set W = 0.50 p < 0.001 and the main set W = 0.55 p < 0.001, 'posterior nipple line' being the most difficult descriptor. The weighted total scores differentiated the 4 new categories Perfect, Good, Adequate and Inadequate (p < 0.001). We have developed an assessment tool by Delphi consensus and weighted consensus criteria. We have successfully tabulated a range of numerical scores for each new category providing the first validated and reproducible mammography IQ scoring system. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

48 CFR 39.103 - Modular contracting.

Code of Federal Regulations, 2011 CFR

2011-10-01

... increments to take advantage of any evolution in technology or needs that occur during implementation and use... CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY General 39.103 Modular contracting. (a) This section implements Section 5202, Incremental Acquisition of Information Technology, of the Clinger-Cohen...

48 CFR 39.103 - Modular contracting.

Code of Federal Regulations, 2013 CFR

2013-10-01

... increments to take advantage of any evolution in technology or needs that occur during implementation and use... CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY General 39.103 Modular contracting. (a) This section implements Section 5202, Incremental Acquisition of Information Technology, of the Clinger-Cohen...

48 CFR 39.103 - Modular contracting.

Code of Federal Regulations, 2012 CFR

2012-10-01

... increments to take advantage of any evolution in technology or needs that occur during implementation and use... CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY General 39.103 Modular contracting. (a) This section implements Section 5202, Incremental Acquisition of Information Technology, of the Clinger-Cohen...

Similarity relations in visual search predict rapid visual categorization

PubMed Central

Mohan, Krithika; Arun, S. P.

2012-01-01

How do we perform rapid visual categorization?It is widely thought that categorization involves evaluating the similarity of an object to other category items, but the underlying features and similarity relations remain unknown. Here, we hypothesized that categorization performance is based on perceived similarity relations between items within and outside the category. To this end, we measured the categorization performance of human subjects on three diverse visual categories (animals, vehicles, and tools) and across three hierarchical levels (superordinate, basic, and subordinate levels among animals). For the same subjects, we measured their perceived pair-wise similarities between objects using a visual search task. Regardless of category and hierarchical level, we found that the time taken to categorize an object could be predicted using its similarity to members within and outside its category. We were able to account for several classic categorization phenomena, such as (a) the longer times required to reject category membership; (b) the longer times to categorize atypical objects; and (c) differences in performance across tasks and across hierarchical levels. These categorization times were also accounted for by a model that extracts coarse structure from an image. The striking agreement observed between categorization and visual search suggests that these two disparate tasks depend on a shared coarse object representation. PMID:23092947

Facilitators for the development and implementation of health promoting policy and programs - a scoping review at the local community level.

PubMed

Weiss, Daniel; Lillefjell, Monica; Magnus, Eva

2016-02-11

Health promotion, with a focus on multidimensional upstream factors and an ecological, life-course approach, is establishing itself as the guiding philosophy for addressing public health. Action at the political and programmatic level on the Social Determinants of Health has proven effective for promoting and building public health at all levels but has been particularly evident at the national and international levels - due in large part to available documents and guidelines. Although research and experience establish that health promotion is most effective when settings-based, the development of health promoting policies and programs at the local level is still difficult. This study intended to investigate available knowledge on the development and implementation of health promoting policies and programs at the local level and identify factors most important for facilitating capacity building and outcome achievement. We used a scoping review in order to review the current literature on local policy development and program implementation. Keywords were chosen based on results of a previous literature review. A total of 53 articles were divided into two categories: policy and implementation. Critical analysis was conducted for each article and a summary assembled. Data was charted with specific focus on the aims of the study, data acquisition, key theories/concepts/frameworks used, outcome measures, results, and conclusions. The articles included in this study primarily focused on discussing factors that facilitate the development of health promoting policy and the implementation of health promotion programs. Most significant facilitators included: collaborative decision-making, agreement of objectives and goals, local planning and action, effective leadership, building and maintaining trust, availability of resources, a dynamic approach, a realistic time-frame, and trained and knowledgeable staff. Within each of these important facilitating factors, various elements supporting implementation were discussed and highlighted in this study. Our results indicate that clear and consistent facilitators exist for supporting health promoting policy development and program implementation at the local level. These results offer a starting point for local action on the Social Determinants of Health and have the potential to contribute to the development of a framework for improving action at the local level.

Enablers and barriers in delivery of a cancer exercise program: the Canadian experience

PubMed Central

Mina, D. Santa; Petrella, A.; Currie, K.L.; Bietola, K.; Alibhai, S.M.H.; Trachtenberg, J.; Ritvo, P.; Matthew, A.G.

2015-01-01

Background Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-exercise programs have been developed to enhance clinical care; however, few programs exist in Canada. Expansion of cancer-exercise programming depends on an understanding of the process of program implementation, as well as enablers and barriers to program success. Gaining knowledge from current professionals in cancer-exercise programs could serve to facilitate the necessary understanding. Methods Key personnel from Canadian cancer-exercise programs (n = 14) participated in semistructured interviews about program development and delivery. Results Content analysis revealed 13 categories and 15 subcategories, which were grouped by three organizing domains: Program Implementation, Program Enablers, and Program Barriers. ■ Program Implementation (5 categories, 8 subcategories) included Program Initiation (clinical care extension, research project expansion, program champion), Funding, Participant Intake (avenues of awareness, health and safety assessment), Active Programming (monitoring patient exercise progress, health care practitioner involvement, program composition), and Discharge and Follow-up Plan.■ Program Enablers (4 categories, 4 subcategories) included Patient Participation (personalized care, supportive network, personal control, awareness of benefits), Partnerships, Advocacy and Support, and Program Characteristics.■ Program Barriers (4 categories, 3 subcategories) included Lack of Funding, Lack of Physician Support, Deterrents to Participation (fear and shame, program location, competing interests), and Disease Progression and Treatment. Conclusions Interview results provided insight into the development and delivery of cancer-exercise programs in Canada and could be used to guide future program development and expansion in Canada. PMID:26715869

Context-specific control and context selection in conflict tasks.

PubMed

Schouppe, Nathalie; Ridderinkhof, K Richard; Verguts, Tom; Notebaert, Wim

2014-02-01

This study investigated whether participants prefer contexts with relatively little cognitive conflict and whether this preference is related to context-specific control. A conflict selection task was administered in which participants had to choose between two categories that contained different levels of conflict. One category was associated with 80% congruent Stroop trials and 20% incongruent Stroop trials, while the other category was associated with only 20% congruent Stroop trials and 80% incongruent Stroop trials. As predicted, participants selected the low-conflict category more frequently, indicating that participants avoid contexts with high-conflict likelihood. Furthermore, we predicted a correlation between this preference for the low-conflict category and the control implementation associated with the categories (i.e., context-specific proportion congruency effect, CSPC effect). Results however did not show such a correlation, thereby failing to support a relationship between context control and context selection. Copyright © 2013 Elsevier B.V. All rights reserved.

Attitude and perception of farmers to the implementation of conservation farming in the mountainous area of South Sulawesi

NASA Astrophysics Data System (ADS)

Busthanul, N.; Lumoindong, Y.; Syafiuddin, M.; Heliawaty; Lanuhu, N.; Ibrahim, T.; Ambrosius, R. R.

2018-05-01

Farmers’ attitudes and perceptions may be the cause of ineffective implementation of conservation farming for agriculture sustainability due to vary of implementing of conservation techniques. The purpose of this research is to know the attitude and perception of farmer toward the application of conservation technique and to know correlation between farmer attitude and perception toward the application of conservation technique. The research was carried out in Kanreapia Village, Tombolo Pao District, Gowa Regency, South Sulawesi Province, Indonesia. Sampling was done by randomly with 30 farmers; using non-parametric statistics with quantitative and qualitative descriptive data analysis approach, using Likert scale. The result showed that farmer attitude and perception toward conservation technique implementation which having the highest category (appropriate) is seasonal crop rotation, while the lowest with less appropriate category is the processing of land according to the contour and the cultivation of the plants accordingly. There is a very strong relationship between farmer attitude and perception. The implications of the findings are that improvements the implementation of conservation farming techniques should be made through improved perceptions.

Measuring the Diagnostic Features of Social (Pragmatic) Communication Disorder: An Exploratory Study.

PubMed

Yuan, Haiying; Dollaghan, Christine

2018-03-27

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition introduced a new neurodevelopmental disorder, social (pragmatic) communication disorder (SPCD), that is characterized by deficits in 4 areas of communication. Although descriptions of these areas are provided, no assessment tools for SPCD are recommended. The purpose of this study was to examine the extent to which items from measurement tools commonly used in assessing pragmatic language impairment and related disorders might be useful in assessing the characteristics of social communication that define SPCD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Based on a literature search, 594 items from assessment tools commonly used to measure social communication abilities in people with pragmatic language impairment were identified. The first author judged whether each item reflected 1, more than 1, or none of the 4 SPCD diagnostic characteristics. After a brief training process, 5 second raters independently mapped subsets of items to the 6 categories. We calculated the percentage of agreement and Cohen's kappa for each pair of raters in assigning items to categories. Percentages of agreement ranged from 76% to 82%, and Cohen's kappa values ranged from .69 to .76, indicating substantial agreement. Sources and item numbers for the 206 items that both raters assigned to the same SPCD feature are provided. These items may provide guidance in assessing SPCD and in designing standardized screening and diagnostic measures for SPCD.

International classification of functioning, disability and health categories for spinal cord injury nursing in China.

PubMed

Li, Kun; Yan, Tiebin; You, Liming; Li, Rui; Ross, Amy Miner

2015-01-01

To explore a set of International Classification of Functioning, Disability and Health (ICF) categories that cover the spinal cord injury (SCI) nursing practice in China through a national expert survey. An internet-based email survey was used. An original set of ICF categories specifically for SCI nursing has been developed from the preliminary studies based on an international perspective. For cultural adaptation in China, a national expert survey was conducted with Chinese experts on SCI nursing to identify the ICF categories that were specifically for SCI nursing in China. The ICF categories which received more than 80% support from the experts would be reported. Twenty-nine Chinese experts on SCI nursing participated. There were 81 ICF categories which received more than 80% agreement among the experts, including 33 Body Functions categories, eight Body Structures, 24 Activities and Participation, six Environmental Factors and 10 Personal Factors items. A set of ICF categories that cover the SCI nursing practice in China was identified. It reflects the main issues that Chinese nurses focus on in caring SCI patients. These categories can facilitate Chinese nurses to use the ICF in multidisciplinary teamwork and improve the participation of nurses in the team. Implications for Rehabilitation In China, nurses lack of an effective model or tool to communicate with the other health professionals in the rehabilitation team for spinal cord injury (SCI) patients. International Classification of Functioning, Disability and Health (ICF) is a tool for multidisciplinary use, which can promote the communication and collaboration in the healthcare team by establishing a common language across different disciplines and sectors. This set of ICF categories developed from this study can serve as a roadmap for important items for use in clinical practice of Chinese SCI nursing.

Contingency Contractor Optimization Phase 3 Sustainment Cost by JCA Implementation Guide

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

Durfee, Justin David; Frazier, Christopher Rawls; Arguello, Bryan

This document provides implementation guidance for implementing personnel group FTE costs by JCA Tier 1 or 2 categories in the Contingency Contractor Optimization Tool – Engineering Prototype (CCOT-P). CCOT-P currently only allows FTE costs by personnel group to differ by mission. Changes will need to be made to the user interface inputs pages and the database

Improving energy efficiency in handheld biometric applications

NASA Astrophysics Data System (ADS)

Hoyle, David C.; Gale, John W.; Schultz, Robert C.; Rakvic, Ryan N.; Ives, Robert W.

