Direct-to-consumer ads can influence behavior. Advertising increases consumer knowledge and prescription drug requests.

PubMed

Peyrot, M; Alperstein, N M; Van Doren, D; Poli, L G

1998-01-01

This study examines the impact of direct-to-consumer (DTC) pharmaceutical advertising on prescription drug knowledge and the requesting behavior of consumers. The authors developed and tested a conceptual model of prescription drug knowledge and requests. Consumers' belief that drug advertising can educate them was associated with a greater amount of drug knowledge, and the belief they would upset physicians by asking for specific drugs was associated with less knowledge. The belief that drug advertising reduces prices was associated with greater probability of drug requests, and the belief that physicians should be the sole source of drug information was associated with lesser probability of request. Preference for generic drugs was associated with a lesser likelihood of requesting a specific drug. Media exposure and drug advertising awareness were associated with higher drug knowledge and a greater probability of drug requesting.

Exploring changes over time and characteristics associated with data retrieval across individual participant data meta-analyses: systematic review

PubMed Central

Marson, Anthony G; Davie, Becky; Reynolds, Sally; Williams, Lisa; Smith, Catrin Tudur

2017-01-01

Abstract Objective To investigate whether the success rate of retrieving individual participant data (IPD) for use in IPD meta-analyses has increased over time, and to explore the characteristics associated with IPD retrieval. Design Systematic review of published IPD meta-analyses, supplemented by a reflection of the Cochrane Epilepsy Group’s 20 years’ experience of requesting IPD. Data sources Medline, CENTRAL, Scopus, Web of Science, CINAHL Plus, and PsycINFO. Eligibility criteria for study selection IPD meta-analyses of studies of all designs and all clinical areas published in English. Results 760 IPD meta-analyses which identified studies by systematic methods that had been published between 1987 and 2015 were included. Only 188 (25%) of these IPD meta-analyses retrieved 100% of the eligible IPD for analysis, with 324 (43%) of these IPD meta-analyses retrieving 80% or more of relevant IPD. There is insufficient evidence to suggest that IPD retrieval rates have improved over time. IPD meta-analyses that included only randomised trials, had an authorship policy, included fewer eligible participants, and were conducted outside of the Cochrane Database of Systematic Reviews were associated with a high or complete IPD retrieval rate. There was no association between the source of funding of the IPD meta-analyses and IPD retrieval rate. The IPD retrieval rate of the Cochrane Epilepsy Group has declined from 83% (up to 2005) to 65% (between 2012 and 2015) and the reported reasons for lack of data availability have changed in recent years. Conclusions IPD meta-analyses are considered to be the “gold standard” for the synthesis of data from clinical research studies; however, only 25% of published IPD meta-analyses have had access to all IPD. PMID:28381561

78 FR 26775 - Information Collection Request Submitted to OMB for Review and Approval; Comment Request...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-08

...), Distribution of Offsite Consequence Analysis Information under Section 112(r)(7)(H) of the Clean Air Act (CAA... a risk management plan (RMP) to EPA. The RMP includes information on offsite consequence analyses... ENVIRONMENTAL PROTECTION AGENCY [EPA-HQ-OAR-2003-0073; FRL-9530-6] Information Collection Request...

Analyses of Selected Provisions of Proposed Energy Legislation: 2003

EIA Publications

2003-01-01

This study responds to a July 31, 2003 request from Senator Byron L. Dorgan. The study is based primarily on analyses the Energy Information Administration has previously done for studies requested by Congress. It includes analysis of the Renewable Portfolio Standard, Renewable Fuels Standard, production in the Alaskan National Wildlife Refuge, the construction of an Alaskan Natural Gas pipeline, and various tax provisions.

Evaluations of care by adults following a denial of an advertisement-related prescription drug request: the role of expectations, symptom severity, and physician communication style.

PubMed

Shah, Mansi B; Bentley, John P; McCaffrey, David J

2006-02-01

As patients continue to take a more active role in their health care, an understanding of patient requests of health care providers, including what happens when requests are not fulfilled, is becoming more important. Although its merits have been debated, direct-to-consumer advertising of prescription drugs generates patient requests. The objective of this study was to assess the influence of physician communication style, respondents' expectations of receiving a requested prescription, and perceived symptom severity on respondents' evaluations of care following a physician denial of a prescription drug request stimulated by direct-to-consumer advertising. A 2 x 2 x 2, between-subjects experimental design was used. The respondents were made up of employees of the University of Mississippi. Physician communication style, respondents' expectations, and respondents' perceived symptom severity were manipulated using vignettes. Respondents' post-visit evaluations of care were assessed by measuring trust in the physician, visit-based satisfaction with the physician, and commitment toward the physician. Factorial analysis of variance procedures for a three-way design were used to test the hypotheses and assess the research questions. Manipulation checks suggested that the independent variables were appropriately manipulated. No significant first-order or second-order interactions were noted in any of the analyses. Post-visit evaluations of care were significantly associated with physician communication style (a partnership response led to better evaluations of care). There were no significant effects of either prior expectation of request fulfillment or perceived symptom severity. However, non-significant trends in mean scores suggested a potential role of these variables in the evaluation process following request denial. The manner in which a physician communicates with an individual is an important determinant of the evaluation of care following the denial of a request. The results suggest that health care providers attempting to minimize the effect of request denials on patient evaluations should make an effort to involve the patient in the decision-making process.

Television and children's consumption patterns. A review of the literature.

PubMed

Coon, K A; Tucker, K L

2002-10-01

The recent increase in childhood obesity has, among other things, focused attention on the role that television may play. This paper summarizes results of studies published in peer review journals since 1970 with data pertaining to the relationship between television use and children's food intake. Studies fall into four categories: content analyses; effects of television advertising on children's food behaviors; television and pediatric obesity, with effects on children's dietary intake and physical activity; and television use and children's food consumption patterns. Content analyses have shown that food is the most frequently advertised product category on children's TV. The majority of these ads target highly sweetened products, but more recently, the proportion from fast food meal promotions has been growing. Controlled studies on children's choices have consistently shown that children exposed to advertising choose advertised food products at significantly higher rates than do those not exposed. Purchase request studies have documented associations between number of hours of TV watched and number of requests from the child to the mother for specific food items, as well as the presence of those items in the home. Greater TV use has been associated with higher intakes of energy, fat, sweet and salty snacks, and carbonated beverages and lower intakes of fruit and vegetables. Several large studies have documented associations between number of hours of TV watched and both the prevalence and incidence of obesity. The combination of lifestyle factors that accompany heavy television use appear to place children at risk of obesity and poor nutritional status.

Prevention of Labour-Associated Pelvic Floor Injuries – What is Known for Sure

PubMed Central

Franz, H. B.G.; Erxleben, C.; Franz, A.; Hofmann, R.

2012-01-01

In order to avoid pelvic floor injuries a caesarean section is on the one hand often requested by the pregnant women and, on the other hand, offered by obstetric staff. For both forms of delivery, comprehensive risk-benefit analyses should be carried out before deciding in favour of the surgical procedure. The present brief review summarizes the current evidence on the avoidance of pelvic floor injuries. PMID:26640288

Analysis of a 10% Renewable Portfolio Standard, Supplement to

EIA Publications

2003-01-01

On June 10, 2003, Senator Pete Domenici, Chairman of the Senate Committee on Energy and Natural Resources, requested additional analysis of a Renewable Portfolio Standard (RPS), expected to be proposed as an amendment to energy legislation currently pending before the U.S. Senate. This request asked the Energy Information Administration (EIA) to provide additional results from two previously released EIA analyses of the proposed legislation, and to conduct further analyses with modified assumptions.

Physicians' shared decision-making behaviors in depression care.

PubMed

Young, Henry N; Bell, Robert A; Epstein, Ronald M; Feldman, Mitchell D; Kravitz, Richard L

2008-07-14

Although shared decision making (SDM) has been reported to facilitate quality care, few studies have explored the extent to which SDM is implemented in primary care and factors that influence its application. This study assesses the extent to which physicians enact SDM behaviors and describes factors associated with physicians' SDM behaviors within the context of depression care. In a secondary analysis of data from a randomized experiment, we coded 287 audiorecorded interactions between physicians and standardized patients (SPs) using the Observing Patient Involvement (OPTION) system to assess physician SDM behaviors. We performed a series of generalized linear mixed model analyses to examine physician and patient characteristics associated with SDM behavior. The mean (SD) OPTION score was 11.4 (3.3) of 48 possible points. Older physicians (partial correlation coefficient = -0.29; beta = -0.09; P < .01) and physicians who practiced in a health maintenance organization setting (beta = -1.60; P < .01) performed fewer SDM behaviors. Longer visit duration was associated with more SDM behaviors (partial correlation coefficient = 0.31; beta = 0.08; P < .01). In addition, physicians enacted more SDM behaviors with SPs who made general (beta = 2.46; P < .01) and brand-specific (beta = 2.21; P < .01) medication requests compared with those who made no request. In the context of new visits for depressive symptoms, primary care physicians performed few SDM behaviors. However, physician SDM behaviors are influenced by practice setting and patient-initiated requests for medication. Additional research is needed to identify interventions that encourage SDM when indicated.

Childbirth or termination of pregnancy: does paid employment matter? A population study of women in reproductive age in Norway.

PubMed

Eskild, Anne; Herdlevaer, Ida E; Strøm-Roum, Ellen M; Monkerud, Lars; Grytten, Jostein

2016-05-01

We studied whether female paid employment is associated with pregnancy outcome; childbirth or pregnancy termination. All women in Norway, 16-54 years of age, during the years 2007-10 were included. Data sources were; the Norwegian Central Person Registry, the Medical Birth Registry of Norway, and the Registry of Pregnancy Termination. We compared the proportion without paid employment among all women, women who gave birth, and among women who requested termination of pregnancy. Thereafter, and among pregnant women, we estimated the odds ratio for pregnancy termination request for women without paid employment by applying logistic regression analyses, using women with paid employment as reference. Among all women 16-54 years of age, 23.5% were without paid employment. Among women who gave birth, 15.8% were without paid employment, whereas this proportion was 46.4% among women who requested pregnancy termination (p < 0.05). Among the 307 512 women who were pregnant, 60 734 (19.4%) requested pregnancy termination. The odds ratio for pregnancy termination request was 3.18 (95% CI 3.11-3.25) for women without paid employment. Adjustments were made for age, number of children, and region of residence in Norway. Being without paid employment was more common among women in the general population and among women requesting pregnancy termination than among women who gave birth. Hence, women seem to have children when they are in paid employment. The role of women's paid employment for reproductive choices should be further investigated. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Decision analysis of visual range improvements attributable to sulfur dioxide emission reductions in the eastern United States

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

Balson, W.E.; Rice, J.S.

1988-01-01

The Environmental Protection Agency (EPA) recently published an advanced notice of proposed rulemaking (ANPR) (Federal Register, July 1, 1987) inquiring into the need for a secondary ambient standard for fine particles to protect visibility in the east and urban west. The EPA has solicited comments on the application of cost and benefits analyses in making decisions about such standards. In response to this request for comments, the utility air regulatory group (UARG) requested that Decision Focus Incorporated (DFI) estimate the benefits of visibility improvements reasonably associated with changes in SO{sub 2} emissions, to compare those benefits with the cost ofmore » achieving those emission reduction, and to assess the value of acquiring more information before making a decision, taking into account the uncertainties associated with these estimates. This request followed a presentation by DFI on such a method at the Grand Teton Specialty Conference on Visibility. In coordination with this cost and benefit comparison, UARG has also requested that other contractors estimate the levels of uncertainty in visibility improvements, the household value for visibility improvements, and the costs of implementation. The information provided by those contractors served as key inputs for the methodology and the results that are described in this paper. The information on visibility improvements was provided by AeroVironment Incorporated (AV), Zannetti. The information on household value was provided by Dr. Paul Ruud. Finally, the information on costs was provided by Temple, Baker, and Sloane, Incorporated (TBS). The three reports described above are discussed in this paper.« less

78 FR 61365 - Assessment of the Risk of Human Salmonellosis Associated With the Consumption of Tree Nuts...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-03

...] Assessment of the Risk of Human Salmonellosis Associated With the Consumption of Tree Nuts; Request for... Salmonellosis Associated With the Consumption of Tree Nuts; Request for Comments, Scientific Data and... associated with the consumption of tree nuts. We are taking this action in response to requests for an...

25 CFR 517.4 - Requirements for making requests.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INFORMATION ACT PROCEDURES § 517.4 Requirements for making requests. (a) How to make a FOIA request. Requests... additional information. If the requester is making a request for records about another individual, the..., the requester will be notified of this decision and advised that fees associated with the processing...

Board on Earth Sciences and Resources and its Activities

NASA Technical Reports Server (NTRS)

Schiffries, Craig M.

1997-01-01

The Board will provide oversight of the earth science and resource activities within the National Research Council, provide a review of research and public activities in the solid-earth sciences, and provide analyses and recommendations relevant to the supply, delivery, and associated impacts of and issues related to hydrocarbon, metallic, and non-metallic mineral resources. The Board will monitor the status of the earth sciences, assess the health of the disciplines, and identify research opportunities, and will respond to specific agency requests.

Exploring changes over time and characteristics associated with data retrieval across individual participant data meta-analyses: systematic review.

PubMed

Nevitt, Sarah J; Marson, Anthony G; Davie, Becky; Reynolds, Sally; Williams, Lisa; Smith, Catrin Tudur

2017-04-05

Objective  To investigate whether the success rate of retrieving individual participant data (IPD) for use in IPD meta-analyses has increased over time, and to explore the characteristics associated with IPD retrieval. Design  Systematic review of published IPD meta-analyses, supplemented by a reflection of the Cochrane Epilepsy Group's 20 years' experience of requesting IPD. Data sources  Medline, CENTRAL, Scopus, Web of Science, CINAHL Plus, and PsycINFO. Eligibility criteria for study selection  IPD meta-analyses of studies of all designs and all clinical areas published in English. Results  760 IPD meta-analyses which identified studies by systematic methods that had been published between 1987 and 2015 were included. Only 188 (25%) of these IPD meta-analyses retrieved 100% of the eligible IPD for analysis, with 324 (43%) of these IPD meta-analyses retrieving 80% or more of relevant IPD. There is insufficient evidence to suggest that IPD retrieval rates have improved over time. IPD meta-analyses that included only randomised trials, had an authorship policy, included fewer eligible participants, and were conducted outside of the Cochrane Database of Systematic Reviews were associated with a high or complete IPD retrieval rate. There was no association between the source of funding of the IPD meta-analyses and IPD retrieval rate. The IPD retrieval rate of the Cochrane Epilepsy Group has declined from 83% (up to 2005) to 65% (between 2012 and 2015) and the reported reasons for lack of data availability have changed in recent years. Conclusions  IPD meta-analyses are considered to be the "gold standard" for the synthesis of data from clinical research studies; however, only 25% of published IPD meta-analyses have had access to all IPD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Lack of emergency medical services documentation is associated with poor patient outcomes: a validation of audit filters for prehospital trauma care.

PubMed

Laudermilch, Dann J; Schiff, Melissa A; Nathens, Avery B; Rosengart, Matthew R

2010-02-01

Our previous Delphi study identified several audit filters considered sensitive to deviations in prehospital trauma care and potentially useful in conducting performance improvement, a process currently recommended by the American College of Surgeons Committee on Trauma. This study validates 2 of those proposed audit filters. We studied 4,744 trauma patients using the electronic records of the Central Region Trauma registry and Emergency Medical Services (EMS) patient logs for the period January 1, 2002, to December 31, 2004. We studied whether requests by on-scene Basic Life Support (BLS) for Advanced Life Support (ALS) assistance or failure by EMS personnel to record basic patient physiology at the scene was associated with increased in-hospital mortality. We performed multivariate analyses, including a propensity score quintile approach, adjusting for differences in case mix and clustering by hospital. Overall mortality was 6.1%. A total of 28.2% (n = 1,337) of EMS records were missing patient scene physiologic data. Multivariate analysis revealed that patients missing 1 or more measures of patient physiology at the scene had increased risk of death (adjusted odds ratio = 2.15; 95% CI, 1.13 to 4.10). In 17.4% (n = 402) of cases BLS requested ALS assistance. Patients for whom BLS requested ALS had a similar risk of death as patients for whom ALS was initially dispatched (odds ratio = 1.04; 95% CI, 0.51 to 2.15). Failure of EMS to document basic measures of scene physiology is associated with increased mortality. This deviation in care can serve as a sensitive audit filter for performance improvement. The need by BLS for ALS assistance was not associated with increased mortality.

Factors Associated With Pediatrician Responses to Alternative Immunization Schedule Requests.

PubMed

Mohanty, Salini; Feemster, Kristen A; Buttenheim, Alison; Moser, Charlotte A; Field, Robert I; Mayer, Whitney; Carroll-Scott, Amy

2018-02-01

We conducted a cross-sectional online survey among 4 chapters of the American Academy of Pediatrics from July through October 2014 to describe characteristics of pediatricians and practices associated with practice-level responses to alternative immunization schedule requests. Among 374 pediatricians, 58% reported frequent alternative immunization schedule requests and 24% reported feeling comfortable using them. Pediatricians who work in practices that accommodate alternative immunization schedule requests have increased odds of having a high frequency of alternative immunization schedule requests, and beliefs that relationships with families would be negatively affected if they refused requests. Practices that discontinue care to families who request alternative immunization schedules have increased odds of being a private group practice and having a formal office vaccine policy. Pediatricians are frequently asked to use alternative immunization schedules and many are not comfortable using them. Practice-level responses to alternative immunization schedules are associated with characteristics of pediatricians and practices.

78 FR 21912 - Proposed Information Collection; Comment Request; Processed Products Family of Forms

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-12

... Collection; Comment Request; Processed Products Family of Forms AGENCY: National Oceanic and Atmospheric... NOAA in the economic and social analyses developed when proposing and evaluating fishery management... collection). Affected Public: Business or other for-profit organizations. Estimated Number of Respondents...

[Motivational and Volitional Determinants of Applying for Psychosomatic Rehabilitation: Findings of a Cohort Study].

PubMed

Bethge, M; Peters, E; Michel, E; Radoschewski, F M; Spanier, K

2016-12-01

Objective: Analyses of motivational and volitional determinants of applying for psychosomatic rehabilitation Methods: Determinants of a rehabilitation request were assessed by a questionnaire in 2013. Applications for psychosomatic rehabilitation measures until the end of 2014 were extracted from administrative data records. Included were employees with mental disorders. Results: Only 55 of 974 persons requested a rehabilitation measure. The intention to apply for a rehabilitation measure was strongest determined by self-efficacy and family and professional support. Planning was explained by intention and to a lesser extent by family and physician support. Persons with higher planning scores were more likely to apply for a rehabilitation measure. Physician support also increased the likelihood of a rehabilitation request. Conclusion: The analyses identified determinants of rehabilitation claims that are modifiable. This gives opportunities to support rehabilitation claims. However, the contribution of these factors to explain rehabilitation requests is only limited. © Georg Thieme Verlag KG Stuttgart · New York.

Combined guaranteed throughput and best effort network-on-chip

DOEpatents

Chen, Gregory K.; Anders, Mark A.; Kaul, Himanshu; Krishnamurthy, Ram K.; Stillmaker, Aaron T.

2018-05-22

A first packet-switched reservation request is received. Data associated with the first packet-switched reservation request is communicated through a first circuit-switched channel according to a best effort communication scheme. A second packet-switched reservation request is received. Data associated with the second packet-switched reservation request is communicated through a second circuit-switched channel according to a guaranteed throughput communication scheme.

24 CFR 81.65 - Other information and analyses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Other information and analyses. 81... information and analyses. When deemed appropriate and requested in writing, on a case by-case basis, by the... conduct additional analyses concerning any such report. A GSE shall submit additional reports or other...

24 CFR 81.65 - Other information and analyses.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Other information and analyses. 81... information and analyses. When deemed appropriate and requested in writing, on a case by-case basis, by the... conduct additional analyses concerning any such report. A GSE shall submit additional reports or other...

24 CFR 81.65 - Other information and analyses.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Other information and analyses. 81... information and analyses. When deemed appropriate and requested in writing, on a case by-case basis, by the... conduct additional analyses concerning any such report. A GSE shall submit additional reports or other...

24 CFR 81.65 - Other information and analyses.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Other information and analyses. 81... information and analyses. When deemed appropriate and requested in writing, on a case by-case basis, by the... conduct additional analyses concerning any such report. A GSE shall submit additional reports or other...

24 CFR 81.65 - Other information and analyses.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Other information and analyses. 81... information and analyses. When deemed appropriate and requested in writing, on a case by-case basis, by the... conduct additional analyses concerning any such report. A GSE shall submit additional reports or other...

75 FR 31745 - Notice of Request for Approval of an Information Collection; National Veterinary Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-04

...] Notice of Request for Approval of an Information Collection; National Veterinary Services Laboratories... collection associated with the National Veterinary Services Laboratories animal health diagnostic system...: For information on request forms associated with the National Veterinary Services Laboratories animal...

Pester power and its consequences: do European children's food purchasing requests relate to diet and weight outcomes?

PubMed

Huang, Christina Y; Reisch, Lucia A; Gwozdz, Wencke; Molnár, Dénes; Konstabel, Kenn; Michels, Nathalie; Tornaritis, Michalis; Eiben, Gabriele; Siani, Alfonso; Fernández-Alvira, Juan M; Ahrens, Wolfgang; Pigeot, Iris; Lissner, Lauren

2016-09-01

Children may influence household spending through 'pester power'. The present study examined pestering through parent-child food shopping behaviours in relation to children's diet and weight status. Cross-sectional and prospective analyses drawn from the IDEFICS study, a cohort study of parents and their children. Children's height and weight were measured and their recent diets were reported by parental proxy based on the Children's Eating Habits Questionnaire-FFQ at baseline and 2-year follow-up. Parents also completed questionnaires at both time points about pestering, including whether the child goes grocery shopping with them, asks for items seen on television and is bought requested food items. Participants were recruited from eight European countries for the IDEFICS study (non-nationally representative sample). Study participants were children aged 2-9 years at enrolment and their parents. A total of 13 217 parent-child dyads were included at baseline. Two years later, 7820 of the children were re-examined. Most parents (63 %) at baseline reported 'sometimes' acquiescing to their children's requests to purchase specific foods. Pestering was modestly associated with weight and diet. At baseline, children whose parents 'often' complied consumed more high-sugar and high-fat foods. Children who 'often' asked for items seen on television were likely to become overweight after 2 years (OR=1·31), whereas 'never' asking protected against overweight (OR=0·72). Pestering was modestly related to diet and weight in cross-sectional, but not longitudinal analyses. Asking for items seen on television had the most robust relationships across child outcomes and over time.

48 CFR 815.404-1 - Proposal analysis techniques.

Code of Federal Regulations, 2010 CFR

2010-10-01

... technical reviews. (See 801.602-70.) (b) Contracting officers determine the level of technical analyses... under them, and contract modifications. Contracting officers must request technical analyses of the proposals from the appropriate technical personnel. The technical analyses must address, as a minimum, the...

48 CFR 815.404-1 - Proposal analysis techniques.

Code of Federal Regulations, 2011 CFR

2011-10-01

... technical reviews. (See 801.602-70.) (b) Contracting officers determine the level of technical analyses... under them, and contract modifications. Contracting officers must request technical analyses of the proposals from the appropriate technical personnel. The technical analyses must address, as a minimum, the...

Health care providers' requests to Teratogen Information Services on medication use during pregnancy and lactation.

PubMed

Gendron, Marie-Pierre; Martin, Brigitte; Oraichi, Driss; Bérard, Anick

2009-05-01

Medication use during pregnancy and lactation is prevalent. However, current knowledge of the risks and benefits of medication use during pregnancy and lactation is incomplete as the best available evidence has been obtained from cohort studies of inadvertent exposures and registries. This situation may partly explain health care providers' (HCP) risk perceptions and thus the increasing number of calls to Teratogen Information Services (TIS). The objectives of this study were (1) to identify the medication classes for which HCP are seeking counseling from the IMAGe center, a Quebec TIS; (2) to identify the medical conditions for which medication classes were used during pregnancy and lactation; (3) to identify and quantify predictors of medication information requests during pregnancy and lactation. A retrospective analysis of data was conducted within the population served by the IMAGe center, a TIS based at CHU Ste-Justine in Montreal, Quebec, Canada, that serves the French population of Canada. To be included, calls had to be received between January 1, 2004 and April 30, 2007, and the subject of the call had to be directly associated with the exposure, or not, of a pregnant or breastfeeding woman to medication. Multivariate generalized estimating equation (GEE) regression models were performed to identify the predictors of medication requests. A total of 11, 076 requests regarding medication exposure during pregnancy, 12 055 requests regarding pregnant women before the exposure took place, and 13, 364 requests regarding lactation were included for analyses. Pregnant women were most frequently exposed to antidepressants (17.3), antibiotics (6.3%), and benzodiazepines (5.3%). Prior to drug exposure, the most frequent inquiries by HCP were on antibiotics (11.0%), anti-inflammatory drugs (6.0%), and antiemetics (5.1%). Inquiries concerning lactating women most frequently requested information on the drug classes of antidepressants (10.8%), antibiotics (9.1%), and anti-inflammatory drugs (7.8%). Depressive disorders were an indication of antidepressant, benzodiazepine and antipsychotic exposures reported to IMAGe. Associations were found between medication use and maternal age, previous pregnancies, trimester of pregnancy at the time of the call and lifestyle habits. The IMAGe received frequent inquiries on antidepressant, antibiotic, and benzodiazepine exposures, with depressive disorders being the most frequently declared indication. Predictors of medication requests were identified among exposed women during pregnancy, and breastfeeding women. These results emphasize the need for effective studies on drug use during pregnancy and lactation and for better knowledge transfer programs.

78 FR 19464 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-01

... identifiers or contact information. Any associated form(s) for this collection may be located within this same... number, and title. FOR FURTHER INFORMATION CONTACT: To request more information on this proposed... Public Outreach at (703) 695- 3845. Title; Associated Form; and OMB Number: Request for Armed Forces...

77 FR 75414 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-20

... conduct non-DoDEA sponsored research studies in DoDEA schools, districts, and/ or areas. The DoDEA Form 2071.3-F1, ``Research Study Request'' collects information about the researcher, the research project, audience, timeline, and the statistical analyses that will be conducted during the proposed research study...

76 FR 32142 - Proposed Information Collection; Comment Request; Alaska Saltwater Sportfishing Economic Survey

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-03

... Collection; Comment Request; Alaska Saltwater Sportfishing Economic Survey AGENCY: National Oceanic and... a survey to collect data for conducting economic analyses of marine sport fishing in Alaska. This survey is necessary to understand the factors that affect the economic value of marine recreational...

78 FR 32681 - Notice of Proposed Information Collection: Comment Request; Condominium Project Approval Document...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-31

... techniques or other forms of information technology, e.g., permitting electronic submission of responses... information collected will be used for performance, risk, trend and other analyses. Agency form numbers, if... Information Collection: Comment Request; Condominium Project Approval Document Collection AGENCY: Office of...

75 FR 75462 - Notice of Proposed Information Collection Requests

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-03

... used in a timely manner; (3) is the estimate of burden accurate; (4) how might the Department enhance... collected from administrators at Carol M. White Physical Education Program (PEP) projects and analyses of... the PEP, and will inform future improvements to the program. Requests for copies of the proposed...

77 FR 5281 - State-of-the-Art Reactor Consequence Analyses Reports

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-02

... Analyses Reports AGENCY: Nuclear Regulatory Commission. ACTION: Draft NUREG; public meeting and request for... release of Draft NUREG-1935, ``State-of-the-Art Reactor Consequence Analyses (SOARCA) Report,'' for public comment. The purpose of Draft NUREG-1935 is to report a pilot study of best estimate analyses of the...

7 CFR 91.4 - Kinds of services.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., chemical, and certain other analyses, requested by the applicant and performed on tobacco, seed, dairy, egg, fruit and vegetable, meat and poultry products, and related processed products. Analyses are performed... and cooperative agreements. Laboratory analyses are also performed on egg products as part of the...

12 CFR 611.1211 - Special requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Institution Status § 611.1211 Special requirements. (a) Special assessments, analyses, studies, and rulings... assessments, analyses, or studies, or to request rulings, including, but not limited to: (1) Assessments of fair value; (2) Analyses and rulings on tax implications; and (3) Studies of the effect of your...

12 CFR 611.1211 - Special requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Institution Status § 611.1211 Special requirements. (a) Special assessments, analyses, studies, and rulings... assessments, analyses, or studies, or to request rulings, including, but not limited to: (1) Assessments of fair value; (2) Analyses and rulings on tax implications; and (3) Studies of the effect of your...

Factors associated with ambulance requests for febrile seizures.

PubMed

Sakai, Rie; Marui, Eiji

2008-08-01

The objective of this study was to determine factors associated with ambulance requests for febrile seizures. This study retrospectively investigated medical records of patients who visited the Emergency Care Unit at Tokyo Metropolitan Toshima Hospital in the 5-year period after April 2001. Subjects' basic characteristics (e.g., age and sex), medical history of febrile seizures, sibling and parental medical history of febrile seizures, and distance from hospital were investigated. In total, 310 subjects used ambulances, and 106 came to the hospital without requesting ambulances. The results of binomial logistic analysis indicated that factors associated with ambulance requests included patient's and parents' medical history of febrile seizures. Increasing awareness of febrile seizures and provision of a general public educational campaign are possible strategies to help decrease unnecessary ambulance requests. However, a medical history of febrile seizures among siblings revealed no association, indicating the need to conduct repeated early-stage interventions.

78 FR 65242 - Occupational Exposure to Crystalline Silica; Extension of Comment Period; Extension of Period To...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

... scientific and technical analyses, OSHA requests that you disclose: (1) The nature of any financial... such as social security numbers and birthdates. If you submit scientific or technical studies or other... data and technical information submitted to the record. This request is consistent with Executive Order...

75 FR 57809 - Information Collection Request to Office of Management and Budget; OMB Control Numbers: 1625-0002...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-22

... Office of Management and Budget; OMB Control Numbers: 1625-0002, 1625-0017, 1625-0019, and 1625- 0030... (ICRs) and Analyses to the Office of Management and Budget (OMB) requesting an extension of its approval..., Waiver, and Continuous Synopsis Record; (2) 1625-0017, Various International Agreement Safety...

Longitudinal evaluation of a World Wide Web-based antimicrobial stewardship program: assessing factors associated with approval patterns and trends over time.

PubMed

Venugopal, Vidya; Lehmann, Christoph U; Diener-West, Marie; Agwu, Allison L

2014-02-01

The Johns Hopkins Children's Medical and Surgery Center developed a Web-based Antimicrobial Stewardship Program (ASP) in 2005. The present study aimed to assess longitudinal antimicrobial request and approval patterns for this ASP. We analyzed a total of 16,229 antimicrobial requests for 3,542 patients between June 1, 2005, and June 30, 2009. Antimicrobial approval was the outcome of interest. We assessed gaming by studying trends in automatically approved requests. Nonparametric tests for trend were performed to detect changes in approval patterns. Multiple logistic regression was used to identify factors associated with approval. The vast majority (91.3%) of antimicrobial requests were approved, with an increase of 6.1% over time (P < .01). Renewal requests were more likely than primary requests (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.45-2.04) to be approved. Antiviral requests had higher odds of approval than antibiotic requests (aOR, 1.27; 95% CI, 1.04-1.56). Compared with requests by medical services, requests by surgical services had lower odds of approval (aOR, 0.70; 95% CI, 0.59-0.83), whereas pediatric intensive care requests had higher odds of approval (aOR, 1.18; 95% CI, 1.00-1.40). The number of auto-approved requests remained consistent. The Web-based ASP allows management of a large number of antimicrobial requests, without apparent gaming. Observed differences in approval patterns based on patient, requestor, and antimicrobial factors may inform the development of ASPs and evaluation of provider education and training. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Risk factors for inappropriate blood requisition among hospitals in Tanzania.

PubMed

Mauka, Wilhellmuss I; Mtuy, Tara B; Mahande, Michael J; Msuya, Sia E; Mboya, Innocent B; Juma, Abdul; Philemon, Rune N

2018-01-01

Blood is a critical aspect of treatment in life saving situations, increasing demand. Blood requisition practices greatly effect sufficient supply in blood banks. This study aimed to determine the risk factors for inappropriate blood requisition in Tanzania. This was a cross sectional study using secondary data of 14,460 patients' blood requests from 42 transfusion hospitals. Primary data were obtained by using cluster-sampling design. Data were analysed using a two-level mixed-effects Poisson regression to determine fixed-effects of individual-level factors and hospital level factors associated with inappropriate blood requests. P-value <0.05 (2-tails) was considered statistically significant. Inappropriate requisition was 28.8%. Factors significantly associated with inappropriate requisition were; reporting pulse rate and capillary refill decrease the risk (RR 0.74; 95% CI 0.64, 0.84) and (RR 0.73; 95% CI 0.63, 0.85) respectively and the following increased the risk; having surgery during hospital stay (RR 1.22; 95% CI 1.06, 1.4); being in general surgical ward (RR 3.3; 95% CI 2.7, 4.2), paediatric ward (RR 1.8; 95% CI 1.2, 2.7), obstetric ward (RR 2.5; 95% CI 2.0, 3.1), gynaecological ward (RR 2.1; 95% CI 1.5, 2.9), orthopaedics ward (RR 3.8; 95% CI 2.2, 6.7). Age of the patient, pallor and confirmation of pre-transfusion haemoglobin level were also significantly associated with inappropriate requisition. Majority of appropriate requisitions within the wards were marked in internal medicine (91.7%) and gynaecological wards (77.8%). The proportion of inappropriate blood requests was high. Blood requisition was determined by clinical and laboratory findings and the ward patients were admitted to. Adherence to transfusion guidelines is recommended to assure the best use of limited blood supply.

Assessment of Requests for Assisted Suicide by a Swiss Right-to-Die Society

ERIC Educational Resources Information Center

Bosshard, Georg; Ulrich, Esther; Ziegler, Stephen J.; Bar, Walter

2008-01-01

Non-physician volunteers of Exit, the largest right-to-die organization in Switzerland, play an important role in assisted suicide. They conduct assessments and deliver lethal medications for a member to self-administer. This study analyses the content of 114 intake sheets (checklists) of Exit members whose requests for assisted suicide were…

Obstetrician gender and the likelihood of performing a maternal request for a cesarean delivery.

PubMed

Liu, Tsai-Ching; Lin, Herng-Ching; Chen, Chin-Shyan; Lee, Hsin-Chien

2008-01-01

To examine the relationship between obstetrician gender and the likelihood of maternal request for cesarean section (CS) within different healthcare institutions (medical centers, regional hospitals, district hospitals, and obstetric and gynecology clinics). Five years of population-based data from Taiwan covering 857,920 singleton deliveries without a clinical indication for a CS were subjected to a multiple logistic regression to examine the association between obstetrician gender and the likelihood of maternal request for a CS. After adjusting for physician and institutional characteristics, it was found that male obstetricians were more likely to perform a requested CS than female obstetricians in district hospitals (OR=1.53) and clinics (OR=2.26), while obstetrician gender had no discernible associations with the likelihood of a CS upon maternal request in medical centers and regional hospitals. While obstetrician gender had the greatest association with delivery mode decisions in the lowest obstetric care units, those associations were diluted in higher-level healthcare institutions.

Hepatitis B in Moroccan-Dutch: a quantitative study into determinants of screening participation.

PubMed

Hamdiui, Nora; Stein, Mart L; Timen, Aura; Timmermans, Danielle; Wong, Albert; van den Muijsenbergh, Maria E T C; van Steenbergen, Jim E

2018-03-29

In November 2016, the Dutch Health Council recommended hepatitis B (HBV) screening for first-generation immigrants from HBV endemic countries. However, these communities show relatively low attendance rates for screening programmes, and our knowledge on their participation behaviour is limited. We identified determinants associated with the intention to request an HBV screening test in first-generation Moroccan-Dutch immigrants. We also investigated the influence of non-refundable costs for HBV screening on their intention. Offline and online questionnaires were distributed among first- and second/third-generation Moroccan-Dutch immigrants using respondent-driven sampling. Random forest analyses were conducted to determine which determinants had the greatest impact on (1) the intention to request an HBV screening test on one's own initiative, and (2) the intention to participate in non-refundable HBV screening at €70,-. Of the 379 Moroccan-Dutch respondents, 49.3% intended to request a test on their own initiative, and 44.1% were willing to attend non-refundable screening for €70,-. Clarity regarding infection status, not having symptoms, fatalism, perceived self-efficacy, and perceived risk of having HBV were the strongest predictors to request a test. Shame and stigma, fatalism, perceived burden of screening participation, and social influence of Islamic religious leaders had the greatest predictive value for not intending to participate in screening at €70,- non-refundable costs. Perceived severity and possible health benefit were facilitators for this intention measure. These predictions were satisfyingly accurate, as the random forest method retrieved area under the curve scores of 0.72 for intention to request a test and 0.67 for intention to participate in screening at €70,- non-refundable costs. By the use of respondent-driven sampling, we succeeded in studying screening behaviour among a hard-to-reach minority population. Despite the limitations associated with correlated data and the sampling method, we recommend to (1) incorporate clarity regarding HBV status, (2) stress the risk of an asymptomatic infection, (3) emphasise mother-to-child transmission as the main transmission route, and (4) team up with Islamic religious leaders to help decrease elements of fatalism, shame, and stigma to enhance screening uptake of Moroccan immigrants in the Netherlands.