2012-06-01

With improved smartphone and tablet technology, it is becoming increasingly feasible to implement powerful biometric recognition algorithms on portable devices. Typical iris recognition algorithms, such as Ridge Energy Direction (RED), utilize two-dimensional convolution in their implementation. This paper explores the energy consumption implications of 12 different methods of implementing two-dimensional convolution on a portable device. Typically, convolution is implemented using floating point operations. If a given algorithm implemented integer convolution vice floating point convolution, it could drastically reduce the energy consumed by the processor. The 12 methods compared include 4 major categories: Integer C, Integer Java, Floating Point C, and Floating Point Java. Each major category is further divided into 3 implementations: variable size looped convolution, static size looped convolution, and unrolled looped convolution. All testing was performed using the HTC Thunderbolt with energy measured directly using a Tektronix TDS5104B Digital Phosphor oscilloscope. Results indicate that energy savings as high as 75% are possible by using Integer C versus Floating Point C. Considering the relative proportion of processing time that convolution is responsible for in a typical algorithm, the savings in energy would likely result in significantly greater time between battery charges.

40 CFR 63.11427 - Who implements and enforces this subpart?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 14 2010-07-01 2010-07-01 false Who implements and enforces this subpart? 63.11427 Section 63.11427 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants for Lead Acid Battery...

Materials requirements for optical processing and computing devices

NASA Technical Reports Server (NTRS)

Tanguay, A. R., Jr.

1985-01-01

Devices for optical processing and computing systems are discussed, with emphasis on the materials requirements imposed by functional constraints. Generalized optical processing and computing systems are described in order to identify principal categories of requisite components for complete system implementation. Three principal device categories are selected for analysis in some detail: spatial light modulators, volume holographic optical elements, and bistable optical devices. The implications for optical processing and computing systems of the materials requirements identified for these device categories are described, and directions for future research are proposed.

23 CFR 1200.23 - Vouchers and project agreements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 23 Highways 1 2012-04-01 2012-04-01 false Vouchers and project agreements. 1200.23 Section 1200.23... Implementation and Management of the Highway Safety Program § 1200.23 Vouchers and project agreements. Each State... rate (or Special matching writeoff used, i.e., sliding scale rate authorized under 23 U.S.C. 120(a...

23 CFR 1200.23 - Vouchers and project agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Vouchers and project agreements. 1200.23 Section 1200.23... Implementation and Management of the Highway Safety Program § 1200.23 Vouchers and project agreements. Each State... rate (or Special matching writeoff used, i.e., sliding scale rate authorized under 23 U.S.C. 120(a...

23 CFR 1200.23 - Vouchers and project agreements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Vouchers and project agreements. 1200.23 Section 1200.23... Implementation and Management of the Highway Safety Program § 1200.23 Vouchers and project agreements. Each State... rate (or Special matching writeoff used, i.e., sliding scale rate authorized under 23 U.S.C. 120(a...

78 FR 22226 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-15

... the United States-Peru Trade Promotion Agreement Implementation Act (Act). Form Number(s): N/A. OMB... request; 2 hours per response; and 1 hour per rebuttal. Needs and Uses: The United States and Peru negotiated the U.S.-Peru Trade Promotion Agreement (the Agreement), which entered into force on February 1...

77 FR 22058 - Notice of Fiscal Year 2012 Cooperative Agreement Solicitation for Applications; Specialized Heavy...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-12

...-0091] Notice of Fiscal Year 2012 Cooperative Agreement Solicitation for Applications; Specialized Heavy... agreement opportunity is to support the FMCSA and the FHWA to collect data for a Specialized Heavy Vehicle... performance of heavier vehicles, the FMCSA and the FHWA are partnering to implement the Specialized Heavy...

Southwestern Power Administration Update, October- December 2004

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

None

2004-12-01

On October 29, 2004, Southwestern and Southwest Power Pool, Inc. (SPP) reached agreement on interim arrangements to be implemented after the October 31, 2004, expiration of the membership agreement between the two parties. According to Jim McDonald, Director of Southwestern’s Division of Customer Service, the interim agreement forged between Southwestern and SPP seeks to minimize impacts to SPP as well as to Southwestern and its customers while Southwestern and SPP work on a seams/coordination agreement to succeed the expired membership agreement.

Agreement between hysterosalpingography and laparoscopic chromopertubation in assessment of tubal patency.

PubMed

Matorras, R; Rodriguez, F; Pêrez, C; Pijoan, J I; Echanojauregui, A; Rodriguez-Escudero, F J

1998-01-01

To assess the agreement between tubal patency assessed by laparoscopy with chromopertubation and by hysterosalpingography using contrast media. University Medical School. 314 consecutive women subjected to laparoscopy and hysterosalpingography for an infertility study. Prospective study. Chromopertubation using Methylen blue dye, performed on days 20-24. Hysterosalpingography performed on days 7-10 with water soluble contrast. Kappa coefficient calculation. Kappa coefficient ranged from 0.40 to 0.36, depending on the categories analyzed, corresponding to a fair agreement. The diagnosis of tubal factor requires that both tubal patency tests (Hysterosalpingography and laparoscopy) show an abnormal patency. When one of the aforementioned tests is normal, performing the second one has little clinical advantage. However, it is suggested that when there is a discordant patency the pregnancy rates could be somewhat reduced.

Measures of Agreement Between Many Raters for Ordinal Classifications

PubMed Central

Nelson, Kerrie P.; Edwards, Don

2015-01-01

Screening and diagnostic procedures often require a physician's subjective interpretation of a patient's test result using an ordered categorical scale to define the patient's disease severity. Due to wide variability observed between physicians’ ratings, many large-scale studies have been conducted to quantify agreement between multiple experts’ ordinal classifications in common diagnostic procedures such as mammography. However, very few statistical approaches are available to assess agreement in these large-scale settings. Existing summary measures of agreement rely on extensions of Cohen's kappa [1 - 5]. These are prone to prevalence and marginal distribution issues, become increasingly complex for more than three experts or are not easily implemented. Here we propose a model-based approach to assess agreement in large-scale studies based upon a framework of ordinal generalized linear mixed models. A summary measure of agreement is proposed for multiple experts assessing the same sample of patients’ test results according to an ordered categorical scale. This measure avoids some of the key flaws associated with Cohen's kappa and its extensions. Simulation studies are conducted to demonstrate the validity of the approach with comparison to commonly used agreement measures. The proposed methods are easily implemented using the software package R and are applied to two large-scale cancer agreement studies. PMID:26095449

Behavior States: Now You See Them, Now You Don't.

ERIC Educational Resources Information Center

Mudford, Oliver C.; Hogg, James; Roberts, Jessie

1999-01-01

A study attempted to replicate a previous study that presented reliability data from recordings of behavior state using a 13-category coding system. Replication was unsuccessful. Obtained mean percentage agreement on occurrence for individual behavior state and participants (n=34) ranged across observer pairs from 0 to 58 percent. (Contains 13…

Movement of Negative Adverbs in French Infinitival Clauses.

ERIC Educational Resources Information Center

Martineau, France

1994-01-01

Positioning of negative adverbs (e.g., "mie, pas, point, jamais") in Middle and Classical French infinitival clauses is analyzed. It is proposed that, rather than linking movement of this infinitival verb to the strength of functional categories such as agreement, it be linked to parametric change in strength of the negative. (Author/MSE)

Orchestra Festival Evaluations: Interjudge Agreement and Relationships between Performance Categories and Final Ratings.

ERIC Educational Resources Information Center

Garman, Barry R.; And Others

1991-01-01

Band, orchestra, and choir festival evaluations are a regular part of many secondary school music programs, and most such festivals engage adjudicators who rate each group's performance. Because music ensemble performance is complex and multi-dimensional, it does not lend itself readily to precise measurement; generally, musical performances are…

Moderators of Informant Agreement in the Assessment of Adolescent Psychopathology: Extension to a Forensic Sample

ERIC Educational Resources Information Center

Penney, Stephanie R.; Skilling, Tracey A.

2012-01-01

A well-documented finding in developmental psychopathology research is that different informants often provide discrepant ratings of a youth's internalizing and externalizing problems. The current study examines youth- and parent-based moderators (i.e., youth age, gender, and IQ; type of psychopathology; offense category; psychopathic traits;…

What Is the deficit in Phonological Processing Deficits: Auditory Sensitivity, Masking, or Category Formation?

ERIC Educational Resources Information Center

Nittrouer, Susan; Shune, Samantha; Lowenstein, Joanna H.

2011-01-01

Although children with language impairments, including those associated with reading, usually demonstrate deficits in phonological processing, there is minimal agreement as to the source of those deficits. This study examined two problems hypothesized to be possible sources: either poor auditory sensitivity to speech-relevant acoustic properties,…

Orbital Debris Shape Characterization Project Abstract

NASA Technical Reports Server (NTRS)

Pease, Jessie

2016-01-01

I have been working on a project to further our understanding of orbital debris by helping create a new dataset previously too complex to be implemented in past orbital debris propagation models. I am doing this by creating documentation and 3D examples and illustrations of the shape categories. Earlier models assumed all orbital debris to be spherical aluminum fragments. My project will help expand our knowledge of shape populations to 6 categories: Straight Needle/Rod/Cylinder, Bent Needle/Rod/Cylinder, Flat Plate, Bent Plate, Nugget/Parallelepiped/Spheroid, and Flexible. The last category, Flexible, is still up for discussion and may be modified. These categories will be used to characterize fragments in the DebriSat experiment.

10 CFR 61.32 - Facility information and verification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... WASTE Licenses Us/iaea Safeguards Agreement § 61.32 Facility information and verification. (a) In... as necessary to implement the US/IAEA Safeguards Agreement, as described in Part 75 of this chapter...

Advanced Vehicle and Power Initiative

DTIC Science & Technology

2010-07-29

optimize vehicle operation, and capture vehicle kinetic energy during braking ( regenerative energy). As much as two-thirds of this imported oil comes... categories . Figure 4 provides a visual representation of many of the HEV and BEV options available on the 2010 GSA Schedule. Figure 4 - GSA...gallon • Renewable energy generated 24 • Vehicle miles driven by vehicle category • Implementation costs – Infrastructure modifications required

Toward an International Classification of Functioning, Disability and Health clinical data collection tool: the Italian experience of developing simple, intuitive descriptions of the Rehabilitation Set categories.