40 CFR 91.512 - Request for public hearing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... plans and statistical analyses have been properly applied (specifically, whether sampling procedures and statistical analyses specified in this subpart were followed and whether there exists a basis for... will be made available to the public during Agency business hours. ...

78 FR 47253 - Approval and Promulgation of Air Quality Implementation Plans; Maine; Oxides of Nitrogen...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

...-hour ozone standard in any area in the OTR. The State's submittals include detailed technical analyses... areas in the OTR. The State's technical analyses rely on several different techniques used to analyze... Maine's requests? Based on the ME DEP's technical analyses discussed above, EPA believes that the State...

78 FR 43879 - Information Collection Request Submitted to OMB for Review and Approval; Comment Request...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-22

... Submitted to OMB for Review and Approval; Comment Request; Standards for Pesticide Containers and... Protection Agency has submitted an information collection request (ICR), ``Standards for Pesticide Containers... covers the information collection activities associated with the container design and residue removal...

Indications for laboratory tests in primary care: assessment of the most frequent indications and requests with blank clinical information

PubMed Central

Salinas, Maria; López-Garrigós, Maite; Flores, Emilio; Leiva-Salinas, Maria; Esteban, Patricia; Ahumada, Miguel; Leiva-Salinas, Carlos

2016-01-01

Introduction The aim of this work is twofold. Firstly, to study the temporal evolution in the number of laboratory requests from primary care without clinical indication, and to analyse the number of such requests before and after the implementation of an automated requesting procedure. Secondly, to investigate what are the most frequent clinical indications that prompted laboratory testing. Materials and methods This is a retrospective observational study conducted from January 2009 to December 2015. We counted the requests without clinical question, calculated the number of such requests per total number of requests and listed the most frequent indications. Results The number of tests requests with a blank clinical indication was significantly higher in 2009 when compared to 2015 (80% vs. 20%; P < 0.001). For every year in this 7-year period, dyslipidemia, essential hypertension and diabetes were the most prevalent diagnoses that prompted a laboratory test in primary care, accounting for more than 20% of all indications. Conclusions The number of primary care requests without patient clinical question has decreased after the implementation of an automated requesting procedure. Disorders of lipid metabolism, essential hypertension and diabetes mellitus were the most prevalent diagnoses that prompted a laboratory test in primary care. PMID:27812310

48 CFR 305.202 - Exceptions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... acquisition channels, including the HCA, to Associate DAS for Acquisition requesting an exception to synopsizing. The Associate DAS for Acquisition shall review the request and decide whether an exception is appropriate and reasonable. If it is, the Associate DAS for Acquisition shall take the necessary coordinating...

40 CFR 90.712 - Request for public hearing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... sampling plans and statistical analyses have been properly applied (specifically, whether sampling procedures and statistical analyses specified in this subpart were followed and whether there exists a basis... Clerk and will be made available to the public during Agency business hours. ...

Estimating and circumventing the effects of perturbing and swapping inventory plot locations

Treesearch

Ronald E. McRoberts; Geoffrey R. Holden; Mark D. Nelson; Greg C. Liknes; Warren K. Moser; Andrew J. Lister; Susan L. King; Elizabeth B. LaPoint; John W. Coulston; W. Brad Smith; Gregory A. Reams

2005-01-01

The Forest Inventory and Analysis (FIA) program of the USDA Forest Service reports data and information about the Nation's forest resources. Increasingly, users request that FIA data and information be reported and distributed in a geospatial context, and they request access to exact plot locations for their own analyses. However, the FIA program is constrained by...

"I Just Need More Time": A Study of Native and Non-Native Students' Requests to Faculty for an Extension

ERIC Educational Resources Information Center

Woodfield, Helen; Economidou-Kogetsidis, Maria

2010-01-01

This paper examines the status-unequal requests of 89 advanced mixed-L1 learners and 87 British English native speakers elicited by a written discourse completion task. Significant differences were observed in all three dimensions analysed: internal and external modification, and perspective. The data demonstrate learners' overuse of zero marking…

78 FR 59341 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-26

...: Title, Associated Form and OMB Number: TRICARE Plus Enrollment Application (DD 2853) and TRICARE Plus Disenrollment Request (DD 2854); OMB Control Number 0720-0028. Type of Request: Reinstatement with Change Number...

MGAS: a powerful tool for multivariate gene-based genome-wide association analysis.

PubMed

Van der Sluis, Sophie; Dolan, Conor V; Li, Jiang; Song, Youqiang; Sham, Pak; Posthuma, Danielle; Li, Miao-Xin

2015-04-01

Standard genome-wide association studies, testing the association between one phenotype and a large number of single nucleotide polymorphisms (SNPs), are limited in two ways: (i) traits are often multivariate, and analysis of composite scores entails loss in statistical power and (ii) gene-based analyses may be preferred, e.g. to decrease the multiple testing problem. Here we present a new method, multivariate gene-based association test by extended Simes procedure (MGAS), that allows gene-based testing of multivariate phenotypes in unrelated individuals. Through extensive simulation, we show that under most trait-generating genotype-phenotype models MGAS has superior statistical power to detect associated genes compared with gene-based analyses of univariate phenotypic composite scores (i.e. GATES, multiple regression), and multivariate analysis of variance (MANOVA). Re-analysis of metabolic data revealed 32 False Discovery Rate controlled genome-wide significant genes, and 12 regions harboring multiple genes; of these 44 regions, 30 were not reported in the original analysis. MGAS allows researchers to conduct their multivariate gene-based analyses efficiently, and without the loss of power that is often associated with an incorrectly specified genotype-phenotype models. MGAS is freely available in KGG v3.0 (http://statgenpro.psychiatry.hku.hk/limx/kgg/download.php). Access to the metabolic dataset can be requested at dbGaP (https://dbgap.ncbi.nlm.nih.gov/). The R-simulation code is available from http://ctglab.nl/people/sophie_van_der_sluis. Supplementary data are available at Bioinformatics online. © The Author 2014. Published by Oxford University Press.

Process and outcomes of euthanasia requests under the belgian act on euthanasia: a nationwide survey.

PubMed

Van Wesemael, Yanna; Cohen, Joachim; Bilsen, Johan; Smets, Tinne; Onwuteaka-Philipsen, Bregje; Deliens, Luc

2011-11-01

Since 2002, the administration of a lethal drug by a physician at the explicit request of the patient has been legal in Belgium. The incidence of euthanasia in Belgium has been studied, but the process and outcomes of euthanasia requests have not been investigated. To describe which euthanasia requests were granted, withdrawn, and rejected since the enactment of the euthanasia law in terms of the characteristics of the patient, treating physician, and aspects of the consultation with a second physician. A representative sample of 3006 Belgian physicians received a questionnaire investigating their most recent euthanasia request. The response rate was 34%. Since 2002, 39% of respondents had received a euthanasia request. Forty-eight percent of requests had been carried out, 5% had been refused, 10% had been withdrawn, and in 23%, the patient had died before euthanasia could be performed. Physicians' characteristics associated with receiving a request were not being religious, caring for a high number of terminally ill patients, and having experience in palliative care. Patient characteristics associated with granting a request were age, having cancer, loss of dignity, having no depression, and suffering without prospect of improvement as a reason for requesting euthanasia. A positive initial position toward the request from the attending physician and positive advice from the second physician also contributed to having a request granted. Under the Belgian Act on Euthanasia, about half of the requests are granted. Factors related to the reason for the request, position of the attending physician toward the request, and advice from the second physician influence whether a request is granted or not. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

77 FR 38631 - Request for Comments on Ethical Issues Associated with the Development of Medical Countermeasures...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-28

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Request for Comments on Ethical Issues Associated with the... ethical issues associated with the development of medical countermeasures for children, including ethical considerations surrounding clinical research with children, ethical considerations surrounding pediatric medical...

16 CFR 1051.5 - Requirements and recommendations for petitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... injury data; or a research study); and (5) Contain an explicit request to initiate Commission rulemaking... hazardous product; and (3) Supply or reference any known documentation, engineering studies, technical studies, reports of injuries, medical findings, legal analyses, economic analyses and environmental impact...

16 CFR 1051.5 - Requirements and recommendations for petitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... injury data; or a research study); and (5) Contain an explicit request to initiate Commission rulemaking... hazardous product; and (3) Supply or reference any known documentation, engineering studies, technical studies, reports of injuries, medical findings, legal analyses, economic analyses and environmental impact...

An Analysis of Interlibrary Loan Requests Made to the Neoucom Information Center from Its Associated Council Hospital Libraries: Maximizing Service to Hospital Libraries in the Era of Hospital Downsizing.

ERIC Educational Resources Information Center

Gonda-Farley, Kristine M.

This study examines the interlibrary loan requests made to NEOUCOM's (Northeastern Ohio Universities College of Medicine) Oliver Ocasek Regional Medical Information Center in Rootstown, OH from its associated council hospital libraries. A total of 636 interlibrary loan requests from the period July 1994-July 1995 were analyzed. Components of the…

THE EFFECT OF THE "EVOKING FREEDOM" TECHNIQUE ON AN UNUSUAL AND DISTURBING REQUEST.

PubMed

Guéguen, Nicolas; Silone, Fabien; David, Mathieu; Pascual, Alexandre

2015-06-01

The "evoking freedom" technique consists in soliciting someone to comply with a request by simply saying that she is free to accept or to refuse the request. However, previous studies used low cost requests. The present study examined the magnitude of this technique associated with a more disturbing and costly request. Sixty men and 60 women aged approximately 20-25 years walking in the street were asked by a male confederate to hold a closed transparent box containing a live trap-door spider while he went into the post office to pick up a package. In the evoking freedom condition, the confederate added in his request that the participant was "free to accept or to refuse." More compliance occurred in the "evoking freedom" condition (53.3%) than in the control condition (36.7%). These results confirm the robustness and the magnitude of the evoking freedom technique on compliance and show that this technique remained effective even when the request was psychologically costly to perform and was associated with fear.

77 FR 18791 - Proposed Information Collection; Comment Request; NIST Associates Information System

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... Collection; Comment Request; NIST Associates Information System AGENCY: National Institute of Standards and Technology (NIST). ACTION: Notice. SUMMARY: The Department of Commerce, as part of its continuing effort to...-975-4188, [email protected]nist.gov . SUPPLEMENTARY INFORMATION: I. Abstract NIST Associates (NA) will...

76 FR 53168 - Proposed Collection; Comment Request for Form 1120-H

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-25

... 1120-H AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments... Form 1120-H, U.S. Income Tax Return for Homeowners Associations. DATES: Written comments should be... Associations. OMB Number: 1545-0127. Form Number: 1120-H. Abstract: Homeowners associations file Form 1120-H to...

A time-motion study of inpatient rounds using a family-centered rounds model.

PubMed

Bhansali, Priti; Birch, Sarah; Campbell, Joyce K; Agrawal, Dewesh; Hoffner, Wendy; Manicone, Paul; Shah, Kyle; Krieger, Evelina; Ottolini, Mary

2013-01-01

Family-centered rounds (FCR) have become increasingly prevalent in pediatric hospital settings. The objective of our study was to describe time use and discrete events during pediatric inpatient rounds by using a FCR model. We conducted a prospective observational study at Children's National Medical Center between September 2010 and February 2011. Investigators directly observed rounds on hospitalist and neurology services. Events were timed, and key features were recorded by using a Microsoft Access-based program. Associations with increased time spent during rounds were determined by using regression analyses. One hundred fifty-nine rounding encounters were observed. Rounds lasted 7.9 minutes on average per patient. An average of 1.3 minutes was spent between patients during rounds. Eighty-six (54%) encounters occurred outside the patient's room, 3% of the time because of the family's request. Infectious isolation was associated with rounds occurring outside the room (P<.0001). Participation of the parent, location of rounds inside or outside the patient's room, most teaching behaviors, and interruptions were not significantly associated with increased time spent during rounds. Teaching physical examination techniques by allowing multiple trainees to examine the patient was associated with increased rounding time (P= .02). The majority of rounds occurred outside the patient's room, yet rarely at the parent's request. Patients on infectious isolation were more likely to have rounds occur outside the patient's room. Neither parental participation nor most teaching behaviors were associated with increased time spent on rounds. These findings will enrich the evidence base needed to establish FCR best practices.

Using social cognitive theory to explain consumers' behavioral intentions in response to direct-to-consumer prescription drug advertising.

PubMed

Young, Henry N; Lipowski, Earlene E; Cline, Rebecca J W

2005-06-01

Previous research describing consumers' communication behaviors in response to direct-to-consumer advertising (DTCA) suggests a social cognitive rationale to explain DTCA-related communication behavior. Guided by social cognitive theory, the objective of this study was to explore outcome expectancy and self-efficacy beliefs as predictors of individuals' intentions to communicate with their physicians about an advertised drug. One hundred and seven female college students completed a questionnaire, read an advertisement for an oral contraceptive drug, and completed a second questionnaire. The questionnaires assessed participants' self-efficacy and outcome expectancy beliefs, intended communication behavior, and demographic information. Pearson product-moment correlation analyses showed that outcome expectancy (r=0.75, P<.01) and self-efficacy (r=0.21, P<.05) beliefs were associated positively with intentions to communicate with physicians in response to DTCA. However, ordinary least squares regression analyses revealed that only outcome expectancy beliefs predicted intended communication behavior (B=1.56, P<.01). Results also showed that participants had a relatively greater likelihood of requesting information about, than requesting a prescription for, the advertised drug [t(106)=14.75, P<.01]. The results identify cognitive factors that guide consumers' plans for interacting with physicians in response to DTCA. Health care providers can use these results to guide communication with patients regarding DTCA and meet patients' drug-related informational expectations.

76 FR 59952 - Occupational Injury and Illness Recording and Reporting Requirements-NAICS Update and Reporting...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-28

... request made by the National Automobile Dealers Association. The record will remain open for 30 days... Automobile Dealers Association requested this extension to provide them more time to evaluate the Bureau of...

How Extension Can Help Communities Conduct Impact Analyses.

ERIC Educational Resources Information Center

Wisconsin Univ., Madison. Dept. of Agricultural Journalism.

Intended to provide guidance to Extension specialists and agents faced with requests for impact analyses from communities experiencing economic development, this report also summarizes issues that need to be considered. The first section, on private sector impacts, addresses questions on predicting changes in production, employment, and housing…

78 FR 12360 - PNC Bank, National Association, Retail Bank Franklin, PA; PNC Bank, National Association, Retail...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-22

... at Tata Consultancy Services'' in India. The request also states that the ``other facilities within... Chester, Illinois facilities are ``over 90 miles away resulting in a 2-hour one-way commute.'' The request...

13 CFR 121.1204 - What are the procedures for requesting and granting waivers?

Code of Federal Regulations, 2011 CFR

2011-01-01

... granting waivers? (a) Waivers for classes of products. (1) SBA may, at its own initiative, examine a class..., association, or Federal agency may submit a request for a waiver for a particular class of products. Requests... Administration, 409 3rd Street SW., Washington, DC 20416. (3) Requests for a waiver of a class of products need...

Pharmacy costs associated with nonformulary drug requests.

PubMed

Sweet, B V; Stevenson, J G

2001-09-15

Pharmacy costs associated with handling nonformulary drug requests were studied. Data for all nonformulary drug orders received at a university hospital between August 1 and October 31, 1999, were evaluated to determine their outcome and the cost differential between the nonformulary drug and formulary alternative. Two sets of data were used to analyze medication costs: data from nonformulary medication request forms, which allowed the cost of nonformulary drugs and their formulary alternatives to be calculated, and data from the pharmacy computer system, which enabled actual nonformulary drug use to be captured. Labor costs associated with processing these requests were determined through time analysis, which included the potential for orders to be received at different times of the day and with different levels of technician and pharmacist support. Economic analysis revealed that the greatest cost saving occurred when converting nonformulary injectable products to formulary alternatives. Interventions were least costly during normal business hours, when all the satellite pharmacies were open and fully staffed. Pharmacists' interventions in oral product orders resulted in a net increase in expenditures. Incremental pharmacy costs associated with processing nonformulary medication requests in an inpatient setting are greater than the drug acquisition cost saving for most agents, particularly oral medications.

78 FR 53736 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-30

...: Title, Associated Form and OMB Number: Defense Industrial Base Cyber Security/Information Assurance (DIB CS/IA) Cyber Incident Reporting; OMB Control Number 0704-0489. Type of Request: Reinstatement without.... The requested information supports the collaborative cyber threat information sharing and incident...

Request for HIV serology in primary care: A survey of medical and nursing professionals.

PubMed

Pichiule-Castañeda, Myrian; Domínguez-Berjón, M Felicitas; Esteban-Vasallo, María D; García-Riolobos, Carmen; Álvarez-Castillo, M Carmen; Astray-Mochales, Jenaro

2018-01-15

In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. An 'on-line' survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% CI: 0.82-10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84-6.93) and the nurses with: age (<50 years; aOR: 2.75; 95% CI: 0.97-7.75), and number of years working in primary care (>13 years; aOR: 3.02; 95% CI: 1.07-8.52). It is necessary to promote HIV testing and training in pre-post HIV test counselling for medical and nursing professionals in primary care centres. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Analysis of S.139, the Climate Stewardship Act of 2003

EIA Publications

2003-01-01

On January 9, 2003, Senators John McCain and Joseph I. Lieberman introduced Senate Bill 139 (S.139), the Climate Stewardship Act of 2003, in the U.S. Senate. S.139 would require the Administrator of the U.S. Environmental Protection Agency (EPA) to promulgate regulations to limit greenhouse gas emissions. On January 28, 2003, Senator James M. Inhofe requested that the Energy Information Administration (EIA) perform a comprehensive analysis of S.139. On April 2, 2003, Senators McCain and Lieberman, cosponsors of S.139, made a further request for analyses of their bill. This Service Report responds to both requests.

76 FR 4278 - Notice of Availability of Pest Risk Analyses for the Importation of Fresh Edible Flowers of Izote...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-25

... inflorescences of chufle, and fresh leaves of chipilin from El Salvador. Based on those analyses, we believe that... of chipilin from El Salvador. We are making the pest risk analyses available to the public for review... request from the Government of El Salvador to allow the importation of edible fresh flowers of izote...

75 FR 57737 - Notice of Request for Approval of an Information Collection; National Veterinary Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-22

...] Notice of Request for Approval of an Information Collection; National Veterinary Services Laboratories... Service's intention to request approval of an information collection associated with National Veterinary...' Information Collection Coordinator, at (301) 851-2908. SUPPLEMENTARY INFORMATION: Title: National Veterinary...

A Comparison of Request Process and Outcomes in Donation after Cardiac Death (DCD) and Donation after Brain Death (DBD): Results from a National Study

PubMed Central

Siminoff, Laura A.; Alolod, Gerard P.; Wilson-Genderson, Maureen; Yuen, Eva Y. N.; Traino, Heather M.

2016-01-01

Available literature points to healthcare providers’ discomfort with donation after cardiac death (DCD) and their perception of the public’s reluctance toward the procedure. Using a national sample, we report on the communication content of actual DCD and donation after brain death (DBD) approaches by organ procurement organization (OPO) requesters and compare family decision makers’ (FDMs’) experiences of both modalities. We recruited 1,601 FDMs using a validated protocol; 347 (21.7%) were of potential DCD donors. Semi-structured telephone interviews yielded FDMs’ sociodemographic data, predisposition toward donation, assessment of approach, final outcomes, and substantiating reasons. Initial analysis consisted of bivariate analyses. Multilevel mixture models compared groups representing authorization outcome and DCD/DBD status. No significant differences in family authorization were found between DCD and DBD cases. Statistically significant associations were found between sociodemographic characteristics and authorization, with White FDMs more likely to authorize DCD or DBD than Black FDMs. FDMs of both modalities had similar evaluations of requester skills, topics discussed, satisfaction, and reasons for refusal. The findings suggest that the DCD/DBD distinction may not be notable to families. We recommend the use of similar communication skills and strategies during approaches and the development of education campaigns about the public’s acceptance of DCD. PMID:27753206

A Comparison of Request Process and Outcomes in Donation After Cardiac Death and Donation After Brain Death: Results From a National Study.

PubMed

Siminoff, L A; Alolod, G P; Wilson-Genderson, M; Yuen, E Y N; Traino, H M

2017-05-01

Available literature points to healthcare providers' discomfort with donation after cardiac death (DCD) and their perception of public reluctance toward the procedure. Using a national sample, we report on the communication content of actual DCD and donation after brain death (DBD) approaches by organ procurement organization (OPO) requesters and compare family decision makers' (FDMs') experiences of both modalities. We recruited 1601 FDMs using a validated protocol; 347 (21.7%) were of potential DCD donors. Semistructured telephone interviews yielded FDMs' sociodemographic data, donation attitudes, assessment of approach, final outcomes, and substantiating reasons. Initial analysis consisted of bivariate analyses. Multilevel mixture models compared groups representing authorization outcome and DCD/DBD status. No significant differences in family authorization were found between DCD and DBD cases. Statistically significant associations were found between sociodemographic characteristics and authorization, with white FDMs more likely to authorize DCD or DBD than black FDMs. FDMs of both modalities had similar evaluations of requester skills, topics discussed, satisfaction, and refusal reasons. The findings suggest that the DCD/DBD distinction may not be notable to families. We recommend the use of similar approach strategies and communication skills and the development of education campaigns about the public's acceptance of DCD. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

[Prior health advice to immigrants who travel to visit family and friends].

PubMed

Roca, Carme; Aguilar, Anna; Valerio, Lluís; Solsona, Lluís; Carrasco, Clara; Gimeno-Feliu, Luis Andrés

2014-04-01

Immigrants who make or plan journeys to visit their families in their countries of origin (immigrants -visiting friends and relatives, I-VFR) have a higher risk of acquiring travel-associated diseases than other travellers. The main aim of this study is to analyse the knowledge of the immigrant population on the need to receive health advice (HA) before making international journeys in general and in particular before travelling to their country of origin. Observational, multicentre study. Ten Family Doctors from 10 Health Centres in Catalonia and Aragon participated A total of 555 immigrants ≥ 15 years of age, who consulted their Family Doctor and agreed to answer a questionnaire. Opportunity sampling was used. A total of 389 (70.1%) of those surveyed considered it necessary to receive HA before making an international journey, 406 (73.2%) were I-VFR and 145 (35.7%) had requested HA prior to the journey, mostly from their Family Doctor (n=60; 41.1%). Almost two-thirds (261, 65.2%) of the subjects did not seek HA, with the most common reason being that they did not consider it necessary (173, 42.6%). I-VFR do not usually request HA prior to travelling, basic due to considering it unnecessary. When they do request it, they are very often initially directed to their Family Doctor. Copyright © 2013 Elsevier España, S.L. All rights reserved.

42 CFR 416.190 - Request for review of payment amount.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Technology Intraocular Lenses Furnished by Ambulatory Service Centers § 416.190 Request for review of payment... technology IOLs must be submitted to CMS in accordance with the annual published deadline. (b) Who may submit a request. Any individual, partnership, corporation, association, society, scientific or academic...

42 CFR 416.190 - Request for review of payment amount.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Technology Intraocular Lenses Furnished by Ambulatory Service Centers § 416.190 Request for review of payment... technology IOLs must be submitted to CMS in accordance with the annual published deadline. (b) Who may submit a request. Any individual, partnership, corporation, association, society, scientific or academic...

Predictors of two forms of attrition in a longitudinal health study involving ageing participants: an analysis based on the Whitehall II study.

PubMed

Mein, Gill; Johal, Suneeta; Grant, Robert L; Seale, Clive; Ashcroft, Richard; Tinker, Anthea

2012-10-29

Longitudinal studies are crucial providers of information about the needs of an ageing population, but their external validity is affected if partipants drop out. Previous research has identified older age, impaired cognitive function, lower educational level, living alone, fewer social activities, and lower socio-economic status as predictors of attrition. This project examined attrition in participants of the Whitehall II study aged between 51-71 years, using data from questionnaires participants have completed biennially since 1985 when the study began. We examine the possibility of two distinct forms of attrition--non-response and formally requesting to withdraw--and whether they have different predictors. Potential predictors were age, gender, marital status, occupational grade, retirement, home ownership, presence of longstanding illness, SF-36 quality of life scores, social participation and educational level comparing participants and those who had withdrawn from the study. The two forms of attrition share many predictors and are associated but remain distinct. Being older, male, having a lower job grade, not being a home owner, not having a long standing illness, having higher levels of education, and not having retired, were all associated with a greater probability of non-response; being married was associated with higher probability in women and lower in men. Being older, male, having a lower job grade, not being a home owner, having lower SF-36 scores, taking part in fewer social activities, and not having a long standing illness, were all associated with greater probability of withdrawal. The results suggest a strong gender effect on both routes not previously considered in analyses of attrition. Investigators of longitudinal studies should take measures to retain older participants and lower level socio-economic participants, who are more likely to cease participating. Recognition should be given to the tendency for people with health problems to be more diligent participants in studies with a medical screening aspect, and for those with lower socio-economic status (including home ownership), quality of life and social participation, to be more likely to request withdrawal. Without taking these features into account, bias and loss of power could affect statistical analyses.

Plain abdominal radiographs in acute medical emergencies: an abused investigation?

PubMed

Feyler, S; Williamson, V; King, D

2002-02-01

Plain abdominal radiographs are commonly requested for acute medical emergencies on patients with non-specific abdominal symptoms and signs. In this study 131 plain abdominal radiographs performed on the day of admission were prospectively analysed. In only 16 cases (12%) the reasons for requests conformed to the recommended guidelines by the Royal College of Radiologists. The reason for the request was stated in the case notes in only three cases. In 62 cases (47%), there was no comment made on the film by the requesting clinician. There was a discrepancy in the interpretation of the radiograph between the clinician and the radiologist in 31 cases (24%). The clinical management was influenced by plain abdominal radiographs in only nine cases (7%). The majority of plain abdominal radiographs requested on acute medical emergencies is inappropriate. There is a need to ensure guidelines are followed to prevent unnecessary exposure of patients to radiation as well as preventing expenditure on irrelevant investigations.

Plain abdominal radiographs in acute medical emergencies: an abused investigation?

PubMed Central

Feyler, S; Williamson, V; King, D

2002-01-01

Plain abdominal radiographs are commonly requested for acute medical emergencies on patients with non-specific abdominal symptoms and signs. In this study 131 plain abdominal radiographs performed on the day of admission were prospectively analysed. In only 16 cases (12%) the reasons for requests conformed to the recommended guidelines by the Royal College of Radiologists. The reason for the request was stated in the case notes in only three cases. In 62 cases (47%), there was no comment made on the film by the requesting clinician. There was a discrepancy in the interpretation of the radiograph between the clinician and the radiologist in 31 cases (24%). The clinical management was influenced by plain abdominal radiographs in only nine cases (7%). The majority of plain abdominal radiographs requested on acute medical emergencies is inappropriate. There is a need to ensure guidelines are followed to prevent unnecessary exposure of patients to radiation as well as preventing expenditure on irrelevant investigations. PMID:11807192

Plain ABDO X-rays: a waste of time?

PubMed

2002-03-01

Plain abdominal radiographs are commonly requested for acute medical emergencies on patients with non-specific abdominal symptoms and signs. In this study, 131 plain abdominal radiographs performed on the day of admission were prospectively analysed by the research team. In only 16 cases (12 per cent) the reasons for requests conformed to the recommended guidelines by the Royal College of Radiologists. The reason for the request was stated in the case notes in only three cases. In 62 cases (47 per cent), there was no comment made on the film by the requesting clinician. There was a discrepancy in the interpretation of the radiograph between the clinician and the radiologist in 31 cases (24 per cent). The clinical management was influenced by plain abdominal radiographs in only nine cases (7 per cent). The researchers argue that most plain abdominal radiographs requested on acute medical emergencies are inappropriate. They suggest there is a need to ensure guidelines are followed to prevent unnecessary exposure of patients to radiation as well as preventing expenditure on irrelevant investigations.

77 FR 52718 - Agency Information Collection Activities: Proposed Information Collection; Comment Request

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... nonmember banks and state savings associations titled, ``Annual Stress Test Reporting Template and... FDIC is requesting comment on the following new proposed information collection: Title: Annual Stress... associations, to conduct annual stress tests \\2\\ and requires the primary financial regulatory agency \\3\\ of...

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10 CFR 216.3 - Requests for assistance.

Code of Federal Regulations, 2014 CFR

2014-01-01

... associated with a program or project which may qualify as an eligible energy program or project and wishing... requesting DOE to determine whether a program or project maximizes domestic energy supplies and to find... description of the energy program or project for which assistance is requested and an assessment of its impact...

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76 FR 74838 - Agency Information Collection Activities: Proposed Request

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... their disability or resources that might influence SSA's unfavorable determination. We may use the... hearing to appeal the decision. To request a hearing, individuals use Form HA-501, the associated... request within the prescribed time; is the proper party; and has taken the steps necessary to obtain the...

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78 FR 52168 - Submission for OMB Review; Comment Request

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7 CFR 91.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Agriculture. Analyses. Microbiological, chemical, or physical tests performed on a commodity. Applicant. Any person or organization requesting services provided by the Science and Technology (S&T) programs. Legal...

7 CFR 91.2 - Definitions.

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2011-01-01

... Agriculture. Analyses. Microbiological, chemical, or physical tests performed on a commodity. Applicant. Any person or organization requesting services provided by the Science and Technology (S&T) programs. Legal...

7 CFR 91.2 - Definitions.

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... Agriculture. Analyses. Microbiological, chemical, or physical tests performed on a commodity. Applicant. Any person or organization requesting services provided by the Science and Technology (S&T) programs. Legal...

7 CFR 91.2 - Definitions.

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2014-01-01

... Agriculture. Analyses. Microbiological, chemical, or physical tests performed on a commodity. Applicant. Any person or organization requesting services provided by the Science and Technology (S&T) programs. Legal...

Integration and acceleration of virtual microscopy as the key to successful implementation into the routine diagnostic process.

PubMed

Wienert, Stephan; Beil, Michael; Saeger, Kai; Hufnagl, Peter; Schrader, Thomas

2009-01-09

The virtual microscopy is widely accepted in Pathology for educational purposes and teleconsultation but is far from the routine use in surgical pathology due to the technical requirements and some limitations. A technical problem is the limited bandwidth of a usual network and the delayed transmission rate and presentation time on the screen. In this study the process of secondary diagnostic was evaluated using the "T.Konsult Pathologie" service of the Professional Association of German Pathologists within the German breast cancer screening program. The characteristics of the access to the WSI (Whole Slide Images) have been analyzed to explore the possibilities of prefetching and caching to reduce the presentation and transfer time with the goal to increase user acceptance. The log files of the web server were analyzed to reconstruct the movements of the pathologist on the WSI and to create the observation path. Using a specialized tool the observation paths were extracted automatically from the log files. The attributes linearity, 3-point-linearity, changes per request, and number of consecutive requests were calculated to design, develop and evaluate different caching and prefetching strategies. The analysis of the observation paths showed that a complete accordance of two image requests is a very rare event. But more frequently a partial covering of two requested image areas can be found. In total 257 diagnostic paths from 131 WSI have been extracted and analysed. On average a diagnostic path consists of 16 image requests and takes 189 seconds between first and last image request. The mean linearity was 0,41 and the mean 3-point-linearity 0,85. Three different caching algorithms have been compared with respect to hit rate and additional image requests on the WSI server. Tests demonstrated that 95% of the diagnostic paths could be loaded without any deletion of entries in the cache (cache size 12,2 Megapixel). If the image parts are stored after JPEG compression this complies with less than 2 MB. WSI telepathology is a technology which offers the possibility to break the limitations of conventional static telepathology. The complete histological slide may be investigated instead of sets of images of lesions sampled by the presenting pathologist. The benefit is demonstrated by the high diagnostic security of 95% accordance between first and second diagnosis.

Integration and acceleration of virtual microscopy as the key to successful implementation into the routine diagnostic process

PubMed Central

Wienert, Stephan; Beil, Michael; Saeger, Kai; Hufnagl, Peter; Schrader, Thomas

2009-01-01

Background The virtual microscopy is widely accepted in Pathology for educational purposes and teleconsultation but is far from the routine use in surgical pathology due to the technical requirements and some limitations. A technical problem is the limited bandwidth of a usual network and the delayed transmission rate and presentation time on the screen. Methods In this study the process of secondary diagnostic was evaluated using the "T.Konsult Pathologie" service of the Professional Association of German Pathologists within the German breast cancer screening program. The characteristics of the access to the WSI (Whole Slide Images) have been analyzed to explore the possibilities of prefetching and caching to reduce the presentation and transfer time with the goal to increase user acceptance. The log files of the web server were analyzed to reconstruct the movements of the pathologist on the WSI and to create the observation path. Using a specialized tool the observation paths were extracted automatically from the log files. The attributes linearity, 3-point-linearity, changes per request, and number of consecutive requests were calculated to design, develop and evaluate different caching and prefetching strategies. Results The analysis of the observation paths showed that a complete accordance of two image requests is a very rare event. But more frequently a partial covering of two requested image areas can be found. In total 257 diagnostic paths from 131 WSI have been extracted and analysed. On average a diagnostic path consists of 16 image requests and takes 189 seconds between first and last image request. The mean linearity was 0,41 and the mean 3-point-linearity 0,85. Three different caching algorithms have been compared with respect to hit rate and additional image requests on the WSI server. Tests demonstrated that 95% of the diagnostic paths could be loaded without any deletion of entries in the cache (cache size 12,2 Megapixel). If the image parts are stored after JPEG compression this complies with less than 2 MB. Discussion WSI telepathology is a technology which offers the possibility to break the limitations of conventional static telepathology. The complete histological slide may be investigated instead of sets of images of lesions sampled by the presenting pathologist. The benefit is demonstrated by the high diagnostic security of 95% accordance between first and second diagnosis. PMID:19134181

26 CFR 301.7216-2 - Permissible disclosures or uses without consent of the taxpayer.

Code of Federal Regulations, 2012 CFR

2012-04-01

... professional association ethics committee or board, or the Public Company Accounting Oversight Board. The.... (5) A written request from a professional association ethics committee or board investigating the ethical conduct of the tax return preparer. (6) A written request from the Public Company Accounting...

75 FR 60407 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... DEPARTMENT OF COMMERCE Submission for OMB Review; Comment Request The Department of Commerce will... Endangered Species Act on October 22, 2008 (73 FR 62919). The public benefits associated with the results of... the non-consumptive value people attribute to such protection (e.g., active use values associated with...

77 FR 36330 - Agency Information Collection Activities: Requests for Comments; Clearance of Renewed Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-18

... certificates and associated ratings. Pilot schools train private, commercial, flight instructor, and airline transport pilots, along with training for associated ratings in various types of aircraft. The form is also... Activities: Requests for Comments; Clearance of Renewed Approval of Information Collection: Pilot Schools...

78 FR 24729 - National Fire Codes: Request for Comments on NFPA's Codes and Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-26

... DEPARTMENT OF COMMERCE National Institute of Standards and Technology National Fire Codes: Request... this notice on behalf of the National Fire Protection Association (NFPA) to announce the availability...: Since 1896, the National Fire Protection Association (NFPA) has accomplished its mission by advocating...

Availability and Use of Shared Data From Cardiometabolic Clinical Trials.

PubMed

Vaduganathan, Muthiah; Nagarur, Amulya; Qamar, Arman; Patel, Ravi B; Navar, Ann Marie; Peterson, Eric D; Bhatt, Deepak L; Fonarow, Gregg C; Yancy, Clyde W; Butler, Javed

2018-02-27

Sharing of patient-level clinical trial data has been widely endorsed. Little is known about how extensively these data have been used for cardiometabolic diseases. We sought to evaluate the availability and use of shared data from cardiometabolic clinical trials. We extracted data from ClinicalStudyDataRequest.com, a large, multisponsor data-sharing platform hosting individual patient-level data from completed studies sponsored by 13 pharmaceutical companies. From January 2013 to May 2017, the platform had data from 3374 clinical trials, of which 537 (16%) evaluated cardiometabolic therapeutics (phase 1, 36%; phase 2, 17%; phase 2/3, 1%; phase 3, 42%; phase 4, 4%). They covered 74 therapies and 398 925 patients. Diabetes mellitus (60%) and hypertension (15%) were the most common study topics. Median time from study completion to data availability was 79 months. As of May 2017, ClinicalStudyDataRequest.com had received 318 submitted proposals, of which 163 had signed data-sharing agreements. Thirty of these proposals were related to cardiometabolic therapies and requested data from 79 unique studies (15% of all trials, 29% of phase 3/4 trials). Most (96%) data requesters of cardiometabolic clinical trial data were from academic centers in North America and Western Europe, and half the proposals were unfunded. Most proposals were for secondary hypothesis-generating questions, with only 1 proposed reanalysis of the original study primary hypothesis. To date, 3 peer-reviewed articles have been published after a median of 19 months (9-32 months) from the data-sharing agreement. Despite availability of data from >500 cardiometabolic trials in a multisponsor data-sharing platform, only 15% of these trials and 29% of phase 3/4 trials have been accessed by investigators thus far, and a negligible minority of analyses have reached publication. © 2017 American Heart Association, Inc.