PubMed

Selb, Melissa; Gimigliano, Francesca; Prodinger, Birgit; Stucki, Gerold; Pestelli, Germano; Iocco, Maurizio; Boldrini, Paolo

2017-04-01

As part of international efforts to develop and implement national models including the specification of ICF-based clinical data collection tools, the Italian rehabilitation community initiated a project to develop simple, intuitive descriptions of the ICF Rehabilitation Set, highlighting the core concept of each category in user-friendly language. This paper outlines the Italian experience in developing simple, intuitive descriptions of the ICF Rehabilitation Set as an ICF-based clinical data collection tool for Italy. Consensus process. Expert conference. Multidisciplinary group of rehabilitation professionals. The first of a two-stage consensus process involved developing an initial proposal for simple, intuitive descriptions of each ICF Rehabilitation Set category based on descriptions generated in a similar process in China. Stage two involved a consensus conference. Divided into three working groups, participants discussed and voted (vote A) whether the initially proposed descriptions of each ICF Rehabilitation Set category was simple and intuitive enough for use in daily practice. Afterwards the categories with descriptions considered ambiguous i.e. not simple and intuitive enough, were divided among the working groups, who were asked to propose a new description for the allocated categories. These proposals were then voted (vote B) on in a plenary session. The last step of the consensus conference required each working group to develop a new proposal for each and the same categories with descriptions still considered ambiguous. Participants then voted (final vote) for which of the three proposed descriptions they preferred. Nineteen clinicians from diverse rehabilitation disciplines from various regions of Italy participated in the consensus process. Three ICF categories already achieved consensus in vote A, while 20 ICF categories were accepted in vote B. The remaining 7 categories were decided in the final vote. The findings were discussed in light of current efforts toward developing strategies for ICF implementation, specifically for the application of an ICF-based clinical data collection tool, not only for Italy but also for the rest of Europe. Promising as minimal standards for monitoring the impact of interventions and for standardized reporting of functioning as a relevant outcome in rehabilitation.

CLARIPED: a new tool for risk classification in pediatric emergencies.

PubMed

Magalhães-Barbosa, Maria Clara de; Prata-Barbosa, Arnaldo; Alves da Cunha, Antonio José Ledo; Lopes, Cláudia de Souza

2016-09-01

To present a new pediatric risk classification tool, CLARIPED, and describe its development steps. Development steps: (i) first round of discussion among experts, first prototype; (ii) pre-test of reliability, 36 hypothetical cases; (iii) second round of discussion to perform adjustments; (iv) team training; (v) pre-test with patients in real time; (vi) third round of discussion to perform new adjustments; (vii) final pre-test of validity (20% of medical treatments in five days). CLARIPED features five urgency categories: Red (Emergency), Orange (very urgent), Yellow (urgent), Green (little urgent) and Blue (not urgent). The first classification step includes the measurement of four vital signs (Vipe score); the second step consists in the urgency discrimination assessment. Each step results in assigning a color, selecting the most urgent one for the final classification. Each color corresponds to a maximum waiting time for medical care and referral to the most appropriate physical area for the patient's clinical condition. The interobserver agreement was substantial (kappa=0.79) and the final pre-test, with 82 medical treatments, showed good correlation between the proportion of patients in each urgency category and the number of used resources (p<0.001). CLARIPED is an objective and easy-to-use tool for simple risk classification, of which pre-tests suggest good reliability and validity. Larger-scale studies on its validity and reliability in different health contexts are ongoing and can contribute to the implementation of a nationwide pediatric risk classification system. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

77 FR 20656 - Postal Service Classification and Price Adjustments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-05

... noticing a recently-filed Postal Service notice announcing its intent to implement Picture Permit Imprint... implement Picture Permit Imprint Indicia as price categories for First-Class Mail and Standard Mail letters... Dominant Classification and Price Changes for Picture Permit Imprint Indicia, March 28, 2012 (Notice). II...

78 FR 16783 - Approval and Promulgation of Implementation Plans; Georgia; Control Techniques Guidelines and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-19

... Promulgation of Implementation Plans; Georgia; Control Techniques Guidelines and Reasonably Available Control...), related to reasonably available control technology (RACT) requirements. This correcting amendment corrects... October 21, 2009, SIP submittal for certain source categories for which EPA has issued control technique...

Investigating nutrient profiling and Health Star Ratings on core dairy products in Australia.

PubMed

Wellard, Lyndal; Hughes, Clare; Watson, Wendy L

2016-10-01

To determine whether the ratings from the Australian front-of-pack labelling scheme, Health Star Rating (HSR), and the ability to carry health claims using the Nutrient Profiling Scoring Criterion (NPSC) for core dairy products promote foods consistent with the Australian Dietary Guidelines. The Australian nutrient profiling model used for assessing eligibility for health claims was compared with the nutrient profiling model underpinning the HSR system to determine their agreement when assessing dairy products. Agreement between the extent to which products met nutrient profiling criteria and scored three stars or over using the HSR calculator was determined using Cohen's kappa tests. The four largest supermarket chains in Sydney, Australia. All available products in the milk, hard cheese, soft cheese and yoghurt categories (n 1363) were surveyed in March-May 2014. Nutrition composition and ingredients lists were recorded for each product. There was 'good' agreement between NPSC and HSR overall (κ=0·78; 95 % CI 0·75, 0·81; P<0·001), for hard cheeses (κ=0·72; 95 % CI 0·65, 0·79; P<0·001) and yoghurt (κ=0·79; 95 % CI 0·73, 0·86; P<0·001). There was 'fair' agreement for milk (κ=0·33; 95 % CI 0·20, 0·45; P<0·001) and 'very good' agreement for soft cheese (κ=0·84; 95 % CI 0·75, 0·92; P<0·001). Generally, products tended to have HSR consistent with other products of a similar type within their categories. For dairy products, the HSR scheme largely aligned with the NPSC used for determining eligibility for health claims. Both systems appeared be consistent with the Australian Dietary Guidelines for dairy products, with lower-fat products rating higher.

Concordance of hypervascular liver nodule characterization between the organ procurement and transplant network and liver imaging reporting and data system classifications.

PubMed

Bashir, Mustafa R; Huang, Rong; Mayes, Nicholas; Marin, Daniele; Berg, Carl L; Nelson, Rendon C; Jaffe, Tracy A

2015-08-01

To determine the rate of agreement between the Organ Procurement and Transplant Network (OPTN) and Liver Imaging Reporting and Data System (LI-RADS) classifications for hypervascular liver nodules at least 1 cm in diameter, and for patient eligibility for hepatocellular/MELD (Model for Endstage Liver Disease) exception points. This retrospective study was approved by our Institutional Review Board and was compliant with the Health Insurance Portability and Accountability Act. The requirement for informed consent was waived. This study included 200 hypervascular hepatocellular nodules at least 1 cm in diameter on computed tomography (CT) or magnetic resonance imaging (MRI) examinations in 105 patients with chronic liver disease. Three radiologists blinded to clinical data independently evaluated nodule characteristics, including washout, capsule, size, and size on prior examination. Based on those characteristics, nodules were automatically classified as definite hepatocellular carcinoma (HCC) or not definite HCC using both the OPTN and LI-RADS classifications. Using these classifications and the Milan criteria, each examination was determined to be "below transplant criteria," "within transplant criteria," or "beyond transplant criteria." Agreement was assessed between readers and classification systems, using Fleiss' kappa, intraclass correlation coefficients (ICCs), and simple proportions. Interreader agreement was moderate for nodule features (κ = 0.59-0.69) and nodule classification (0.66-0.69). The two systems were in nearly complete agreement on nodule category assignment (98.7% [592/600]) and patient eligibility for transplant exemption priority (99.4% [313/315]). A few discrepancies occurred for the nodule feature of growth (1.3% [8/600]) and for nodule category assignment (1.3% [8/600]). Agreement between the OPTN and LI-RADS classifications is very strong for categorization of hypervascular liver nodules at least 1 cm in diameter, and for patient eligibility for hepatocellular/MELD exception points. Interreader variability is much higher than intersystem variability. © 2014 Wiley Periodicals, Inc.

Diagnostic discrepancies in retinopathy of prematurity classification

PubMed Central

Campbell, J. Peter; Ryan, Michael C.; Lore, Emily; Tian, Peng; Ostmo, Susan; Jonas, Karyn; Chan, R.V. Paul; Chiang, Michael F.

2016-01-01

Objective To identify the most common areas for discrepancy in retinopathy of prematurity (ROP) classification between experts. Design Prospective cohort study. Subjects, Participants, and/or Controls 281 infants were identified as part of a multi-center, prospective, ROP cohort study from 7 participating centers. Each site had participating ophthalmologists who provided the clinical classification after routine examination using binocular indirect ophthalmoscopy (BIO), and obtained wide-angle retinal images, which were independently classified by two study experts. Methods Wide-angle retinal images (RetCam; Clarity Medical Systems, Pleasanton, CA) were obtained from study subjects, and two experts evaluated each image using a secure web-based module. Image-based classifications for zone, stage, plus disease, overall disease category (no ROP, mild ROP, Type II or pre-plus, and Type I) were compared between the two experts, and to the clinical classification obtained by BIO. Main Outcome Measures Inter-expert image-based agreement and image-based vs. ophthalmoscopic diagnostic agreement using absolute agreement and weighted kappa statistic. Results 1553 study eye examinations from 281 infants were included in the study. Experts disagreed on the stage classification in 620/1553 (40%) of comparisons, plus disease classification (including pre-plus) in 287/1553 (18%), zone in 117/1553 (8%), and overall ROP category in 618/1553 (40%). However, agreement for presence vs. absence of type 1 disease was >95%. There were no differences between image-based and clinical classification except for zone III disease. Conclusions The most common area of discrepancy in ROP classification is stage, although inter-expert agreement for clinically-significant disease such as presence vs. absence of type 1 and type 2 disease is high. There were no differences between image-based grading and the clinical exam in the ability to detect clinically-significant disease. This study provides additional evidence that image-based classification of ROP reliably detects clinically significant levels of ROP with high accuracy compared to the clinical exam. PMID:27238376

Creating Objects and Object Categories for Studying Perception and Perceptual Learning

PubMed Central

Hauffen, Karin; Bart, Eugene; Brady, Mark; Kersten, Daniel; Hegdé, Jay

2012-01-01

In order to quantitatively study object perception, be it perception by biological systems or by machines, one needs to create objects and object categories with precisely definable, preferably naturalistic, properties1. Furthermore, for studies on perceptual learning, it is useful to create novel objects and object categories (or object classes) with such properties2. Many innovative and useful methods currently exist for creating novel objects and object categories3-6 (also see refs. 7,8). However, generally speaking, the existing methods have three broad types of shortcomings. First, shape variations are generally imposed by the experimenter5,9,10, and may therefore be different from the variability in natural categories, and optimized for a particular recognition algorithm. It would be desirable to have the variations arise independently of the externally imposed constraints. Second, the existing methods have difficulty capturing the shape complexity of natural objects11-13. If the goal is to study natural object perception, it is desirable for objects and object categories to be naturalistic, so as to avoid possible confounds and special cases. Third, it is generally hard to quantitatively measure the available information in the stimuli created by conventional methods. It would be desirable to create objects and object categories where the available information can be precisely measured and, where necessary, systematically manipulated (or 'tuned'). This allows one to formulate the underlying object recognition tasks in quantitative terms. Here we describe a set of algorithms, or methods, that meet all three of the above criteria. Virtual morphogenesis (VM) creates novel, naturalistic virtual 3-D objects called 'digital embryos' by simulating the biological process of embryogenesis14. Virtual phylogenesis (VP) creates novel, naturalistic object categories by simulating the evolutionary process of natural selection9,12,13. Objects and object categories created by these simulations can be further manipulated by various morphing methods to generate systematic variations of shape characteristics15,16. The VP and morphing methods can also be applied, in principle, to novel virtual objects other than digital embryos, or to virtual versions of real-world objects9,13. Virtual objects created in this fashion can be rendered as visual images using a conventional graphical toolkit, with desired manipulations of surface texture, illumination, size, viewpoint and background. The virtual objects can also be 'printed' as haptic objects using a conventional 3-D prototyper. We also describe some implementations of these computational algorithms to help illustrate the potential utility of the algorithms. It is important to distinguish the algorithms from their implementations. The implementations are demonstrations offered solely as a 'proof of principle' of the underlying algorithms. It is important to note that, in general, an implementation of a computational algorithm often has limitations that the algorithm itself does not have. Together, these methods represent a set of powerful and flexible tools for studying object recognition and perceptual learning by biological and computational systems alike. With appropriate extensions, these methods may also prove useful in the study of morphogenesis and phylogenesis. PMID:23149420

25 CFR 224.82 - What activities will the Department continue to perform after approval of a TERA?

Code of Federal Regulations, 2011 CFR

2011-04-01

... INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT AND SELF DETERMINATION ACT Implementation of Tribal Energy Resource Agreements Applicable Authorities...

77 FR 15943 - United States-Korea Free Trade Agreement

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-19

...This rule amends the Customs and Border Protection (CBP) regulations on an interim basis to implement the preferential tariff treatment and other customs-related provisions of the United States- Korea Free Trade Agreement.

Video training and certification program improves reliability of postischemic neurologic deficit measurement in the rat.

PubMed

Taninishi, Hideki; Pearlstein, Molly; Sheng, Huaxin; Izutsu, Miwa; Chaparro, Rafael E; Goldstein, Larry B; Warner, David S

2016-12-01

Scoring systems are used to measure behavioral deficits in stroke research. Video-assisted training is used to standardize stroke-related neurologic deficit scoring in humans. We hypothesized that a video-assisted training and certification program can improve inter-rater reliability in assessing neurologic function after middle cerebral artery occlusion in rats. Three expert raters scored neurologic deficits in post-middle cerebral artery occlusion rats using three published systems having different complexity levels (3, 18, or 48 points). The system having the highest point estimate for the correlation between neurologic score and infarct size was selected to create a video-assisted training and certification program. Eight trainee raters completed the video-assisted training and certification program. Inter-rater agreement ( Κ: score) and agreement with expert consensus scores were measured before and after video-assisted training and certification program completion. The 48-point system correlated best with infarct size. Video-assisted training and certification improved agreement with expert consensus scores (pretraining = 65 ± 10, posttraining = 87 ± 14, 112 possible scores, P < 0.0001), median number of trainee raters with scores within ±2 points of the expert consensus score (pretraining = 4, posttraining = 6.5, P < 0.01), categories with Κ:  > 0.4 (pretraining = 4, posttraining = 9), and number of categories with an improvement in the Κ: score from pretraining to posttraining (n = 6). Video-assisted training and certification improved trainee inter-rater reliability and agreement with expert consensus behavioral scores in rats after middle cerebral artery occlusion. Video-assisted training and certification may be useful in multilaboratory preclinical studies. © The Author(s) 2015.

Observer variation in the assessment of root canal curvature.

PubMed

Faraj, S; Boutsioukis, C

2017-02-01

To evaluate the inter- and intra-observer agreement between training/trained endodontists regarding the ex vivo classification of root canal curvature into three categories and its measurement using three quantitative methods. Periapical radiographs of seven extracted human posterior teeth with varying degrees of curvature were exposed ex vivo. Twenty training/trained endodontists were asked to classify the root canal curvature into three categories (<10°, 10-30°, >30°), to measure the curvature using three quantitative methods (Schneider, Weine, Pruett) and to draw angles of 10° or 30°, as a control experiment. The procedure was repeated after six weeks. Inter- and intra-observer agreement was evaluated by the intraclass correlation coefficient and weighted kappa. The inter-observer agreement on the visual classification of root canal curvature was substantial (ICC = 0.65, P < 0.018), but a trend towards underestimation of the angle was evident. Participants modified their classifications both within and between the two sessions. Median angles drawn as a control experiment were not significantly different from the target values (P > 0.10), but the results of individual participants varied. When quantitative methods were used, the inter- and intra-observer agreement on the angle measurements was considerably better (ICC = 0.76-0.82, P < 0.001) than on the radius measurements (ICC = 0.16-0.19, P > 0.895). Visual estimation of root canal curvature was not reliable. The use of computer-based quantitative methods is recommended. The measurement of radius of curvature was more subjective than angle measurement. Endodontic Associations need to provide specific guidelines on how to estimate root canal curvature in case difficulty assessment forms. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Estimated water use, by county, in North Carolina, 1995

USGS Publications Warehouse

Walters, D.A.

1997-01-01

Data on water use in North Carolina were compiled for 1995 as part of a cooperative agreement between the U.S. Geological Survey and the Division of Water Resources of the North Carolina Department of Environment and Natural Resources. Data were compiled from a number of Federal, State, and private sources for the offstream water-use categories of public supply, domestic, commercial, industrial, mining, livestock, irrigation, and thermoelectric-power generation. Data also were collected for instream use from hydroelectric facilities. Total withdrawals (fresh and saline) during 1995 were an estimated 9,286 million gallons per day for the offstream water-use categories. About 94 percent of the water withdrawn was from surface water. Thermoelectric-power generation accounted for 80 percent of all withdrawals. Instream water use for hydroelectric-power generation totaled about 56,400 million gallons per day. Each water-use category is summarized in this report by county and source of water supply.

Why Certain Trade Agreements Are Approved as Congressional-Executive Agreements Rather Than as Treaties

DTIC Science & Technology

2010-09-08

described as an action “approving the United States’ international legal obligations specified by the Agreement,” and the amendment of statutes to... unconstitutionally delegate either legislative or treaty-making authority to the President.3 In the Reciprocal Trade Agreements Act of 1934, as amended and extended...legislative vetoes of executive implementing actions might not comport with constitutional requirements regarding the passage of legislation. In the Trade

77 FR 65439 - Implementation of United States-Panama Trade Promotion Agreement Tariff-Rate Quota for Imports of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

... Promotion Agreement Tariff-Rate Quota for Imports of Sugar AGENCY: Office of the United States Trade Representative. ACTION: Notice. SUMMARY: USTR is providing notice that the tariff-rate quotas for sugar... Agreement establishes three tariff-rate quotas for imports of sugar from Panama. USTR is providing notice...

77 FR 24759 - Implementation of United States-Colombia Trade Promotion Agreement Tariff-Rate Quota for Imports...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-25

... Promotion Agreement Tariff-Rate Quota for Imports of Sugar AGENCY: Office of the United States Trade Representative. ACTION: Notice. SUMMARY: USTR is providing notice that the tariff-rate quota for sugar... Agreement establishes a tariff-rate quota for imports of sugar from Colombia. USTR is providing notice that...

47 CFR 51.809 - Availability of agreements to other telecommunications carriers under section 252(i) of the Act.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Availability of agreements to other telecommunications carriers under section 252(i) of the Act. 51.809 Section 51.809 Telecommunication FEDERAL... Implementation of Section 252 of the Act § 51.809 Availability of agreements to other telecommunications carriers...

47 CFR 51.809 - Availability of agreements to other telecommunications carriers under section 252(i) of the Act.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Availability of agreements to other telecommunications carriers under section 252(i) of the Act. 51.809 Section 51.809 Telecommunication FEDERAL... Implementation of Section 252 of the Act § 51.809 Availability of agreements to other telecommunications carriers...

3 CFR 8818 - Proclamation 8818 of May 14, 2012. To Implement the United States-Colombia Trade Promotion...

Code of Federal Regulations, 2013 CFR

2013-01-01

..., 2009, modified certain rules of origin under the North American Free Trade Agreement and incorporated... Schedule of the United States to Adjust Rules of Origin Under the North American Free Trade Agreement... commitments under the United States-Korea Free Trade Agreement and incorporated by reference Publication 4308...

47 CFR 51.809 - Availability of agreements to other telecommunications carriers under section 252(i) of the Act.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Availability of agreements to other telecommunications carriers under section 252(i) of the Act. 51.809 Section 51.809 Telecommunication FEDERAL... Implementation of Section 252 of the Act § 51.809 Availability of agreements to other telecommunications carriers...

47 CFR 51.809 - Availability of agreements to other telecommunications carriers under section 252(i) of the Act.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Availability of agreements to other telecommunications carriers under section 252(i) of the Act. 51.809 Section 51.809 Telecommunication FEDERAL... Implementation of Section 252 of the Act § 51.809 Availability of agreements to other telecommunications carriers...

47 CFR 51.809 - Availability of agreements to other telecommunications carriers under section 252(i) of the Act.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Availability of agreements to other telecommunications carriers under section 252(i) of the Act. 51.809 Section 51.809 Telecommunication FEDERAL... Implementation of Section 252 of the Act § 51.809 Availability of agreements to other telecommunications carriers...

40 CFR 63.5707 - What is an implementation plan for open molding operations and when do I need to prepare one?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 12 2010-07-01 2010-07-01 true What is an implementation plan for open... AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards for Hazardous Air Pollutants for Boat Manufacturing Standards for Open Molding Resin and Gel Coat Operations § 63.5707 What is an implementation plan...

Opportunities in the commercial uses of remote sensing and GIS technologies - An overview of NASA's Visiting Investigator Program at Stennis Space Center

NASA Technical Reports Server (NTRS)

Davis, Bruce A.; Carr, Hugh V., Jr.; Schmidt, Nicholas; Hickerson, Logan

1993-01-01

The Visiting Investigator Program (VIP) developed at NASA-Stennis' Science and Technology Laboratory (STL) allows U.S. industry to use the specialized resources of STL in the fields of remote sensing and GIS, with a view to the development of new commercial processes and improved services. Attention is given to the novel agreement mechanisms developed by NASA to implement VIP. These agreements encompass a memorandum of understanding, a technical exchange agreement, a sponsored-transfer agreement, a proprietary work agreement, and a joint endeavor agreement.

Factors that enable and hinder the implementation of projects in the alcohol and other drug field.

PubMed

MacLean, Sarah; Berends, Lynda; Hunter, Barbara; Roberts, Bridget; Mugavin, Janette

2012-02-01

Few studies systematically explore elements of successful project implementation across a range of alcohol and other drug (AOD) activities. This paper provides an evidence base to inform project implementation in the AOD field. We accessed records for 127 completed projects funded by the Alcohol, Education and Rehabilitation Foundation from 2002 to 2008. An adapted realist synthesis methodology enabled us to develop categories of enablers and barriers to successful project implementation, and to identify factors statistically associated with successful project implementation, defined as meeting all funding objectives. Thematic analysis of eight case study projects allowed detailed exploration of findings. Nine enabler and 10 barrier categories were identified. Those most frequently reported as both barriers and enablers concerned partnerships with external agencies and communities, staffing and project design. Achieving supportive relationships with partner agencies and communities, employing skilled staff and implementing consumer or participant input mechanisms were statistically associated with successful project implementation. The framework described here will support development of evidence-based project funding guidelines and project performance indicators. The study provides evidence that investing project hours and resources to develop robust relationships with project partners and communities, implementing mechanisms for consumer or participant input and attracting skilled staff are legitimate and important activities, not just in themselves but because they potentially influence achievement of project funding objectives. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

The deep space network, Volume 11

NASA Technical Reports Server (NTRS)

1972-01-01

Deep Space Network progress in flight project support, Tracking and Data Acquisition research and technology, network engineering, hardware and software implementation, and operations are presented. Material is presented in each of the following categories: description of DSN; mission support; radio science; support research and technology; network engineering and implementation; and operations and facilities.

77 FR 58953 - Approval and Promulgation of Air Quality Implementation Plans; Delaware; Control Technique...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-25

... Promulgation of Air Quality Implementation Plans; Delaware; Control Technique Guidelines for Plastic Parts... categories: Plastic Parts, Metal Furniture, Large Appliances, and Miscellaneous Metal Parts. EPA is approving... Compounds, sections 2.0 ``Definitions,'' 12.0 ``Surface Coating of Plastic Parts,'' 19.0 ``Coating of Metal...