Generation-based memory synchronization in a multiprocessor system with weakly consistent memory accesses

DOEpatents

Ohmacht, Martin

2017-08-15

In a multiprocessor system, a central memory synchronization module coordinates memory synchronization requests responsive to memory access requests in flight, a generation counter, and a reclaim pointer. The central module communicates via point-to-point communication. The module includes a global OR reduce tree for each memory access requesting device, for detecting memory access requests in flight. An interface unit is implemented associated with each processor requesting synchronization. The interface unit includes multiple generation completion detectors. The generation count and reclaim pointer do not pass one another.

Generation-based memory synchronization in a multiprocessor system with weakly consistent memory accesses

DOEpatents

Ohmacht, Martin

2014-09-09

In a multiprocessor system, a central memory synchronization module coordinates memory synchronization requests responsive to memory access requests in flight, a generation counter, and a reclaim pointer. The central module communicates via point-to-point communication. The module includes a global OR reduce tree for each memory access requesting device, for detecting memory access requests in flight. An interface unit is implemented associated with each processor requesting synchronization. The interface unit includes multiple generation completion detectors. The generation count and reclaim pointer do not pass one another.

78 FR 27472 - Agency Information Collection Activities: Requests for Comments; Clearance of New Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-10

... Display to Industry (ASDI) Block Requests AGENCY: Federal Aviation Administration (FAA), DOT. ACTION... information will be used by the National Air Space Data Release Office to block aircraft flight data as... Display to Industry (ASDI) Block Requests. Form Numbers: There are no FAA forms associated with this...

75 FR 75475 - Agency Information Collection Activities; Proposed Collection; Comment Request; Index of Legally...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-03

... hours associated with indexing of legally marketed unapproved new animal drugs for minor species. [[Page... criteria and procedures for requesting eligibility for indexing and for requesting addition to the index as... actions and Sec. 516.125 provides for investigational use of new animal drugs intended for indexing...

75 FR 75481 - Agency Information Collection Activities; Proposed Collection; Comment Request; Index of Legally...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-03

... hours associated with indexing of legally marketed unapproved new animal drugs for minor species. DATES... criteria and procedures for requesting eligibility for indexing and for requesting addition to the index as... actions and Sec. 516.125 provides for investigational use of new animal drugs intended for indexing...

77 FR 50980 - Notice of Request for a Revision to and Extension of Approval of an Information Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-23

...] Notice of Request for a Revision to and Extension of Approval of an Information Collection; Tuberculosis... request an extension of approval of an information collection associated with the bovine tuberculosis... coming. FOR FURTHER INFORMATION CONTACT: For information on the domestic tuberculosis program, contact Dr...

76 FR 78230 - Notice of Request for Extension of Approval of an Information Collection; Requirements for...

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2011-12-16

...In accordance with the Paperwork Reduction Act of 1995, this notice announces the Animal and Plant Health Inspection Service's intention to request an extension of approval of an information collection associated with the requirements for requests to amend import regulations for plants, plant parts, and plant products.

76 FR 22383 - National Fire Codes: Request for Proposals for Revision of Codes and Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-21

... DEPARTMENT OF COMMERCE National Institute of Standards and Technology National Fire Codes: Request... publishing this notice on behalf of the National Fire Protection Association (NFPA) to announce the NFPA's proposal to revise some of its fire safety codes and standards and requests proposals from the public to...

75 FR 11075 - Enhancing Airline Passenger Protections: Response to Requests To Extend Compliance Date

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-10

...] RIN No. 2105-AE00 Enhancing Airline Passenger Protections: Response to Requests To Extend Compliance... proposed rulemaking. SUMMARY: The Department of Transportation is proposing to extend by 45 days, or until... days requested by the carrier associations is needed. Therefore, this NPRM proposes to extend the...

75 FR 69047 - Proposed Information Collection; Comment Request; Questionnaire on Business-Related Visa Processes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-10

... Request; Questionnaire on Business-Related Visa Processes AGENCY: International Trade Administration... five years. The DOC will request that U.S. industry and trade associations use the questionnaire to... questionnaires is critical to enabling DOC to ascertain the economic impact, if any, of current U.S. business...

76 FR 34032 - Notice of Revision and Request for Extension of Approval of an Information Collection; Swine...

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...] Notice of Revision and Request for Extension of Approval of an Information Collection; Swine Health... revise an information collection associated with regulations to prevent the interstate spread of swine diseases and to request extension of approval of the information collection to protect swine health. DATES...

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2013-10-03

...] Notice of Request for Extension of Approval of an Information Collection; Importation of Fresh Baby Kiwi... an information collection; comment request. SUMMARY: In accordance with the Paperwork Reduction Act... an extension of approval of an information collection associated with the regulations for the...

Relational Uncertainty and Message Production within Courtship: Features of Date Request Messages

ERIC Educational Resources Information Center

Knobloch, Leanne K.

2006-01-01

This paper theorizes about how relational uncertainty may predict features of date request messages within courtship. It reports a study in which 248 individuals role-played leaving a date request voice mail message for their partner. Relational uncertainty was negatively associated with the fluency (H1), affiliativeness (H2), relationship focus…

Audit of an emergency biochemistry service.

PubMed Central

Smellie, W S; Murphy, M J; Galloway, P J; Hinnie, J; McIlroy, J; Dryburgh, F J

1995-01-01

AIM--To examine a model for the evaluation of appropriateness of testing in an emergency biochemistry laboratory. METHODS--A model was devised in which incoming emergency test requests were categorised as appropriate or inappropriate. Explicit criteria were used to define eight minor categories, which were chosen to reflect accurately current working practice within the hospital and laboratory. Five junior medical staff each undertook a prospective 24 hour assessment, during which time all incoming requests were monitored and categorised according to these criteria. Concordance between monitors was evaluated before and during assessments. RESULTS--Of 509 requests, 384 (75%) were appropriate and 125 (25%) were inappropriate according to the criteria used to define categories. Inappropriate requests fell into three main groups: preoperative samples (43.2% (54/125) of all inappropriate requests), missed routine samples (33.6% (42/125)) and accelerated (priority) analyses (16% (20/125)). Various other reasons accounted for the remaining 7.2% (9/125). CONCLUSION--This model may be used to obtain valid information about current clinical and laboratory practice. Strategies to reduce the number of inappropriate requests have been identified in order to reserve the emergency service for situations of true need. PMID:8568000

78 FR 65422 - Agency Request for Emergency Processing of Collections of Information Associated With Today's...

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78 FR 26690 - Hours of Service (HOS) of Drivers; Application for Renewal and Expansion of American Pyrotechnics...

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77 FR 38128 - Qualification of Drivers; Application for Exemptions; National Association of the Deaf

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2012-06-26

..., notice requesting public comments on the National Association of the Deaf's (NAD) application for... Regulations (FMCSRs). On June 6, 2012, NAD formally requested that the Agency extend the comment period. The..., 2012 (77 FR 31423), announcing that NAD had applied for exemptions on behalf of 45 individuals from the...

Characteristics associated with requests by pathologists for second opinions on breast biopsies

PubMed Central

Geller, Berta M; Nelson, Heidi D; Weaver, Donald L; Frederick, Paul D; Allison, Kimberly H; Onega, Tracy; Carney, Patricia A; Tosteson, Anna N A; Elmore, Joann G

2018-01-01

Aims Second opinions in pathology improve patient safety by reducing diagnostic errors, leading to more appropriate clinical treatment decisions. Little objective data are available regarding the factors triggering a request for second opinion despite second opinion consultations being part of the diagnostic system of pathology. Therefore we sought to assess breast biopsy cases and interpreting pathologists characteristics associated with second opinion requests. Methods Collected pathologist surveys and their interpretations of 60 test set cases were used to explore the relationships between case characteristics, pathologist characteristics and case perceptions, and requests for second opinions. Data were evaluated by logistic regression and generalised estimating equations. Results 115 pathologists provided 6900 assessments; pathologists requested second opinions on 70% (4827/6900) of their assessments 36% (1731/4827) of these would not have been required by policy. All associations between case characteristics and requesting second opinions were statistically significant, including diagnostic category, breast density, biopsy type, and number of diagnoses noted per case. Exclusive of institutional policies, pathologists wanted second opinions most frequently for atypia (66%) and least frequently for invasive cancer (20%). Second opinion rates were higher when the pathologist had lower assessment confidence, in cases with higher perceived difficulty, and cases with borderline diagnoses. Conclusions Pathologists request second opinions for challenging cases, particularly those with atypia, high breast density, core needle biopsies, or many co-existing diagnoses. Further studies should evaluate whether the case characteristics identified in this study could be used as clinical criteria to prompt system-level strategies for mandating second opinions. PMID:28465449

A Study of the First Year of the End-of-Life Clinic for Physician-Assisted Dying in the Netherlands.

PubMed

Snijdewind, Marianne C; Willems, Dick L; Deliens, Luc; Onwuteaka-Philipsen, Bregje D; Chambaere, Kenneth

2015-10-01

Right to Die NL, an organization in the Netherlands that advocates for the option of euthanasia, founded the End-of-Life Clinic in 2012 to provide euthanasia or physician-assisted suicide for patients who meet all legal requirements but whose regular physicians rejected their request. Many patients whose requests are rejected have less common situations, such as a psychiatric or psychological condition, dementia, or being tired of living. To study outcomes of requests for euthanasia or physician-assisted suicide received by the clinic and factors associated with granting or rejecting requests. Analysis of application forms and registration files from March 1, 2012, to March 1, 2013, the clinic's first year of operation, for 645 patients who applied to the clinic with a request for euthanasia or physician-assisted suicide and whose cases were concluded during the study period. A request could be granted, rejected, or withdrawn or the patient could have died before a final decision was reached. We analyzed bivariate and multivariate associations with medical conditions, type of suffering, and sociodemographic variables. Of the 645 requests made by patients, 162 requests (25.1%) were granted, 300 requests (46.5%) were refused, 124 patients (19.2%) died before the request could be assessed, and 59 patients (9.1%) withdrew their requests. Patients with a somatic condition (113 of 344 [32.8%]) or with cognitive decline (21 of 56 [37.5%]) had the highest percentage of granted requests. Patients with a psychological condition had the smallest percentage of granted requests. Six (5.0%) of 121 requests from patients with a psychological condition were granted, as were 11 (27.5%) of 40 requests from patients who were tired of living. Physicians in the Netherlands have more reservations about less common reasons that patients request euthanasia and physician-assisted suicide, such as psychological conditions and being tired of living, than the medical staff working for the End-of-Life Clinic. The physicians and nurses employed by the clinic, however, often confirmed the assessment of the physician who previously cared for the patient; they rejected nearly half of the requests for euthanasia and physician-assisted suicide, possibly because the legal due care criteria had not been met.

Analysis of S. 485, the Clear Skies Act of 2003, and S. 843, the Clean Air Planning Act of 2003

EIA Publications

2003-01-01

On July 30, 2003, Senator James M. Inhofe requested the Energy Information Administration to undertake analyses of S.843, The Clean Air Planning Act of 2003, introduced by Senator Thomas Carper, and S.485, Clear Skies Act of 2003. Senator Inhofe also asked the Energy Information Administration (EIA) to analyze S. 485 without the mercury provisions and S. 843 without the mercury and carbon dioxide provisions. This service report responds to both requests.

Changing effects of direct-to-consumer broadcast drug advertising information sources on prescription drug requests.

PubMed

Lee, Annisa Lai

2009-06-01

This study tracks the changes of the effects of 4 information sources for direct-to-consumer drug advertising on patients' requests for prescription drugs from physicians since the inception of the "Guidance for Industry about Consumer-directed Broadcast Advertisements." The Guidance advises pharmaceuticals to use four information sources for consumers to seek further information to supplement broadcast drug advertisements: small-print information, the Internet, a toll-free number, and health-care providers (nurses, doctors, and pharmacists). Logistic models were created by using survey data collected by the Food and Drug Administration in 1999 and 2002. Results show that throughout the years, health-care providers remain the most used and strongest means associated with patients' direct requests for nonspecific and specific prescription drugs from doctors. The small-print information source gains power and changes from an indirect means associated with patients' discussing drugs with health-care providers to a direct means associated with patients' asking about nonspecific and specific drugs from their doctors. The Internet is not directly related to drug requests, but the effect of its association with patients seeking information from health-care providers grew 11-fold over the course of the study. The toll-free number lost its power altogether for both direct request for a prescription drug and further discussion with health-care providers. Patient demographics will be considered for specific policy implications.

32 CFR 299.6 - Fees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROGRAM NATIONAL SECURITY AGENCY/CENTRAL SECURITY SERVICE (NSA/CSS) FREEDOM OF INFORMATION ACT PROGRAM... requested. There are no fees associated with a Privacy Act request, except as stated in NSA/CSS Regulation...

32 CFR 299.6 - Fees.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROGRAM NATIONAL SECURITY AGENCY/CENTRAL SECURITY SERVICE (NSA/CSS) FREEDOM OF INFORMATION ACT PROGRAM... requested. There are no fees associated with a Privacy Act request, except as stated in NSA/CSS Regulation...

32 CFR 299.6 - Fees.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROGRAM NATIONAL SECURITY AGENCY/CENTRAL SECURITY SERVICE (NSA/CSS) FREEDOM OF INFORMATION ACT PROGRAM... requested. There are no fees associated with a Privacy Act request, except as stated in NSA/CSS Regulation...

78 FR 53132 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-28

...: Title, Associated Form and OMB Number: National Geospatial-Intelligence Agency Enterprise Workforce System; OMB Control Number 0704-TBD. Type of Request: New Collection. Number of Respondents: 12,000...

Use of geographic information systems to determine new helipad locations and improve timely response while mitigating risk of helicopter emergency medical services operations.

PubMed

Foo, Cheryl P Z; Ahghari, Mahvareh; MacDonald, Russell D

2010-01-01

Traumatic injury is a leading cause of morbidity and mortality, but these can be minimized by timely transport to definite care. Helicopter emergency medical services (HEMS) provide timely transport and can influence survival. However, accident analyses indicate that landing at an unsecured landing zone (LZ), particularly at night, increases the risk of aviation accidents. To ensure safety, some HEMS operations land only at designated, secured LZs. This study utilized geographic information systems (GISs) to compare locations of scene call requests and secure LZs. The goal was to determine the optimal placement of new helipads as a strategy to improve access while mitigating the risk of aviation accidents. Call request data from a large air medical transport service were used to determine the geographic locations of all requests for scene responses in 2006. Request locations were compared with the locations of existing helipads, and straight-line distances between scene and helipad were determined using the GIS application. The application was then used to determine potential locations for new helipads. During the study period, 748 requests for scene calls and 269 helipads were available. There were 476 (52.4%) requests at least 10 kilometers from a helipad and 356 (36.6%) requests at least 15 kilometers from a helipad. One particular region, Southwestern Ontario, was identified as having the highest number of requests >15 kilometers from the closest helipad. GISs can be used to determine potential locations for new helipad construction using historical call request data. This evidence-based approach can improve HEMS access while mitigating operational risk.

77 FR 26796 - Self-Regulatory Organizations; The Depository Trust Company; Notice of Filing of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-07

... today's practices, DTC will process requests for these types of post-payable adjustments up to one year... interest. DTC has been requested a number of times by the Association of Global Custodians to focus more...\\ In fact, the Association of Global Custodians' recommendation was to adopt a new practice in which...

75 FR 63145 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-14

... information on other life history and reference level data, including marine mammal tissue analyses, [email protected] . Dated: October 7, 2010. Gwellnar Banks, Management Analyst, Office of the Chief...

Providers perspective and geographic and institutional factors associated with family planning counseling.

PubMed

de la Vara-Salazar, Elvia; Suárez-López, Leticia; Rivera, Leonor; Lazcano-Ponce, Eduardo

2018-06-01

Family planning (FP) counseling is an essential activity to prevent unplanned pregnancies and allow a fulfilling sex life. We defined adequate counseling in FP as the counseling given to women and men of reproductive age that provided complete information about use, application, effectiveness, side effects, and contraindications. Two objectives are proposed in this study. First, we seek to analyze geographic and institutional factors associated with FP counseling in primary and secondary healthcare facilities in Mexico. Second, we seek to identify the cultural barriers that providers perceive as a limitation of the clients so that they can come to request information related to FP and that are associated with FP counseling. This cross-sectional study uses a complex, probabilistic, stratified sampling design representative at national level by institution, region and rural-urban areas. We collected 16,829 provider questionnaires at healthcare facilities. Bivariate and logistic regression analyses were performed. Providers in rural areas had a greater possibility of offering adequate counseling (OR = 2.98; 95%CI 1.18-7.53). Providers in the northern region of the country were more likely to provide adequate counseling (OR = 5.37; 95% CI 1.91-15.12). Providers whom perceive religion as a limitation for clients to come to request information about FP are less likely to provide adequate counseling (OR = 0.37; 95% CI 0.15-0.88). Physical space exclusively for the provision of FP counseling and the availability of manuals were not associated with adequate counseling. There is a need to address the social and cultural influences on the quality of counseling in these healthcare facilities. Copyright © 2018 Elsevier B.V. All rights reserved.

Characterization of patients' requests and pharmacists' professional practice in oropharyngeal condition in Spain.

PubMed

Hernández, Antonio; Garcia-Delgado, Pilar; Garcia-Cardenas, Victoria; Ocaña, Ana; Labrador, Elena; Orera, Maria Luisa; Martinez-Martinez, Fernando

2015-04-01

A sore throat is the reason behind 4 million visits to health care services per year in Spain. The management of these ailments is usually associated with an inappropriate use of medicines. Community pharmacists are often the first point of contact for patients under the healthcare system and play a major role in the management of minor ailments. To characterize the pharmacists' professional practice in oropharyngeal condition in terms of patients' requests and pharmacists' interventions performed. Community pharmacies throughout Spanish territory. Cross-sectional multicenter observational study, undertaken between November 2012 and March 2013. Patients were recruited consecutively in the participant pharmacies. Eligible patients were those making a consultation related to an oropharyngeal condition or requesting treatment for an oropharyngeal condition. A univariate descriptive analysis showing the frequency of occurrence of the different variables was performed. This was completed with a multivariate statistical analysis through a multiple correspondence method, in order to analyze the potential association between the pharmacist profile and the intervention provided. Professional Pharmacy Service requested (dispensing/counselling/medication review with follow-up), reason for consultation, source of the recommendation, Pharmacist's intervention and reason for referral. 710 pharmacies and 3,547 patients participated in the study. The most frequently requested service was dispensing (44.7 %), followed by counselling (31.8 %). Regarding dispensing, the majority of patients requested a throat preparation, mostly antiseptics. Symptoms associated with the pharmacy consultation were mainly throat symptoms (70.8 %), voice symptoms (24.9 %), and mouth/tongue/lip symptoms (10.1 %). The most common pharmacist intervention was "selection of pharmacological treatment", followed by "dispensing the requested medicine"; 6.51 % of the patients were referred to a general practitioner, mainly due to fever and other symptoms associated with infection. No relationship between the pharmacist profile and the intervention performed was found. The most frequently requested professional service was the dispensing service, mainly for treating throat symptoms. Community pharmacists play a major role in managing patients with an oropharyngeal condition. They can keep them out of general practice or act as referral agents when a more severe disease is identified.

Randomised controlled trial of routine individual feedback to improve rationality and reduce numbers of test requests.

PubMed

Winkens, R A; Pop, P; Bugter-Maessen, A M; Grol, R P; Kester, A D; Beusmans, G H; Knottnerus, J A

1995-02-25

Feedback can be described as a way to provide information on doctors' performance to enable changes in future behaviour. Feedback is used with the aim of changing test-ordering behaviour. It can lead to reductions in test usage and cost savings. It is not sufficiently clear, however, whether feedback leads to more appropriate test use. Since 1985, the Diagnostic Coordinating Center Maastricht has been giving feedback on diagnostic tests as a routine health care activity to all family doctors in its region. Both quantity and quality of requests are discussed. In a randomised, controlled trial over 2.5 years, discussion of tests not included previously was added to the existing routine feedback. One group of family doctors (n = 39) received feedback on test-group A (electrocardiography, endoscopy, cervical smears, and allergy tests), the other (n = 40) on test-group B (radiographic and ultrasonographic tests). Thus, each group of doctors acted as a control group for the other. Changes in volume and rationality of requests were analysed. The number of requests decreased during the trial (p = 0.036). Request numbers decreased particularly for test-group A (p = 0.04). The proportion of requests that were non-rational decreased more in the intervention than in the control groups (p = 0.009). Rationality improved predominantly for test-group B (p = 0.043). Thus, routine feedback can change the quantity and quality of requests.

Obligatory consultation of an independent physician on euthanasia requests in the Netherlands: what influences the SCEN physicians judgment of the legal requirements of due care?

PubMed

Brinkman-Stoppelenburg, Arianne; Vergouwe, Yvonne; van der Heide, Agnes; Onwuteaka-Philipsen, Bregje D

2014-03-01

In the Netherlands, euthanasia is allowed if physicians adhere to legal requirements. Consultation of an independent physician is one of the requirements. SCEN (Support and Consultation on Euthanasia in the Netherlands) physicians have been trained to provide such consultations. To study why euthanasia requests are sometimes judged not to meet requirements of due care and to find out which characteristics are associated with the SCEN physicians' judgments. During 5 years (2006, 2008-2011) standardized registration forms were used for data-collection. We used multilevel logistic regression analysis to assess the associations of characteristics and SCEN physicians' judgments. We analyzed 1631 euthanasia requests, involving 415 SCEN physicians. Patient characteristics that were associated with a lower likelihood to meet due care requirements were: being tired with life, depression and not wanting to be a burden. Physical suffering and higher patient age were related to greater chances of meeting the requirements. There was no clear association between SCEN physicians' characteristics and their judgment. Psychological suffering involves a greater chance that SCEN physicians judge that requirements of due care are not met. The association between SCEN physician characteristics and the judgment of euthanasia requests is limited, suggesting uniformity in their judgment. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

77 FR 23264 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

... the existing home health prospective payment system. The study team's analytic plan focuses on... populations that cannot be learned through analyses of administrative data. Form Number: CMS-10429 (OCN: 0938...

Characteristics associated with requests by pathologists for second opinions on breast biopsies.

PubMed

Geller, Berta M; Nelson, Heidi D; Weaver, Donald L; Frederick, Paul D; Allison, Kimberly H; Onega, Tracy; Carney, Patricia A; Tosteson, Anna N A; Elmore, Joann G

2017-11-01

Second opinions in pathology improve patient safety by reducing diagnostic errors, leading to more appropriate clinical treatment decisions. Little objective data are available regarding the factors triggering a request for second opinion despite second opinion consultations being part of the diagnostic system of pathology. Therefore we sought to assess breast biopsy cases and interpreting pathologists characteristics associated with second opinion requests. Collected pathologist surveys and their interpretations of 60 test set cases were used to explore the relationships between case characteristics, pathologist characteristics and case perceptions, and requests for second opinions. Data were evaluated by logistic regression and generalised estimating equations. 115 pathologists provided 6900 assessments; pathologists requested second opinions on 70% (4827/6900) of their assessments 36% (1731/4827) of these would not have been required by policy. All associations between case characteristics and requesting second opinions were statistically significant, including diagnostic category, breast density, biopsy type, and number of diagnoses noted per case. Exclusive of institutional policies, pathologists wanted second opinions most frequently for atypia (66%) and least frequently for invasive cancer (20%). Second opinion rates were higher when the pathologist had lower assessment confidence, in cases with higher perceived difficulty, and cases with borderline diagnoses. Pathologists request second opinions for challenging cases, particularly those with atypia, high breast density, core needle biopsies, or many co-existing diagnoses. Further studies should evaluate whether the case characteristics identified in this study could be used as clinical criteria to prompt system-level strategies for mandating second opinions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Professional Veterinary Programs' Perceptions and Experiences Pertaining to Emotional Support Animals and Service Animals, and Recommendations for Policy Development.

PubMed

Schoenfeld-Tacher, Regina M; Kogan, Lori R

Given the unique nature of programs in professional veterinary medicine (PVM), the increasing numbers of students requesting accommodations for emotional support animals (ESAs) in higher education settings is of growing interest to student affairs and administrative staff in PVM settings. Since the legislation pertaining to this type of support animal differs from the laws governing disability service animals, colleges and universities now need to develop new policies and guidelines. Representatives from a sample of 28 PVM programs completed a survey about the prevalence of student requests for ESAs and service animals. PVM associate deans for academic affairs also reported their perceptions of this issue and the challenges these requests might pose within veterinary teaching laboratories and patient treatment areas. Responses indicated that approximately one third of PVM programs have received requests for ESAs (32.1%) in the last 2 years, 17.9% have had requests for psychiatric service animals, and 17.9% for other types of service animals. Despite this, most associate deans reported not having or not being aware of university or college policies pertaining to these issues. Most associate deans are interested in learning more about this topic. This paper provides general recommendations for establishing university or PVM program policies.

When unbearable suffering incites psychiatric patients to request euthanasia: qualitative study†

PubMed Central

Verhofstadt, Monica; Thienpont, Lieve; Peters, Gjalt-Jorn Ygram

2017-01-01

Background The concept of ‘unbearable suffering’ is central to legislation governing whether euthanasia requests may be granted, but remains insufficiently understood, especially in relation to psychiatric patients. Aims To provide insights into the suffering experiences of psychiatric patients who have made a request for euthanasia. Method Testimonials from 26 psychiatric patients who requested euthanasia were analysed using QualiCoder software. Results Five domains of suffering were identified: medical, intrapersonal, interpersonal, societal and existential. Hopelessness was confirmed to be an important contributor. The lengthy process of applying for euthanasia was a cause of suffering and added to experienced hopelessness, whereas encountering physicians who took requests seriously could offer new perspectives on treatment. Conclusions The development of measurement instruments to assess the nature and extent of suffering as experienced by psychiatric patients could help both patients and physicians to better navigate the complicated and sensitive process of evaluating requests in a humane and competent way. Some correlates of suffering (such as low income) indicate the need for a broad medical, societal and political debate on how to reduce the burden of financial and socioeconomic difficulties and inequalities in order to reduce patients' desire for euthanasia. Euthanasia should never be seen (or used) as a means of resolving societal failures. PMID:28970302

When unbearable suffering incites psychiatric patients to request euthanasia: qualitative study.

PubMed

Verhofstadt, Monica; Thienpont, Lieve; Peters, Gjalt-Jorn Ygram

2017-10-01

Background The concept of 'unbearable suffering' is central to legislation governing whether euthanasia requests may be granted, but remains insufficiently understood, especially in relation to psychiatric patients. Aims To provide insights into the suffering experiences of psychiatric patients who have made a request for euthanasia. Method Testimonials from 26 psychiatric patients who requested euthanasia were analysed using QualiCoder software. Results Five domains of suffering were identified: medical, intrapersonal, interpersonal, societal and existential. Hopelessness was confirmed to be an important contributor. The lengthy process of applying for euthanasia was a cause of suffering and added to experienced hopelessness, whereas encountering physicians who took requests seriously could offer new perspectives on treatment. Conclusions The development of measurement instruments to assess the nature and extent of suffering as experienced by psychiatric patients could help both patients and physicians to better navigate the complicated and sensitive process of evaluating requests in a humane and competent way. Some correlates of suffering (such as low income) indicate the need for a broad medical, societal and political debate on how to reduce the burden of financial and socioeconomic difficulties and inequalities in order to reduce patients' desire for euthanasia. Euthanasia should never be seen (or used) as a means of resolving societal failures. © The Royal College of Psychiatrists 2017.

Uncovering Hospitalists' Information Needs from Outside Healthcare Facilities in the Context of Health Information Exchange Using Association Rule Learning.

PubMed

Martinez, D A; Mora, E; Gemmani, M; Zayas-Castro, J

2015-01-01

Important barriers to health information exchange (HIE) adoption are clinical workflow disruptions and troubles with the system interface. Prior research suggests that HIE interfaces providing faster access to useful information may stimulate use and reduce barriers for adoption; however, little is known about informational needs of hospitalists. To study the association between patient health problems and the type of information requested from outside healthcare providers by hospitalists of a tertiary care hospital. We searched operational data associated with fax-based exchange of patient information (previous HIE implementation) between hospitalists of an internal medicine department in a large urban tertiary care hospital in Florida, and any other affiliated and unaffiliated healthcare provider. All hospitalizations from October 2011 to March 2014 were included in the search. Strong association rules between health problems and types of information requested during each hospitalization were discovered using Apriori algorithm, which were then validated by a team of hospitalists of the same department. Only 13.7% (2 089 out of 15 230) of the hospitalizations generated at least one request of patient information to other providers. The transactional data showed 20 strong association rules between specific health problems and types of information exist. Among the 20 rules, for example, abdominal pain, chest pain, and anaemia patients are highly likely to have medical records and outside imaging results requested. Other health conditions, prone to have records requested, were lower urinary tract infection and back pain patients. The presented list of strong co-occurrence of health problems and types of information requested by hospitalists from outside healthcare providers not only informs the implementation and design of HIE, but also helps to target future research on the impact of having access to outside information for specific patient cohorts. Our data-driven approach helps to reduce the typical biases of qualitative research.

Timing of gazes in child dialogues: a time-course analysis of requests and back channelling in referential communication.

PubMed

Sandgren, Olof; Andersson, Richard; van de Weijer, Joost; Hansson, Kristina; Sahlén, Birgitta

2012-01-01

This study investigates gaze behaviour in child dialogues. In earlier studies the authors have investigated the use of requests for clarification and responses in order to study the co-creation of understanding in a referential communication task. By adding eye tracking, this line of research is now expanded to include non-verbal contributions in conversation. To investigate the timing of gazes in face-to-face interaction and to relate the gaze behaviour to the use of requests for clarification. Eight conversational pairs of typically developing 10-15 year olds participated. The pairs (director and executor) performed a referential communication task requiring the description of faces. During the dialogues both participants wore head-mounted eye trackers. All gazes were recorded and categorized according to the area fixated (Task, Face, Off). The verbal context for all instances of gaze at the partner's face was identified and categorized using time-course analysis. The results showed that the executor spends almost 90% of the time fixating the gaze on the task, 10% on the director's face and less than 0.5% elsewhere. Turn shift, primarily requests for clarification, and back channelling significantly predicted the executors' gaze to the face of the task director. The distribution of types of requests showed that requests for previously unmentioned information were significantly more likely to be associated with gaze at the director. The study shows that the executors' gaze at the director accompanies important dynamic shifts in the dialogue. The association with requests for clarification indicates that gaze at the director can be used to monitor the response with two modalities. Furthermore, the significantly higher association with requests for previously unmentioned information indicates that gaze may be used to emphasize the verbal content. The results will be used as a reference for studies of gaze behaviour in clinical populations with hearing and language impairments. © 2012 Royal College of Speech and Language Therapists.

47 CFR 69.3 - Filing of access service tariffs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... waiver includes a request for confidentiality of some or all of the materials supporting the request..., 103 FCC 2d 1026-1027 (1986). (4) If a telephone company elects to withdraw from Association tariffs...

76 FR 35669 - Sunscreen Drug Products for Over-the-Counter Human Use; Request for Data and Information...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-17

... of sunscreen active ingredients and propellants? What are typical particle size distributions for... risks associated with inhalation of sunscreen active ingredients and propellants?), we request...

Criteria for the request of preoperative tests among oral and maxillofacial surgeons.

PubMed

da Silva, Luiz Carlos Ferreira; Oliveira, Ana Carla de Assunção; dos Santos, Jadson Alípio Santana Sousa; Santos, Thiago de Santana

2012-10-01

The aim of this study was to analyze the criteria employed for the requesting of preoperative tests among maxillofacial surgeons. Thirty maxillofacial surgeons working in Aracaju (Brazil) received a questionnaire to fill out. The study inquired about the practice of requesting preoperative tests for healthy patients scheduled to undergo elective surgery. Most of the surgeons interviewed requested tests that are not recommended for the case in question. The highest frequency of requests was a complete blood count, coagulation test, blood glucose test and chest radiograph. The absence of strict rules for the requesting of preoperative tests causes uncertainty and a lack of criteria regarding pre-surgical conduct. It was not possible to clearly define the criteria used by surgeons for requesting such tests, as the clinical characteristics of the hypothetical case presented suggest a smaller number of tests. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Subjective motives for requesting in-patient treatment in female with anorexia nervosa: a qualitative study.

PubMed

Gorse, Pauline; Nordon, Clementine; Rouillon, Frederic; Pham-Scottez, Alexandra; Revah-Levy, Anne

2013-01-01

Anorexia nervosa is a severe psychiatric disorder mainly affecting women. Its treatment is long and accepted with much difficulty, in particular in-patient treatment. To describe the subjective motives of women with anorexia nervosa for requesting in-patient admission, from a qualitative analysis of application letters. Participants were adult women (18 years and older) with anorexia nervosa who were admitted as in-patients in a referral hospital unit in France from January 2008 to December 2010. The application letters, prerequisites to admission, were studied by the interpretative phenomenological method of content analysis. 63 letters have been analysed, allowing the identification of six themes related to requests for in-patient care: loss of control of behaviour, and of thoughts, mental exhaustion, isolation, inner struggle and fear of recovery. Requests for in-patient admission were motivated by very personal, subjective experiences, unrelated to medical reasons for admission. These results may help improve pre-admission motivational work with individuals, by basing it on their subjective experience.

48 CFR 49.109-7 - Settlement by determination.

Code of Federal Regulations, 2011 CFR

2011-10-01

... certified mail (return receipt requested) to submit written evidence, so as to reach the TCO on or before a... additional information, schedules, and analyses as appropriate. The TCO shall explain each major item of...

76 FR 65207 - Endangered Species; Receipt of Applications for Permit

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-20

... quantitative information or studies; and (2) Those that include citations to, and analyses of, the applicable... applicants each request a permit to import the sport- hunted trophy of one male bontebok (Damaliscus pygargus...

Prayer and the Registered Nurse (PRN): nurses' reports of ease and dis-ease with patient-initiated prayer request.

PubMed

Minton, Mary E; Isaacson, Mary; Banik, Deborah

2016-09-01

To explore nurse comfort with patient-initiated prayer request scenarios. Spiritual care is fundamental to patient care evidenced by Joint Commission requirement of a spiritual assessment on a patient's hospital admission. Prayer is an assessment component. Patients may seek solace and support by requesting prayer from the bedside nurse, the nurse may lack confidence in responding. Absent in the literature are reports specific to nurses' comfort when patients initiate prayer requests. Cross-sectional mixed methods study. Data were collected in early 2014 from 134 nurses in the USA via an online survey using QuestionPro. The qualitative results reported here were collated by scenario and analysed using thematic analysis. The scenario responses revealed patterns of ease and dis-ease in response to patient requests for prayer. The pattern of ease of prayer with patients revealed three themes: open to voice of calm or silence; physical or spiritual; can I call the chaplain. For these nurses, prayer is a natural component of nursing care, as the majority of responses to all scenarios demonstrated an overwhelming ease in response and capacity to pray with patients on request. The pattern of dis-ease of prayer with patients distinguished two themes: cautious hesitancy and whose God. These nurses experienced dis-ease with the patient's request no matter the situation. Educators and administrators must nurture opportunities for students and nurses to learn about and engage in the reflective preparation needed to respond to patient prayer requests. © 2016 John Wiley & Sons Ltd.

75 FR 30770 - Notice of Request for Extension of a Currently Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-02

... comment period on the information collection requests (ICRs) associated with DATES: Written comments on this notice will be accepted until close of business August 2, 2010. ADDRESSES: Interested persons are...

76 FR 31674 - Agency Information Collection Activities: Requests for Comments; Clearance of Renewed Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-01

... Satisfaction Survey AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice and request for comments...: SWIFT Customer Satisfaction Survey. Form Numbers: There are no FAA Forms associated with this collection...

Method and apparatus for granting processors access to a resource

DOEpatents

Blumrich, Matthias A.; Salapura, Valentina

2010-03-16

An apparatus and method for granting one or more requesting entities access to a resource in a predetermined time interval. The apparatus includes a first circuit receiving one or more request signals, and implementing logic for assigning a priority to the one or more request signals, and, generating a set of first_request signals based on the priorities assigned. One or more priority select circuits for receiving the set of first_request signals and generating corresponding one or more fixed grant signals representing one or more highest priority request signals when asserted during the predetermined time interval. A second circuit device receives the one or more fixed grant signals generates one or more grant signals associated with one or more highest priority request signals assigned, the grant signals for enabling one or more respective requesting entities access to the resource in the predetermined time interval, wherein the priority assigned to the one or more request signals changes each successive predetermined time interval. In one embodiment, the assigned priority is based on a numerical pattern, the first circuit changing the numerical pattern with respect to the first_request signals generated at each successive predetermined time interval.

Hazard Analysis for the Mark III Space Suit Assembly (SSA) Used in One-g Operations

NASA Technical Reports Server (NTRS)

Mitchell, Kate; Ross, Amy; Blanco, Raul; Wood, Art

2012-01-01

This Hazard Analysis document encompasses the Mark III Space Suit Assembly (SSA) and associated ancillary equipment. It has been prepared using JSC17773, "Preparing Hazard Analyses for JSC Ground Operation", as a guide. The purpose of this document is to present the potential hazards involved in ground (23 % maximum O2, One-g) operations of the Mark III and associated ancillary support equipment system. The hazards listed in this document are specific to suit operations only; each supporting facility (Bldg. 9, etc.) is responsible for test specific Hazard Analyses. A "hazard" is defined as any condition that has the potential for harming personnel or equipment. This analysis was performed to document the safety aspects associated with manned use of the Mark III for pressurized and unpressurized ambient, ground-based, One-g human testing. The hazards identified herein represent generic hazards inherent to all standard JSC test venues for nominal ground test configurations. Non-standard test venues or test specific configurations may warrant consideration of additional hazards analysis prior to test. The cognizant suit engineer is responsible for the safety of the astronaut/test subject, space suit, and suit support personnel. The test requester, for the test supported by the suit test engineer and suited subject, is responsible for overall safety and any necessary Test Readiness Reviews (TRR).

Two years' experience with Web-based teleconsulting in dermatology.

PubMed

Massone, C; Soyer, H P; Hofmann-Wellenhof, R; Di Stefani, A; Lozzi, G P; Gabler, G; Dong, H; Argenziano, G; Ozdemir, F; Fink-Puches, R; Salmhofer, W; Zalaudek, I; Nunzi, E; Kerl, H

2006-01-01

A non-commercial teledermatology network based on store-and-forward operation was established in April 2002. The aim was to create an easy-to-use platform for teleconsultation services, where physicians could seek diagnostic advice in dermatology from a pool of expert consultants and where they could present and discuss challenging dermatology cases with special emphasis on diagnosis and therapy. An online moderated discussion forum was added in October 2003. During the first two years, 348 health-care professionals from 45 countries registered to use the Website. A total of 783 requests for consultations were answered; 285 requests concerned pigmented skin lesions, 440 requests were from the whole range of clinical dermatology and 58 requests were about non-melanoma skin cancer. Of a total of 133 requests analysed, 80 (60%) were answered within one day, 47 (35%) within one week, five (4%) within two weeks and one (1%) consultation was answered in more than two weeks. Our experience with a discretionary, non-commercial, multilingual Website for open-access teleconsulting in dermatology appears to be successful. The Website represents an example of user-generated content, together with active interaction between users, who can present and discuss cases with remote colleagues.

Use of contraception among women who request first trimester pregnancy termination in Norway.

PubMed

Strøm-Roum, Ellen Marie; Lid, Julie; Eskild, Anne

2016-08-01

Among women requesting pregnancy termination, we studied the proportion of women who reported having used contraception when they became pregnant and the contraceptive method that they had used. We included all requests for pregnancy termination in Norway during the years 2007-2011 (n=80,346) by obtaining information from the Norwegian Registry of Pregnancy Termination. By using a logistic regression model, we estimated odds ratios for using any contraceptive method associated with the woman's age, previous childbirth, previous pregnancy termination, marital status, employment status and educational level. In total, 36.5% of the women who requested pregnancy termination (29,305/80,346) reported having used contraception when they became pregnant. Of all women, 16.6% reported having used the combined contraceptive pill/progestin pill, 11.5% the condom and 1.1% long-acting reversible contraceptives (1.0% intrauterine contraception). Overall, 38.9% of women 20-24years old had used contraception, compared to 29.9% of women 40-44years old (odds ratio 0.55, 95% confidence interval 0.51-0.60). Previous childbirth, previous pregnancy termination and high educational level were also associated with contraceptive use. Among women who requested pregnancy termination in Norway, 36.5% reported having used contraception when they became pregnant. Contraception use was associated with young age and having previously been pregnant. A large proportion of women who request pregnancy termination have experienced contraceptive failure. Women who are fertile and do not wish to become pregnant should be offered a contraceptive method that carries low risk of incorrect use. Copyright © 2016 Elsevier Inc. All rights reserved.

Identifying an outbreak of a novel swine disease using test requests for porcine reproductive and respiratory syndrome as a syndromic surveillance tool

PubMed Central

2012-01-01

Background Animal disease monitoring and surveillance are crucial for ensuring the health of animals, humans and the environment. Many studies have investigated the utility of monitoring syndromes associated with data from veterinary laboratory submissions, but no research has focused on how negative test results from a veterinary diagnostic laboratory data can be used to improve our knowledge of disease outbreaks. For example, if a diagnostic laboratory was seeing a disproportionate number of negative test results for a known disease could this information be an indication of a novel disease outbreak? The objective of this study was to determine the association between the porcine circovirus associated disease (PCVAD) outbreak in Ontario 2004–2006 and the results of porcine reproductive and respiratory syndrome virus (PPRSV) enzyme-linked immunosorbent assay (ELISA) and the results of PRRSV polymerase chain reaction (PCR) diagnostic tests requested by veterinarians. Results Retrospective data were collected from the Animal Health Laboratory (AHL) at the University of Guelph, Guelph, Ontario Canada and were comprised of weekly counts of PRRSV ELISA and PRRSV PCR diagnostic tests requested by swine practitioners from 2000–2007. The results of the PRRSV ELISA and PRRSV PCRs were analysed separately in two models using logistic regression with the dependent variables being: the weekly probability of PRRSV ELISA positivity, and the weekly probability of PRRSV PCR positivity, respectively. The weekly probability of PRRSV PCR positivity decreased during the PVCAD outbreak (OR=0.66, P=0.01). The weekly probability of PRRSV ELISA positivity was not associated with the PCVAD outbreak. Conclusions The results of this study showed that during the PCVAD outbreak in Ontario from December 2004-May 2006, the probability of a positive PRRSV PCR at the AHL decreased. We conclude that when a decrease in test positivity occurs for a known disease, it may suggest that a new disease agent is emerging in the population. Hence, monitoring the test results of commonly used first-order tests for a known disease (e.g. PRRSV) has the potential to be a unique form of syndromic data for the timely identification of novel disease outbreaks in swine populations. PMID:23072647

Request for Revised Ozone HREA Chapter 7 Appendix Tables, Sasser, May 2014 Memo

EPA Pesticide Factsheets

On May 1, 2014, members of the Clean Air Scientific Advisory Committee’s Ozone Review Panel requested EPA provide revised appendix tables associated with the recently corrected Chapter 7epidemiological-based risk results.

76 FR 70722 - Request for Co-Sponsors for the Office of Healthcare Quality's Programs To Strengthen...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-15

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Request for Co-Sponsors for the Office of Healthcare... Healthcare-Associated Infections AGENCY: Department of Health and Human Services, Office of the Secretary, [[Page 70723

TSCA Section 21 Petition Requesting EPA to Regulate Anthropogenic Emissions Carbon Dioxide

EPA Pesticide Factsheets

This petition requests EPA to promulgate regulations under section 6 of TSCA to protect “public health and the environment from the serious harms associated with anthropogenic emissions of carbon dioxide, including ocean acidification.

77 FR 57090 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-17

... bonus payments to three-star plans and eliminating the cap on blended county benchmarks that would... supplement what can be learned from the analyses of administrative and financial data for MAOs, and from an...

Description of 'REQUEST-KYUSHYU' for KYUKEICHO regional data base

NASA Astrophysics Data System (ADS)

Takimoto, Shin'ichi

Kyushu Economic Research Association (a foundational juridical person) initiated the regional database services, ' REQUEST-Kyushu ' recently. It is the full scale databases compiled based on the information and know-hows which the Association has accumulated over forty years. It covers the regional information database for journal and newspaper articles, and statistical information database for economic statistics. As to the former database it is searched on a personal computer and then a search result (original text) is sent through a facsimile. As to the latter, it is also searched on a personal computer where the data is processed, edited or downloaded. This paper describes characteristics, content and the system outline of 'REQUEST-Kyushu'.

[Law courts and clinical documentation].

PubMed

Jiménez Carnicero, M P; Magallón, A I; Gordillo, A

2006-01-01

Background. Until 2004, requests for clinical documentation proceeding from the Judicial Administration on Specialist Care of Pamplona were received in six different centres and were processed independently, with different procedures, and documents were even sent in duplicate, with the resulting work load. This article describes the procedure for processing requests for documentation proceeding from the Law Courts and analyses the requests received. Methods. A circuit was set up to channel the judicial requests that arrived at the Specialist Health Care Centres of Pamplona and at the Juridical Regime Service of the Health System of Navarra-Osasunbidea, and a Higher Technician in Health Documentation was contracted to centralise these requests. A proceedings protocol was established to unify criteria and speed up the process, and a database was designed to register the proceedings. Results. In the course of 2004, 210 requests for documentation by legal requirement were received. Of these, 24 were claims of patrimonial responsibility and 13 were requested by lawyers with the patient's authorisation. The most frequent jurisdictional order was penal (43.33%). Ninety-three point one five percent (93.15%) of the requests proceeded from law courts in the autonomous community of Navarra. The centre that received the greatest number of requests was the "Príncipe de Viana" Consultation Centre (33.73%).The most frequently requested documentation was a copy of reports (109) and a copy of the complete clinical record (39). On two occasions the original clinical record was required. The average time of response was 6.6 days. Conclusions. The centralisation of administration has brought greater agility to the process and homogeneity in the criteria of processing. Less time is involved in preparing and dispatching the documentation, the dispatch of duplicate documents is avoided, the work load has been reduced and the dispersal of documentation is avoided, a situation that guarantees greater privacy for the patient.

Laboratory-based clinical audit as a tool for continual improvement: an example from CSF chemistry turnaround time audit in a South-African teaching hospital.

PubMed

Imoh, Lucius C; Mutale, Mubanga; Parker, Christopher T; Erasmus, Rajiv T; Zemlin, Annalise E

2016-01-01

Timeliness of laboratory results is crucial to patient care and outcome. Monitoring turnaround times (TAT), especially for emergency tests, is important to measure the effectiveness and efficiency of laboratory services. Laboratory-based clinical audits reveal opportunities for improving quality. Our aim was to identify the most critical steps causing a high TAT for cerebrospinal fluid (CSF) chemistry analysis in our laboratory. A 6-month retrospective audit was performed. The duration of each operational phase across the laboratory work flow was examined. A process-mapping audit trail of 60 randomly selected requests with a high TAT was conducted and reasons for high TAT were tested for significance. A total of 1505 CSF chemistry requests were analysed. Transport of samples to the laboratory was primarily responsible for the high average TAT (median TAT = 170 minutes). Labelling accounted for most delays within the laboratory (median TAT = 71 minutes) with most delays occurring after regular work hours (P < 0.05). CSF chemistry requests without the appropriate number of CSF sample tubes were significantly associated with delays in movement of samples from the labelling area to the technologist's work station (caused by a preference for microbiological testing prior to CSF chemistry). A laboratory-based clinical audit identified sample transportation, work shift periods and use of inappropriate CSF sample tubes as drivers of high TAT for CSF chemistry in our laboratory. The results of this audit will be used to change pre-analytical practices in our laboratory with the aim of improving TAT and customer satisfaction.

75 FR 78257 - Agency Information Collection Activities; Proposed Collection; Comment Request; Voluntary...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-15

...] Agency Information Collection Activities; Proposed Collection; Comment Request; Voluntary Cosmetic... associated with the Agency's Voluntary Cosmetic Registration Program (VCRP). DATES: Submit either electronic... appropriate, and other forms of information technology. Voluntary Cosmetic Registration Program--21 CFR Parts...

A prospective analysis of unplanned patient-initiated contacts in an adult cystic fibrosis centre.

PubMed

Burnet, Espérie; Hubert, Dominique; Champreux, Juliette; Honoré, Isabelle; Kanaan, Reem; Panzo, Rosewilta; Burgel, Pierre-Régis

2018-05-07

Timely response should be provided when patients contact the cystic fibrosis (CF) centre in between scheduled visits. Little data exist on unplanned patient-initiated contacts in CF adults. A two-stage prospective study was undertaken from 1 January to 31 December 2015 at Cochin Hospital, Paris (France). The first stage included all adults (≥18 years) who initiated unplanned contacts to the CF centre over four months. Four physicians and three nurses systematically recorded unplanned patient-initiated contacts. The data was analysed to determine why and how patients contacted the CF centre and time spent responding to their request(s). The second stage (one physician, three nurses) lasted twelve months and explored whether high contact frequency was associated with disease severity, using multivariate logistic regression. In the first stage, 259 of 410 patients (63%) initiated at least one unplanned contact, corresponding to 1067 contacts over 4 months. Patients favoured email with physicians (61% of contacts) and telephone with nurses (87% of contacts). Total time spent by the 7 caregivers on providing responses was 8 h/work week. Reasons for contacting the CF centre varied greatly, but <20% of contacts were directly related to symptom management. In the second stage, 180 of 212 patients (85%) initiated 1876 contacts over 12 months. Factors associated with ≥5 contacts/year were female sex, FEV 1  ≤ 30% predicted, ≥5 physician visits/year, and ≥ 1 hospital admission/year. Answering unplanned patient-initiated contacts represented a significant workload for CF caregivers. Increased disease severity was associated with high contact frequency. Copyright © 2018 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

The association between an electric pump loan program and the timing of requests for formula by working mothers in WIC.

PubMed

Meehan, Karen; Harrison, Gail G; Afifi, Abdelmonem A; Nickel, Nathan; Jenks, Eloise; Ramirez, Anthony

2008-05-01

An electric pump loan program designed to facilitate breastfeeding for low-income mothers returning to full-time work was evaluated. All mothers were WIC participants in the Los Angeles area. Electric pump loans were made until the infant's first birthday or until the mother requested formula from WIC. Information was provided to employers on supporting breastfeeding in the workplace. A subsample of mothers who received an electric pump on return to full-time work was compared with counterparts in a wait list control group. Mothers who received an electric pump as soon as requested did not request formula until 8.8 months on average, whereas those who did not receive an electric pump requested formula on average at 4.8 months (P < .0001). Mothers who received an electric pump when requested were 5.5 (95% CI 2.0-15.1) times as likely as mothers who did not receive an electric pump to not request formula at 6 months.

78 FR 20095 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-03

...; Comment Request AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice. SUMMARY: In... of the proposal and associated collection instruments, please write to Defense Finance and Accounting... by the Directorate of Annuity Pay, Defense Finance and Accounting Service--Cleveland (DFAS-CL/JFBDA...

49 CFR 520.34 - Comments on environmental statements prepared by other agencies.

Code of Federal Regulations, 2012 CFR

2012-10-01

... action or referral to TES where appropriate. Offices within NHTSA may be requested by the Associate... distributed as follows: (1) The original and 1 copy to the requesting agency; (2) 1 copy to TES-70; and (3) 5...

49 CFR 520.34 - Comments on environmental statements prepared by other agencies.

Code of Federal Regulations, 2013 CFR

2013-10-01

... action or referral to TES where appropriate. Offices within NHTSA may be requested by the Associate... distributed as follows: (1) The original and 1 copy to the requesting agency; (2) 1 copy to TES-70; and (3) 5...

49 CFR 520.34 - Comments on environmental statements prepared by other agencies.

Code of Federal Regulations, 2014 CFR

2014-10-01

... action or referral to TES where appropriate. Offices within NHTSA may be requested by the Associate... distributed as follows: (1) The original and 1 copy to the requesting agency; (2) 1 copy to TES-70; and (3) 5...

45 CFR 1701.3 - Requests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Regulations Relating to Public Welfare (Continued) NATIONAL COMMISSION ON LIBRARIES AND INFORMATION SCIENCE... Commission on Libraries and Information Science by writing to the Associate Director, National Commission on Libraries and Information Science, Suite 601, 1717 K Street, NW, Washington, DC 20036. (b) A request for...

45 CFR 1701.3 - Requests.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Regulations Relating to Public Welfare (Continued) NATIONAL COMMISSION ON LIBRARIES AND INFORMATION SCIENCE... Commission on Libraries and Information Science by writing to the Associate Director, National Commission on Libraries and Information Science, Suite 601, 1717 K Street, NW, Washington, DC 20036. (b) A request for...

45 CFR 1701.3 - Requests.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Regulations Relating to Public Welfare (Continued) NATIONAL COMMISSION ON LIBRARIES AND INFORMATION SCIENCE... Commission on Libraries and Information Science by writing to the Associate Director, National Commission on Libraries and Information Science, Suite 601, 1717 K Street, NW, Washington, DC 20036. (b) A request for...

45 CFR 1701.3 - Requests.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Regulations Relating to Public Welfare (Continued) NATIONAL COMMISSION ON LIBRARIES AND INFORMATION SCIENCE... Commission on Libraries and Information Science by writing to the Associate Director, National Commission on Libraries and Information Science, Suite 601, 1717 K Street, NW, Washington, DC 20036. (b) A request for...

45 CFR 1701.3 - Requests.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Regulations Relating to Public Welfare (Continued) NATIONAL COMMISSION ON LIBRARIES AND INFORMATION SCIENCE... Commission on Libraries and Information Science by writing to the Associate Director, National Commission on Libraries and Information Science, Suite 601, 1717 K Street, NW, Washington, DC 20036. (b) A request for...

76 FR 30421 - Agency Information Collection Activities: Requests for Comments; Clearance of Renewed Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-25

... and Flight Rules AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice and request for...: 2120-0005. Title: General Operating and Flight Rules. Form Numbers: There are no FAA forms associated... Flight Rules, are [[Page 30422

76 FR 38655 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

... Request: New collection; Title of Information Collection: Analysis of Transportation Barriers to... of the proposed study is to identify and analyze transportation barriers associated with the... analyze the health outcomes resulting from those barriers, and ultimately to identify potential solutions...

47 CFR 1.925 - Waivers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Waivers. 1.925 Section 1.925 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Wireless Radio Services Applications and... requests. (1) Requests for waiver of rules associated with licenses or applications in the Wireless Radio...

77 FR 58422 - New Postal Product

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2012-09-20

... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request to add Priority Mail Contract 43 to the competitive product list... request and associated supporting information to add Priority Mail Contract 43 to the competitive product...

77 FR 58421 - New Postal Product

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-20

... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request to add Priority Mail Contract 42 to the competitive product list... request and associated supporting information to add Priority Mail Contract 42 to the competitive product...

Glenn Extreme Environments Rig (GEER) Independent Review

NASA Technical Reports Server (NTRS)

Jankovsky, Robert S.; Smiles, Michael D.; George, Mark A.; Ton, Mimi C.; Le, Son K.

2015-01-01

The Chief of the Space Science Project Office at Glenn Research Center (GRC) requested support from the NASA Engineering and Safety Center (NESC) to satisfy a request from the Science Mission Directorate (SMD) Associate Administrator and the Planetary Science Division Chief to obtain an independent review of the Glenn Extreme Environments Rig (GEER) and the operational controls in place for mitigating any hazard associated with its operation. This document contains the outcome of the NESC assessment.

78 FR 12757 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-25

... the cap on blended county benchmarks that would otherwise limit QBPs. Through this demonstration, CMS... (MAOs) and up to 10 case studies with MAOs in order to supplement what can be learned from the analyses...

78 FR 15403 - Agency Information Collection Activities; Proposed Collection; Comment Request; Company-Run...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-11

... Activities; Proposed Collection; Comment Request; Company-Run Annual Stress Test Reporting Template and... Federal savings associations titled, ``Company-Run Annual Stress Test Reporting Template and Documentation....occ.gov/tools-forms/forms/bank-operations/stress-test-reporting.html ). SUPPLEMENTARY INFORMATION: The...

The Vendors' Corner--The Request for Proposal.

ERIC Educational Resources Information Center

Sugnet, Chris; And Others

1987-01-01

Several online vendors address the issue of RFPs (requests for proposals) for library systems, discussing the documents' style, technical standards, library expectations, liabilities associated with using this procedure, factors in the decision to bid, and the need for a standardized document and national clearinghouse. (CLB)

Apparatus and method for managing digital resources by passing digital resource tokens between queues

DOEpatents

Crawford, H.J.; Lindenstruth, V.

1999-06-29

A method of managing digital resources of a digital system includes the step of reserving token values for certain digital resources in the digital system. A selected token value in a free-buffer-queue is then matched to an incoming digital resource request. The selected token value is then moved to a valid-request-queue. The selected token is subsequently removed from the valid-request-queue to allow a digital agent in the digital system to process the incoming digital resource request associated with the selected token. Thereafter, the selected token is returned to the free-buffer-queue. 6 figs.

Apparatus and method for managing digital resources by passing digital resource tokens between queues

DOEpatents

Crawford, Henry J.; Lindenstruth, Volker

1999-01-01

A method of managing digital resources of a digital system includes the step of reserving token values for certain digital resources in the digital system. A selected token value in a free-buffer-queue is then matched to an incoming digital resource request. The selected token value is then moved to a valid-request-queue. The selected token is subsequently removed from the valid-request-queue to allow a digital agent in the digital system to process the incoming digital resource request associated with the selected token. Thereafter, the selected token is returned to the free-buffer-queue.

Attitudes towards euthanasia in severely ill and dementia patients and cremation in Cyprus: a population-based survey

PubMed Central

2013-01-01

Background Population studies on end-of-life decisions have not been conducted in Cyprus. Our study aim was to evaluate the beliefs and attitudes of Greek Cypriots towards end-of-life issues regarding euthanasia and cremation. Methods A population-based telephone survey was conducted in Cyprus. One thousand randomly selected individuals from the population of Cyprus age 20 years or older were invited to participate. Beliefs and attitudes on end-of-life decisions were collected using an anonymous and validated questionnaire. Statistical analyses included cross-tabulations, Pearson’s chi-square tests and multivariable-adjusted logistic regression models. Results A total of 308 males and 689 females participated in the survey. About 70% of the respondents did not support euthanasia for people with incurable illness and/or elders with dementia when requested by them and 77% did not support euthanasia for people with incurable illness and/or elders with dementia when requested by relatives. Regarding cremation, 78% were against and only 14% reported being in favor. Further statistical analyses showed that male gender, being single and having reached higher educational level were factors positively associated with support for euthanasia in a statistically significant fashion. On the contrary, the more religiosity expressed by study participants, the less support they reported for euthanasia or cremation. Conclusions The vast majority of Greek Cypriots does not support euthanasia for people with incurable illness and/or elders with dementia and also do not support cremation. Certain demographic characteristics such as age and education have a positive influence towards attitudes for euthanasia and cremation, while religiosity exerts a strong negative influence on the above. Family bonding as well as social and cultural traditions may also play a role although not comprehensively evaluated in the current study. PMID:24060291

Attitudes towards euthanasia in severely ill and dementia patients and cremation in Cyprus: a population-based survey.

PubMed

Televantos, Anastasios; Talias, Michael A; Charalambous, Marianna; Soteriades, Elpidoforos S

2013-09-23

Population studies on end-of-life decisions have not been conducted in Cyprus. Our study aim was to evaluate the beliefs and attitudes of Greek Cypriots towards end-of-life issues regarding euthanasia and cremation. A population-based telephone survey was conducted in Cyprus. One thousand randomly selected individuals from the population of Cyprus age 20 years or older were invited to participate. Beliefs and attitudes on end-of-life decisions were collected using an anonymous and validated questionnaire. Statistical analyses included cross-tabulations, Pearson's chi-square tests and multivariable-adjusted logistic regression models. A total of 308 males and 689 females participated in the survey. About 70% of the respondents did not support euthanasia for people with incurable illness and/or elders with dementia when requested by them and 77% did not support euthanasia for people with incurable illness and/or elders with dementia when requested by relatives. Regarding cremation, 78% were against and only 14% reported being in favor. Further statistical analyses showed that male gender, being single and having reached higher educational level were factors positively associated with support for euthanasia in a statistically significant fashion. On the contrary, the more religiosity expressed by study participants, the less support they reported for euthanasia or cremation. The vast majority of Greek Cypriots does not support euthanasia for people with incurable illness and/or elders with dementia and also do not support cremation. Certain demographic characteristics such as age and education have a positive influence towards attitudes for euthanasia and cremation, while religiosity exerts a strong negative influence on the above. Family bonding as well as social and cultural traditions may also play a role although not comprehensively evaluated in the current study.

76 FR 10573 - Notice of Proposed Information Collection Requests

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-25

... study will use quasi- experimental designs to explore the relationship between magnet programs and... that (1) described the study design and full data collection activities and (2) requested approval for... associated with the fourth and fifth year of data collection necessary for the rigorous comparative...

75 FR 52710 - Notice of Request for Extension of Approval of an Information Collection; National Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-27

...] Notice of Request for Extension of Approval of an Information Collection; National Management Information... approval of an information collection associated with cooperative wildlife damage management programs...: For information on the national management information system for cooperative wildlife damage...

77 FR 71774 - Notice of Request for Extension of Approval of an Information Collection; National Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-04

...] Notice of Request for Extension of Approval of an Information Collection; National Management Information... approval of an information collection associated with cooperative wildlife damage management programs... FURTHER INFORMATION CONTACT: For information on the national management information system for cooperative...

77 FR 32928 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-04

... DEPARTMENT OF COMMERCE Submission for OMB Review; Comment Request The Department of Commerce will... published on April 11, 2011 (76 FR 20180). The public benefits associated with protection actions for the... alternatives and to complement other information available about the costs, benefits, and impacts of...

78 FR 54249 - Agency Information Collection Activities: Comment Request

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2013-09-03

... request. Form Title: EIB 92-30 Report of Premiums Payable for Financial Institutions Only. SUMMARY: The... insurance coverage. The Report of Premiums Payable for Financial Institutions Only is used to determine the... financial institution provide the industry code (NAICS) associated with each specific export. The insured...

78 FR 41065 - Agency Information Collection Activities; Proposed Collection; Comment Request; Medical Devices...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-09

...] Agency Information Collection Activities; Proposed Collection; Comment Request; Medical Devices; Third... notice solicits comments on the information collection associated with medical devices third-party review... that members of the public submit reports, keep records, or provide information to a third party...

77 FR 59590 - Notice of Request for Extension of Approval of an Information Collection; National Animal Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-28

...In accordance with the Paperwork Reduction Act of 1995, this notice announces the Animal and Plant Health Inspection Service's intention to request an extension of approval of an information collection associated with the National Animal Health Reporting System.

49 CFR 236.1017 - Independent third party verification and validation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... validation. 236.1017 Section 236.1017 Transportation Other Regulations Relating to Transportation (Continued... validation. (a) The PTCSP must be supported by an independent third-party assessment when the Associate... request should include supporting information identified in paragraph (c) of this section. FRA may request...

Request for Correction 11001 Toxicological Review of Halogenated Platinum Salts and Platinum Compounds

EPA Pesticide Factsheets

Request for Correction by the International Platinum Group Metals Association seeking the correction of information disseminated in the draft EPA document Toxicological Review of Halogenated Platinum Salts and Platinum Compounds: In Support of Summary Information on the Integrated Risk Information System (IRIS).

78 FR 16538 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Standard on...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-15

.... SUMMARY: The Department of Labor (DOL) is submitting the Occupational Safety and Health Administration (OSHA) sponsored information collection request (ICR) titled, ``Standard on 4,4'-Methylenedianiline in...'-Methylenedianiline (MDA) in Construction protects workers from adverse health effects associated with occupational...

76 FR 23540 - Proposed Information Collection; Comment Request; Annual Survey of Manufactures

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2011-04-27

... provides valuable information to private companies, research organizations, and trade associations... DEPARTMENT OF COMMERCE Census Bureau Proposed Information Collection; Comment Request; Annual... information collections, as required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506...

75 FR 8995 - Agency Information Collection Activities: New Collection, Comments Requested

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2010-02-26

... Under Review: New collection; InfraGard Knowledge/Skills/Abilities Profile Questionnaire. The Department... submitting the following information collection requests to the Office of Management and Budget (OMB) for... contained in this notice, especially the estimated public burden and associated response time, should be...

33 CFR 1.05-10 - Regulatory process overview.

Code of Federal Regulations, 2011 CFR

2011-07-01

... regulation, alternatives considered, and potential cost and benefits, including possible environmental... or for changes to an existing regulation. The need may arise due to statutory changes, or be based on... Federal Register. These may include regulatory evaluations, environmental analyses, requests for comments...

33 CFR 1.05-10 - Regulatory process overview.

Code of Federal Regulations, 2010 CFR

2010-07-01

... regulation, alternatives considered, and potential cost and benefits, including possible environmental... or for changes to an existing regulation. The need may arise due to statutory changes, or be based on... Federal Register. These may include regulatory evaluations, environmental analyses, requests for comments...

78 FR 41784 - Submission for OMB Review; Comment Request

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2013-07-11

... submit to the Office of Management and Budget (OMB) for clearance the following proposal for collection...: National Oceanic and Atmospheric Administration (NOAA). Title: Southeast Region Logbook Family of Forms... for scientific analyses that support critical conservation and management decisions made by national...

Factors leading to the involvement of Forensic Advisors in the Belgian criminal justice system.

PubMed

Bitzer, Sonja

2018-04-01

Forensic Advisors at the National Institute for Criminalistics and Criminology in Brussels act as advising body to the magistrate regarding analytical possibilities and the usefulness of trace analysis in a case. Initially, their function was devised to assist in complex murder cases with unknown offender. However, in a previous study, the increasing diversity of the cases they are requested for has been observed (Bitzer et al., in press). In order to deepen our understanding of the decision steps in the criminal investigation process, the decision to involve a Forensic Advisor and the factors leading to their involvement were evaluated. The study focused on homicide, robbery and burglary cases with and without requests for a Forensic Advisor between January 2014 and June 2016. The factors were categorised into five knowledge dimensions: strategic, immediate, physical, criminal and utility. Decision tree modelling was carried out in order to identify the factors influencing the request for a Forensic Advisor in the case. The decision to request a Forensic Advisor differs between different types of offences. It also depends on the complexity of the case in terms of the number of traces and objects collected at the crime scene, and the availability of witness reports. Indeed, Forensic Advisors take the role of trace analysis coordinator by providing an overview of all available traces, objects, analyses and results. According to the principal implication factors and the performed case study, the contribution of Forensic Advisors consists mainly in summarising all information and advise on potential additional analyses. This might be explained by a loss of overview of the information and the possibilities regarding trace analysis by the magistrate responsible of the case. Copyright © 2018 Elsevier B.V. All rights reserved.

Diagnostic yield of lumbosacral magnetic resonance imaging requested by paediatric urology consultations.

PubMed

Fernández-Ibieta, M; Rojas Ticona, J; Villamil, V; Guirao Piñera, M J; López García, A; Zambudio Carmona, G

2017-11-01

In the historical series, the diagnostic yield of lumbosacral magnetic resonance imaging to rule out occult spinal dysraphism (or occult myelodysplasia), requested by paediatric urology, ranged from 2% to 15%. The aim of this study was to define our cost-effectiveness in children with urinary symptoms and to define endpoints that increase the possibility of finding occult spinal dysraphism. A screening was conducted on patients with urinary dysfunction for whom an magnetic resonance imaging was requested by the paediatric urology clinic, for persistent symptoms after treatment, voiding dysfunction or other clinical or urodynamic findings. We analysed clinical (UTI, daytime leaks, enuresis, voiding dysfunction, urgency, renal ultrasonography, lumbosacral radiography, history of acute urine retention, skin stigma and myalgia) and urodynamic endpoints (hyperactivity or areflexia, voiding dysfunction, interrupted pattern, accommodation value and maximum flow). A univariate analysis was conducted with SPSS 20.0. We analysed 21 patients during the period 2011-2015. The median age was 6 years (3-10). Three patients (14.3%) had occult spinal dysraphism: one spinal lipoma, one filum lipomatosus and one caudal regression syndrome with channel stenosis. The endpoints with statistically significant differences were the myalgias and the history of acute urine retention (66.7% vs. 5.6%, P=.04; OR= 34; 95%CI: 1.5-781 for both endpoints). The diagnostic yield of magnetic resonance imaging requested for children with urinary dysfunctions without skin stigma or neuro-orthopaedic abnormalities is low, although nonnegligible. In this group, the patients with a history of acute urine retention and muscle pain (pain, «cramps») can experience a greater diagnostic yield or positive predictive value. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Analysis of forensic odontological examinations at the National Forensic Service of Korea from 2011 to 2015.

PubMed

Roh, Byung-Yoon; Lee, Won-Joon; Seo, Jeong-Uk; Lee, U-Young; Lee, Sang-Seob

2018-05-01

The National Forensic Service (NFS) of Korea is a government agency responsible for examining and evaluating evidence obtained at crime scenes. The Section of Forensic Odontology of the Medical Examiner's Office conducts forensic odontological analyses of human remains, and mainly criminal cases are handled. In this study, 588 forensic odontological cases referred to NFS during 2011-2015 were analyzed for referral pattern, evidence material, examination criteria, and other factors and were compared with respective data from 2007 to 2010. Majority of the requests were internal (further dental examinations after autopsy) rather than external (direct requests from other agencies such as police departments). Regarding evidence materials, "Teeth" (including teeth and resected jaws) were dominant evidences. Due to the seasonal effects in Korea, the highest number of requests was in September of each year, but the number of requests in April has recently increased. Evidence materials were mostly found in suburban and rural area, especially in mountainous area due to the geographic characteristics of Korea. Regarding specific examinations, profiling, including age estimation, accounted for majority of the requests; this number had increased relative to the findings of a previous study, whereas the number of requests for dental identification and bite mark analysis had decreased. With this analysis, trends in forensic odontology can be observed, and we expect that these trends would be served as a reference for designing study and making training protocol for forensic odontology. Copyright © 2018 Elsevier B.V. All rights reserved.

Prevalence of and Factors Associated with Negative Microscopic Diagnosis of Cutaneous Leishmaniasis in Rural Peru.

PubMed

Lamm, Ryan; Alves, Clark; Perrotta, Grace; Murphy, Meagan; Messina, Catherine; Sanchez, Juan F; Perez, Erika; Rosales, Luis Angel; Lescano, Andres G; Smith, Edward; Valdivia, Hugo; Fuhrer, Jack; Ballard, Sarah-Blythe

2018-06-04

Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using χ 2 test, t -test, and multivariate logistic regression analyses. Negative microscopy with positive PCR occurred in 31% (123/403) of the 403 cases. After adjusting for confounders, binary multivariate logistic regression analyses revealed that negative microscopy with positive PCR was associated with patients who were male (adjusted OR = 1.93 [1.06-3.53], P = 0.032), had previous leishmaniasis (adjusted OR = 2.93 [1.65-5.22], P < 0.0001), had larger lesions (adjusted OR = 1.02 [1.003-1.03], P = 0.016), and/or had a longer duration between lesion appearance and PCR testing (adjusted OR = 1.12 [1.02-1.22], P = 0.017). Future research should focus on further exploration of these underlying variables, discovery of other factors that may be associated with negative microscopy diagnosis, and the development and implementation of improved testing in endemic regions.

The Plant Ontology: A Tool for Plant Genomics.

PubMed

Cooper, Laurel; Jaiswal, Pankaj

2016-01-01

The use of controlled, structured vocabularies (ontologies) has become a critical tool for scientists in the post-genomic era of massive datasets. Adoption and integration of common vocabularies and annotation practices enables cross-species comparative analyses and increases data sharing and reusability. The Plant Ontology (PO; http://www.plantontology.org/ ) describes plant anatomy, morphology, and the stages of plant development, and offers a database of plant genomics annotations associated to the PO terms. The scope of the PO has grown from its original design covering only rice, maize, and Arabidopsis, and now includes terms to describe all green plants from angiosperms to green algae.This chapter introduces how the PO and other related ontologies are constructed and organized, including languages and software used for ontology development, and provides an overview of the key features. Detailed instructions illustrate how to search and browse the PO database and access the associated annotation data. Users are encouraged to provide input on the ontology through the online term request form and contribute datasets for integration in the PO database.

A mixed-method examination of food marketing directed towards children in Australian supermarkets.

PubMed

Campbell, Sarah; James, Erica L; Stacey, Fiona G; Bowman, Jennifer; Chapman, Kathy; Kelly, Bridget

2014-06-01

The purpose of this study was to determine the prevalence of children's food requests, and parents' experiences of food marketing directed towards children, in the supermarket environment. A mixed-method design was used. Firstly, intercept interviews were conducted with parents accompanied by a child/children on exiting supermarkets (sampled from a large regional centre in Australia). Parents were asked about the prevalence and types of food requests by child/children during their supermarket visit and whether they purchased these foods. Secondly, focus groups (n = 13) and telephone interviews (n = 3) were conducted exploring parents' experiences of supermarket shopping with children and the impact of child-directed marketing. Of the 158 intercept survey participants (30% response rate), 73% reported a food request during the supermarket visit. Most requested food items (88%) were unhealthy foods, with chocolate/confectionery being the most common food category requested (40%). Most parents (70%) purchased at least one food item requested during the shopping trip. Qualitative interviews identified four themes associated with food requests and prompts in the supermarket: parents' experience of pester power in the supermarket; prompts for food requests in the supermarket; parental responses to pestering in the supermarket environment, and; strategies to manage pestering and minimize requests for food items. Food requests from children are common during supermarket shopping. Despite the majority of the requests being unhealthy, parents often purchase these foods. Parents reported difficulties dealing with constant requests and expressed desire for environmental changes including confectionery-free checkouts, minimization of child friendly product placement and reducing children's exposure to food marketing.