Inclusive Education: A Case of Beliefs Competing for Implementation

ERIC Educational Resources Information Center

Meltz, Adrienne; Herman, Chaya; Pillay, Venitha

2014-01-01

The study explored the understanding and implementation of inclusive education in an independent Jewish community school; a school with a community ethos of care and belonging, whose context is, by definition, exclusionary on the grounds of a particular social category--religion. However, this exclusionary agenda positioned the school as inclusive…

Predictor Implementation School/District Self-Assessment

ERIC Educational Resources Information Center

National Post-School Outcomes Center, 2013

2013-01-01

The checklist provided here is intended to provide schools, districts, or other stakeholders in secondary transition with a framework for determining the degree to which their program is implementing practices that are likely to lead to more positive post-school outcomes for students with disabilities. The predictor categories listed have been…

A Contingent Analysis of the Relationship between IS Implementation Strategies and IS Success.

ERIC Educational Resources Information Center

Kim, Sang-Hoon; Lee, Jinjoo

1991-01-01

Considers approaches to dealing with user attitudes toward newly implemented information systems (IS), and suggests that behavioral management strategies relevant to IS fall into three categories: (1) empirical/rational; (2) normative/reeducative; and (3) power/coercive, based on "planned change" theories. An integrative contingent model…

Kentucky's Program for Educationally Deficient School Districts: A Case Study.

ERIC Educational Resources Information Center

Fry, Patricia; And Others

The development and implementation of Kentucky's Program for Educationally Deficient School Districts is examined in this case study. Implemented in 1987, the program required districts to meet certain performance, planning, and reporting criteria. Districts failing to comply could be placed in categories of noncompliance. Data were derived from…

Appeals in gynecologic cytology proficiency testing: review and analysis of data from the 2006 College of American Pathologists gynecologic cytology proficiency testing program.

PubMed

Crothers, Barbara A; Moriarty, Ann T; Fatheree, Lisa A; Booth, Christine N; Tench, William D; Wilbur, David C

2009-01-01

In 2006, 9643 participants took the initial College of American Pathologists (CAP) Proficiency Test (PT). Failing participants may appeal results on specific test slides. Appeals are granted if 3 referee pathologists do not unanimously agree on the initial reference diagnosis in a masked review process. To investigate causes of PT failures, subsequent appeals, and appeal successes in 2006. Appeals were examined, including patient demographic information, Centers for Medicare and Medicaid Services category (A, B, C, or D), exact reference diagnosis, examinees per appeal, examinee's Centers for Medicare and Medicaid Services category, referee's Centers for Medicare and Medicaid Services category, slide preparation type, and slide field validation rate. There was a 94% passing rate for 2006. One hundred fifty-five examinees (1.6%) appealed 86 slides of all preparation types. Forty-five appeals (29%) were granted on 21 slides; 110 appeals (72%) were denied on 65 slides. Reference category D and B slides were most often appealed. The highest percentage of granted appeals occurred in category D (35% slides; 42% of participants) and the lowest occurred in category B (9% slides; 8% of participants). The field validation rate of all appealed slides was greater than 90%. Despite rigorous field validation of slides, 6% of participants failed. Thirty percent of failing participants appealed; most appeals involved misinterpretation of category D as category B. Referees were never unanimous in their agreement with the participant. The participants and referees struggled with the reliability and reproducibility of finding rare cells, "overdiagnosis" of benign changes, and assigning the morphologically dynamic biologic changes of squamous intraepithelial lesions to static categories.

Counteracting obesity: developing a policy framework to guide action.

PubMed

Cismaru, Magdalena

2008-01-01

The purpose of this paper is to stimulate further debate regarding possible courses of policy action aimed at preventing obesity. Gostin's framework for classifying antiobesity legal interventions is tested and extended to incorporate non-legislative policy initiatives to include a comprehensive array of policy actions available to deal with obesity. A web search of the literature has been conducted. Initiatives from USA, Canada and the European Union were discussed in terms of their objectives and fit with the framework. Gostin's framework was found to be a useful tool in organizing all the initiatives (legislative and non-legislative). However, sometimes a broader definition of the category was needed. As well, in some categories, few initiatives were implemented to date and several new categories have to be added to the framework to classify all the existing initiatives. The theoretical developed framework will assist new initiatives assess possible courses of action as well as countries or organizations that have already implemented some measures identify what else can be done to effectively fight overweight and obesity.

Cancellation of scheduled procedures as a mechanism to generate hospital bed surge capacity-a pilot study.

PubMed

Soremekun, Olan A; Zane, Richard D; Walls, Andrew; Allen, Matthew B; Seefeld, Kimberly J; Pallin, Daniel J

2011-06-01

The ability to generate hospital beds in response to a mass-casualty incident is an essential component of public health preparedness. Although many acute care hospitals' emergency response plans include some provision for delaying or cancelling elective procedures in the event of an inpatient surge, no standardized method for implementing and quantifying the impact of this strategy exists in the literature. The aim of this study was to develop a methodology to prospectively emergency plan for implementing a strategy of delaying procedures and quantifying the potential impact of this strategy on creating hospital bed capacity. This is a pilot study. A categorization methodology was devised and applied retrospectively to all scheduled procedures during four one-week periods chosen by convenience. The categorization scheme grouped procedures into four categories: (A) procedures with no impact on inpatient capacity; (B) procedures that could be delayed indefinitely; (C) procedures that could be delayed by one week; and (D) procedures that could not be delayed. The categorization scheme was applied by two research assistants and an emergency medicine resident. All three raters categorized the first 100 cases to allow for calculation of inter-rater reliability. Maximal hospital bed capacity was defined as the 95th percentile weekday occupancy, as this is more representative of functional bed capacity than is the number of licensed beds. The main outcome was the number of hospital beds that could be created by postponing procedures in categories B and C. Maximal hospital bed capacity was 816 beds. Mean occupancy during weekdays was 759 versus 694 on weekends. By postponing Group B and C procedures, a mean of 60 beds (51 general medical/surgical and nine intensive care unit (ICU)) could be created on weekdays, and four beds (three general medical/surgical and one ICU) on weekends. This represents 7.3% and 0.49% of maximal hospital bed capacity and ICU capacity, respectively. In the event that sustained surge is needed, delaying all category B and C procedures for one week would lead to the generation of 1,235 hospital-bed days. Inter-rater reliability was high (kappa = 0.74) indicating good agreement between all three raters. For the institution studied, the strategy of delaying scheduled procedures could generate inpatient capacity with maximal impact during weekdays and little impact on weekends. Future research is needed to validate the categorization scheme and increase the ability to predict inpatient surge capacity across various hospital types and sizes.

Mathematical Modeling of Language Games

NASA Astrophysics Data System (ADS)

Loreto, Vittorio; Baronchelli, Andrea; Puglisi, Andrea

In this chapter we explore several language games of increasing complexity. We first consider the so-called Naming Game, possibly the simplest example of the complex processes leading progressively to the establishment of human-like languages. In this framework, a globally shared vocabulary emerges as a result of local adjustments of individual word-meaning association. The emergence of a common vocabulary only represents a first stage while it is interesting to investigate the emergence of higher forms of agreement, e.g., compositionality, categories, syntactic or grammatical structures. As an example in this direction we consider the so-called Category Game. Here one focuses on the process by which a population of individuals manages to categorize a single perceptually continuous channel. The problem of the emergence of a discrete shared set of categories out of a continuous perceptual channel is a notoriously difficult problem relevant for color categorization, vowels formation, etc. The central result here is the emergence of a hierarchical category structure made of two distinct levels: a basic layer, responsible for fine discrimination of the environment, and a shared linguistic layer that groups together perceptions to guarantee communicative success.

Evidence-Based School Behavior Assessment of Externalizing Behavior in Young Children

PubMed Central

Bagner, Daniel M.; Boggs, Stephen R.; Eyberg, Sheila M.

2011-01-01

This study examined the psychometric properties of the Revised Edition of the School Observation Coding System (REDSOCS). Participants were 68 children ages 3 to 6 who completed parent-child interaction therapy for Oppositional Defiant Disorder as part of a larger efficacy trial. Interobserver reliability on REDSOCS categories was moderate to high, with percent agreement ranging from 47% to 90% (M = 67%) and Cohen’s kappa coefficients ranging from .69 to .95 (M = .82). Convergent validity of the REDSOCS categories was supported by significant correlations with the Intensity Scale of the Sutter-Eyberg Student Behavior Inventory-Revised and related subscales of the Conners’ Teacher Rating Scale-Revised: Long Version (CTRS-R: L). Divergent validity was indicated by nonsignificant correlations between REDSOCS categories and scales on the CTRS-R: L expected not to relate to disruptive classroom behavior. Treatment sensitivity was demonstrated for two of the three primary REDSOCS categories by significant pre to posttreatment changes. This study provides psychometric support for the designation of REDSOCS as an evidence-based assessment procedure for young children. PMID:21687781

Color Comprehension and Color Categories among Blind Students: A Multi-Sensory Approach in Implementing Concrete Language to Include All Students in Advanced Writing Classes

ERIC Educational Resources Information Center

Antarasena, Salinee

2009-01-01

This study investigates teaching methods regarding color comprehension and color categorization among blind students, as compared to their non-blind peers and whether they understand and represent the same color comprehension and color categories. Then after digit codes for color comprehension teaching and assistive technology for the blind had…

Creating a New Learning Community: A Case Study of School Leaders' Perceptions of the Baldrige Criteria for Performance Excellence and Their Implementation in a Suburban School District

ERIC Educational Resources Information Center

Adams, Denean

2013-01-01

The Baldrige Criteria for Performance Excellence (Baldrige categories) are increasingly being used throughout the health, education, and business sectors to drive continuous improvement in quality organizations. In each industry, specific categories are available to assist in identifying quality practices deployed throughout an organization. The…

Expanding NASA and Roscosmos Scientific Collaboration on the International Space Station

NASA Technical Reports Server (NTRS)

Hasbrook, Pete

2016-01-01

The International Space Station (ISS) is a world-class laboratory orbiting in space. NASA and Roscosmos have developed a strong relationship through the ISS Program Partnership, working together and with the other ISS Partners for more than twenty years. Since 2013, based on a framework agreement between the Program Managers, NASA and Roscosmos are building a joint program of collaborative research on ISS. This international collaboration is developed and implemented in phases. Initially, members of the ISS Program Science Forum from NASA and TsNIIMash (representing Roscosmos) identified the first set of NASA experiments that could be implemented in the "near term". The experiments represented the research categories of Technology Demonstration, Microbiology, and Education. Through these experiments, the teams from the "program" and "operations" communities learned to work together to identify collaboration opportunities, establish agreements, and jointly plan and execute the experiments. The first joint scientific activity on ISS occurred in January 2014, and implementation of these joint experiments continues through present ISS operations. NASA and TsNIIMash have proceeded to develop "medium term" collaborations, where scientists join together to improve already-proposed experiments. A major success is the joint One-Year Mission on ISS, with astronaut Scott Kelly and cosmonaut Mikhail Kornienko, who returned from ISS in March, 2016. The teams from the NASA Human Research Program and the RAS Institute for Biomedical Problems built on their considerable experience to design joint experiments, learn to work with each other's protocols and processes, and share medical and research data. New collaborations are being developed between American and Russian scientists in complex fluids, robotics, rodent research and space biology, and additional human research. Collaborations are also being developed in Earth Remote Sensing, where scientists will share data from imaging systems mounted on ISS as well as other orbiting spacecraft to improve our understanding of the Earth and its climate. NASA and Roscosmos continue to encourage international scientific cooperation and expanded use of the ISS Laboratory. "Long-term", larger collaborations will achieve scientific objectives that no single national science team or agency can achieve on its own. The joint accomplishments achieved so far have paved the way for a stronger international scientific community and improved results and benefits from ISS.