78 FR 23537 - Submission for OMB Review; Comment Request

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2012-11-13

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24 CFR 81.53 - Processing of program requests.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Processing of program requests. 81.53 Section 81.53 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development THE SECRETARY OF HUD'S REGULATION OF THE FEDERAL NATIONAL MORTGAGE ASSOCIATION (FANNIE...

RE: National Alliance of Forest Owner's Response to Center for Biological Diversity's Request for Correction

EPA Pesticide Factsheets

Letter from the National Alliance of Forest Owners requesting the EPA consider its previous response to EPA's Call for Information on Greenhouse Gas Emissions Associated with Bioenergy and Other Biogenic Sources and consider the Center for Biological Diversity's assertions without merit.

76 FR 4904 - Agency Information Collection Request; 30-Day Public Comment Request

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2011-01-27

... datasets that are not specific to individual's personal health information to improve decision making by... making health indicator datasets (data that is not associated with any individuals) and tools available.../health . These datasets and tools are anticipated to benefit development of applications, web-based tools...

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76 FR 36544 - Scientific Evaluation of Modified Risk Tobacco Product Applications; Public Workshop; Request for...

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75 FR 21641 - Infusion Pumps; Public Meeting; Request for Comments

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System for Secure Integration of Aviation Data

NASA Technical Reports Server (NTRS)

Kulkarni, Deepak; Wang, Yao; Keller, Rich; Chidester, Tom; Statler, Irving; Lynch, Bob; Patel, Hemil; Windrem, May; Lawrence, Bob

2007-01-01

The Aviation Data Integration System (ADIS) of Ames Research Center has been established to promote analysis of aviation data by airlines and other interested users for purposes of enhancing the quality (especially safety) of flight operations. The ADIS is a system of computer hardware and software for collecting, integrating, and disseminating aviation data pertaining to flights and specified flight events that involve one or more airline(s). The ADIS is secure in the sense that care is taken to ensure the integrity of sources of collected data and to verify the authorizations of requesters to receive data. Most importantly, the ADIS removes a disincentive to collection and exchange of useful data by providing for automatic removal of information that could be used to identify specific flights and crewmembers. Such information, denoted sensitive information, includes flight data (here signifying data collected by sensors aboard an aircraft during flight), weather data for a specified route on a specified date, date and time, and any other information traceable to a specific flight. The removal of information that could be used to perform such tracing is called "deidentification." Airlines are often reluctant to keep flight data in identifiable form because of concerns about loss of anonymity. Hence, one of the things needed to promote retention and analysis of aviation data is an automated means of de-identification of archived flight data to enable integration of flight data with non-flight aviation data while preserving anonymity. Preferably, such an automated means would enable end users of the data to continue to use pre-existing data-analysis software to identify anomalies in flight data without identifying a specific anomalous flight. It would then also be possible to perform statistical analyses of integrated data. These needs are satisfied by the ADIS, which enables an end user to request aviation data associated with de-identified flight data. The ADIS includes client software integrated with other software running on flight-operations quality-assurance (FOQA) computers for purposes of analyzing data to study specified types of events or exceedences (departures of flight parameters from normal ranges). In addition to ADIS client software, ADIS includes server hardware and software that provide services to the ADIS clients via the Internet (see figure). The ADIS server receives and integrates flight and non-flight data pertaining to flights from multiple sources. The server accepts data updates from authorized sources only and responds to requests from authorized users only. In order to satisfy security requirements established by the airlines, (1) an ADIS client must not be accessible from the Internet by an unauthorized user and (2) non-flight data as airport terminal information system (ATIS) and weather data must be displayed without any identifying flight information. ADIS hardware and software architecture as well as encryption and data display scheme are designed to meet these requirements. When a user requests one or more selected aviation data characteristics associated with an event (e.g., a collision, near miss, equipment malfunction, or exceedence), the ADIS client augments the request with date and time information from encrypted files and submits the augmented request to the server. Once the user s authorization has been verified, the server returns the requested information in de-identified form.

The impact of adjustment latitude on self-assessed work ability in regard to gender and occupational type.

PubMed

Johansson, Gun; Hultin, Hanna; Möller, Jette; Hallqvist, Johan; Kjellberg, Katarina

2012-07-01

Adjustment latitude describes opportunities to change demands at work when ill and may affect work ability. The aim here is to study the association between adjustment latitude and self-assessed work ability among men and women and employees from different occupational sectors. This cross-sectional study used data from a questionnaire sent to 3020 employees in three occupational sectors in Sweden; 1430 responded. Subjects were divided into: full, moderately reduced, and greatly reduced work ability. Presence of nine adjustment opportunities was requested and subjects were divided into three groups. Each specific opportunity was also analyzed in relation to work ability. Multinomial logistic regression was used for analyses. Number of opportunities to adjust was associated with work ability among men and employees in health care. "Shortening the working day" was associated with work ability in most groups. For men and industrial employees, "postponing work", "going home and working later", and "working without disturbance" were associated with work ability. "To work from home" was associated with work ability among women and employees in insurance. The assumption that adjustment latitude affects work ability is supported. Associations differ with regard to gender and occupational sectors. Further studies with longitudinal design and alternative samples are needed.

Laboratory-based clinical audit as a tool for continual improvement: an example from CSF chemistry turnaround time audit in a South-African teaching hospital

PubMed Central

Imoh, Lucius C; Mutale, Mubanga; Parker, Christopher T; Erasmus, Rajiv T; Zemlin, Annalise E

2016-01-01

Introduction Timeliness of laboratory results is crucial to patient care and outcome. Monitoring turnaround times (TAT), especially for emergency tests, is important to measure the effectiveness and efficiency of laboratory services. Laboratory-based clinical audits reveal opportunities for improving quality. Our aim was to identify the most critical steps causing a high TAT for cerebrospinal fluid (CSF) chemistry analysis in our laboratory. Materials and methods A 6-month retrospective audit was performed. The duration of each operational phase across the laboratory work flow was examined. A process-mapping audit trail of 60 randomly selected requests with a high TAT was conducted and reasons for high TAT were tested for significance. Results A total of 1505 CSF chemistry requests were analysed. Transport of samples to the laboratory was primarily responsible for the high average TAT (median TAT = 170 minutes). Labelling accounted for most delays within the laboratory (median TAT = 71 minutes) with most delays occurring after regular work hours (P < 0.05). CSF chemistry requests without the appropriate number of CSF sample tubes were significantly associated with delays in movement of samples from the labelling area to the technologist’s work station (caused by a preference for microbiological testing prior to CSF chemistry). Conclusion A laboratory-based clinical audit identified sample transportation, work shift periods and use of inappropriate CSF sample tubes as drivers of high TAT for CSF chemistry in our laboratory. The results of this audit will be used to change pre-analytical practices in our laboratory with the aim of improving TAT and customer satisfaction. PMID:27346964

49 CFR 525.6 - Requirements for petition.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EXEMPTIONS FROM AVERAGE FUEL ECONOMY STANDARDS § 525.6 Requirements... arguments of the petitioner supporting the exemption and alternative average fuel economy standard requested... analyses used to develop that information and data. No documents may be incorporated by reference in a...

INDOT Research Program Benefit Cost Analysis—Return on Investment for Projects Completed in FY 2016

DOT National Transportation Integrated Search

2017-12-01

The Governors Office requested an annual financial analysis of the INDOT Research Program to determine the return on the research investment (ROI). The current financial analysis is for research projects that completed in FY 2016. Analyses on prev...

76 FR 56146 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-12

... submit to the Office of Management and Budget (OMB) for clearance the following proposal for collection...: National Oceanic and Atmospheric Administration (NOAA). Title: Alaska Saltwater Sport Fishing Economic... to collect data for conducting economic analyses of marine sport fishing in Alaska. This survey is...

Anticipation, Teamwork, and Cognitive Load: Chasing Efficiency during Robot-Assisted Surgery

PubMed Central

Sexton, Kevin; Johnson, Amanda; Gotsch, Amanda; Hussein, Ahmed A.; Cavuoto, Lora; Guru, Khurshid A.

2018-01-01

Introduction Robot-assisted surgery (RAS) has changed the traditional operating room, occupying more space with equipment and isolating console surgeons away from the patients and their team. We aimed to evaluate how anticipation of surgical steps and familiarity between team members impacted efficiency and safety. Methods We analyzed recordings (video and audio) of 12 robot-assisted radical prostatectomies. Any requests between surgeon and the team members were documented and classified by personnel, equipment type, mode of communication, level of inconvenience in fulfilling the request, and anticipation. Surgical team members completed questionnaires assessing team familiarity and cognitive load (NASA-TLX). Predictors of team efficiency were assessed using Pearson correlation and stepwise linear regression. Results 1330 requests were documented of which 413 (31%) were anticipated. Anticipation correlated negatively with operative time resulting in overall 8% reduction of OR time. Team familiarity negatively correlated with inconveniences. Anticipation ratio, percent of requests that were nonverbal, and total request duration were significantly correlated with the console surgeons’ cognitive load (r=0.77, p=0.006; r=0.63, p=0.04; and r=0.70, p=0.02, respectively). Conclusions Anticipation and active engagement by the surgical team resulted in shorter operative time; and higher familiarity scores were associated with fewer inconveniences. Less anticipation and nonverbal requests were also associated with lower cognitive load for the console surgeon. Training efforts to increase anticipation and team familiarity can improve team efficiency during RAS. PMID:28689193

Evaluation of hospital staff’s perceived quality of librarian-mediated literature searching services*,†

PubMed Central

McKeown, Sandra; Konrad, Shauna-Lee; McTavish, Jill; Boyce, Erin

2017-01-01

Objective The research evaluated the perceived quality of librarian-mediated literature searching services at one of Canada’s largest acute care teaching hospitals for the purpose of continuous quality improvement and investigation of relationships between variables that can impact user satisfaction. Methods An online survey was constructed using evidence-based methodologies. A systematic sample of staff and physicians requesting literature searches at London Health Sciences Centre were invited to participate in the study over a one-year period. Data analyses included descriptive statistics of closed-ended questions and coding of open-ended questions. Results A range of staff including clinicians, researchers, educators, leaders, and analysts submitted a total of 137 surveys, representing a response rate of 71%. Staff requested literature searches for the following “primary” purposes: research or publication (34%), teaching or training (20%), informing a policy or standard practice (16%), patient care (15%), and “other” purposes (15%). While the majority of staff (76%) submitted search requests using methods of written communication, including email and search request forms, staff using methods of verbal communication, including face-to-face and telephone conversations, were significantly more likely to be extremely satisfied with the librarian’s interpretation of the search request (p=0.004) and to rate the perceived quality of the search results as excellent (p=0.005). In most cases, librarians followed up with staff to clarify the details of their search requests (72%), and these staff were significantly more likely to be extremely satisfied with the librarian’s interpretation of the search request (p=0.002). Conclusions Our results demonstrate the limitations of written communication in the context of librarian-mediated literature searching and suggest a multifaceted approach to quality improvement efforts. PMID:28377674

Evaluation of hospital staff's perceived quality of librarian-mediated literature searching services.

PubMed

McKeown, Sandra; Konrad, Shauna-Lee; McTavish, Jill; Boyce, Erin

2017-04-01

The research evaluated the perceived quality of librarian-mediated literature searching services at one of Canada's largest acute care teaching hospitals for the purpose of continuous quality improvement and investigation of relationships between variables that can impact user satisfaction. An online survey was constructed using evidence-based methodologies. A systematic sample of staff and physicians requesting literature searches at London Health Sciences Centre were invited to participate in the study over a one-year period. Data analyses included descriptive statistics of closed-ended questions and coding of open-ended questions. A range of staff including clinicians, researchers, educators, leaders, and analysts submitted a total of 137 surveys, representing a response rate of 71%. Staff requested literature searches for the following "primary" purposes: research or publication (34%), teaching or training (20%), informing a policy or standard practice (16%), patient care (15%), and "other" purposes (15%). While the majority of staff (76%) submitted search requests using methods of written communication, including email and search request forms, staff using methods of verbal communication, including face-to-face and telephone conversations, were significantly more likely to be extremely satisfied with the librarian's interpretation of the search request ( p =0.004) and to rate the perceived quality of the search results as excellent ( p =0.005). In most cases, librarians followed up with staff to clarify the details of their search requests (72%), and these staff were significantly more likely to be extremely satisfied with the librarian's interpretation of the search request ( p =0.002). Our results demonstrate the limitations of written communication in the context of librarian-mediated literature searching and suggest a multifaceted approach to quality improvement efforts.

Local Media Influence on Opting-Out from an Exception from Informed Consent Trial

PubMed Central

Nelson, Maria J; DeIorio, Nicole M; MD, Terri Schmidt; Griffiths, Denise; Daya, Mohamud; Haywood, Liana; Zive, Dana; Newgard, Craig D

2010-01-01

Objectives News media are used for community education and notification in exception from informed consent clinical trials, yet their effectiveness as an added safeguard in such research remains unknown. We assessed the number of callers requesting opt-out bracelets following each local media report and described the errors and content within each media report. Methods We undertook a descriptive analysis of local media trial coverage (newspaper, television, radio, and weblog) and opt-out requests over a 41-month period at a single site participating in an exception from informed consent out-of-hospital trial. Two non-trial investigators independently assessed forty-one content-based media variables (including background, trial information, graphics, errors, publication information, assessment) using a standardized, semi-qualitative data collection tool. Major errors were considered serious misrepresentation of the trial purpose or protocol, whereas minor errors included misinformation unlikely to mislead the lay reader about the trial. We plotted the temporal relationship between opt-out bracelet requests and media reports. Descriptive information about the news sources and the trial coverage are presented. Results We collected 39 trial-related media reports (33 newspaper, 1 television, 1 radio, and 4 blogs). There were thirteen errors in 9 (23%) publications, 7 of which were major and 6 minor. Of 384 requests for 710 bracelets, 310 requests (80%) occurred within 4 days after trial media coverage. Graphical timeline representation of the data suggested a close association between media reports about the trial and requests for opt-out bracelets. Conclusions Based on results from a single site, local media coverage for an exception from informed consent clinical trial had a substantial portion of errors and appeared closely associated with opt-out requests. PMID:19682770

Human Immune Function and Microbial Pathogenesis in Human Spaceflight

NASA Technical Reports Server (NTRS)

Pierson, Duane J.; Ott, M.

2006-01-01

This oral presentation was requested by Conference conveners. The requested subject is microbial risk assessment considering changes in the human immune system during flight and microbial diversity of environmental samples aboard the International Space Station (ISS). The presentation will begin with an introduction discussing the goals and limitations of microbial risk assessment during flight. The main portion of the presentation will include changes in the immune system that have been published, historical data from microbial analyses, and initial modeling of the environmental flora aboard ISS. The presentation will conclude with future goals and techniques to enhance our ability to perform microbial risk assessment on long duration missions.

78 FR 27991 - Notice of Request for Nominees for the Advisory Committee on Water Information

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-13

... water-related associations, academia, private industry, water utility associations, civil engineering... associations, environmental and educational groups. Member organizations designate their representatives and...

Review of Restricted Experiment Requests, Division of Select Agents and Toxins, Centers for Disease Control and Prevention, 2006-2013.

PubMed

Smith, Jacinta; Gangadharan, Denise; Weyant, Robbin

2015-01-01

The Centers for Disease Control and Prevention (CDC) Division of Select Agents and Toxins (DSAT) regulates laboratories that possess, use, or transfer select agents and toxins in the United States. DSAT also mitigates biosafety risks through the review of "restricted experiments," which under the select agent regulations are experiments that pose heightened biosafety risks. From January 2006 through December 2013, DSAT received 618 requests from 109 entities to perform potentially restricted experiments. Of these requests, 85% were determined not to meet the regulatory definition of a restricted experiment, while 15% of the requests met the definition of a restricted experiment. Of the 91 restricted experiments proposed, DSAT approved 31 (34%) requests because the biosafety conditions proposed were commensurate with the experiments' biosafety risk. All 31 approved restricted experiments were for work with select toxins. DSAT did not approve 60 restricted experiment requests due to potentially serious biosafety risks to public health and safety. All 60 denied restricted experiments proposed inserting drug resistance traits into select agents that could compromise the control of disease. The select agents and toxins associated most frequently with requests that met the regulatory definition of a restricted experiment are Shiga toxin (n = 16), Burkholderia mallei (n = 15), Botulinum neurotoxin (n = 14), and Brucella abortus (n = 14). In general, all restricted experiment decisions are determined on a case-by-case basis. This article describes the trends and characteristics of the data associated with restricted experiment requests among select agents that have an impact on public health and safety (HHS only agents) or both public health and safety and animal health or products (overlap agents). The information presented here, coupled with the information published in the restricted experiment guidance document ( www.selectagents.gov ), is intended to promote awareness among the research community of the type of experiments that meet the regulatory definition of a restricted experiment as well as to provide a greater understanding of the restricted experiment review process.

77 FR 429 - Clarification and Further Guidance on the Fireworks Approvals Policy

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-05

...) and the American Pyrotechnic Association (APA) Standard 87-1. PHMSA understands that it is a common... approval is requested conforms to the APA Standard 87-1, and the descriptions and technical information... manufacturer must sign and certify that the device for which the approval is requested conforms to the APA...

76 FR 44080 - Agency Information Collection Activities: Requests for Comments; Clearance of Renewed Approval of...

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2011-07-22

... and Flight Rules AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice and request for.... Title: General Operating and Flight Rules. Form Numbers: There are no FAA forms associated with this... requirements of Federal Aviation Regulation (FAR) Part 91, General Operating and Flight Rules, are authorized...

75 FR 67976 - Agency Information Collection Request. 30-Day Public Comment Request

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2010-11-04

... Putting Prevention to Work Cost Study Instrument--OMB No. 0990-NEW--Office of the Assistant Secretary for... collection is to collect quarterly cost information from all community- level CPPW awardees. This will allow HHS to receive reports on direct awardee costs associated with carrying out the selected evidence...

41 CFR 102-34.65 - How may we request an exemption from the fuel economy standards?

Code of Federal Regulations, 2011 CFR

2011-01-01

... exemption from the fuel economy standards? 102-34.65 Section 102-34.65 Public Contracts and Property... an exemption from the fuel economy standards? You must submit a written request for an exemption from the fuel economy standards to: Administrator, General Services Administration, ATTN: Deputy Associate...

41 CFR 102-34.65 - How may we request an exemption from the fuel economy standards?

Code of Federal Regulations, 2014 CFR

2014-01-01

... exemption from the fuel economy standards? 102-34.65 Section 102-34.65 Public Contracts and Property... an exemption from the fuel economy standards? You must submit a written request for an exemption from the fuel economy standards to: Administrator, General Services Administration, ATTN: Deputy Associate...

41 CFR 102-34.65 - How may we request an exemption from the fuel economy standards?

Code of Federal Regulations, 2012 CFR

2012-01-01

... exemption from the fuel economy standards? 102-34.65 Section 102-34.65 Public Contracts and Property... an exemption from the fuel economy standards? You must submit a written request for an exemption from the fuel economy standards to: Administrator, General Services Administration, ATTN: Deputy Associate...

41 CFR 102-34.65 - How may we request an exemption from the fuel economy standards?

Code of Federal Regulations, 2013 CFR

2013-07-01

... exemption from the fuel economy standards? 102-34.65 Section 102-34.65 Public Contracts and Property... an exemption from the fuel economy standards? You must submit a written request for an exemption from the fuel economy standards to: Administrator, General Services Administration, ATTN: Deputy Associate...

75 FR 63833 - Proposed Collection; Comment Request; the NIH-American Association for Retired Persons (AARP...

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2010-10-18

... information technology. FOR FURTHER INFORMATION CONTACT: To request more information on the proposed project... Interview by Computer Study (iCLIC) (NCI) SUMMARY: In compliance with the requirement of Section 3506(c)(2... collection projects, the National Cancer Institute (NCI), the National Institutes of Health (NIH) will...

How to Use FASTLANEs to Protect IP Networks

DTIC Science & Technology

2006-08-18

parameters exists in its QoS database , then determine which VRF table is assigned to the QoS request. Once an association between the requested QoS and a...Generation, 18 Oct 2002 [30] TMOK: mistvan, MPLS for Linux How-To, 2001. [31] Italy (Telecom Italia Lab S.p.A.) and UK (CCSR, University of

75 FR 75169 - Notice of Request for Extension of Approval of an Information Collection; Update of Nursery Stock...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-02

...In accordance with the Paperwork Reduction Act of 1995, this notice announces the Animal and Plant Health Inspection Service's intention to request extension of approval of an information collection associated with regulations for the importation of nursery stock into the United States.

78 FR 4121 - Notice of Request for Revision to and Extension of Approval of an Information Collection; Cut...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-18

...] Notice of Request for Revision to and Extension of Approval of an Information Collection; Cut Flowers... collection associated with the regulations for the importation of cut flowers from countries with... coming. FOR FURTHER INFORMATION CONTACT: For information on the regulations for the importation of cut...

75 FR 31746 - Notice of Request for Extension of Approval of an Information Collection; Importation of Mangoes...

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2010-06-04

...] Notice of Request for Extension of Approval of an Information Collection; Importation of Mangoes from the... approval of an information collection associated with regulations for the importation of mangoes from the... INFORMATION CONTACT: For information on regulations for the importation of mangoes from the Philippines...

77 FR 4857 - Agency Information Collection Activities: Comment Request

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2012-01-31

... that might influence SSA's unfavorable determination. We may use the information to: (1) Reconsider and... appeal the decision. To request a hearing, individuals use Form HA-501, the associated Modernized Claims... prescribed time; is the proper party; and has taken the steps necessary to obtain the right to a hearing. SSA...

78 FR 56733 - Notice of Inventory Completion: Logan Museum of Anthropology, Beloit College, Beloit, WI

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2013-09-13

... organization not identified in this notice that wish to request transfer of control of these human remains and... Anthropology, Beloit College. If no additional requestors come forward, transfer of control of the human... control of these human remains and associated funerary objects should submit a written request with...

76 FR 78225 - Notice of Request for Extension of Approval of an Information Collection; Importation of Citrus...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

...] Notice of Request for Extension of Approval of an Information Collection; Importation of Citrus From Peru... an information collection associated with regulations for the importation of citrus from Peru. DATES... from Peru, contact Mr. Tony Rom[aacute]n, Import Specialist, Regulatory Coordination and Compliance...

76 FR 44896 - Union Electric Company, dba AmerenUE; Notice of Application for Amendment of License and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-27

... Request: AmerenUE requests Commission authorization to permit the Nauti Rooster Restaurant & Bar to... restaurant and bar. No dredging activities, shoreline stabilization, or fueling facilities are associated... Documents: Any filing must (1) Bear in all capital letters the title ``Comments'', ``Protest'', or ``Motion...

78 FR 76276 - Notice of Request for Extension of Approval of an Information Collection; Importation of Ovine...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-17

...] Notice of Request for Extension of Approval of an Information Collection; Importation of Ovine Meat From... approval of an information collection associated with the regulations for the importation of ovine meat... for the importation of ovine meat from Uruguay, contact Dr. Silvia Kreindel, Senior Staff Veterinarian...

77 FR 75413 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-20

.... Title, Associated Forms and OMB Number: Application for a Review by the Physical Disability Board of... disability rating of 20 percent disabled or less; and were found to be not eligible for retirement request a... should be sent to Ms. Toppings at WHS/ESD Information Management Division, 4800 Mark Center Drive, East...

77 FR 37923 - Comment Request for Information Collection for the Workforce Investment Act (WIA) Adult and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-25

... collection request consists of follow-up surveys for a sample of WIA customers participating in the WIA... Development and Research, Employment and Training Administration, U.S. Department of Labor, 200 Constitution... Policy Research and its subcontractors--Social Policy Research Associates, MDRC, and the Corporation for...

75 FR 36478 - Proposed Collection; Comment Request for Form 1120-C

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-25

... 1120-C AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments... 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning Form 1120-C, U.S. Income Tax Return for Cooperative Associations. DATES: Written comments should be...

78 FR 28945 - Proposed Collection; Comment Request for Form 1120-C

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... 1120-C AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments... 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning Form 1120-C, U.S. Income Tax Return for Cooperative Associations. DATES: Written comments should be...

40 CFR 63.1420 - Applicability and designation of affected sources.

Code of Federal Regulations, 2010 CFR

2010-07-01

... limited to, records of chemicals purchased for the process, analyses of process stream composition, engineering calculations, or process knowledge. (ii) When requested by the Administrator, demonstrate that the... applies. (3) Reactions or processing that occur after the epoxide polymerization is complete and after all...

Exploring Business Request Genres: Students' Rhetorical Choices

ERIC Educational Resources Information Center

Nguyen, Hai; Miller, Jennifer

2012-01-01

This article presents selective findings from an ongoing study that investigates rhetorical differences in business letter writing between Vietnamese students taking an English for Specific Purposes course in Vietnam and business professionals. Rhetorical analyses are based on two corpora, namely, scenario (N = 20) and authentic business letters…

78 FR 44164 - Notice of Intent To Seek Approval To Establish an Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-23

..., and published literature; qualitative and quantitative analyses of surveys and interviews with.... This information collection request will include a survey instrument for principal investigators of past and current AISL projects, a survey instrument for project evaluators, and protocols for follow-up...

76 FR 36583 - New Postal Product

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-22

... Docket No. CP2010-36 serve as the baseline contract for future functional equivalence analyses of the... commitments, do not alter the contract's functional equivalency. Id. at 4. The Postal Service asserts that... offered or the fundamental structure of the contract. Therefore, it requests that the instant contract be...

76 FR 76441 - Emergency Clearance; Public Information Collection Requirements Submitted to the Office of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-07

... surveyed. Basic analyses will include descriptive statistics on each category of information requested by... Equipment Donations for Schools. Title of Collection: Survey of Laboratory Equipment Donations for Schools... laboratory equipment to elementary schools and secondary schools. The Director * * * shall survey...

7 CFR 91.19 - General requirements of suitable samples.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the analyses requested. (b) Each sample must be identified with the following information: (1) Product... other information which is required by the specific program under which analysis or test is performed. ... LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Samples § 91.19 General requirements of suitable...

7 CFR 91.19 - General requirements of suitable samples.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the analyses requested. (b) Each sample must be identified with the following information: (1) Product... other information which is required by the specific program under which analysis or test is performed. ... LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Samples § 91.19 General requirements of suitable...

7 CFR 91.19 - General requirements of suitable samples.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the analyses requested. (b) Each sample must be identified with the following information: (1) Product... other information which is required by the specific program under which analysis or test is performed. ... LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Samples § 91.19 General requirements of suitable...

7 CFR 91.19 - General requirements of suitable samples.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the analyses requested. (b) Each sample must be identified with the following information: (1) Product... other information which is required by the specific program under which analysis or test is performed. ... LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Samples § 91.19 General requirements of suitable...

7 CFR 91.19 - General requirements of suitable samples.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the analyses requested. (b) Each sample must be identified with the following information: (1) Product... other information which is required by the specific program under which analysis or test is performed. ... LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Samples § 91.19 General requirements of suitable...

Eager protocol on a cache pipeline dataflow

DOEpatents

Ohmacht, Martin; Sugavanam, Krishnan

2012-11-13

A master device sends a request to communicate with a slave device to a switch. The master device waits for a period of cycles the switch takes to decide whether the master device can communicate with the slave device, and the master device sends data associated with the request to communicate at least after the period of cycles has passed since the master device sent the request to communicate to the switch without waiting to receive an acknowledgment from the switch that the master device can communicate with the slave device.

The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial).

PubMed

Campbell, John L; Fletcher, Emily; Britten, Nicky; Green, Colin; Holt, Tim; Lattimer, Valerie; Richards, David A; Richards, Suzanne H; Salisbury, Chris; Taylor, Rod S; Calitri, Raff; Bowyer, Vicky; Chaplin, Katherine; Kandiyali, Rebecca; Murdoch, Jamie; Price, Linnie; Roscoe, Julia; Varley, Anna; Warren, Fiona C

2015-02-01

Telephone triage is proposed as a method of managing increasing demand for primary care. Previous studies have involved small samples in limited settings, and focused on nurse roles. Evidence is limited regarding the impact on primary care workload, costs, and patient safety and experience when triage is used to manage patients requesting same-day consultations in general practice. In comparison with usual care (UC), to assess the impact of GP-led telephone triage (GPT) and nurse-led computer-supported telephone triage (NT) on primary care workload and cost, patient experience of care, and patient safety and health status for patients requesting same-day consultations in general practice. Pragmatic cluster randomised controlled trial, incorporating economic evaluation and qualitative process evaluation. General practices (n = 42) in four regions of England, UK (Devon, Bristol/Somerset, Warwickshire/Coventry, Norfolk/Suffolk). Patients requesting same-day consultations. Practices were randomised to GPT, NT or UC. Data collection was not blinded; however, analysis was conducted by a statistician blinded to practice allocation. Primary - primary care contacts [general practice, out-of-hours primary care, accident and emergency (A&E) and walk-in centre attendances] in the 28 days following the index consultation request. Secondary - resource use and costs, patient safety (deaths and emergency hospital admissions within 7 days of index request, and A&E attendance within 28 days), health status and experience of care. Of 20,990 eligible randomised patients (UC n = 7283; GPT n = 6695; NT n = 7012), primary outcome data were analysed for 16,211 patients (UC n = 5572; GPT n = 5171; NT n = 5468). Compared with UC, GPT and NT increased primary outcome contacts (over 28-day follow-up) by 33% [rate ratio (RR) 1.33, 95% confidence interval (CI) 1.30 to 1.36] and 48% (RR 1.48, 95% CI 1.44 to 1.52), respectively. Compared with GPT, NT was associated with a marginal increase in primary outcome contacts by 4% (RR 1.04, 95% CI 1.01 to 1.08). Triage was associated with a redistribution of primary care contacts. Although GPT, compared with UC, increased the rate of overall GP contacts (face to face and telephone) over the 28 days by 38% (RR 1.38, 95% CI 1.28 to 1.50), GP face-to-face contacts were reduced by 39% (RR 0.61, 95% CI 0.54 to 0.69). NT reduced the rate of overall GP contacts by 16% (RR 0.84, 95% CI 0.78 to 0.91) and GP face-to-face contacts by 20% (RR 0.80, 95% CI 0.71 to 0.90), whereas nurse contacts increased. The increased rate of primary care contacts in triage arms is largely attributable to increased telephone contacts. Estimated overall patient-clinician contact time on the index day increased in triage (GPT = 10.3 minutes; NT = 14.8 minutes; UC = 9.6 minutes), although patterns of clinician use varied between arms. Taking account of both the pattern and duration of primary outcome contacts, overall costs over the 28-day follow-up were similar in all three arms (approximately £75 per patient). Triage appeared safe, and no differences in patient health status were observed. NT was somewhat less acceptable to patients than GPT or UC. The process evaluation identified the complexity associated with introducing triage but found no consistency across practices about what works and what does not work when implementing it. Introducing GPT or NT was associated with a redistribution of primary care workload for patients requesting same-day consultations, and at similar cost to UC. Although triage seemed to be safe, investigation of the circumstances of a larger number of deaths or admissions after triage might be warranted, and monitoring of these events is necessary as triage is implemented. Current Controlled Trials ISRCTN20687662. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 13. See the NIHR Journals Library website for further project information.

Evaluating a restrictive formulary system by assessing nonformulary-drug requests.

PubMed

Green, J A; Chawla, A K; Fong, P A

1985-07-01

Nonformulary-drug requests were used to evaluate a restrictive formulary system in a large university hospital, and a telephone survey of eight similar hospitals was conducted to assess the restrictiveness of their formulary systems. Nonformulary-drug requests were evaluated by two drug information pharmacists over a 12-month period (January-December 1984) to assess the frequency with which nonformulary items were ordered, the costs associated with the procurement of nonformulary drug products, and the rationales given by physicians when ordering nonformulary products. Of all nonformulary requests, 65% were for drugs previously evaluated by the pharmacy and therapeutics committee and denied admission to the formulary. A cost savings of $1887 would have resulted if formulary alternates had been used instead of nonformulary products. Excluding 22% of nonformulary items that were requested for the continuation of preadmission drug therapy, only 13% of the rationales for the remaining requests were appropriate. Although the eight other hospitals surveyed said they had restrictive formularies, all had frequent requests and procedures for procuring nonformulary items and some formularies included most available drugs. The formulary system at the study hospital was considered restrictive, but procedures for nonformulary-drug requests limited the effectiveness of the system. If any benefit is to result from formulary systems, hospitals must strengthen their enforcement of formulary restrictions.

Washington State Pediatricians' Attitudes Toward Alternative Childhood Immunization Schedules

PubMed Central

Wightman, Aaron; Marcuse, Edgar K.; Taylor, James A.

2011-01-01

OBJECTIVE: To determine the frequency of parents' requests for alternative childhood immunization schedules (ACISs) and pediatricians' comfort with and willingness to use ACISs. METHODS: Washington State primary care pediatricians were asked to complete an Internet-based survey on ACISs. The main outcome measures were the frequency of parents' requests for ACISs, pediatricians' comfort with their use, and pediatricians' willingness to use ACISs for individual vaccines. In addition, respondents were asked to characterize their practices and to provide demographic information. RESULTS: Of the 311 respondents (response rate: 65%), 209 met inclusion criteria and were included in analyses. Overall, 77% of eligible respondents reported that parents sometimes or frequently requested ACISs, and 61% were comfortable using an ACIS if requested by a parent. Pediatricians were least willing to consider using ACISs for diphtheria-tetanus toxoids-acellular pertussis vaccine, Haemophilus influenzae type b vaccine, and pneumococcal conjugate vaccine. Pediatricians who practiced in a neighborhood or community clinic were less comfortable using ACISs than were those in a 1- or 2-physician practice (odds ratio: 0.10). CONCLUSIONS: Washington State pediatricians are regularly being asked to use ACISs, and most of them are comfortable using them if requested. Pediatricians are least willing to delay H influenzae type b vaccine, diphtheria-tetanus toxoids-acellular pertussis vaccine, and pneumococcal conjugate vaccine, which suggests prioritization of immunizations that protect against potentially devastating bacterial infections of infancy and early childhood. PMID:22123877

Gut Microbiota Patterns Associated with Colonization of Different Clostridium difficile Ribotypes

PubMed Central

Skraban, Jure; Dzeroski, Saso; Zenko, Bernard; Mongus, Domen; Gangl, Simon; Rupnik, Maja

2013-01-01

C. difficile infection is associated with disturbed gut microbiota and changes in relative frequencies and abundance of individual bacterial taxons have been described. In this study we have analysed bacterial, fungal and archaeal microbiota by denaturing high pressure liquid chromatography (DHPLC) and with machine learning methods in 208 faecal samples from healthy volunteers and in routine samples with requested C. difficile testing. The latter were further divided according to stool consistency, C. difficile presence or absence and C. difficile ribotype (027 or non-027). Lower microbiota diversity was a common trait of all routine samples and not necessarily connected only to C. difficile colonisation. Differences between the healthy donors and C. difficile positive routine samples were detected in bacterial, fungal and archaeal components. Bifidobacterium longum was the single most important species associated with C. difficile negative samples. However, by machine learning approaches we have identified patterns of microbiota composition predictive for C. difficile colonization. Those patterns also differed between samples with C. difficile ribotype 027 and other C. difficile ribotypes. The results indicate that not only the presence of a single species/group is important but that certain combinations of gut microbes are associated with C. difficile carriage and that some ribotypes (027) might be associated with more disturbed microbiota than the others. PMID:23469128

Dealing with requests for euthanasia: a qualitative study investigating the experience of general practitioners.

PubMed

Georges, J-J; The, A M; Onwuteaka-Philipsen, B D; van der Wal, G

2008-03-01

Caring for terminally ill patients is a meaningful task, however the patient's suffering can be a considerable burden and cause of frustration. The aim of this study is to describe the experiences of general practitioners (GPs) in The Netherlands in dealing with a request for euthanasia from a terminally ill patient. The data, collected through in-depth interviews, were analysed according to the constant comparative method. Having to face a request for euthanasia when attempting to relieve a patient's suffering was described as a very demanding experience that GPs generally would like to avoid. Nearly half of the GPs (14/30) strive to avoid euthanasia or physician assisted suicide because it was against their own personal values or because it was emotional burdening to be confronted with this issue. They explained that by being directed on promoting a peaceful dying process, or the quality of end-of-life of a patient by caring and supporting the patient and the relatives it was mainly possible to shorten patient's suffering without "intentionally hastening a patient's death on his request". The other GPs (16/30) explained that as sometimes the suffering of a patient could not be lessened they were open to consider a patient's request for euthanasia or physician assisted suicide. They underlined the importance of a careful decision-making process, based on finding a balance between the necessity to shorten the patient's suffering through euthanasia and their personal values. Dealing with requests for euthanasia is very challenging for GPs, although they feel committed to alleviate a patient's suffering and to promote a peaceful death.

Six-year activity on approval of compassionate use of medicines by the Ethics Committee of the University Hospital of Bologna (Italy): time to update rules and recommendations.

PubMed

Montanaro, Nicola; Melis, Mauro; Proni, Stefania; Chiabrando, Giacomo; Motola, Domenico

2017-04-01

Compassionate use of forthcoming drugs has become an increasing pathway through which patients can take advantage of promising medicines. We aimed to analyse the main features of the requests of compassionate use submitted to the Independent Ethics Committee (IEC) of the University Hospital of Bologna in the period 2010-2015. The present analysis concerns the requests of compassionate use received by the IEC in the period 2010-2015. For each requested drug, we paired the date of the first request to our IEC with the date(s) of (a) submission to EMA, (b) CHMP positive opinion, and (c) European marketing authorization (if issued). In the period 2010-2015, our IEC received compassionate use requests for 610 patients. Most of the requests concerned patients suffering from solid or haematological cancers not responsive to first or second line of treatment. Sixty-five couples of medicine/clinical condition (corresponding to 56 individual medicines) were submitted to our IEC, and 62 of them regarded products following the centralised procedure at the EMA. Twenty-one out of the latter (34%) had already obtained CHMP positive opinion. Our results indicate that compassionate use of forthcoming medicines represents a not negligible portion of the therapies utilized in hospital care. The observed large resort to medicines still on trial may suggest that doctors are more aware with the potential benefits of the new drugs. However, this trend may also indicate an increasing marketing activity of the pharmaceutical industry, addressing to get the clinicians used to the upcoming medicines.

Quality of requests for serum digoxin concentrations: experience from an Australian regional health service.

PubMed

Ellington, Chris; Grgurinovich, Nick; Miners, John O; Mangoni, Arduino A

2007-05-01

* Therapeutic drug monitoring of serum digoxin concentrations (SDC) is considered useful in enhancing the therapeutic benefits of digoxin and minimizing the incidence of adverse drug reactions. * The quality of requests for SDC has been reported to be generally unsatisfactory. However, studies have focused on few information parameters. * A better knowledge of these issues might be useful to target appropriate areas of weakness within heathcare systems. * The poor quality of the information in SDC requests involves a wide range of codes from the contact details of the requester to the time interval between the last dose of digoxin and blood sampling. * Misuse of the therapeutic drug monitoring service is common across different specialties and healthcare settings. To assess the quality of the information provided with serum digoxin concentration (SDC) requests received by a therapeutic drug monitoring service in a regional health service. We conducted a retrospective audit of a consecutive series of 685 SDC requests during a 7-month period. Information regarding (i) contact details, (ii) reasons for request, (iii) dose, (iv) route of administration, (v) concurrent therapy, (vi) treatment duration and (vii) time interval between the last dose and sampling was reviewed and coded as appropriate or inappropriate/missing. Data were analysed according to the origin of request, i.e. from different specialties/wards (emergency department and critical care, cardiology and coronary care unit, medicine and aged care, surgery, and general/private practice) and healthcare settings (teaching hospital, geriatric hospital and general/private practice). The quality of SDC requests was generally poor across different specialties and healthcare settings. The information provided for the coded parameters was appropriate only in 19.1% (i), 6.4% (ii), 54.7% (iii), 45.8% (iv), 12.8% (v), 32.9% (vi) and 47.1% (vii) of cases. No SDC request was complete in all the information codes. SDC requests from general/private practice lacked more often details regarding the dose (information provided in 46.7% of requests, P = 0.007 vs. other specialties; P = 0.02 vs. other settings) and the route of administration (20.0%, P < 0.001 vs. other specialties and vs. other settings). SDC requests from the emergency department and critical care unit lacked more often details regarding the treatment duration (22.6%, P < 0.001 vs. other specialties) and the time interval between the last dose and blood sampling (40.1%, P = 0.01 vs. other specialties). The quality of the information in SDC requests is poor across different specialties and healthcare settings. Educational strategies to ensure the appropriate use of this service are urgently needed.

Quality of requests for serum digoxin concentrations: experience from an Australian Regional Health Service

PubMed Central

Ellington, Chris; Grgurinovich, Nick; Miners, John O; Mangoni, Arduino A

2007-01-01

What is already known about this subject Therapeutic drug monitoring of serum digoxin concentrations (SDC) is considered useful in enhancing the therapeutic benefits of digoxin and minimizing the incidence of adverse drug reactions. The quality of requests for SDC has been reported to be generally unsatisfactory. However, studies have focused on few information parameters. A better knowledge of these issues might be useful to target appropriate areas of weakness within heathcare systems. What this study adds The poor quality of the information in SDC requests involves a wide range of codes from the contact details of the requester to the time interval between the last dose of digoxin and blood sampling. Misuse of the therapeutic drug monitoring service is common across different specialties and healthcare settings. Aims To assess the quality of the information provided with serum digoxin concentration (SDC) requests received by a therapeutic drug monitoring service in a regional health service. Methods We conducted a retrospective audit of a consecutive series of 685 SDC requests during a 7-month period. Information regarding (i) contact details, (ii) reasons for request, (iii) dose, (iv) route of administration, (v) concurrent therapy, (vi) treatment duration and (vii) time interval between the last dose and sampling was reviewed and coded as appropriate or inappropriate/missing. Data were analysed according to the origin of request, i.e. from different specialties/wards (emergency department and critical care, cardiology and coronary care unit, medicine and aged care, surgery, and general/private practice) and healthcare settings (teaching hospital, geriatric hospital and general/private practice). Results The quality of SDC requests was generally poor across different specialties and healthcare settings. The information provided for the coded parameters was appropriate only in 19.1% (i), 6.4% (ii), 54.7% (iii), 45.8% (iv), 12.8% (v), 32.9% (vi) and 47.1% (vii) of cases. No SDC request was complete in all the information codes. SDC requests from general/private practice lacked more often details regarding the dose (information provided in 46.7% of requests, P = 0.007 vs. other specialties; P = 0.02 vs. other settings) and the route of administration (20.0%, P < 0.001 vs. other specialties and vs. other settings). SDC requests from the emergency department and critical care unit lacked more often details regarding the treatment duration (22.6%, P < 0.001 vs. other specialties) and the time interval between the last dose and blood sampling (40.1%, P = 0.01 vs. other specialties). Conclusions The quality of the information in SDC requests is poor across different specialties and healthcare settings. Educational strategies to ensure the appropriate use of this service are urgently needed. PMID:17073890

Predictors of dental visits among primary school children in the rural Australian community of Lithgow.

PubMed

John, James Rufus; Mannan, Haider; Nargundkar, Subrat; D'Souza, Mario; Do, Loc Giang; Arora, Amit

2017-04-11

Regular dental attendance is significant in maintaining and improving children's oral health and well-being. This study aims to determine the factors that predict and influence dental visits in primary school children residing in the rural community of Lithgow, New South Wales (NSW), Australia. All six primary schools of Lithgow were approached to participate in a cross-sectional survey prior to implementing water fluoridation in 2014. Children aged 6-13 years (n = 667) were clinically examined for their oral health status and parents were requested to complete a questionnaire on fluoride history, diet, last dental visit, and socio-demographic characteristics. Multiple logistic regression analyses were employed to examine the independent predictors of a 6-monthly and a yearly dental visit. Overall, 53% of children visited a dentist within six months and 77% within twelve months. In multiple logistic regression analyses, age of the child and private health insurance coverage were significantly associated with both 6-monthly and twelve-month dental visits. In addition, each serve of chocolate consumption was significantly associated with a 27% higher odds (OR = 1.27, 95% CI: 1.05-1.54) of a 6-monthly dental visit. It is imperative that the socio-demographic and dietary factors that influence child oral health must be effectively addressed when developing the oral health promotion policies to ensure better oral health outcomes.

75 FR 69681 - Proposed Collection; Comment Request; California Health Interview Survey Cancer Control Module...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-15

... State. The CHIS sample is designed to provide statistically reliable estimates statewide, for California... activity, obesity, and human papillomavirus. Additionally, CHIS is designed to be comparable to the National Health Interview Survey (NHIS) data in order to conduct comparative analyses. CHIS provides...

76 FR 2398 - Submission for OMB Review; Comment Request; California Health Interview Survey Cancer Control...

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... designed to provide statistically reliable estimates statewide, for California counties, and for California... papillomavirus. Additionally, CHIS is designed to be comparable to the National Health Interview Survey (NHIS) data in order to conduct comparative analyses. CHIS provides enhanced estimates for cancer risk factors...

76 FR 28098 - Records Schedules; Availability and Request for Comments

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..., housing, medical, educational, and personnel services for Army family members with special needs. The... evaluation data that support analyses and studies relating to educational issues. Proposed for permanent... files and survey reports. 10. Department of Justice, Federal Bureau of Investigation (N1-65- 10-5, 39...

10 CFR 501.34 - Public hearing.

Code of Federal Regulations, 2011 CFR

2011-01-01

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ANALYSIS RESULTS FOR BUILDING 241 702-AZ A TRAIN

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

DUNCAN JB; FRYE JM; COOKE CA

2006-12-13

This report presents the analyses results for three samples obtained under RPP-PLAN-28509, Sampling and Analysis Plan for Building 241 702-AZ A Train. The sampling and analysis was done in response to problem evaluation request number PER-2004-6139, 702-AZ Filter Rooms Need Radiological Cleanup Efforts.

Combining Non–Destructive Magnetic and Raman Spectroscopic Analyses for Mars Sample Return — Powerful Tools In Situ and in Laboratory

NASA Astrophysics Data System (ADS)

Hoffmann, V. H.; Kaliwoda, M.; Hochleitner, R.; Mikouchi, T.; Wimmer, K.

2018-04-01

Very sophisticated, high-end techniques are requested for the investigation of pristine particles from a planetary surface, such as Mars, in situ or in our laboratories, in case of martian meteorites or even returned samples from (future) missions.

10 CFR 52.98 - Finality of combined licenses; information requests.

Code of Federal Regulations, 2011 CFR

2011-01-01

... condition of the combined license, the design of the facility, the inspections, tests, analyses, and acceptance criteria contained in the license which are not derived from a referenced standard design... chapter, as applicable. (b) If the combined license does not reference a design certification or a reactor...

10 CFR 52.98 - Finality of combined licenses; information requests.

Code of Federal Regulations, 2010 CFR

2010-01-01

... condition of the combined license, the design of the facility, the inspections, tests, analyses, and acceptance criteria contained in the license which are not derived from a referenced standard design... chapter, as applicable. (b) If the combined license does not reference a design certification or a reactor...

75 FR 79053 - New Postal Product

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2010-12-17

... POSTAL REGULATORY COMMISSION [Docket Nos. MC2011-7, CP2011-39 and CP2011-40; Order No. 607] New... Service seeks to add Global Plus 1B as a new product, to the competitive product list.\\1\\ The Request has... instant contracts be considered ``the new `baseline' contracts for future functional equivalency analyses...

78 FR 17747 - Agency Information Collection Activities: Request for Comments for a New Information Collection.

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... define the types of analyses to be used to evaluate benefits, cost-effectiveness and feasibility...: Feasibility of Element-Level Bridge Inspection for Non- National Highway System Bridges. Background: The... a requirement for a study on the benefits, cost-effectiveness, and feasibility of requiring element...

Outcomes of a Chemistry Content Professional Learning Session: Teachers' Perspectives

ERIC Educational Resources Information Center

Rowen, Catherine; Woods-McConney, Amanda; Hughes, Leonie; Laird, Damian

2017-01-01

The national curriculum for chemistry includes topics that have not previously been taught at secondary level. In response to requests for teacher professional learning (PL) covering these topics, a course called "Divide and Analyse" was developed. Investigations into the PL needs of chemistry teachers were carried out in conjunction…

Response to Ecological Risk Assessment Forum Request for Information on the Benefits of PCB Congener-Specific Analyses

EPA Science Inventory

In August, 2001, the Ecological Risk Assessment Forum (ERAF) submitted a formal question to the Ecological Risk Assessment Support Center (ERASC) on the benefits of evaluating PCB congeners in environmental samples. This question was developed by ERAF members Bruce Duncan and Cla...

10 CFR 52.98 - Finality of combined licenses; information requests.

Code of Federal Regulations, 2012 CFR

2012-01-01

... condition of the combined license, the design of the facility, the inspections, tests, analyses, and acceptance criteria contained in the license which are not derived from a referenced standard design... chapter, as applicable. (b) If the combined license does not reference a design certification or a reactor...

10 CFR 52.98 - Finality of combined licenses; information requests.

Code of Federal Regulations, 2014 CFR

2014-01-01

... condition of the combined license, the design of the facility, the inspections, tests, analyses, and acceptance criteria contained in the license which are not derived from a referenced standard design... chapter, as applicable. (b) If the combined license does not reference a design certification or a reactor...

10 CFR 52.98 - Finality of combined licenses; information requests.

Code of Federal Regulations, 2013 CFR

2013-01-01

... condition of the combined license, the design of the facility, the inspections, tests, analyses, and acceptance criteria contained in the license which are not derived from a referenced standard design... chapter, as applicable. (b) If the combined license does not reference a design certification or a reactor...

75 FR 3753 - Agency Information Collection Activities: Comment Request for the USGS Mine, Development, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-22

... to make domestic ore resource analyses. Tabulations of volumetric data concerning domestic mining... mined and the resulting marketable product. These data are an indicator of the future mining outlook... the U.S. Geological Survey with domestic production, exploration, and mine development data for...

78 FR 50481 - Request for Public Comments Regarding the National Trade Estimate Report on Foreign Trade Barriers

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2013-08-19

... (e.g., tariffs and other import charges, quantitative restrictions, import licensing, and customs... operate as ``localization barriers to trade''. Localization barriers are measures designed to protect... comparative analyses of a barrier's effect over a range of industries. Requirements for Submissions...

75 FR 47675 - Request for Public Comments To Compile the National Trade Estimate Report on Foreign Trade...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-06

... import charges, quantitative restrictions, import licensing, and customs barriers); (2) SPS measures; (3... assessment procedures, such as mandatory process or design standards, labeling or registration requirements... conduct comparative analyses of a barrier's effect over a range of industries. Requirements for...

75 FR 70939 - Approval of SAYBOLT LP, as a Commercial Gauger and Laboratory

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-19

... Commercial Gauger and Laboratory AGENCY: U.S. Customs and Border Protection, Department of Homeland Security. ACTION: Notice of accreditation and approval of Saybolt LP, as a commercial gauger and laboratory... wishing to employ this entity to conduct laboratory analyses and gauger services should request and...

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

King, David A.

Oak Ridge Associated Universities (ORAU), under the Oak Ridge Institute for Science and Education (ORISE) contract, collected split surface water samples with Nuclear Fuel Services (NFS) representatives on August 21, 2013. Representatives from the U.S. Nuclear Regulatory Commission (NRC) and the Tennessee Department of Environment and Conservation were also in attendance. Samples were collected at four surface water stations, as required in the approved Request for Technical Assistance number 11-018. These stations included Nolichucky River upstream (NRU), Nolichucky River downstream (NRD), Martin Creek upstream (MCU), and Martin Creek downstream (MCD). Both ORAU and NFS performed gross alpha and gross betamore » analyses, and the comparison of results using the duplicate error ratio (DER), also known as the normalized absolute difference, are tabulated. All DER values were less than 3 and results are consistent with low (e.g., background) concentrations.« less

78 FR 6119 - Submission for OMB Review; Comment Request: National Institutes of Health Information Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-29

... National Institutes of Health (NIH) has submitted to the Office of Management and Budget (OMB) a request to... fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to... associated response time, should be directed to the: Office of Management and Budget, Office of Regulatory...

77 FR 47590 - Notice of Request for a Revision to and Extension of Approval of an Information Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-09

... requirements or power calculations that justify the proposed sample size, the expected response rate, methods...] Notice of Request for a Revision to and Extension of Approval of an Information Collection; Qualitative... associated with qualitative customer and stakeholder feedback on service delivery by the Animal and Plant...

76 FR 37057 - Notice of Request for Extension of Approval of an Information Collection; Virus-Serum-Toxin Act...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-24

...] Notice of Request for Extension of Approval of an Information Collection; Virus-Serum-Toxin Act and... approval of an information collection associated with the Virus-Serum-Toxin Act and regulations. DATES: We...: For information on the Virus-Serum- Toxin Act and regulations, contact Dr. Albert Morgan, Section...

78 FR 32229 - Notice of Request for Revision to and Extension of Approval of an Information Collection; Virus...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-29

...] Notice of Request for Revision to and Extension of Approval of an Information Collection; Virus-Serum... associated with the Virus-Serum-Toxin Act and regulations. DATES: We will consider all comments that we... call (202) 799-7039 before coming. FOR FURTHER INFORMATION CONTACT: For information regarding the Virus...

77 FR 50982 - Notice of Request for Extension of Approval of an Information Collection; Foreign Quarantine Notices

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-23

...In accordance with the Paperwork Reduction Act of 1995, this notice announces the Animal and Plant Health Inspection Service's intention to request an extension of approval of an information collection associated with regulations to prevent the introduction or spread of foreign plant pests into or within the United States.

76 FR 71914 - Nondiscrimination on the Basis of Disability in Air Travel: Accessibility of Web Sites and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-21

... Disability in Air Travel: Accessibility of Web Sites and Automated Kiosks at U.S. Airports AGENCY: Office of... January 9, 2012. This extension is a result of requests from a number of parties for additional time to... constructive comments for the Department's consideration. The Interactive Travel Services Association requested...

75 FR 73088 - Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-29

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare and Medicaid Services [CMS-2332-PN... Secretary of the Department of Health and Human Services publish a notice that identifies the national accrediting body making the request, describes the nature of the request, and provides at least a 30-day...

75 FR 48306 - Proposed Information Collection; Comment Request; National Survey of Fishing, Hunting, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-10

...; National Survey of Fishing, Hunting, and Wildlife-Associated Recreation (FHWAR) Cell Phone and Debit Card... operation. The first panel will receive an advance letter with a prepaid cell phone. The advance letter will request that a household member call the telephone center and complete an interview using the cell phone...

75 FR 48304 - Notice of Request for Revision and Extension of Approval of an Information Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-10

... Live Swine, Pork, and Pork Products from Certain Regions Free of Classical Swine Fever in Chile and... revise an information collection associated with regulations for the importation of live swine, pork, and pork products from certain regions free of classical swine fever in Chile and Mexico and to request...

78 FR 58512 - Notice of Request for Extension of Approval of an Information Collection; Swine Health

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-24

...] Notice of Request for Extension of Approval of an Information Collection; Swine Health AGENCY: Animal and... information collection associated with the regulations to prevent the interstate spread of swine diseases and protect swine health. DATES: We will consider all comments that we receive on or before November 25, 2013...

24 CFR 81.85 - Public disclosure of final orders and agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ASSOCIATION (FANNIE MAE) AND THE FEDERAL HOME LOAN MORTGAGE CORPORATION (FREDDIE MAC) Procedures for Actions... with the Secretary a reply to such a request within 5 working days after a request is made or some... must be reduced to writing and filed with the ALJ within 3 working days of the making of the oral order...

Primary care requests for anaemia chemistry tests in Spain: potential iron, transferrin and folate over-requesting.

PubMed

Salinas, Maria; López-Garrigós, Maite; Flores, Emilio; Leiva-Salinas, Carlos

2017-09-01

To study the regional variability of requests for anaemia chemistry tests in primary care in Spain and the associated economic costs of potential over-requesting. Requests for anaemia tests were examined in a cross-sectional study. Clinical laboratories from different autonomous communities (AACCs) were invited to report on primary care anaemia chemistry tests requested during 2014. Demand for iron, ferritin, vitamin B12 and folate tests per 1000 inhabitants and the ratios of the folate/vitamin B12 and transferrin/ferritin requests were compared between AACCs. We also calculated reagent costs and the number of iron, transferrin and folate tests and the economic saving if every AACC had obtained the results achieved by the AACC with best practice. 110 laboratories participated (59.8% of the Spanish population). More than 12 million tests were requested, resulting in reagent costs exceeding €16.5 million. The serum iron test was the most often requested, and the ferritin test was the most costly (over €7 million). Close to €4.5 million could potentially have been saved if iron, transferrin and folate had been appropriately requested (€6 million when extrapolated to the whole Spanish population). The demand for and expenditure on anaemia chemistry tests in primary care in Spain is high, with significant regional differences between different AACCs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Does counsellor's attitude influence change in a request for a caesarean in women with fear of birth?

PubMed

Halvorsen, Lotta; Nerum, Hilde; Sørlie, Tore; Oian, Pål

2010-02-01

the attitudes of two counsellors towards women requesting a caesarean section due to fear of birth were identified. One emphasised the ability to overcome any emotional obstacle to vaginal birth ('coping attitude'), and the other emphasised that the ultimate choice of mode of birth was the womans' ('autonomy attitude'). Two research questions were asked: (1) What are the predictors of change in a wish for a caesarean and of vaginal birth in women with fear of birth? (2) Does a change from an 'autonomy attitude' to a 'coping attitude' increase the number of women who change their request for a caesarean and who give birth vaginally? the study population consisted of two samples of pregnant women with fear of birth and concurrent request for a caesarean, referred for crisis-oriented counselling at the antenatal clinic, University Hospital of North Norway between 2000-2002 (n=86) and 2004-2006 (n=107). Data were gathered from referral letters, counseling and antenatal, intra- and postpartum records. a coping attitude of the counsellor was positively associated with change in the request for a caesarean and with vaginal birth. A change from an autonomy attitude to a coping attitude was associated with a significant increase in the percentage of women who changed their desire for a caesarean from 77 to 93, and who had a vaginal birth from 42 to 81. a coping attitude was strongly associated with change in the desire for a caesarean and giving birth vaginally. A coping attitude can be learned through critical reflection and awareness of the counsellor's attitude, with measurable clinical results. Copyright 2008 Elsevier Ltd. All rights reserved.

An 11-year retrospective experience of antibodies against the voltage-gated potassium channel (VGKC) complex from a tertiary neurological centre.

PubMed

Huda, S; Wong, S H; Pettingill, P; O'Connell, D; Vincent, A; Steiger, M

2015-02-01

Acquired diseases classically associated with VGKC-complex antibodies include peripheral nerve hyperexcitability (PNH), Morvan's syndrome, limbic encephalitis (LE), and epilepsy. However, not all such patients have VGKC-complex antibodies and antibodies have been reported in patients without a defined immune-mediated syndrome. To analyse the clinical relevance of positive VGKC-complex antibodies requested on the basis of initial clinical suspicion. We retrospectively analysed patients with positive VGKC-complex antibodies (>100 pM) referred to our institution between 2001 and 2011. 1,614 VGKC-complex assays were performed in 1,298 patients. Titres >100 pM were detected in 57/1,298 (4 %) patients. A classic VGKC-complex channelopathy (60 %) was associated with VGKC-complex antibody titres >400 pM (p = 0.0004). LGI1 or CASPR2 antibodies were only detected in classic VGKC-complex channelopathies (LE; n = 3/4 and PNH; n = 1/5). VGKC-complex antibody titres <400 pM were seen with PNH (n = 15/22; 68 %) but also a heterogeneous range of central and/or peripheral nervous system disorders. Electromyography was supportive of PNH in 65 % of cases and symptomatic treatment was beneficial in 46 % of patients. Irrespective of titre, the rate of malignancy in patients with VGKC-complex antibodies was higher than the age-matched national incidence of malignancy (OR 19.9, 95 % CI 8.97-44.0 p<0.0001). Clinical phenotyping and antibody titres >400 pM can help determine VGKC-complex antibody relevance. Antibody titres <400 pM are associated with PNH but also a more heterogeneous clinical spectrum. The antibody association in the latter is of doubtful clinical relevance. The rate of malignancy was significantly higher than the national incidence irrespective of titre.

Love Canal Emergency Declaration Area habitability study. Volume 5. Peer review summary: TRC (Technical Review Committee) responses. Final report

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

Not Available

Environmental studies were conducted to provide data that could be used by the Commissioner of Health for the State of New York in determining whether the Emergency Declaration Area surrounding the Love Canal hazardous-waste site is habitable. These volumes (II through IV) were reviewed by a peer-review panel of expert scientists. The scientists concluded that each of the three environmental studies was well planned and well executed. Volume V summarizes the peer review and gives additional information or clarifications as requested during the peer review. Volume V also provides additional supplemental statistical analyses requested by the peer reviewer panel.

Nurses and requests for female genital mutilation: cultural rights versus human rights.

PubMed

Sala, R; Manara, D

2001-05-01

In this article we focus on female genital mutilation. We analyse this problem as one of the most important issues of multiculturalism, which is also coming to the attention of the public in Italy as a consequence of the growing number of immigrants from African countries. The fundamental problem is about the acceptability of this practice: can female genital mutilation be permitted and, if so, on what basis? We will try to cope with this as a genuine conflict between culture-relative values and universal values, such as human rights. Some attention will be drawn to Italian law. Finally, the impact on nurses of requests for genital mutilation will be described.

Using economic evaluations to make formulary coverage decisions. So much for guidelines.

PubMed

Anis, A H; Gagnon, Y

2000-07-01

It is mandatory for drug manufacturers requesting formulary inclusion under the British Columbia (BC) provincial drug plan to submit a pharmacoeconomic analysis according to published guidelines. These submissions are reviewed by the Pharmacoeconomic Initiative (PI) of BC. To assess the compliance of submitted studies with specific criteria outlined in the guidelines, to assess the methodological quality of individual submissions, and to demonstrate the importance of submitting guidelines-compliant pharmacoeconomic analyses. All submissions between January 1996 and April 1999 assessed by the PI of BC were included. Submissions were reviewed according to a checklist to establish compliance with respect to choice of comparator drug, study perspective, sensitivity analysis, analytical horizon and discounting. Submissions were examined for association between analytical technique and author, and between source of submission and compliance. Association between compliance and recommendation for approval was also examined. 95 applications were reviewed. Seven submitted no analyses. There were 25 cost-comparison/consequence, 14 cost-effectiveness, 11 cost-minimisation, 9 cost-utility/benefit and 29 budget-impact analyses. 65 of these 88 submissions failed to comply with guidelines. Of these, 45% used an inappropriate comparator drug, 61% lacked a sensitivity analysis, 73% used a third-party payer and excluded a societal perspective, 66% did not provide a long term evaluation and 25% did not specify any time horizon. 80% of noncompliant studies were cost-comparison/consequence or budget-impact analyses (p < 0.001, Fisher's Exact). Of 25 cost-comparison/consequence and 29 budget-impact analyses, 19 (76%) and 24 (83%), respectively, were industry-conducted, whereas cost-effectiveness (11 of 14) and cost-utility/benefit (6 of 9) analyses were mostly subcontracted to private consultants or academics (p < 0.001, Fisher's Exact). 74% of all submissions (compliant and noncompliant) were not recommended by the PI for listing as a provincial drug plan benefit, 16% received approval for restricted benefit and 9% were recommended as full benefit. 80% of the noncompliant submissions were not recommended (p = 0.06, Fisher's Exact test). Moreover, a strong association between type of analysis and type of recommendation was found (p = 0.03, Fisher's Exact test). Cost-comparison/consequence and budget-impact analyses were less likely to be recommended. IMPLICATIONS OF FINDINGS: Our findings show poor compliance with guidelines, especially among industry-conducted studies. Possible explanations are lack of expertise in pharmacoeconomics and/or scepticism regarding the importance of guidelines and submission quality in decision making. As corroborated by the strong associations between type of recommendation and compliance, and between type of recommendation and type of analysis, these 2 characteristics have a significant impact on decision making.

Female genital cosmetic surgery: Investigating the role of the general practitioner.

PubMed

Harding, Tristan; Hayes, Jenny; Simonis, Magdalena; Temple-Smith, Meredith

2015-01-01

Labiaplasty, the surgical reduction of the labia minora, has significantly increased in demand in Australia. Although general practice is one gatekeeper for patients requesting labiaplasty, as a referral is necessary to claim Medicare entitlements, there is little information available to assist general practitioners (GPs) in managing these requests for female genital cosmetic surgery. Semi-structured interviews were conducted with health professionals, including GPs, gynaecologists and plastic surgeons. Participants were recruited through the Victorian Primary Care Practice-based Research Network (VicReN), clinical teaching hospitals and snowball sampling. All interviews were digitally recorded, transcribed, and analysed using content and thematic analysis. Twenty-seven interviews were conducted. All participants were aware of genital labiaplasty; many had patients who were concerned about genital appearance, for which information had often been sought opportunistically. All participants agreed on the need for resources to inform women of normal genital appearance. This novel study demonstrates a need for clinical resources for GPs managing requests for genital labiaplasty.

Distributed metadata in a high performance computing environment

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

Bent, John M.; Faibish, Sorin; Zhang, Zhenhua

A computer-executable method, system, and computer program product for managing meta-data in a distributed storage system, wherein the distributed storage system includes one or more burst buffers enabled to operate with a distributed key-value store, the co computer-executable method, system, and computer program product comprising receiving a request for meta-data associated with a block of data stored in a first burst buffer of the one or more burst buffers in the distributed storage system, wherein the meta data is associated with a key-value, determining which of the one or more burst buffers stores the requested metadata, and upon determination thatmore » a first burst buffer of the one or more burst buffers stores the requested metadata, locating the key-value in a portion of the distributed key-value store accessible from the first burst buffer.« less

Pre-travel consultation: evaluation of primary care physician practice in the Franche-Comté region.

PubMed

Piotte, Emeline; Bellanger, Anne-Pauline; Piton, Gaël; Millon, Laurence; Marguet, Philippe

2013-01-01

Primary care physicians (PCP) are first in line to provide adequate pre-travel medical advice. Little data are available on the content of pre-travel PCP consultations in France. We undertook an observational survey to assess the level of specific knowledge among PCPs on health advice, vaccinations, and malaria prophylaxis. Standardized questionnaires were sent to a random sample of 400 PCPs practicing in the Franche-Comté regions (eastern France) who were asked to complete and return it on a voluntary and anonymous basis. The questionnaire requested sociodemographic details, practice-related characteristics, and proposed three clinical situations with multiple choice questions (MCQ). To identify factors associated with a higher level of specific knowledge in travel medicine, results were studied by uni- and multivariate analyses. An overall score was calculated based on the MCQ answers and a motivation score was calculated based on parameters such as frequency and developments in pre-travel consulting at the practice, PCPs' personal experience as travelers, and the formal agreement of PCPs to administer yellow fever vaccination. The response rate was 37.5%, with 150 questionnaires returned completed and suitable for analysis. After multivariate logistic regression, the three variables associated with a higher score were: proximity of a vaccination center (p = 0.001), motivation score (p = 0.004), and absence of request for expert advice on malaria prophylaxis (p = 0.007). PCPs play an important role in travel medicine. This study showed that their high level of knowledge in travel medicine was mostly linked to their motivation to practice in this specialized discipline. © 2013 International Society of Travel Medicine.

Mutations in the autoinflammatory cryopyrin-associated periodic syndrome gene: epidemiological study and lessons from eight years of genetic analysis in France.

PubMed

Cuisset, L; Jeru, I; Dumont, B; Fabre, A; Cochet, E; Le Bozec, J; Delpech, M; Amselem, S; Touitou, I

2011-03-01

Cryopyrin-associated periodic syndromes (CAPS) consist of a continuum of autoinflammatory diseases caused by a defect in interleukin 1β regulation. Although symptoms may vary widely, the discovery, in 2001, of the gene involved (NLRP3) has dramatically helped diagnosis. To define the spectrum and prevalence of NLRP3 mutations in France and to delineate initial criteria before molecular analysis. Retrospective review (2001-9) of genetic analysis data and request forms of patients living in France with an NLRP3 mutation since the set up of CAPS molecular diagnosis by the three French laboratories providing this test (GenMAI network). Over 800 analyses of this gene have been conducted, identifying 135 cases with an NLRP3 mutation (55 probands; 33 multiplex families); the estimated prevalence in France was equal to 1/360 000. A total of 21 different sequence variants were detected, among which four are common and nine are new mutations. Although the number of NLRP3 test requests has doubled over the past 5 years, genetic screening has not contributed to enhanced detection of new index cases each year. There are two possible reasons for this: (i) no clinical prerequisite for genetic diagnosis and (ii) few new large families are now identified (unlike the initial study based on a selection by linkage). A set of initial clinical criteria have been drawn up which it is recommended should be fulfilled before a patient is tested: at least three recurrent bouts, age at disease onset < 20 years and elevated levels of C-reactive protein, especially in individuals with urticaria and moderate fever.

Oral and non oral diseases and conditions associated with bad breath.

PubMed

Migliario, M; Rimondini, L

2011-03-01

The causes of bad breath are numerous and related to conditions dependent or not on oral and general health. The aim of our observational study is the assessment of the simultaneous relationships between halitosis, oral and/or nonoral diseases, and lifestyles using the principal components analysis of categorical data (CATPCA) to identify the main components involved in the detection of the symptom. A sample of 192 patients, who requested general dental examination at the Dental Clinic, participated at the study. Alimentary and voluptuary habits, general health information, drugs assumption, the status of teeth and intraoral medical devices including fillers, lesions of the oral mucosa, tongue coating score (TCS), plaque index (PI), probing bleeding index (PBI) and organoleptic tests were all evaluated. Data were analysed using CATPCA model. A strong relationship between halitosis and plaque, probing bleeding and tongue coating indexes was observed, whereas incongruous fillers, prostheses, systemic pathologies or diet were not clearly associated with halitosis probably because their effects on breath were clinically sheltered by the periodontal condition. The data of our observational study confirm that halitosis is more indicative of tongue coating and periodontal disease, rather than other oral and non oral associated conditions, like systemic pathologies or specific habits of life.

78 FR 66945 - Proposed Collection; 60-Day Comment request: Gulf Long-Term Follow-Up Study (GuLF STUDY)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-07

... Comment request: Gulf Long-Term Follow-Up Study (GuLF STUDY) Summary: In compliance with the requirement... days of the date of this publication. Proposed Collection: Gulf Long-Term Follow-Up Study (GuLF STUDY... GuLF STUDY is to investigate potential short- and long-term health effects associated with oil spill...

State Assessment Program Item Banks: Model Language for Request for Proposals (RFP) and Contracts

ERIC Educational Resources Information Center

Swanson, Leonard C.

2010-01-01

This document provides recommendations for request for proposal (RFP) and contract language that state education agencies can use to specify their requirements for access to test item banks. An item bank is a repository for test items and data about those items. Item banks are used by state agency staff to view items and associated data; to…

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

PubMed

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

2011-03-01

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

Tobacco smoking trajectory and associated ethnic differences among adolescent smokers seeking cessation treatment.

PubMed

Robinson, Miqun L; Berlin, Ivan; Moolchan, Eric T

2004-09-01

To examine smoking trajectories in a clinical sample of adolescent smokers seeking cessation treatment, including: (a) smoking onset (initial, daily) and time intervals from initial to daily smoking and from daily smoking to treatment request, (b) associations between current level of tobacco dependence and smoking history, and (c) differences in smoking trajectory between African-American and non-African-American youth. Four hundred and thirty-two adolescent smokers (aged 13-17 years, 61.8% female, 32% African-American) responding to various media advertisement completed a telephone interview as part of pre-eligibility screening for a smoking cessation trial. Smoking trajectory data included age at onset of initial and daily smoking, intervals between those time points, and cigarettes smoked per day (CPD). Tobacco dependence was assessed using the Fagerström Test for Nicotine Dependence (FTND). Data were analyzed using regression models and multiple analyses of covariance. Initial smoking occurred at a mean age of less than 12 years and daily smoking at age 13 years. Earlier onset of daily smoking was associated with higher FTND scores and longer duration from daily smoking to treatment request. For the entire sample, the time interval from initial to daily smoking was 1.14 years. When the sample was divided into early (before age 14 years) and later (at or after age 14 years) initiators, early initiators showed a slower progression from initial to daily smoking compared with late initiators (16 months vs. 6 months). Compared with non-African-American teen smokers, African-American youth reported a 1-year delay in onset of both initial and daily smoking. Early age of daily smoking and short time interval from initial to daily smoking highlight a brief window of opportunity to prevent the development of tobacco addiction and its consequences. Ethnic differences in smoking trajectory uncovered in this report call for ethnically tailored interventions to reduce youth smoking.

Cronobacter, the emergent bacterial pathogen Enterobacter sakazakii comes of age; MLST and whole genome sequence analysis.