Long-term contracts for forest land and timber in the South

Treesearch

William C. Siegel

1973-01-01

By means of long-term contracts, southern wood-using industries control almost 7 million acres of privately owned, nonindustrial forest. While pine is the prevalent timber type under contract, there are also substantial acreages of hardwood. Nearly all agreements are written on an individual basis, but most fit into one of several broad categories.

19 CFR 12.104g - Specific items or categories designated by agreements or emergency actions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... approximately 9000 B.C.), Pre-Classic, Classic, and Post-Classic Periods of the Pre-Columbian era through the Early and Late Colonial Periods CBP Dec. 13-05. Bolivia Archaeological and Ethnological Material from... from 1500 B.C. to 1530 A.D. and ecclesiastical ethnological material of the Colonial period ranging...

International management platform for children's interstitial lung disease (chILD-EU).

PubMed

Griese, Matthias; Seidl, Elias; Hengst, Meike; Reu, Simone; Rock, Hans; Anthony, Gisela; Kiper, Nural; Emiralioğlu, Nagehan; Snijders, Deborah; Goldbeck, Lutz; Leidl, Reiner; Ley-Zaporozhan, Julia; Krüger-Stollfuss, Ingrid; Kammer, Birgit; Wesselak, Traudl; Eismann, Claudia; Schams, Andrea; Neuner, Doerthe; MacLean, Morag; Nicholson, Andrew G; Lauren, McCann; Clement, Annick; Epaud, Ralph; de Blic, Jacques; Ashworth, Michael; Aurora, Paul; Calder, Alistair; Wetzke, Martin; Kappler, Matthias; Cunningham, Steve; Schwerk, Nicolaus; Bush, Andy

2018-03-01

Children's interstitial lung diseases (chILD) cover many rare entities, frequently not diagnosed or studied in detail. There is a great need for specialised advice and for internationally agreed subclassification of entities collected in a register.Our objective was to implement an international management platform with independent multidisciplinary review of cases at presentation for long-term follow-up and to test if this would allow for more accurate diagnosis. Also, quality and reproducibility of a diagnostic subclassification system were assessed using a collection of 25 complex chILD cases. A web-based chILD management platform with a registry and biobank was successfully designed and implemented. Over a 3-year period, 575 patients were included for observation spanning a wide spectrum of chILD. In 346 patients, multidisciplinary reviews were completed by teams at five international sites (Munich 51%, London 12%, Hannover 31%, Ankara 1% and Paris 5%). In 13%, the diagnosis reached by the referring team was not confirmed by peer review. Among these, the diagnosis initially given was wrong (27%), imprecise (50%) or significant information was added (23%).The ability of nine expert clinicians to subcategorise the final diagnosis into the chILD-EU register classification had an overall exact inter-rater agreement of 59% on first assessment and after training, 64%. Only 10% of the 'wrong' answers resulted in allocation to an incorrect category. Subcategorisation proved useful but training is needed for optimal implementation. We have shown that chILD-EU has generated a platform to help the clinical assessment of chILD. Results, NCT02852928. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Impact of implementing an EMR on physical exam documentation by ambulance personnel.

PubMed

Katzer, R; Barton, D J; Adelman, S; Clark, S; Seaman, E L; Hudson, K B

2012-01-01

Georgetown University has a student run Emergency Medical Services (EMS) organization with over 100 emergency medical technicians (EMTs). We set out to determine whether implementing an electronic patient care report (ePCR) system was associated with improved physical exam documentation. This study evaluated documentation of the physical exam on prehospital patient care reports (PCRs). An ePCR system was implemented. ePCR documentation was compared to that of the previously used paper PCRs. This study looked retrospectively at 154 PCRs. 77 were hand written PCRs from before the electronic system. The PCRs involved chief complaints that were primarily respiratory, neurologic, or both. 77 ePCRs of matching chief complaint categories were used for comparison. Each chart was reviewed for completion of certain physical exam findings. The mean percentage of documented components from the ePCRs was compared to that of the hand written PCRs. The null hypothesis was that the absolute increase in the mean was not more than 20 percent. The two exclusion criteria were PCRs completed by study investigators after the design of the project and partially or completely missing PCRs. The absolute increase in mean physical exam component documentation was 36% (95% CI = 29-43%). A weighted kappa of 0.894 showed very good agreement between chart reviewers. This study rejected the null hypothesis that the ePCR system was associated with a mean increase of no more than 20%. It observed increase in physical exam documentation. Limitations of this study included the inability to determine whether documentation of physical exam findings reflected performance of the physical exam, and what components of the ePCR system bundle were responsible for the increase in physical exam component documentation.

Impact of implementing an EMR on physical exam documentation by ambulance personnel

PubMed Central

Katzer, R.; Barton, D.J.; Adelman, S.; Clark, S.; Seaman, E.L.; Hudson, K.B.

2012-01-01

Objectives Georgetown University has a student run Emergency Medical Services (EMS) organization with over 100 emergency medical technicians (EMTs). We set out to determine whether implementing an electronic patient care report (ePCR) system was associated with improved physical exam documentation. Methods This study evaluated documentation of the physical exam on prehospital patient care reports (PCRs). An ePCR system was implemented. ePCR documentation was compared to that of the previously used paper PCRs. This study looked retrospectively at 154 PCRs. 77 were hand written PCRs from before the electronic system. The PCRs involved chief complaints that were primarily respiratory, neurologic, or both. 77 ePCRs of matching chief complaint categories were used for comparison. Each chart was reviewed for completion of certain physical exam findings. The mean percentage of documented components from the ePCRs was compared to that of the hand written PCRs. The null hypothesis was that the absolute increase in the mean was not more than 20 percent. The two exclusion criteria were PCRs completed by study investigators after the design of the project and partially or completely missing PCRs. Results The absolute increase in mean physical exam component documentation was 36% (95% CI = 29–43%). A weighted kappa of 0.894 showed very good agreement between chart reviewers. Conclusions This study rejected the null hypothesis that the ePCR system was associated with a mean increase of no more than 20%. It observed increase in physical exam documentation. Limitations of this study included the inability to determine whether documentation of physical exam findings reflected performance of the physical exam, and what components of the ePCR system bundle were responsible for the increase in physical exam component documentation. PMID:23646077

TRIPS, the Doha declaration and paragraph 6 decision: what are the remaining steps for protecting access to medicines?

PubMed Central

Kerry, Vanessa Bradford; Lee, Kelley

2007-01-01

Background The World Trade Organisation's Declaration on the TRIPS Agreement and Public Health (known as the Doha Declaration) of 2001, and subsequent Decision on the Interpretation of Paragraph 6 reached in 2003, affirmed the flexibilities available under the Agreement on Trade Related Property Rights (TRIPS) to member states seeking to protect public health. Despite these important clarifications, the actual implementation of these measures to improve access to medicines remains uncertain. There are also concerns that so-called TRIPS-plus measures within many regional and bilateral trade agreements are further undermining the capacity of the poor to access affordable medicines. Methods The paper reviews policy debates among governments, nongovernmental organisations and international organisations from 1995, and notably since 2003, surrounding access to medicines and trade agreements. The provisions for protecting public health provided by the Doha Declaration and Paragraph 6 Decision are reviewed in terms of challenges for implementation, along with measures to protect intellectual property rights (IPRs) under selected regional and bilateral trade agreements. Results While provisions, in principle, were affirmed for member states under the TRIPS agreement to protect public health, numerous challenges remain. Implementation of the flexibilities has been hindered by lack of capacity in many LMICs. More intransigent have been stark inequalities in power and influence among trading nations, leaving LMICs vulnerable to pressures to permit the globalization of IPRs in order to protect broader trade and economic interests. Such inequalities are apparent in proposals or adopted TRIPS-plus measures which re-establish the primacy of trade over public health goals. Conclusion Despite being hailed as a "watershed in international trade", the Doha Declaration and Paragraph 6 decision have not resolved the problem of access to affordable medicines. The way forward must begin with a simplification of their content, to enable actual implementation. More fundamentally, once agreed, public health protections under TRIPS must be recognised as taking precedent over measures subsequently adopted under other trade agreements. This requires, above all, setting aside such protections as a basic need and shared goal from trade negotiations at all levels. PMID:17524147

Towards the system-wide implementation of the International Classification of Functioning, Disability and Health in routine practice: Lessons from a pilot study in China.

PubMed

Li, Jianan; Prodinger, Birgit; Reinhardt, Jan D; Stucki, Gerold

2016-06-13

In 2011 the Chinese leadership in rehabilitation, in collaboration with the International Classification of Functioning, Disability and Health (ICF) Research Branch, embarked on an effort towards the system-wide implementation of the ICF in the healthcare system in China. We report here on the lessons learned from the pilot phase of testing the ICF Generic Set, a parsimonious set of 7 ICF categories, which have been shown to best describe functioning across the general population and people with various health conditions, for use in routine clinical practice in China. The paper discusses whether classification and measurement are compatible, what number of ICF categories should be included in data collection in routine practice, and the usefulness of a functioning profile and functioning score in clinical practice and health research planning. In addition, the paper reflects on the use of ICF qualifiers in a rating scale and the particularities of certain ICF categories contained in the ICF Generic Set when used as items in the context of Chinese rehabilitation and healthcare. Finally, the steps required to enhance the utility of system-wide implementation of the ICF in rehabilitation and healthcare services are set out.

RESIDUAL RISK ASSESSMENT: MAGNETIC TAPE ...

EPA Pesticide Factsheets

This document describes the residual risk assessment for the Magnetic Tape Manufacturing source category. For stationary sources, section 112 (f) of the Clean Air Act requires EPA to assess risks to human health and the environment following implementation of technology-based control standards. If these technology-based control standards do not provide an ample margin of safety, then EPA is required to promulgate addtional standards. This document describes the methodology and results of the residual risk assessment performed for the Magnetic Tape Manufacturing source category. The results of this analyiss will assist EPA in determining whether a residual risk rule for this source category is appropriate.

Combining agreement and frequency rating scales to optimize psychometrics in measuring behavioral health functioning.

PubMed

Marfeo, Elizabeth E; Ni, Pengsheng; Chan, Leighton; Rasch, Elizabeth K; Jette, Alan M

2014-07-01

The goal of this article was to investigate optimal functioning of using frequency vs. agreement rating scales in two subdomains of the newly developed Work Disability Functional Assessment Battery: the Mood & Emotions and Behavioral Control scales. A psychometric study comparing rating scale performance embedded in a cross-sectional survey used for developing a new instrument to measure behavioral health functioning among adults applying for disability benefits in the United States was performed. Within the sample of 1,017 respondents, the range of response category endorsement was similar for both frequency and agreement item types for both scales. There were fewer missing values in the frequency items than the agreement items. Both frequency and agreement items showed acceptable reliability. The frequency items demonstrated optimal effectiveness around the mean ± 1-2 standard deviation score range; the agreement items performed better at the extreme score ranges. Findings suggest an optimal response format requires a mix of both agreement-based and frequency-based items. Frequency items perform better in the normal range of responses, capturing specific behaviors, reactions, or situations that may elicit a specific response. Agreement items do better for those whose scores are more extreme and capture subjective content related to general attitudes, behaviors, or feelings of work-related behavioral health functioning. Copyright © 2014 Elsevier Inc. All rights reserved.

Agreement on Use of 11th Grade Smarter Balanced Assessment Results for Student Placement. Issue Brief

ERIC Educational Resources Information Center

Washington State Board for Community and Technical Colleges, 2014

2014-01-01

This issue brief lists the agreement principles relating to the use of 11th grade career and college readiness assessment results for student placement in Washington community and technical colleges. As part of the Washington implementation of the new Common Core State Standards for college- and career-readiness, the agreement described herein has…

76 FR 61042 - Modification of Regulations Regarding the Practice of Accepting Bonds During the Provisional...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-03

... and the terminology under Article 7 of the WTO Agreement on Implementation of Article VI of the General Agreement on Tariffs and Trade 1994 (``ADA'') and Article 17 of the Agreement on Subsidies and... cash deposits as provisional measures. Some of the same parties also note that Article 7 of the ADA and...

Report: Audit of Extramural and Property Management at the Atlantic Ecology Division

EPA Pesticide Factsheets

Report #2000-P-00015, March 29, 2000. Since our 1993 audit, AED made limited progress in implementing the recommendations in our prior report to improve the management of contracts, cooperative agreements and interagency agreements.

Implementation of basic chemistry experiment based on metacognition to increase problem-solving and build concept understanding

NASA Astrophysics Data System (ADS)

Zuhaida, A.

2018-04-01

Implementation of the experiment have the three aspects of the goal: 1) develop basic skills of experimenting; 2) develop problem-solving skills with a scientific approach; 3) improve understanding of the subject matter. On the implementation of the experiment, students have some weaknesses include: observing, identifying problems, managing information, analyzing, and evaluating. This weakness is included in the metacognition indicator.The objective of the research is to implementation of Basic Chemistry Experiment based on metacognition to increase problem-solving skills and build concept understanding for students of Science Education Department. The method of this research is a quasi- experimental method with pretest-posttest control group design. Problem-solving skills are measured through performance assessments using rubrics from problem solving reports, and results presentation. The conceptual mastery is measured through a description test. The result of the research: (1) improve the problem solving skills of the students with very high category; (2) increase the students’ concept understanding better than the conventional experiment with the result of N-gain in medium category, and (3) increase student's response positively for learning implementation. The contribution of this research is to extend the implementation of practical learning for some subjects, and to improve the students' competence in science.

Agreement of label information of cardiovascular drugs in pregnancy among Korea, the USA, the UK, and Japan.

PubMed

Lee, Shin Haeng; Shin, Ju-Young; Park, Mi-Ju; Park, Byung-Joo

2014-04-01

Drug label is a common source of information; however, the content varies widely. This study aims to evaluate label information on cardiovascular drugs regarding pregnancy for their similarities in Korea, USA, UK, and Japan. Study drugs were selected as following (1) cardiovascular drugs according to the WHO ATC code (C01-C09) and (2) drugs currently marketed in all four countries were included. Evidence level was classified into five categories ('Definite', 'Probable', 'Possible', 'Unlikely', and 'Unclassified') and recommendation level was classified into four categories ('Contraindicated', 'Cautious', 'Compatible', and 'Unclassified'). Frequency and proportion were presented. Percent agreement and kappa coefficient with 95% confidence interval (CI) were calculated using SAS ver. 9.3. Total of 50 cardiovascular drugs were included. 'Unclassified' was represented the most in Korea, followed by Japan and UK (58%, 54%, and 46%, p<0.05). For recommendation level, the majority of drugs in all four countries were classified as 'contraindicated' or 'cautious'. Japanese labels had the largest proportion of 'contraindicated' level (62%), and Korea and UK followed (58%, 44%, p<0.05). Only in the USA, 10.0% of the drugs were 'compatible' whereas, there were none in Korea, UK, and Japan (p<0.01). Korea and Japan showed a substantial agreement in evidence and recommendation level (kappa=0.69, 0.67). Labels of cardiovascular drugs in pregnancy differed widely. Reliable safety information in pregnancy should be provided through regular updates. Copyright © 2014 Elsevier Inc. All rights reserved.

Stakeholders analysis on criteria for protected areas management categories in Peninsular Malaysia

NASA Astrophysics Data System (ADS)

Hashim, Z.; Abdullah, S. A.; Nor, S. Md.

2017-10-01

The establishment of protected areas has always been associated with a strategy to conserve biodiversity. A well-managed protected areas not only protect the ecosystem and threatened species but also provides benefits to the public. These indeed require sound management practices through the application of protected areas management categories which can be is seen as tools for planning, establishment and administration of protected areas as well as to regulate the activities in the protected areas. However, in Peninsular Malaysia the implementation of the protected areas management categories was carried out based on the ‘ad-hoc’ basis without realising the important of the criteria based on the local values. Thus, an investigation has been sought to establish the criteria used in application to the protected areas management categories in Peninsular Malaysia. The outcomes revealed the significant of social, environment and economic criteria in establishing the protected area management categories in Peninsular Malaysia.

Quantum random number generation

DOE PAGES

Ma, Xiongfeng; Yuan, Xiao; Cao, Zhu; ...

2016-06-28

Quantum physics can be exploited to generate true random numbers, which play important roles in many applications, especially in cryptography. Genuine randomness from the measurement of a quantum system reveals the inherent nature of quantumness -- coherence, an important feature that differentiates quantum mechanics from classical physics. The generation of genuine randomness is generally considered impossible with only classical means. Based on the degree of trustworthiness on devices, quantum random number generators (QRNGs) can be grouped into three categories. The first category, practical QRNG, is built on fully trusted and calibrated devices and typically can generate randomness at a highmore » speed by properly modeling the devices. The second category is self-testing QRNG, where verifiable randomness can be generated without trusting the actual implementation. The third category, semi-self-testing QRNG, is an intermediate category which provides a tradeoff between the trustworthiness on the device and the random number generation speed.« less

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

Ma, Xiongfeng; Yuan, Xiao; Cao, Zhu

Quantum physics can be exploited to generate true random numbers, which play important roles in many applications, especially in cryptography. Genuine randomness from the measurement of a quantum system reveals the inherent nature of quantumness -- coherence, an important feature that differentiates quantum mechanics from classical physics. The generation of genuine randomness is generally considered impossible with only classical means. Based on the degree of trustworthiness on devices, quantum random number generators (QRNGs) can be grouped into three categories. The first category, practical QRNG, is built on fully trusted and calibrated devices and typically can generate randomness at a highmore » speed by properly modeling the devices. The second category is self-testing QRNG, where verifiable randomness can be generated without trusting the actual implementation. The third category, semi-self-testing QRNG, is an intermediate category which provides a tradeoff between the trustworthiness on the device and the random number generation speed.« less

Industrial Program of Waste Management - Cigeo Project - 13033

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

Butez, Marc; Bartagnon, Olivier; Gagner, Laurent

2013-07-01

The French Planning Act of 28 June 2006 prescribed that a reversible repository in a deep geological formation be chosen as the reference solution for the long-term management of high-level and intermediate-level long-lived radioactive waste. It also entrusted the responsibility of further studies and design of the repository (named Cigeo) upon the French Radioactive Waste Management Agency (Andra), in order for the review of the creation-license application to start in 2015 and, subject to its approval, the commissioning of the repository to take place in 2025. Andra is responsible for siting, designing, implementing, operating the future geological repository, including operationalmore » and long term safety and waste acceptance. Nuclear operators (Electricite de France (EDF), AREVA NC, and the French Commission in charge of Atomic Energy and Alternative Energies (CEA) are technically and financially responsible for the waste they generate, with no limit in time. They provide Andra, on one hand, with waste packages related input data, and on the other hand with their long term industrial experiences of high and intermediate-level long-lived radwaste management and nuclear operation. Andra, EDF, AREVA and CEA established a cooperation agreement for strengthening their collaborations in these fields. Within this agreement Andra and the nuclear operators have defined an industrial program for waste management. This program includes the waste inventory to be taken into account for the design of the Cigeo project and the structural hypothesis underlying its phased development. It schedules the delivery of the different categories of waste and defines associated flows. (authors)« less

Reliability of DSM-III anxiety disorder categories using a new structured interview.

PubMed

Di Nardo, P A; O'Brien, G T; Barlow, D H; Waddell, M T; Blanchard, E B

1983-10-01

The reliability of DSM-III anxiety disorder diagnoses was determined using a new structured interview, the Anxiety Disorders Interview Schedule (ADIS). Two interviewers examined 60 consecutive outpatients at an anxiety disorders clinic and assigned primary and secondary diagnoses based on the ADIS. The kappa statistic, calculated on the basis of perfect matches on primary diagnoses, indicated good agreement for anxiety, affective, and adjustment disorders, as well as for the specific anxiety disorder categories of agoraphobia, panic, social phobia, and obsessive-compulsive disorder, but not for generalized anxiety disorder. We evaluated the causes for diagnostic disagreement, particularly in relation to the difficult differentiation between generalized anxiety disorder and other anxiety disorders.

Monitoring of intratidal lung mechanics: a Graphical User Interface for a model-based decision support system for PEEP-titration in mechanical ventilation.

PubMed

Buehler, S; Lozano-Zahonero, S; Schumann, S; Guttmann, J

2014-12-01

In mechanical ventilation, a careful setting of the ventilation parameters in accordance with the current individual state of the lung is crucial to minimize ventilator induced lung injury. Positive end-expiratory pressure (PEEP) has to be set to prevent collapse of the alveoli, however at the same time overdistension should be avoided. Classic approaches of analyzing static respiratory system mechanics fail in particular if lung injury already prevails. A new approach of analyzing dynamic respiratory system mechanics to set PEEP uses the intratidal, volume-dependent compliance which is believed to stay relatively constant during one breath only if neither atelectasis nor overdistension occurs. To test the success of this dynamic approach systematically at bedside or in an animal study, automation of the computing steps is necessary. A decision support system for optimizing PEEP in form of a Graphical User Interface (GUI) was targeted. Respiratory system mechanics were analyzed using the gliding SLICE method. The resulting shapes of the intratidal compliance-volume curve were classified into one of six categories, each associated with a PEEP-suggestion. The GUI should include a graphical representation of the results as well as a quality check to judge the reliability of the suggestion. The implementation of a user-friendly GUI was successfully realized. The agreement between modelled and measured pressure data [expressed as root-mean-square (RMS)] tested during the implementation phase with real respiratory data from two patient studies was below 0.2 mbar for data taken in volume controlled mode and below 0.4 mbar for data taken in pressure controlled mode except for two cases with RMS < 0.6 mbar. Visual inspections showed, that good and medium quality data could be reliably identified. The new GUI allows visualization of intratidal compliance-volume curves on a breath-by-breath basis. The automatic categorisation of curve shape into one of six shape-categories provides the rational decision-making model for PEEP-titration.