PubMed

Forsythe, Stephen J; Dickins, Benjamin; Jolley, Keith A

2014-12-16

Following the association of Cronobacter spp. to several publicized fatal outbreaks in neonatal intensive care units of meningitis and necrotising enterocolitis, the World Health Organization (WHO) in 2004 requested the establishment of a molecular typing scheme to enable the international control of the organism. This paper presents the application of Next Generation Sequencing (NGS) to Cronobacter which has led to the establishment of the Cronobacter PubMLST genome and sequence definition database (http://pubmlst.org/cronobacter/) containing over 1000 isolates with metadata along with the recognition of specific clonal lineages linked to neonatal meningitis and adult infections Whole genome sequencing and multilocus sequence typing (MLST) has supports the formal recognition of the genus Cronobacter composed of seven species to replace the former single species Enterobacter sakazakii. Applying the 7-loci MLST scheme to 1007 strains revealed 298 definable sequence types, yet only C. sakazakii clonal complex 4 (CC4) was principally associated with neonatal meningitis. This clonal lineage has been confirmed using ribosomal-MLST (51-loci) and whole genome-MLST (1865 loci) to analyse 107 whole genomes via the Cronobacter PubMLST database. This database has enabled the retrospective analysis of historic cases and outbreaks following re-identification of those strains. The Cronobacter PubMLST database offers a central, open access, reliable sequence-based repository for researchers. It has the capacity to create new analysis schemes 'on the fly', and to integrate metadata (source, geographic distribution, clinical presentation). It is also expandable and adaptable to changes in taxonomy, and able to support the development of reliable detection methods of use to industry and regulatory authorities. Therefore it meets the WHO (2004) request for the establishment of a typing scheme for this emergent bacterial pathogen. Whole genome sequencing has additionally shown a range of potential virulence and environmental fitness traits which may account for the association of C. sakazakii CC4 pathogenicity, and propensity for neonatal CNS.

Propensity for obtaining alcohol through shoulder tapping.

PubMed

Toomey, Traci L; Fabian, Lindsey E A; Erickson, Darin J; Lenk, Kathleen M

2007-07-01

Underage youth often obtain alcohol from adults who illegally provide the alcohol. One method for obtaining alcohol from adults is shoulder tapping, where youth approach an adult outside an alcohol establishment and ask the adult to purchase alcohol for them. The goal of this study was to assess what percentage of the general and youth-targeted adult population approached outside of a convenience/liquor store will agree to purchase and then provide alcohol to individuals who appear under age 21. We conducted 2 waves of pseudo-underage shoulder tap request attempts, using requesters who were age 21 or older but appeared 18 to 20 years old. In both waves, requests were conducted at randomly selected liquor and convenience stores, requesters explained that the reason they were asking the adult was because they did not have their identification with them, and requesters asked the adults to purchase a 6-pack of beer. During wave 1, we conducted 102 attempts, with the requester approaching the first adult entering the store alone. During wave 2, we conducted 102 attempts where the requester approached the first casually dressed male entering the store alone who appeared to be 21 to 30 years old. During wave 1, 8% of the general sample of approached adults provided alcohol to the pseudo-underage requesters. The odds of adults providing alcohol in urban areas were 9.4 times greater than in suburban areas. During wave 2, 19% of the approached young men provided alcohol to the requesters. No requester, request attempt, establishment, or community characteristics were associated with request attempt outcomes during wave 2. A small percentage of the general population of adults will agree to provide alcohol to underage youth when approached outside an alcohol establishment. The likelihood of underage youth obtaining alcohol through shoulder tapping increases substantially if the youth approach young men.

Educational Action Research to Achieve the Essential Competencies of the Future

ERIC Educational Resources Information Center

Kapenieks, Janis

2016-01-01

This article analyses the conformity of the educational action research (EAR) process for the improvement of selected competencies that will be necessary in the near future for each active and responsible person. The most requested competencies in the near and midterm future are determined in accordance with near future structural requirements of…

40 CFR 63.7521 - What fuel analyses and procedures must I use?

Code of Federal Regulations, 2010 CFR

2010-07-01

..., at a point prior to mixing with other dissimilar fuel types. (iv) For each fuel type, the analytical methods, with the expected minimum detection levels, to be used for the measurement of selected total metals, chlorine, or mercury. (v) If you request to use an alternative analytical method other than those...

Employers' Skill Preferences across Europe: Between Cognitive and Non-Cognitive Skills

ERIC Educational Resources Information Center

Mýtna Kureková, Lucia; Beblavý, Miroslav; Haita, Corina; Thum, Anna-Elisabeth

2016-01-01

This article analyses online job advertisements to identify skills that are demanded in selected low- and medium-skilled occupations. We explore data from the publicly administered cross-European EURES job search portal and quantify the different cognitive and non-cognitive skills requested by employers in small European economies. While we find…

76 FR 76215 - Privacy Act; System of Records: State-78, Risk Analysis and Management Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-06

... network. Vetting requests, analyses, and results will be stored separately on a classified computer... DEPARTMENT OF STATE [Public Notice 7709] Privacy Act; System of Records: State-78, Risk Analysis... a system of records, Risk Analysis and Management Records, State-78, pursuant to the provisions of...

77 FR 12853 - Draft Guidances Relating to the Development of Biosimilar Products; Public Hearing; Request for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-02

... Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 51, Rm. 6340, Silver... the review of 351(k) applications and general scientific principles in conducting comparative analyses... specific, on the scientific considerations, Q&A, and quality considerations draft guidances. For example...

76 FR 54507 - Proposed Generic Communication; Draft NRC Generic Letter 2011-XX: Seismic Risk Evaluations for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-01

... design estimates. Analyses performed under the Generic Issue program (GIP) indicated the need to evaluate... Examination of External Events (IPEEE) for Severe Accident Vulnerabilities,'' (ADAMS Accession No. ML031150485) to request that each licensee identify and report to the NRC all plant- specific vulnerabilities to...

A Descriptive Analysis of the Principal Workforce in Wisconsin. Issues & Answers. REL 2012-No. 135

ERIC Educational Resources Information Center

Clifford, Matthew; Condon, Chris; Greenberg, Ariela; Williams, Ryan; Gerdeman, R. Dean; Fetters, Jenni; Baker, Bruce

2012-01-01

This study responds to a request from the Wisconsin Department of Public Instruction for information on Wisconsin's school principal workforce population. Descriptive analyses addressed two research questions: (1) How do the demographic characteristics of Wisconsin school principals compare how did these characteristics change over 1999-2009?; and…

NCO Systems Integration

Science.gov Websites

: AWC CPC EMC NCO NHC OPC SPC SWPC WPC Search by city or zip code. Press enter or select the go button to submit request Local forecast by "City, St" City, St Go Search NCEP Go NCEP Quarterly Surface Analysis Product Loops Environmental Models Product Info Current Status Model Analyses &

NCEP Decoder Web Site

Science.gov Websites

: AWC CPC EMC NCO NHC OPC SPC SWPC WPC Search by city or zip code. Press enter or select the go button to submit request Local forecast by "City, St" City, St Go Search NCEP Go NCEP Quarterly Surface Analysis Product Loops Environmental Models Product Info Current Status Model Analyses &

NCO Mail Webmaster

Science.gov Websites

: AWC CPC EMC NCO NHC OPC SPC SWPC WPC Search by city or zip code. Press enter or select the go button to submit request Local forecast by "City, St" City, St Go Search NCEP Go NCEP Quarterly Surface Analysis Product Loops Environmental Models Product Info Current Status Model Analyses &

Environmental Quality Research and Development. A Review and Analysis of Federal Programs.

ERIC Educational Resources Information Center

Executive Office of the President, Washington, DC.

This is the first interagency report on Federal environmental quality research and development programs that presents program descriptions, levels of funding, and analyses. Undertaken at the request of the Federal Council for Science and Technology, the study may be useful in identifying environmental quality research and development programs in…

What happens when the doctor denies a patient's request? A qualitative interview study among general practitioners in Norway.

PubMed

Nilsen, Stein; Malterud, Kirsti

2017-06-01

To explore general practitioners (GPs') experiences from consultations when a patient's request is denied, and outcomes of such incidents. We conducted a qualitative study with semi-structured individual interviews with six GPs in Norway. We asked them to tell about experiences from specific encounters where they had refused a patient's request. The texts were analysed with Systematic Text Condensation, a method for thematic cross-case analysis. Accounts of experiences from consultations when GPs refused their patients' requests. Subjects of dispute included clinical topics like investigation and treatment, certification regarding welfare benefits and medico-legal issues, and administrative matters. The arguments took different paths, sometimes settled by reaching common ground but more often as unresolved disagreement with anger or irritation from the patient, sometimes with open hostility and violence. The aftermath and outcomes of these disputes lead to strong emotional impact where the doctors reflected upon the incidents and sometimes regretted their handling of the consultation. Some long-standing and close patient-doctor relationships were injured or came to an end. The price for denying a patient's request may be high, and GPs find themselves uncomfortable in such encounters. Skills pertaining to this particular challenge could be improved though education and training, drawing attention to negotiation of potential conflicts. Also, the notion that doctors have a professional commitment to his or her own autonomy and to society should be restored, through increased emphasis on core professional ethics in medical education at all levels.

Maternal deaths in eastern Indonesia: 20 years and still walking: an ethnographic study

PubMed Central

2014-01-01

Background The delays in receiving adequate emergency maternal care described by Thaddeus and Maine twenty years ago are still occurring, as exemplified in this study of cases of maternal deaths in a subdistrict in rural eastern Indonesia. Methods An ethnographic design was conducted, recruiting eleven families who reported on cases of maternal deaths in one sub-district of Indonesia, as well as assessing the geographical and cultural context of the villages. Traditional birth attendants and village leaders provided information to the research team which was thematically and contextually analysed. Results Two stages to the first and second delays have been differentiated in this study. First, delays in the decision to seek care comprised time taken to recognise (if at all) that an emergency situation existed, followed by time taken to reach a decision to request care. The decision to request care resided variously with the family or cadre. Second, delays in reaching care comprised time taken to deliver the request for help and then time for help to arrive. A phone was not available to request care in many cases and so the request was delivered by walking or motorbike. In two cases where the decision to seek care and the delivery of the request happened in a timely way, help was delayed because the midwife and ambulance respectively were unavailable. Conclusions This study, although a small sample, confirmed that either a single delay or a sequence of delays can prove fatal. Delays were determined by both social and geographic factors, any of which alone could be limiting. Initiatives to improve maternal health outcomes need to address multiple factors: increased awareness of equitable access to maternal health care, village preparedness for emergency response, improved access to telecommunications and geographic access. PMID:24447873

Review of Restricted Experiment Requests, Division of Select Agents and Toxins, Centers for Disease Control and Prevention, 2006-2013

PubMed Central

Smith, Jacinta; Weyant, Robbin

2015-01-01

The Centers for Disease Control and Prevention (CDC) Division of Select Agents and Toxins (DSAT) regulates laboratories that possess, use, or transfer select agents and toxins in the United States. DSAT also mitigates biosafety risks through the review of “restricted experiments,” which under the select agent regulations are experiments that pose heightened biosafety risks. From January 2006 through December 2013, DSAT received 618 requests from 109 entities to perform potentially restricted experiments. Of these requests, 85% were determined not to meet the regulatory definition of a restricted experiment, while 15% of the requests met the definition of a restricted experiment. Of the 91 restricted experiments proposed, DSAT approved 31 (34%) requests because the biosafety conditions proposed were commensurate with the experiments' biosafety risk. All 31 approved restricted experiments were for work with select toxins. DSAT did not approve 60 restricted experiment requests due to potentially serious biosafety risks to public health and safety. All 60 denied restricted experiments proposed inserting drug resistance traits into select agents that could compromise the control of disease. The select agents and toxins associated most frequently with requests that met the regulatory definition of a restricted experiment are Shiga toxin (n = 16), Burkholderia mallei (n = 15), Botulinum neurotoxin (n = 14), and Brucella abortus (n = 14). In general, all restricted experiment decisions are determined on a case-by-case basis. This article describes the trends and characteristics of the data associated with restricted experiment requests among select agents that have an impact on public health and safety (HHS only agents) or both public health and safety and animal health or products (overlap agents). The information presented here, coupled with the information published in the restricted experiment guidance document (www.selectagents.gov), is intended to promote awareness among the research community of the type of experiments that meet the regulatory definition of a restricted experiment as well as to provide a greater understanding of the restricted experiment review process. PMID:26347984

77 FR 71462 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-30

... for an independent public accountant to examine the financial statements was approximately $46,300 per... costs associated with Rule 17a-12. However, the cost associated with an independent accountant's...

Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations.

PubMed

Everson, Jordan; Kocher, Keith E; Adler-Milstein, Julia

2017-04-01

To assess whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations. Our data included 2163 patients seen in the ED of a large academic medical center for whom clinicians requested and viewed outside information from February 14, 2014, to February 13, 2015. Outside information requests w.ere fulfilled via HIE (Epic's Care Everywhere) or fax/scan to the electronic health record (EHR). We used EHR audit data to capture the time between the information request and when a clinician accessed the data. We assessed whether the relationship between method of information return and ED outcomes (length of visit, odds of imaging [computed tomography (CT), magnetic resonance imaging (MRI), radiographs] and hospitalization, and total charges) was mediated by request-to-access time, controlling for patient demographics, case mix, and acuity. In multivariate analysis, there was no direct association between return of information via HIE vs fax/scan and ED outcomes. HIE was associated with faster outside information access (58.5 minutes on average), and faster access was associated with changes in ED care. For each 1-hour reduction in access time, visit length was 52.9 minutes shorter, the likelihood of imaging was lower (by 2.5, 1.6, and 2.4 percentage points for CT, MRI, and radiographs, respectively), the likelihood of admission was 2.4 percentage points lower, and average charges were $1187 lower ( P  ≤ .001 for all). The relationship between HIE and improved care processes and reduced utilization in the ED is mediated by faster accessing of information from outside organizations. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Evaluation of pseudoephedrine pharmacy sales before and after mandatory recording requirements in Western Australia: a case study.

PubMed

Hattingh, Hendrika Laetitia; Varsani, Janki; Kachouei, Leila Ataei; Parsons, Richard

2016-08-30

A community pharmacy real-time electronic recording program, ProjectSTOP, enables Australian community pharmacists to verify pseudoephedrine requests. In Western Australia the program was available for voluntary use from April 2007 and became mandatory November 2010. This case study explores the effectiveness of the program by reviewing the total requests for pseudoephedrine products, and the proportion of requests which were classified as 'denied sales' before and after mandatory implementation. Seasonal and annual trends in these measures are also evaluated. ProjectSTOP data recordings for Western Australia pharmacies between 1 December 2007 and 28 February 2014 were analysed. Data included a de-identified pharmacy number and date of each pseudoephedrine product request. The total number of requests and sale classification (allowed, denied, safety, or not recorded) were calculated for each month/pharmacy. The potential influence of mandatory reporting using ProjectSTOP was investigated using a Regression Discontinuity Design. Correlations between sales from the same pharmacy were taken into account by classifying the pharmacy number as a random effect. The main effects of year (continuous variable), and season (categorical variable) were also included in the model. There was a small but steady decline in the total requests for pseudoephedrine per month per 100,000 population (per pharmacy) from the time of mandatory reporting. The number of denied sales showed a steady increase up until mandatory reporting, after which it showed a significant decline over time. Total sales were heavily influenced by season, as expected (highest in winter, least in summer). The seasonal pattern was less pronounced for denied sales, which were highest in winter and similar across other seasons. The pattern over time for safety sales was similar to that for denied sales, with a clear change occurring around the time of mandatory reporting. Results indicate a decrease in pseudoephedrine product requests in Western Australia community pharmacies. Findings suggest ProjectSTOP has been successful in addressing suspicious sales and potential diversion however ongoing data review is recommended.

[Euthanasia: legal comparison in selected European countries].

PubMed

Doležal, Adam

2018-01-01

This article deals with the subject of euthanasia (all its forms) and other end-of-life decisions, such as assisted suicide, withdrawing and whithholding life-sustaining treatments. Among other things, the article will also deal with the issue of the offense of Homicide by the Victims Request. Based on an empirical historical method, the article compares the various selected legal orders. From this analysis, it draws some conclusions that have an impact on ethical discourse. First of all, the terminology is defined in the article, which is very important in this area. Further, German law is being analysed, with emphasis on Nazi Germany. On that basis, the so-called reductio ad Hitlerum argument is rejected. Research continues and is followed by another states, the Netherlands, Belgium and Switzerland. By analysing them, the following ethical arguments used in euthanasia debates are examined: the argument of a slippery slope and the argument of respect for autonomy. Finally, the judgment of the European Court of Human Rights in the Pretty case is also analysed. On this case, we can demonstrate, how insufficient is argument of human dignity. The last part is dedicated to the Czech Republic and its legal order. Firstly, it focuses on the history of the legal regulation of euthanasia, but the main part deals with the current legal situation. In addition to the recent state of affairs, the bill of Death with dignity act is also being examined. At the end of the article it is pointed out that the Czech regulation is insufficient and changes are necessary. However, the proposed bill of Death with dignity act is not the right way to follow. Rather, it may be wise to adopt an amendment to the Penal Code that would introduce the offense of Homicide by the Victims Request.Key words: assisted suicide - euthanasia - Homicide by the Victims Request - medical futility - withdrawing and whithholding life-sustaining treatment.

Using routine diagnostic data as a method of surveillance of arboviral infection in travellers: a comparative analysis with a focus on dengue.

PubMed

Cleton, Natalie; Reusken, Chantal; Murk, Jean-Luc; de Jong, Menno; Reimerink, Johan; van der Eijk, Annemiek; Koopmans, Marion

2014-01-01

In a large part of the developing world, limited infectious disease surveillance is performed. In laboratory information management systems data on diagnostic requests is available and may be amenable to trend analyses. We explored this potential, using DENV diagnostic requests as a model. Test results and anonymised information provided by clinicians were received for 8942 patients from diagnostic centres in the Netherlands from January 2000 to May 2011. The data were evaluated for completeness of a predefined minimal dataset and trends in DENV positive results by travel destination. Population travel data were obtained from a commercial registry, and dengue case notification data by country from WHO DengueNet. Vaccination history was rarely reported (0.4%); travel destination was completed for 42% of requests; trends in diagnostic requests and IgM positive tests for this subset correlated to the WHO DENV notifications for the three main travel destinations, with some discrepancies. Additionally, this approach may provide information on disease outbreaks with other pathogens causing diseases clinically similar to DENV. PCR data proved to be insufficient for trend monitoring by country. This approach is not straightforward, but shows potential for use as a source of additional information for surveillance of disease. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Patient identification errors and biological samples in the analytical process: Is it possible to improve patient safety?].

PubMed

Cuadrado-Cenzual, M A; García Briñón, M; de Gracia Hills, Y; González Estecha, M; Collado Yurrita, L; de Pedro Moro, J A; Fernández Pérez, C; Arroyo Fernández, M

2015-01-01

Patient identification errors and biological samples are one of the problems with the highest risk factor in causing an adverse event in the patient. To detect and analyse the causes of patient identification errors in analytical requests (PIEAR) from emergency departments, and to develop improvement strategies. A process and protocol was designed, to be followed by all professionals involved in the requesting and performing of laboratory tests. Evaluation and monitoring indicators of PIEAR were determined, before and after the implementation of these improvement measures (years 2010-2014). A total of 316 PIEAR were detected in a total of 483,254 emergency service requests during the study period, representing a mean of 6.80/10,000 requests. Patient identification failure was the most frequent in all the 6-monthly periods assessed, with a significant difference (P<.0001). The improvement strategies applied showed to be effective in detecting PIEAR, as well as the prevention of such errors. However, we must continue working with this strategy, promoting a culture of safety for all the professionals involved, and trying to achieve the goal that 100% of the analytical and samples are properly identified. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

Potential negative impacts of nuclear activities on local economies: Rethinking the issue

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

Metz, W.C.

1994-10-01

Surveys of public opinion about perceptions of risk associated with the nuclear fuel cycle have shown that the public professes a widespread feeling of dread, a fear of associated stigmas, and a concern about possible catastrophic nuclear accidents. Various interest groups and state governments that oppose congressionally mandated siting of centralized high-level radioactive waste (HLW) storage and disposal facilities are using this negative imagery to create a powerful, emotional obstacle to the siting process. From statistical analyses of images and location preferences, researchers have claimed that possible significant economic losses could potentially accompany the siting of HLW facilities. However, severalmore » paradoxes, or self-contradictory statements, apparently exist between the responses expressed in surveys and the actual economic and demographic behavior evidenced in the marketplace. Federal policymakers need to evaluate whether the request for a change in siting policy is based on subjective fear of a potential negative economic effect or on proven negative effects. Empirically observed behavior does not support predicted negative economic effects based on survey responses. 41 refs.« less

Analysis of the availability of the resources necessary for urgent and emergency healthcare in São Paulo between 2009-2013.

PubMed

Coimbra, Silvana Hebe; Camanho, Eliete Dominguez Lopez; Heringer, Lindolfo Carlos; Botelho, Ricardo Vieira; Vasconcellos, Cidia

2017-06-01

The Regulatory Complex is the structure that operationalizes actions for making resources available to meet the needs of urgent and emergency care in the municipality of São Paulo. In the case of urgent care, needs are immediate and associated with high morbidity and mortality. To identify the most frequently requested resources, the resolution capacity and the mortality rate associated with the unavailability of a certain resource. Our study was based on data from medical bulletins issued by the Urgent and Emergency Regulation Center (CRUE) in the city of São Paulo from 2009 to 2013. 91,823 requests were made over the five years of the study (2009 to 2013). Neurosurgery requests were the most frequent in all years (4,828, 5,159, 4,251, 5,008 and 4,394, respectively), followed by computed tomography (CT) scans, adult intensive care unit (ICU) beds, cardiac catheterization, and pediatric ICU beds. On average, requests for neurosurgery, adult ICU, pediatric ICU, CT scans, catheterization and vascular surgery were answered in 70%, 27%, 39%, 97%, 87% and 77% of cases. The total number of deaths relating to requests for neurosurgery, CT scans, adult ICU, pediatric ICU, catheterization and vascular surgeon assessment were 182, 9, 1,536, 1,536, 135, 49 and 24 cases, respectively. There is a lack of resources to meet urgent and emergency needs in the city of São Paulo.

The Primary Care Electronic Library (PCEL) five years on: open source evaluation of usage.

PubMed

Robinson, Judas; de Lusignan, Simon; Kostkova, Patty

2005-01-01

The Primary Care Electronic Library (PCEL) is a collection of indexed and abstracted internet resources. PCEL contains a directory of quality-assured internet material with associated search facilities. PCEL has been indexed, using metadata and established taxonomies. Site development requires an understanding of usage; this paper reports the use of open source tools to evaluate usage. This evaluation was conducted during a six-month period of development of PCEL. To use open source to evaluate changes in usage of an electronic library. We defined data we needed for analysis; this included: page requests, visits, unique visitors, page requests per visit, geographical location of users, NHS users, chronological information about users and resources used. During the evaluation period, page requests increased from 3500 to 10,000; visits from 1250 to 2300; and unique visitors from 750 to 1500. Up to 83% of users come from the UK, 15% were NHS users. The page requests of NHS users are slowly increasing but not as fast as requests by other users in the UK. PCEL is primarily used Monday to Friday, 9 a.m. to 5 p.m. Monday is the busiest day with use lessening through the week. NHS users had a different list of top ten resources accessed than non-NHS users, with only four resources appearing in both. Open source tools provide useful data which can be used to evaluate online resources. Improving the functionality of PCEL has been associated with increased use.

Array processor architecture connection network

NASA Technical Reports Server (NTRS)

Barnes, George H. (Inventor); Lundstrom, Stephen F. (Inventor); Shafer, Philip E. (Inventor)

1982-01-01

A connection network is disclosed for use between a parallel array of processors and a parallel array of memory modules for establishing non-conflicting data communications paths between requested memory modules and requesting processors. The connection network includes a plurality of switching elements interposed between the processor array and the memory modules array in an Omega networking architecture. Each switching element includes a first and a second processor side port, a first and a second memory module side port, and control logic circuitry for providing data connections between the first and second processor ports and the first and second memory module ports. The control logic circuitry includes strobe logic for examining data arriving at the first and the second processor ports to indicate when the data arriving is requesting data from a requesting processor to a requested memory module. Further, connection circuitry is associated with the strobe logic for examining requesting data arriving at the first and the second processor ports for providing a data connection therefrom to the first and the second memory module ports in response thereto when the data connection so provided does not conflict with a pre-established data connection currently in use.

78 FR 8599 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... for an independent public accountant to examine the financial statements was approximately $46,300 per... costs associated with Rule 17a-12. However, the cost associated with an independent accountant's...

Treatment Study Plan for Nitrate Salt Waste Remediation Revision 1.0

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

Juarez, Catherine L.; Funk, David John; Vigil-Holterman, Luciana R.

2016-03-07

The two stabilization treatment methods that are to be examined for their effectiveness in the treatment of both the unremediated and remediated nitrate salt wastes include (1) the addition of zeolite and (2) cementation. Zeolite addition is proposed based on the results of several studies and analyses that specifically examined the effectiveness of this process for deactivating nitrate salts. Cementation is also being assessed because of its prevalence as an immobilization method used for similar wastes at numerous facilities around the DOE complex, including at Los Alamos. The results of this Treatment Study Plan will be used to provide themore » basis for a Resource Conservation and Recovery Act (RCRA) permit modification request of the LANL Hazardous Waste Facility Permit for approval by the New Mexico Environment Department-Hazardous Waste Bureau (NMED-HWB) of the proposed treatment process and the associated facilities.« less

How Should Clinicians Respond to Medical Requests from Clinician Family Members of Patients?

PubMed

Thurston, Andrew

2017-04-01

In the medical profession, receiving a request for medical management from a colleague is a routine experience. However, when the colleague is a family member of a patient and the desired or requested medical intervention is not medically indicated in the attending physician's view, the situation becomes more complicated. Ethical issues include respect for patient autonomy and social justice as well as nonmaleficence. Furthermore, interpersonal and professional relationships may be tested in this situation. Addressing the colleague's concerns with empathy and respect, without compromising one's own medical judgment, is critical in resolving these kinds of conflicts. © 2017 American Medical Association. All Rights Reserved.

Generating the evidence for risk reduction: a contribution to the future of food-based dietary guidelines.

PubMed

Schwingshackl, Lukas; Schlesinger, Sabrina; Devleesschauwer, Brecht; Hoffmann, Georg; Bechthold, Angela; Schwedhelm, Carolina; Iqbal, Khalid; Knüppel, Sven; Boeing, Heiner

2018-04-30

A major advantage of analyses on the food group level is that the results are better interpretable compared with nutrients or complex dietary patterns. Such results are also easier to transfer into recommendations on primary prevention of non-communicable diseases. As a consequence, food-based dietary guidelines (FBDG) are now the preferred approach to guide the population regarding their dietary habits. However, such guidelines should be based on a high grade of evidence as requested in many other areas of public health practice. The most straightforward approach to generate evidence is meta-analysing published data based on a careful definition of the research question. Explicit definitions of study questions should include participants, interventions/exposure, comparisons, outcomes and study design. Such type of meta-analyses should not only focus on categorical comparisons, but also on linear and non-linear dose-response associations. Risk of bias of the individual studies of the meta-analysis should be assessed, rated and the overall credibility of the results scored (e.g. using NutriGrade). Tools such as a measurement tool to assess systematic reviews or ROBIS are available to evaluate the methodological quality/risk of bias of meta-analyses. To further evaluate the complete picture of evidence, we propose conducting network meta-analyses (NMA) of intervention trials, mostly on intermediate disease markers. To rank food groups according to their impact, disability-adjusted life years can be used for the various clinical outcomes and the overall results can be compared across the food groups. For future FBDG, we recommend to implement evidence from pairwise and NMA and to quantify the health impact of diet-disease relationships.

Organ Donation in Switzerland - An Analysis of Factors Associated with Consent Rate

PubMed Central

Keel, Isabelle; Immer, Franz F.; Jüni, Peter

2014-01-01

Background and Aim Switzerland has a low post mortem organ donation rate. Here we examine variables that are associated with the consent of the deceased’s next of kin (NOK) for organ donation, which is a prerequisite for donation in Switzerland. Methods and Analysis During one year, we registered information from NOK of all deceased patients in Swiss intensive care units, who were approached for consent to organ donation. We collected data on patient demographics, characteristics of NOK, factors related to the request process and to the clinical setting. We analyzed the association of collected predictors with consent rate using univariable logistic regression models; predictors with p-values <0.2 were selected for a multivariable logistic regression. Results Of 266 NOK approached for consent, consent was given in 137 (51.5%) cases. In multivariable analysis, we found associations of consent rates with Swiss nationality (OR 3.09, 95% CI: 1.46–6.54) and German language area (OR 0.31, 95% CI: 0.14–0.73). Consent rates tended to be higher if a parent was present during the request (OR 1.76, 95% CI: 0.93–3.33) and if the request was done before brain death was formally declared (OR 1.87, 95% CI: 0.90–3.87). Conclusion Establishing an atmosphere of trust between the medical staff putting forward a request and the NOK, allowing sufficient time for the NOK to consider donation, and respecting personal values and cultural differences, could be of importance for increasing donation rates. Additional measures are needed to address the pronounced differences in consent rates between language regions. PMID:25208215

31 CFR 315.80 - Payment to corporations or unincorporated associations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY BUREAU OF THE FISCAL SERVICE REGULATIONS... “The Lotus Club, an unincorporated association, by William A. Smith, Treasurer”. A request for payment...

31 CFR 315.80 - Payment to corporations or unincorporated associations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS... “The Lotus Club, an unincorporated association, by William A. Smith, Treasurer”. A request for payment...

31 CFR 315.80 - Payment to corporations or unincorporated associations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS... “The Lotus Club, an unincorporated association, by William A. Smith, Treasurer”. A request for payment...

Computer systems and methods for the query and visualization of multidimensional databases

DOEpatents

Stolte, Chris; Tang, Diane L; Hanrahan, Patrick

2014-04-29

In response to a user request, a computer generates a graphical user interface on a computer display. A schema information region of the graphical user interface includes multiple operand names, each operand name associated with one or more fields of a multi-dimensional database. A data visualization region of the graphical user interface includes multiple shelves. Upon detecting a user selection of the operand names and a user request to associate each user-selected operand name with a respective shelf in the data visualization region, the computer generates a visual table in the data visualization region in accordance with the associations between the operand names and the corresponding shelves. The visual table includes a plurality of panes, each pane having at least one axis defined based on data for the fields associated with a respective operand name.

Computer systems and methods for the query and visualization of multidimensional databases

DOEpatents

Stolte, Chris [Palo Alto, CA; Tang, Diane L [Palo Alto, CA; Hanrahan, Patrick [Portola Valley, CA

2011-02-01

In response to a user request, a computer generates a graphical user interface on a computer display. A schema information region of the graphical user interface includes multiple operand names, each operand name associated with one or more fields of a multi-dimensional database. A data visualization region of the graphical user interface includes multiple shelves. Upon detecting a user selection of the operand names and a user request to associate each user-selected operand name with a respective shelf in the data visualization region, the computer generates a visual table in the data visualization region in accordance with the associations between the operand names and the corresponding shelves. The visual table includes a plurality of panes, each pane having at least one axis defined based on data for the fields associated with a respective operand name.

Computer systems and methods for the query and visualization of multidimensional databases

DOEpatents

Stolte, Chris [Palo Alto, CA; Tang, Diane L [Palo Alto, CA; Hanrahan, Patrick [Portola Valley, CA

2012-03-20

In response to a user request, a computer generates a graphical user interface on a computer display. A schema information region of the graphical user interface includes multiple operand names, each operand name associated with one or more fields of a multi-dimensional database. A data visualization region of the graphical user interface includes multiple shelves. Upon detecting a user selection of the operand names and a user request to associate each user-selected operand name with a respective shelf in the data visualization region, the computer generates a visual table in the data visualization region in accordance with the associations between the operand names and the corresponding shelves. The visual table includes a plurality of panes, each pane having at least one axis defined based on data for the fields associated with a respective operand name.

76 FR 26682 - Study on Protection of Certain Railroad Risk Reduction Data From Discovery or Use in Litigation

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-09

... public relations campaigns but instead serious, comprehensive, and in-depth analyses. In other words... and request for public comment. SUMMARY: In accordance with section 109 of the Rail Safety Improvement Act of 2008 (RSIA), FRA is soliciting public comment on the issue of whether it is in the public...

A Conversation-Analytic Perspective on the Organization of Teacher-Led Clarification and Its Implications for L2 Teacher Training

ERIC Educational Resources Information Center

Atar, Cihat; Seedhouse, Paul

2018-01-01

This study analyses teacher-led clarification sequences in a university second language classroom setting from a conversation-analytic perspective. In the literature, there are many studies of clarification requests, but the focus is on individual categories and quantification. No previous study has examined clarification, as reconceptualised in…

Reply to discussion: ground water response to forest harvest: implications or hillslope stability

Treesearch

Amod Dhakal; Roy C. Sidle; A.C. Johnson; R.T. Edwards

2008-01-01

Dhakal and Sidle (this volume) have requested clarification of some of the rationales and approaches used in analyses described by Johnson et al. (2007). Here we further describe hydrologic conditions typical of southeast Alaska and elaborate on an accepted methodology used for conducting analysis of covariance statistical analysis (ANCOVA). We discuss Dhakal and Sidle...

Estimating Teacher and School Effectiveness in Pittsburgh: Value-Added Modeling and Results. Final Report

ERIC Educational Resources Information Center

Lipscomb, Stephen; Gill, Brian; Booker, Kevin; Johnson, Matthew

2010-01-01

At the request of Pittsburgh Public Schools (PPS) and the Pittsburgh Federation of Teachers (PFT), Mathematica is developing value-added models (VAMs) that aim to estimate the contributions of individual teachers, teams of teachers, and schools to the achievement growth of their students. The analyses described in this report are intended as an…

A Descriptive Analysis of the Principal Workforce in Wisconsin. Summary. Issues & Answers. REL 2012-No. 135

ERIC Educational Resources Information Center

Clifford, Matthew; Condon, Chris; Greenberg, Ariela; Williams, Ryan; Gerdeman, R. Dean; Fetters, Jenni; Baker, Bruce

2012-01-01

This summary describes a study that responds to a request from the Wisconsin Department of Public Instruction for information on Wisconsin's school principal workforce population. In the study, descriptive analyses addressed two research questions: (1) How do the demographic characteristics of Wisconsin school principals compare how did these…

77 FR 45604 - Notification of Two Public Teleconferences of the Science Advisory Board; Environmental Economics...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-01

... regulations after they were implemented (ex post). To improve future benefit-cost analyses, EPA is seeking to compare its predictions of costs (ex ante costs) with actual (ex post) costs and, if they differ substantially, to understand why. EPA has requested the SAB's review of its approach to assessing ex post costs...

Fresh Fruit and Vegetable Program and Requests for Fruits and Vegetables Outside School Settings.

PubMed

Ohri-Vachaspati, Punam; Dachenhaus, Elizabeth; Gruner, Jessie; Mollner, Kristina; Hekler, Eric B; Todd, Michael

2018-01-08

Consumption of fruits and vegetables (F/V) among elementary school-aged children remains inadequate, especially among low-income children. The US Department of Agriculture's Fresh Fruit and Vegetable Program (FFVP) provides F/V as snacks to children during the school day, outside of school meals. School-based initiatives are successful in changing behaviors in school settings; however, their influence on behaviors outside of schools needs investigation. To examine whether FFVP participation is associated with F/V requests at stores, self-efficacy to ask for and choose F/V at home, and F/V consumption. Cross-sectional study. Fourth graders in six classrooms (n=296) from three urban, low-income school districts in Phoenix, AZ, were surveyed during 2015; one FFVP and one non-FFVP school from each district that were similar in school size, percent free/reduced-price meal eligibility, and race/ethnicity of enrolled students were selected. Children's self-reported F/V requests during shopping, their self-efficacy to ask for and choose F/V at home, and F/V consumption on the previous day (non-FFVP school day) were measured using questions adapted from validated surveys. Multivariable mixed-effect regression models, adjusting for clustering of students within classes and classes within schools were explored. In models adjusting for individual-level factors (ie, age and sex) only, several significant positive associations were observed between school FFVP participation and healthier F/V outcomes. After additionally adjusting for school-level factors (ie, total enrollment and % Hispanic/Latino students) significant associations were observed between school FFVP participation and more requests for vegetables during shopping (P<0.001), higher scores on self-efficacy to choose vegetables at home (P=0.004), stronger preferences for vegetables (P<0.001), and more frequent consumption of fruit (P=0.006). School FFVP participation was associated with more requests for vegetables during shopping and higher self-efficacy to make healthy choices at home, suggesting the influence of the FFVP may extend beyond the school day. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

75 FR 81948 - Use of Various Winemaking Terms on Wine Labels and in Advertisements; Comment Period Extension

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-29

...In response to a request made on behalf of a wine industry association, TTB is extending for an additional 60 days the comment period prescribed in Notice No. 109, Use of Various Winemaking Terms on Wine Labels and in Advertisements; Request for Public Comment, an advance notice of proposed rulemaking published in the Federal Register on November 3, 2010.