A Model Driven Framework to Address Challenges in a Mobile Learning Environment

ERIC Educational Resources Information Center

Khaddage, Ferial; Christensen, Rhonda; Lai, Wing; Knezek, Gerald; Norris, Cathie; Soloway, Elliot

2015-01-01

In this paper a review of the pedagogical, technological, policy and research challenges and concepts underlying mobile learning is presented, followed by a brief description of categories of implementations. A model Mobile learning framework and dynamic criteria for mobile learning implementations are proposed, along with a case study of one site…

Rule-based support system for multiple UMLS semantic type assignments

PubMed Central

Geller, James; He, Zhe; Perl, Yehoshua; Morrey, C. Paul; Xu, Julia

2012-01-01

Background When new concepts are inserted into the UMLS, they are assigned one or several semantic types from the UMLS Semantic Network by the UMLS editors. However, not every combination of semantic types is permissible. It was observed that many concepts with rare combinations of semantic types have erroneous semantic type assignments or prohibited combinations of semantic types. The correction of such errors is resource-intensive. Objective We design a computational system to inform UMLS editors as to whether a specific combination of two, three, four, or five semantic types is permissible or prohibited or questionable. Methods We identify a set of inclusion and exclusion instructions in the UMLS Semantic Network documentation and derive corresponding rule-categories as well as rule-categories from the UMLS concept content. We then design an algorithm adviseEditor based on these rule-categories. The algorithm specifies rules for an editor how to proceed when considering a tuple (pair, triple, quadruple, quintuple) of semantic types to be assigned to a concept. Results Eight rule-categories were identified. A Web-based system was developed to implement the adviseEditor algorithm, which returns for an input combination of semantic types whether it is permitted, prohibited or (in a few cases) requires more research. The numbers of semantic type pairs assigned to each rule-category are reported. Interesting examples for each rule-category are illustrated. Cases of semantic type assignments that contradict rules are listed, including recently introduced ones. Conclusion The adviseEditor system implements explicit and implicit knowledge available in the UMLS in a system that informs UMLS editors about the permissibility of a desired combination of semantic types. Using adviseEditor might help accelerate the work of the UMLS editors and prevent erroneous semantic type assignments. PMID:23041716

25 CFR 224.88 - What must the Director do after receiving notice of a violation or breach from the tribe?

Code of Federal Regulations, 2011 CFR

2011-04-01

... THE INTERIOR ENERGY AND MINERALS TRIBAL ENERGY RESOURCE AGREEMENTS UNDER THE INDIAN TRIBAL ENERGY DEVELOPMENT AND SELF DETERMINATION ACT Implementation of Tribal Energy Resource Agreements Violation Or Breach...

40 CFR 35.250 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL... Cooperative Agreements to States (as defined in section 2 of Federal Insecticide, Fungicide, and Rodenticide... Cooperative Agreements are awarded to assist States to develop and implement pesticide programs, including...

40 CFR 35.250 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL... Cooperative Agreements to States (as defined in section 2 of Federal Insecticide, Fungicide, and Rodenticide... Cooperative Agreements are awarded to assist States to develop and implement pesticide programs, including...

40 CFR 35.650 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL... Implementation cooperative agreements to Tribes and Intertribal Consortia under section 23(a)(1) of the Federal Insecticide, Fungicide, and Rodenticide Act. (b) Purpose of program. Cooperative agreements are awarded to...

40 CFR 35.650 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL... Implementation cooperative agreements to Tribes and Intertribal Consortia under section 23(a)(1) of the Federal Insecticide, Fungicide, and Rodenticide Act. (b) Purpose of program. Cooperative agreements are awarded to...

32 CFR 744.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Department of Defense (Continued) DEPARTMENT OF THE NAVY PROCUREMENT, PROPERTY, PATENTS, AND CONTRACTS... RELEASE TO FOREIGN GOVERNMENTS § 744.1 Purpose. This part implements part 264 of this title and the Technical Property Interchange Agreements between the United States and foreign governments which agreements...

Report: EPA Has Improved Efforts to Reduce Unliquidated Obligations in Superfund Cooperative Agreements, But a Uniform Policy Is Needed

EPA Pesticide Factsheets

Report #09-P-0241, September 22, 2009. The regions audited (Regions 3, 5, and 8) have implemented effective procedures to adequately monitor the status of obligations under Superfund Cooperative Agreements.

78 FR 14111 - Final Candidate Conservation Agreement With Assurances, Final Environmental Assessment, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-04

... alternative (Alternative 2) for implementation based on multiple environmental and social factors, including... review of the alternatives and their environmental consequences. Implementation of this decision entails... implementation of conservation actions and measures contained in the CCAA, and social and economic considerations...

Reproducibility of cervical cytopathology following an intervention by an external quality control laboratory.

PubMed

Ázara, Cinara Zago Silveira; Manrique, Edna Joana Claudio; Tavares, Suelene Brito do Nascimento; Alves de Souza, Nadja Lindany; Magalhães, Juliana Cristina; Amaral, Rita Goreti

2016-04-01

This study assessed the effects of a continued education program on the agreement between cervical cytopathology exams interpreted by local laboratories and interpretation made by an external quality control laboratory (LabMEQ). Overall, 9,798 exams were analyzed between 2007 and 2008, prior to implementation of a continued education program, and 10,028 between 2010 and 2011, following implementation. Continued education consisted of theoretical and practical classes held every two months. The chi-square test and the kappa coefficient were used in the statistical analysis. Following implementation of continued education, the rate of false-negative results, and those leading to delays in clinical management fell in eight laboratories and the rate of false-positive results in five. Agreement between the results reported by the laboratories and the findings of LabMEQ, evaluated according to clinical management, remained excellent in three laboratories (kappa >0.80 and <1.0), went from good (kappa >0.60 and <0.80) to excellent in seven and from excellent to good in two. Agreement regarding the identification of metaplastic epithelium was poor (kappa = 0.25) but progressed to excellent following the implementation of continued education (kappa = 0.950). Agreement between cytopathology results improved significantly following implementation of continued education in cases reported as unsatisfactory (P < 0.001), atypical squamous cells of undetermined significance, cannot exclude high-grade squamous intraepithelial lesion (P < 0.001), low-grade squamous intraepithelial lesion (P < 0.001), and glandular atypia (P < 0.001). Continued education contributed towards improving the reproducibility of cervical cytopathology, decreased the rates of false-negative and false-positive results, and reduced delays in clinical management. © 2016 Wiley Periodicals, Inc.

47 CFR 51.807 - Arbitration and mediation of agreements by the Commission pursuant to section 252(e)(5) of the Act.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Arbitration and mediation of agreements by the Commission pursuant to section 252(e)(5) of the Act. 51.807 Section 51.807 Telecommunication FEDERAL... Implementation of Section 252 of the Act § 51.807 Arbitration and mediation of agreements by the Commission...

76 FR 30499 - To Modify the Rules of Origin for the United States-Singapore Free Trade Agreement, and for Other...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-25

... States-Peru Trade Promotion Agreement (USPTPA), and on June 24 and June 25, 2007, the Parties to the...(a) of the United States-Peru Trade Promotion Agreement Implementation Act (the ``USPTPA Act... Note 5 to Annex 2.3 of the USPTPA provides that originating goods of Peru shall not be subject to any...

Success factors for implementing and sustaining a mature electronic medical record in a low-resource setting: a case study of iSanté in Haiti.

PubMed

deRiel, E; Puttkammer, N; Hyppolite, N; Diallo, J; Wagner, S; Honoré, J G; Balan, J G; Celestin, N; Vallès, J S; Duval, N; Thimothé, G; Boncy, J; Coq, N R L; Barnhart, S

2018-03-01

Electronic health information systems, including electronic medical records (EMRs), have the potential to improve access to information and quality of care, among other things. Success factors and challenges for novel EMR implementations in low-resource settings have increasingly been studied, although less is known about maturing systems and sustainability. One systematic review identified seven categories of implementation success factors: ethical, financial, functionality, organizational, political, technical and training. This case study applies this framework to iSanté, Haiti's national EMR in use in more than 100 sites and housing records for more than 750 000 patients. The author group, consisting of representatives of different agencies within the Haitian Ministry of Health (MSPP), funding partner the Centers for Disease Control and Prevention (CDC) Haiti, and implementing partner the International Training and Education Center for Health (I-TECH), identify successes and lessons learned according to the seven identified categories, and propose an additional cross-cutting category, sustainability. Factors important for long-term implementation success of complex information systems are balancing investments in hardware and software infrastructure upkeep, user capacity and data quality control; designing and building a system within the context of the greater eHealth ecosystem with a plan for interoperability and data exchange; establishing system governance and strong leadership to support local system ownership and planning for system financing to ensure sustainability. Lessons learned from 10 years of implementation of the iSanté EMR system are relevant to sustainability of a full range of increasingly interrelated information systems (e.g. for laboratory, supply chain, pharmacy and human resources) in the health sector in low-resource settings. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Experience measuring performance improvement in multiphase picture archiving and communications systems implementations.

PubMed

Reed, G; Reed, D H

1999-05-01

When planning a picture archiving and communications system (PACS) implementation and determining which equipment will be implemented in earlier and later phases, collection and analysis of selected data will aid in setting implementation priorities. If baseline data are acquired relative to performance objectives, the same information used for implementation planning can be used to measure performance improvement and outcomes. The main categories of data to choose from are: (1) financial data; (2) productivity data; (3) operational parameters; (4) clinical data; and (5) information about customer satisfaction. In the authors' experience, detailed workflow data have not proved valuable in measuring PACS performance and outcomes. Reviewing only one category of data in planning will not provide adequate basis for targeting operational improvements that will lead to the most significant gains. Quality improvement takes into account all factors in production: human capacity, materials, operating capital and assets. Once we have identified key areas of focus for quality improvement in each phase, we can translate objectives into implementation requirements and finally into detailed functional and performance requirements. Here, Integration Resources reports its experience measuring PACS performance relative to phased implementation strategies for three large medical centers. Each medical center had its own objectives for overcoming image management, physical/geographical, and functional/technical barriers. The report outlines (1) principal financial and nonfinancial measures used as performance indicators; (2) implementation strategies chosen by each of the three medical centers; and (3) the results of those strategies as compared with baseline data.

Semantic word category processing in semantic dementia and posterior cortical atrophy.

PubMed

Shebani, Zubaida; Patterson, Karalyn; Nestor, Peter J; Diaz-de-Grenu, Lara Z; Dawson, Kate; Pulvermüller, Friedemann

2017-08-01

There is general agreement that perisylvian language cortex plays a major role in lexical and semantic processing; but the contribution of additional, more widespread, brain areas in the processing of different semantic word categories remains controversial. We investigated word processing in two groups of patients whose neurodegenerative diseases preferentially affect specific parts of the brain, to determine whether their performance would vary as a function of semantic categories proposed to recruit those brain regions. Cohorts with (i) Semantic Dementia (SD), who have anterior temporal-lobe atrophy, and (ii) Posterior Cortical Atrophy (PCA), who have predominantly parieto-occipital atrophy, performed a lexical decision test on words from five different lexico-semantic categories: colour (e.g., yellow), form (oval), number (seven), spatial prepositions (under) and function words (also). Sets of pseudo-word foils matched the target words in length and bi-/tri-gram frequency. Word-frequency was matched between the two visual word categories (colour and form) and across the three other categories (number, prepositions, and function words). Age-matched healthy individuals served as controls. Although broad word processing deficits were apparent in both patient groups, the deficit was strongest for colour words in SD and for spatial prepositions in PCA. The patterns of performance on the lexical decision task demonstrate (a) general lexicosemantic processing deficits in both groups, though more prominent in SD than in PCA, and (b) differential involvement of anterior-temporal and posterior-parietal cortex in the processing of specific semantic categories of words. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.