78 FR 7738 - Notice of Request for Revision to and Extension of Approval of an Information Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

...In accordance with the Paperwork Reduction Act of 1995, this notice announces the Animal and Plant Health Inspection Service's intention to request a revision to and extension of approval of an information collection associated with the regulations for a certification program for imported articles of Pelargonium spp. and Solanum spp. to prevent the introduction of potato brown rot into the United States.

78 FR 54619 - Notice of Request for Extension of Approval of an Information Collection; Importation of Emerald...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-05

...In accordance with the Paperwork Reduction Act of 1995, this notice announces the Animal and Plant Health Inspection Service's intention to request an extension of approval of an information collection associated with the regulations for the importation of emerald ash borer host material from Canada to prevent the introduction and spread of emerald ash borer in the United States.

78 FR 34608 - Proposed Establishment of Class D Airspace; Bryant AAF, Anchorage, AK

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-10

... Association (AOPA), Alaska Airmen's Association (AAA), and the Alaskan Aviation Safety Foundation (AASF). One... D airspace. The AAA requested additional time to review the proposal and that the entire composition...

Risk factors for strong regret and subsequent IVF request after having tubal ligation.

PubMed

Kariminia, Azar; Saunders, Douglas M; Chamberlain, Marie

2002-11-01

To identify and describe pre-sterilisation characteristics most consistently associated with intensive post-sterilisation regret and subsequent request for IVF. Case control study. Fertility clinic in a tertiary referral urban hospital, Sydney, Australia. SAMPLE CASES: Ninety-seven sterilised women who underwent evaluation for IVF during the period 1986-1996; 101 sterilised women who remained satisfied with their tubal ligation. Variables known at the time of sterilisation including age, number of living children, history of abortion, underlying medical diseases, marital status, race, education, and timing of sterilisation. In the multivariate analysis of data, age at the time of sterilisation had the most pronounced effect on strong regret. Women younger than 30 years old at the time of sterilisation were more likely to request IVF treatment than women 30 to 34 years old. A concurrent caesarean section was associated with a threefold risk (95% CI, 1.05-10.03) relative to an interval procedure. A strong protective effect (OR = 0.07; 95% CI, 0.01-0.65) was found for women with more than two children compared to childless women. The overwhelming reason stated by women requesting IVF was change in marital status, and the desire to have a child with the new partner. Women with such characteristics who are considering tubal ligation need further caution and counselling.

Aeronautics research and technology. A review of proposed reductions in the FY 1983 NASA program

NASA Technical Reports Server (NTRS)

1982-01-01

Reductions in the Fiscal Year 1983 program from the original proposal to the levels of the appropriation request submitted to Congress are reviewed. The request asked for an assessment of the national criticality of the excluded programs and, for each one, the risk (probability of success) associated with achieving the objectives sought and the degree to which it might be assumed by the private sector. Based on this request, a charge comprising an assessment of those aeronautics projects excluded from the FY 1983 budget request to Congress, the likelihood that industry would undertake them, the impact of their not being done, and the more general question of the need for government to bridge the gap between the aeronautics research and technology base and early application was developed. The charge further specifies that the assessment is to encompass considerations of safety, national defense, efficient transport, and the national economy.

A Staff-Training Program to Increase Spontaneous Vocal Requests in Children With Autism

PubMed Central

Karp, Rebecca

2013-01-01

This study evaluated a staff-training and feedback program to increase (a) staff use of naturalistic language training techniques, and (b) child production of spontaneous vocal requests in a school setting for young children with autism. Training was conducted in integrated preschool centers and in an art group. The results revealed that the training and feedback procedure was successful in increasing staff use of naturalistic language training techniques. Further, these increased strategies were associated with corresponding increases in spontaneous vocal requests for all children during embedded training and ongoing feedback conditions. In addition, probes collected by an unobtrusive observer revealed durability of child requesting when staff feedback was discontinued. Social validity measures from front-line staff regarding the intervention revealed positive ratings. The results are discussed in relation to the continued search for effective service-delivery systems to improve communication for children with autism in the public school setting. PMID:27999635

Evaluating the impact of field-scale management strategies on sediment transport to the watershed outlet.

PubMed

Sommerlot, Andrew R; Pouyan Nejadhashemi, A; Woznicki, Sean A; Prohaska, Michael D

2013-10-15

Non-point source pollution from agricultural lands is a significant contributor of sediment pollution in United States lakes and streams. Therefore, quantifying the impact of individual field management strategies at the watershed-scale provides valuable information to watershed managers and conservation agencies to enhance decision-making. In this study, four methods employing some of the most cited models in field and watershed scale analysis were compared to find a practical yet accurate method for evaluating field management strategies at the watershed outlet. The models used in this study including field-scale model (the Revised Universal Soil Loss Equation 2 - RUSLE2), spatially explicit overland sediment delivery models (SEDMOD), and a watershed-scale model (Soil and Water Assessment Tool - SWAT). These models were used to develop four modeling strategies (methods) for the River Raisin watershed: Method 1) predefined field-scale subbasin and reach layers were used in SWAT model; Method 2) subbasin-scale sediment delivery ratio was employed; Method 3) results obtained from the field-scale RUSLE2 model were incorporated as point source inputs to the SWAT watershed model; and Method 4) a hybrid solution combining analyses from the RUSLE2, SEDMOD, and SWAT models. Method 4 was selected as the most accurate among the studied methods. In addition, the effectiveness of six best management practices (BMPs) in terms of the water quality improvement and associated cost were assessed. Economic analysis was performed using Method 4, and producer requested prices for BMPs were compared with prices defined by the Environmental Quality Incentives Program (EQIP). On a per unit area basis, producers requested higher prices than EQIP in four out of six BMP categories. Meanwhile, the true cost of sediment reduction at the field and watershed scales was greater than EQIP in five of six BMP categories according to producer requested prices. Copyright © 2013 Elsevier Ltd. All rights reserved.

Comparison of peripheral nerve blockade characteristics between non-diabetic patients and patients suffering from diabetic neuropathy: a prospective cohort study.

PubMed

Baeriswyl, M; Taffé, P; Kirkham, K R; Bathory, I; Rancati, V; Crevoisier, X; Cherix, S; Albrecht, E

2018-06-02

Animal data have demonstrated increased block duration after local anaesthetic injections in diabetic rat models. Whether the same is true in humans is currently undefined. We, therefore, undertook this prospective cohort study to test the hypothesis that type-2 diabetic patients suffering from diabetic peripheral neuropathy would have increased block duration after ultrasound-guided popliteal sciatic nerve block when compared with patients without neuropathy. Thirty-three type-2 diabetic patients with neuropathy and 23 non-diabetic control patients, scheduled for fore-foot surgery, were included prospectively. All patients received an ultrasound-guided popliteal sciatic nerve block with a 30 ml 1:1 mixture of lidocaine 1% and bupivacaine 0.5%. The primary outcome was time to first opioid request after block procedure. Secondary outcomes included the time to onset of sensory blockade, and pain score at rest on postoperative day 1 (numeric rating scale 0-10). These outcomes were analysed using an accelerated failure time regression model. Patients in the diabetic peripheral neuropathy group had significantly prolonged median (IQR [range]) time to first opioid request (diabetic peripheral neuropathy group 1440 (IQR 1140-1440 [180-1440]) min vs. control group 710 (IQR 420-1200 [150-1440] min, p = 0.0004). Diabetic peripheral neuropathy patients had a time ratio of 1.57 (95%CI 1.10-2.23, p < 0.01), experienced a 59% shorter time to onset of sensory blockade (median time ratio 0.41 (95%CI 0.28-0.59), p < 0.0001) and had lower median (IQR [range]) pain scores at rest on postoperative day 1 (diabetic peripheral neuropathy group 0 (IQR 0-1 [0-5]) vs. control group 3 (IQR 0-5 [0-9]), p = 0.001). In conclusion, after an ultrasound-guided popliteal sciatic nerve block, patients with diabetic peripheral neuropathy demonstrated reduced time to onset of sensory blockade, with increased time to first opioid request when compared with patients without neuropathy. © 2018 The Association of Anaesthetists.

What happens when the doctor denies a patient’s request? A qualitative interview study among general practitioners in Norway

PubMed Central

Nilsen, Stein; Malterud, Kirsti

2017-01-01

Objective To explore general practitioners (GPs’) experiences from consultations when a patient’s request is denied, and outcomes of such incidents. Design and participants We conducted a qualitative study with semi-structured individual interviews with six GPs in Norway. We asked them to tell about experiences from specific encounters where they had refused a patient’s request. The texts were analysed with Systematic Text Condensation, a method for thematic cross-case analysis. Main outcome measures Accounts of experiences from consultations when GPs refused their patients’ requests. Results Subjects of dispute included clinical topics like investigation and treatment, certification regarding welfare benefits and medico-legal issues, and administrative matters. The arguments took different paths, sometimes settled by reaching common ground but more often as unresolved disagreement with anger or irritation from the patient, sometimes with open hostility and violence. The aftermath and outcomes of these disputes lead to strong emotional impact where the doctors reflected upon the incidents and sometimes regretted their handling of the consultation. Some long-standing and close patient–doctor relationships were injured or came to an end. Conclusions The price for denying a patient’s request may be high, and GPs find themselves uncomfortable in such encounters. Skills pertaining to this particular challenge could be improved though education and training, drawing attention to negotiation of potential conflicts. Also, the notion that doctors have a professional commitment to his or her own autonomy and to society should be restored, through increased emphasis on core professional ethics in medical education at all levels. PMID:28581878

Integrated optimization of location assignment and sequencing in multi-shuttle automated storage and retrieval systems under modified 2n-command cycle pattern

NASA Astrophysics Data System (ADS)

Yang, Peng; Peng, Yongfei; Ye, Bin; Miao, Lixin

2017-09-01

This article explores the integrated optimization problem of location assignment and sequencing in multi-shuttle automated storage/retrieval systems under the modified 2n-command cycle pattern. The decision of storage and retrieval (S/R) location assignment and S/R request sequencing are jointly considered. An integer quadratic programming model is formulated to describe this integrated optimization problem. The optimal travel cycles for multi-shuttle S/R machines can be obtained to process S/R requests in the storage and retrieval request order lists by solving the model. The small-sized instances are optimally solved using CPLEX. For large-sized problems, two tabu search algorithms are proposed, in which the first come, first served and nearest neighbour are used to generate initial solutions. Various numerical experiments are conducted to examine the heuristics' performance and the sensitivity of algorithm parameters. Furthermore, the experimental results are analysed from the viewpoint of practical application, and a parameter list for applying the proposed heuristics is recommended under different real-life scenarios.

Patient-reported healthcare expectations in inflammatory bowel diseases.

PubMed

Pittet, Valérie; Vaucher, Carla; Froehlich, Florian; Maillard, Michel H; Michetti, Pierre

2018-01-01

Patient-reported experience is an important component of a holistic approach to quality of care. Patients' expectations of treatments and global disease management may indicate their illness representations and their satisfaction and hopes regarding quality of care. To study expectations of patients with inflammatory bowel disease. Two focus groups were conducted with 14 patients to explore their expectations about treatments and disease management. From qualitative content analyses of focus group discussions, we built a 22-item expectations questionnaire that was sent to 1756 patients of the Swiss IBD cohort. Answers were collected on a visual analog scale from 0 to 100, and medians (interquartile range [IQR]) calculated. Factor analysis identified main expectation dimensions, and multivariate analyses were performed to describe associations with patient characteristics. Of 1094 patients (62%) included in the study, 54% were female, 54% had Crohn's disease, 35% had tertiary education, and 72% were employed. Expectation dimensions comprised realistic, predictive, and ideal expectations and were linked to information, communication, daily care, and disease recognition. Half (11 of 22) of the expectations were ranked as very high (median score > 70), the 2 most important being good coordination between general practitioners and specialists (median score: 89, IQR: 71-96) and information on treatment adverse events (89, IQR: 71-96). Women had overall higher levels of expectations than did men. Expectations were not associated with psychosocial measures, except those related to disease recognition, and most of them were highly associated with increased concerns on disease constraints and uncertainty. Patients have high expectations for information and communication among caregivers, the levels varying by gender and region. Patients also appear to request more active participation in their disease management.

Heat engine generator control system

DOEpatents

Rajashekara, K.; Gorti, B.V.; McMullen, S.R.; Raibert, R.J.

1998-05-12

An electrical power generation system includes a heat engine having an output member operatively coupled to the rotor of a dynamoelectric machine. System output power is controlled by varying an electrical parameter of the dynamoelectric machine. A power request signal is related to an engine speed and the electrical parameter is varied in accordance with a speed control loop. Initially, the sense of change in the electrical parameter in response to a change in the power request signal is opposite that required to effectuate a steady state output power consistent with the power request signal. Thereafter, the electrical parameter is varied to converge the output member speed to the speed known to be associated with the desired electrical output power. 8 figs.

Heat engine generator control system

DOEpatents

Rajashekara, Kaushik; Gorti, Bhanuprasad Venkata; McMullen, Steven Robert; Raibert, Robert Joseph

1998-01-01

An electrical power generation system includes a heat engine having an output member operatively coupled to the rotor of a dynamoelectric machine. System output power is controlled by varying an electrical parameter of the dynamoelectric machine. A power request signal is related to an engine speed and the electrical parameter is varied in accordance with a speed control loop. Initially, the sense of change in the electrical parameter in response to a change in the power request signal is opposite that required to effectuate a steady state output power consistent with the power request signal. Thereafter, the electrical parameter is varied to converge the output member speed to the speed known to be associated with the desired electrical output power.

Arbitration in crossbar interconnect for low latency

DOEpatents

Ohmacht, Martin; Sugavanam, Krishnan

2013-02-05

A system and method and computer program product for reducing the latency of signals communicated through a crossbar switch, the method including using at slave arbitration logic devices associated with Slave devices for which access is requested from one or more Master devices, two or more priority vector signals cycled among their use every clock cycle for selecting one of the requesting Master devices and updates the respective priority vector signal used every clock cycle. Similarly, each Master for which access is requested from one or more Slave devices, can have two or more priority vectors and can cycle among their use every clock cycle to further reduce latency and increase throughput performance via the crossbar.

Barriers and benefits associated with nurses information seeking related to patient education needs on clinical nursing units.

PubMed

Jones, Josette; Schilling, Katherine; Pesut, Daniel

2011-01-01

The purpose of this study was to answer the following two questions: What are clinical nurses' rationales for their approaches to finding patient educational materials on the web? What are perceived barriers and benefits associated with the use of web-based information resources for patient education in the context of nursing clinical practice?Over 179 individual data units were analyzed to understand clinical nurses' rationales for their approaches to find patient educational materials on the web. Rationales were defined as those underlying catalysts or activators leading to an information need. Analyses found that the primary reasons why clinical nurses conducted web-based information searches included direct patient requests ( 9 requests), colleague requests (6 requests), building patient materials collections (4), patients' family requests (3), routine teaching (1), personal development (1), or staff development (1). From these data, four broad themes emerged: professional reasons, personal reasons, technology reasons, and organization reasons for selecting information resources. Content analysis identified 306 individual data units representing either 'benefits' (178 units) or 'barriers' (128) to the nurses' use of web resources for on-unit patient care. Inter-rater reliability was assessed and found to be excellent (r = 0.943 to 0.961). The primary themes that emerged as barriers to the used of web-based resources included: 1) time requirements to perform a search, 2) nurses' experience and knowledge about the resources or required technology, 3) specific characteristics of individuals electronic information resources, and 4) organizational procedures and policies. Three primary themes that represented the benefits of using web-based resources were also identified: 1) past experiences and knowledge of a specific resource or the required technologies, 2) availability and accessibility on the unit, and 3) specific characteristics of individual information tool. In many cases, nurses commented on specific characteristics or features of favorite information resources. Favorite sites included a variety or reputable health care organizations that displayed context in text, audio, and/or video. In addition such sites were described as easy-to read and provided content related to patient-focused information or specific content such as toll free telephone contact numbers.Information searching is the interaction between and among information users and computer-based information systems. Information seeking is becoming an important part of the knowledge work of nurses. Information seeking and searching intersects with the field of human computer interaction (HCI), which focuses on all aspects of human, and computer interactions. Users of an information system are understood as "actors" in situations, with a set of skills and shared practices based on work experiences with others. Designing better tools and developing information searching strategies that support, extend, and transform practices, begins by asking: Who are the users? What are the tasks? What is the interplay between the technology and the organization of the task? This study contributes fundamental data and information about the rationales nurses use in information seeking tasks. In addition it provides empirical evidences regarding barriers and benefits of information seeking in the context of patient education needs in inpatient clinical settings.

46 CFR 385.35 - Program opportunity notices.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION MISCELLANEOUS RESEARCH AND DEVELOPMENT GRANT... associations, including small business associations; schools, colleges, and universities; appropriate... Business Daily; other MarAd offices; and individuals and organizations who request copies on a one-time...

13 CFR 121.1001 - Who may initiate a size protest or request a formal size determination?

Code of Federal Regulations, 2011 CFR

2011-01-01

... Associate Administrator for Business Development. (3) For SBA's Subcontracting Program, the following... SBA Director, Office of Government Contracting, or the SBA Associate Administrator for Business... Associate Administrator for Business Development. (8) For SBA's Service Disabled Veteran-Owned Small...

13 CFR 121.1001 - Who may initiate a size protest or request a formal size determination?

Code of Federal Regulations, 2013 CFR

2013-01-01

... Associate Administrator for Business Development. (3) For SBA's Subcontracting Program, the following... SBA Director, Office of Government Contracting, or the SBA Associate Administrator for Business... Associate Administrator for Business Development. (8) For SBA's Service Disabled Veteran-Owned Small...

Growing an ethics consultation service: A longitudinal study examining two decades of practice.

PubMed

Gorka, Christine; Craig, Jana M; Spielman, Bethany J

2017-01-01

Little is known about what factors may contribute to the growth of a consultation service or how a practice may change or evolve across time. This study examines data collected from a busy ethics consultation service over a period of more than two decades. We report a number of longitudinal findings that represent significant growth in the volume of ethics consultation requests from 19 in 1990 to 551 in 2013, as well as important changes in the patient population for which ethics help is requested. The findings include (1) a steady growth in requests from primary care providers (e.g., physicians and nurses), as well as increases in ancillary services (e.g., social workers); (2) a decrease in length of stay (days) before ethics help is requested; (3) an increase in the reasons that individuals ask for help from ethics; (4) an upsurge in consults requests from areas outside the intensive care unit (ICU); (5) a decrease in patients that died during hospitalization (e.g., live discharges); and (6) growth in the numbers of patients lacking decision-making capacity. We believe the increases in consult requests reflect appropriate and necessary growth because recent consultations have also been associated with consultations requiring (7) additional interventions and (8) reasonably high time intensity scores.

Does a Caesarean section increase the time to a second live birth? A register-based cohort study.

PubMed

O'Neill, Sinéad M; Khashan, Ali S; Henriksen, Tine B; Kenny, Louise C; Kearney, Patricia M; Mortensen, Preben B; Greene, Richard A; Agerbo, Esben

2014-11-01

Does a primary Caesarean section influence the rate of, and time to, subsequent live birth compared with vaginal delivery? Caesarean section was associated with a reduction in the rate of subsequent live birth, particularly among elective and maternal-requested Caesareans indicating maternal choice plays a role. Several studies have examined the relationship between Caesarean section and subsequent birth rate with conflicting results primarily due to poor epidemiological methods. This Danish population register-based cohort study covered the period from 1982 to 2010 (N = 832 996). All women with index live births were followed until their subsequent live birth or censored (maternal death, emigration or study end) using Cox regression models. In all 577 830 (69%) women had a subsequent live birth. Women with any type of Caesarean had a reduced rate of subsequent live birth (hazard ratio [HR] 0.86, 95% confidence intervals [CI] 0.85, 0.87) compared with spontaneous vaginal delivery. This effect was consistent when analyses were stratified by type of Caesarean: emergency (HR 0.87, 95% CI 0.86, 0.88), elective (HR 0.83, 95% CI 0.82, 0.84) and maternal-requested (HR 0.61, 95% CI 0.57, 0.66) and in the extensive sub-analyses performed. Lack of biological data to measure a woman's fertility is a major limitation of the current study. Unmeasured confounding and limited availability of data (maternal BMI, smoking, access to fertility services and maternal-requested Caesarean section) as well as changes in maternity care over time may also influence the findings. This is the largest study to date and shows that Caesarean section is most likely not causally related to a reduction in fertility. Maternal choice to delay or avoid childbirth is the most plausible explanation. Our findings are generalizable to other middle- to high-income countries; however, cross country variations in Caesarean section rates and social or cultural differences are acknowledged. Funding was provided by the National Perinatal Epidemiology Centre, Cork, Ireland and conducted as part of the Health Research Board PhD Scholars programme in Health Services Research (Grant No. PHD/2007/16). L.C.K. is a Science Foundation Ireland Principal Investigator (08/IN.1/B2083) and the Director of the SFI funded Centre, INFANT (12/RC/2272). The authors have no competing interests to declare. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Prohibiting consent: what are the costs of denying permanent contraception concurrent with abortion care?

PubMed

Krashin, Jamie W; Edelman, Alison B; Nichols, Mark D; Allen, Allison J; Caughey, Aaron B; Rodriguez, Maria I

2014-07-01

Oregon and federal laws prohibit giving informed consent for permanent contraception when presenting for an abortion. The primary objective of this study was to estimate the number of unintended pregnancies associated with this barrier to obtaining concurrent tubal occlusion and abortion, compared with the current policy, which limits women to obtaining interval tubal occlusion after abortion. The secondary objectives were to compare the financial costs, quality-adjusted life years, and the cost-effectiveness of these policies. We designed a decision-analytic model examining a theoretical population of women who requested tubal occlusion at time of abortion. Model inputs came from the literature. We examined the primary and secondary outcomes stratified by maternal age (>30 and <30 years). A Markov model incorporated the possibility of multiple pregnancies. Sensitivity analyses were performed on all variables and a Monte Carlo simulation was conducted. For every 1000 women age <30 years in Oregon who did not receive requested tubal occlusion at the time of abortion, over 5 years there would be 1274 additional unintended pregnancies and an additional $4,152,373 in direct medical costs. Allowing women to receive tubal occlusion at time of abortion was the dominant strategy. It resulted in both lower costs and greater quality-adjusted life years compared to allowing only interval tubal occlusion after abortion. Prohibiting tubal occlusion at time of abortion resulted in an increased incidence of unintended pregnancy and increased public costs. Copyright © 2014 Mosby, Inc. All rights reserved.

Indicators of inappropriate tumour marker use through the mining of electronic health records.

PubMed

Gion, Massimo; Cardinali, Giulia; Trevisiol, Chiara; Zappa, Marco; Rainato, Giulia; Fabricio, Aline S C

2017-08-01

Although the issue of monitoring appropriateness of tumour markers (TMs) request in outpatients remains crucial, proper indicators are still demanding. The present study developed and explored indicators of inappropriate TM ordering in outpatients through the data mining of electronic health records (EHRs). Carcinoembryonic antigen (CEA), alfa-fetoprotein (AFP), carbohydrate antigen (CA)125, CA15.3, CA19.9, and prostate-specific antigen (PSA) ordered in outpatients during a year were examined by mining EHRs of a Local Health Authority in Italy. Evidence-based criteria were used to develop performance indicators. Demographic and clinical information associated with TM orders were examined. A total of 80 813 TMs were ordered in 52 536 outpatients (1.54 markers/patient). Indicators related to disease codes, gender, age, and TM repetitions were developed, and their application showed that (1) CA15.3 and CEA are prevalently requested in patients with cancer (79.2% and 65.6%) whereas the other TMs are largely requested also in patients without cancer; (2) requests of PSA in women and of CA125 or CA15.3 in men are negligible; (3) although requests in people older than 80 years are relevant (16.4% of total), the highest rate of request of all markers occurs in patients aged 40 to 79 years; (4) CA15.3 and CEA are mainly requested in cancer cases between 50 and 79 years and AFP, CA19.9, and CA125 in those between 60 and 69 years; (5) <50% of PSA orders are associated with cancer code for all age intervals; and (6) multiple repetitions of AFP, CA125, CA15.3, CA19.9, and CEA are prevalent in cancer patients or benign diseases to which TMs are appropriate, whereas PSA repetitions occur mainly in patients without cancer. The developed indicators resulted suitable to monitor TM overordering in outpatients through the mining of EHRs. The present study is a first approach towards the use of big-data mining for TM appropriateness evaluation purposes. © 2017 John Wiley & Sons, Ltd.

Contextual and community factors associated with youth access to cigarettes through commercial sources.

PubMed

Lipperman-Kreda, Sharon; Grube, Joel W; Friend, Karen B

2014-01-01

This study examines contextual and community-level characteristics associated with youth access to tobacco through commercial sources in 50 non-contiguous mid-sized California communities. The study is based on data from access surveys conducted by four confederate buyers (two men and two women) in 997 tobacco outlets. City demographics, adult smoking prevalence, and measures of tobacco outlet density, local tobacco retailer licencing and cigarette tax were included. Multilevel regression analyses indicated that buyer's actual age, a male clerk and asking young buyers about their age were related to successful cigarette purchases. Buyer's actual age and minimum age signs increased the likelihood that clerks will request an identification (ID). At the community level, a higher percentage of minors, higher education, and a greater percentage of African-Americans were associated with an increased likelihood of a successful purchase. Lower percentage of minors, lower education, lower percentage of African-Americans, and having a local tobacco retailer licencing were associated with the retailer asking for an ID. Additionally, supermarkets charged significantly more for a pack of cigarettes than small markets, whereas, smoke/tobacco shops and drug stores/pharmacies charged less. Higher prices were associated with higher median household income and greater percentage of Hispanics. Findings about community characteristics, however, differed by cigarette brand. This study enhances our understanding of the associations between contextual and community characteristics and youth access to tobacco through commercial sources which can help policymakers to identify and target at-risk communities and outlets to decrease youth access to tobacco.

Detection of heart disease by open access echocardiography: a retrospective analysis of general practice referrals

PubMed Central

Chambers, John; Kabir, Saleha; Cajeat, Eric

2014-01-01

Background Heart disease is difficult to detect clinically and it has been suggested that echocardiography should be available to all patients with possible cardiac symptoms or signs. Aim To analyse the results of 2 years of open access echocardiography for the frequency of structural heart disease according to request. Design and setting Retrospective database analysis in a teaching hospital open access echocardiography service. Method Reports of all open access transthoracic echocardiograms between January 2011 and December 2012 were categorised as normal, having minor abnormalities, or significant abnormalities according to the indication. Results There were 2343 open access echocardiograms performed and there were significant abnormalities in 29%, predominantly valve disease (n = 304, 13%), LV systolic dysfunction (n = 179, 8%), aortic dilatation (n = 80, 3%), or pulmonary hypertension (n = 91, 4%). If echocardiography had been targeted at a high-risk group, 267 with valve disease would have been detected (compared to 127 with murmur alone) and 139 with LV systolic dysfunction (compared to 91 with suspected heart failure alone). Most GP practices requested fewer than 10 studies, but 6 practices requested over 70 studies. Conclusion Open access echocardiograms are often abnormal but structural disease may not be suspected from the clinical request. Uptake by individual practices is patchy. A targeted expansion of echocardiography in patients with a high likelihood of disease is therefore likely to increase the detection of clinically important pathology. PMID:24567615

Detection of heart disease by open access echocardiography: a retrospective analysis of general practice referrals.

PubMed

Chambers, John; Kabir, Saleha; Cajeat, Eric

2014-02-01

Heart disease is difficult to detect clinically and it has been suggested that echocardiography should be available to all patients with possible cardiac symptoms or signs. To analyse the results of 2 years of open access echocardiography for the frequency of structural heart disease according to request. Retrospective database analysis in a teaching hospital open access echocardiography service. Reports of all open access transthoracic echocardiograms between January 2011 and December 2012 were categorised as normal, having minor abnormalities, or significant abnormalities according to the indication. There were 2343 open access echocardiograms performed and there were significant abnormalities in 29%, predominantly valve disease (n = 304, 13%), LV systolic dysfunction (n = 179, 8%), aortic dilatation (n = 80, 3%), or pulmonary hypertension (n = 91, 4%). If echocardiography had been targeted at a high-risk group, 267 with valve disease would have been detected (compared to 127 with murmur alone) and 139 with LV systolic dysfunction (compared to 91 with suspected heart failure alone). Most GP practices requested fewer than 10 studies, but 6 practices requested over 70 studies. Open access echocardiograms are often abnormal but structural disease may not be suspected from the clinical request. Uptake by individual practices is patchy. A targeted expansion of echocardiography in patients with a high likelihood of disease is therefore likely to increase the detection of clinically important pathology.

76 FR 65769 - Airport Improvement Program: Modifications to Benefit Cost Analysis (BCA) Threshold

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-24

...This document announces the publication of the final policy changes to the Federal Aviation Administration's policy requiring a benefit cost analysis (BCA) for capacity projects funded by Airport Improvement Program (AIP) discretionary funds. On December 16, 2010, the FAA issued a Notice of Availability of Draft Guidance and Request for Comments with regard to the modification of its policy requiring benefit cost analyses (BCA) for capacity projects, which was published in the Federal Register. (78 FR 78798-02, December 16, 2010). The FAA now is (1) Issuing the final policy modifying the threshold at which BCAs are required from $5 million to $10 million in Airport Improvement Program (AIP) Discretionary funds, and (2) responding to comments requested in the Notice on December 16, 2010.

Commercial Television Exposure, Fast Food Toy Collecting, and Family Visits to Fast Food Restaurants among Families Living in Rural Communities.

PubMed

Emond, Jennifer A; Bernhardt, Amy M; Gilbert-Diamond, Diane; Li, Zhigang; Sargent, James D

2016-01-01

To assess the associations between children's exposure to television (TV) networks that aired child-directed advertisements for children's fast food meals with the collection of fast food meal toy premiums and frequency of family visits to those restaurants. One hundred parents of children 3-7 years old were recruited from a rural pediatrics clinic during 2011; families receiving Medicaid were oversampled. Parents reported the child's TV viewing habits and family visit frequency to the fast food restaurants participating in child-directed TV marketing at the time, and their child's requests for visits to and the collecting of toy premiums from those restaurants. Logistic regression models assessed adjusted associations between a child's TV viewing with more frequent restaurant visits (≥monthly in this population). Structural equation modeling assessed if child requests or toy collecting mediated that association. Thirty-seven percent of parents reported ≥monthly visits to the select fast food restaurants. Among children, 54% requested visits to and 29% collected toys from those restaurants. Greater child commercial TV viewing was significantly associated with more frequent family visits to those fast food restaurants (aOR 2.84 for each 1-unit increase in the child's commercial TV viewing scale, P < .001); toy collecting partially mediated that positive association. Higher exposure among children to commercial TV networks that aired child-directed ads for children's fast food meals was associated with more frequent family visits to those fast food restaurants. Child desire for toy premiums may be a mediating factor. Copyright © 2016 Elsevier Inc. All rights reserved.

Commercial TV exposure, fast-food toy collecting and family visits to fast food restaurants among families living in rural communities

PubMed Central

Emond, Jennifer A.; Bernhardt, Amy M.; Gilbert-Diamond, Diane; Li, Zhigang; Sargent, James D.

2015-01-01

Objective To assess the associations between children's exposure to TV networks that aired child-directed advertisements for children's fast food meals with the collection of fast food meal toy premiums and frequency of family visits to those restaurants. Study design One hundred parents of children 3–7 years old were recruited from a rural pediatrics clinic during 2011; families receiving Medicaid were oversampled. Parents reported the child's television viewing habits and family visit frequency to the fast food restaurants participating in child-directed TV marketing at the time, and their child's requests for visits to and the collecting of toy premiums from those restaurants. Logistic regression models assessed adjusted associations between a child's TV viewing with more frequent restaurant visits (≥monthly in this population). Structural equation modeling assessed if child requests or toy collecting mediated that association. Results Thirty-seven percent of parents reported ≥monthly visits to the select fast food restaurants. Among children, 54% requested visits to and 29% collected toys from those restaurants. Greater child commercial TV viewing was significantly associated with more frequent family visits to those fast food restaurants (adjusted odds ratio 2.84 for each one-unit increase in the child's commercial TV viewing scale, p<0.001); toy collecting partially mediated that positive association. Conclusions Higher exposure among children to commercial TV networks that aired child-directed ads for children's fast food meals was associated with more frequent family visits to those fast food restaurants. Child desire for toy premiums may be a mediating factor. PMID:26526362

76 FR 72885 - FM Asymmetric Sideband Operation and Associated Technical Studies

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-28

... Sideband Operation and Associated Technical Studies AGENCY: Federal Communications Commission. ACTION... Asymmetric Sideband Operation and Associated Technical Studies, MM Docket No. 99-325, Public Notice, DA 11-1832 (MB rel. Nov. 1, 2011). The iBiquity and NPR request and the iBiquity and NPR technical studies...

76 FR 70413 - National Fire Protection Association (NFPA): Request for Comments on NFPA's Codes and Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-14

... DEPARTMENT OF COMMERCE National Institute of Standards and Technology National Fire Protection... (NIST) is publishing this notice on behalf of the National Fire Protection Association (NFPA) to..., (301) 975-4019. SUPPLEMENTARY INFORMATION: Since 1896, the National Fire Protection Association (NFPA...

13 CFR 121.1001 - Who may initiate a size protest or request a formal size determination?

Code of Federal Regulations, 2014 CFR

2014-01-01

... district office that services the apparent successful offeror, or the Associate Administrator for Business... Director; the Director, Office of Government Contracting; or the Associate Administrator, Investment... the SBA Associate Administrator for Business Development; (6) For SBA's HUBZone program, the following...

Association between family variables and Mexican American children's dietary behaviors.

PubMed

Ayala, Guadalupe X; Baquero, Barbara; Arredondo, Elva M; Campbell, Nadia; Larios, Sandra; Elder, John P

2007-01-01

To examine the association between family variables and children's diets. Cross-sectional study with households sampled using random-digit dialing. Children completed a one-time, self-administered survey, and mothers participated in a face-to-face structured interview. Data collection occurred in southern San Diego County on the U.S.-Mexico border. One hundred sixty-seven Mexican American children between 8 and 18 years of age and their mothers. Diet: number of snacks, candies and sweets, and sodas consumed daily; dietary fat and fiber; and money spent weekly on fast food and snacks. Family variables: household size, family support for healthful eating, number of meals eaten together, availability of fast food in the home, food ads seen on television, and parent purchasing food products that children saw advertised on television. Regression analyses were used to examine the independent contributions of family variables on dietary intake. Statistical significance was set at P < .05. Greater family support for healthful eating was associated with fewer snacks and more fiber consumed. Children of parents who purchased food products that their children had seen advertised on television reported consuming more snacks and more fat, and they spent more money on fast food and snacks. Family-based interventions are needed to moderate the potential influence of television-advertised food products on children's requests for these food products.

Nationwide survey to evaluate the decision-making process in euthanasia requests in Belgium: do specifically trained 2nd physicians improve quality of consultation?

PubMed

Cohen, Joachim; Van Wesemael, Yanna; Smets, Tinne; Bilsen, Johan; Onwuteaka-Philipsen, Bregje; Distelmans, Wim; Deliens, Luc

2014-07-16

Following the 2002 enactment of the Belgian law on euthanasia, which requires the consultation of an independent second physician before proceeding with euthanasia, the Life End Information Forum (LEIF) was founded which provides specifically trained physicians who can act as mandatory consultants in euthanasia requests. This study assesses quality of consultations in Flanders and Brussels and compares these between LEIF and non-LEIF consultants. A questionnaire was sent in 2009 to a random sample of 3,006 physicians in Belgium from specialties likely involved in the care of dying patients. Several questions about the last euthanasia request of one of their patients were asked. As LEIF serves the Flemish speaking community (i.e. region of Flanders and the bilingual Brussels Capital Region) and no similar counterpart is present in Wallonia, analyses were limited to Flemish speaking physicians in Flanders and Brussels. Response was 34%. Of the 244 physicians who indicated having received a euthanasia request seventy percent consulted a second physician in their last request; in 30% this was with a LEIF physician. Compared to non-LEIF physicians, LEIF physicians were more often not a colleague (69% vs 42%) and not a co-attending physician (89% vs 66%). They tended to more often discuss the request with the attending physician (100% vs 95%) and with the family (76% vs 69%), and also more frequently helped the attending physician with performing euthanasia (44% vs 24%). No significant differences were found in the extent to which they talked to the patient (96% vs 93%) and examined the patient file (94% vs 97%). In cases of explicit euthanasia requests in Belgium, the consultation procedure of another physician by the attending physician is not optimal and can be improved. Training and putting at disposal consultants through forums such as LEIF seems able to improve this situation. Adding stipulations in the law about the necessary competencies and tasks of consulting physicians may additionally incite improvement. Irrespective of whether euthanasia is a legal practice within a country, similar services may prove useful to also improve quality of consultations in various other difficult end-of-life decision-making situations.

Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study

PubMed Central

Thienpont, Lieve; Verhofstadt, Monica; Van Loon, Tony; Distelmans, Wim; Audenaert, Kurt; De Deyn, Peter P

2015-01-01

Objectives To identify patterns in euthanasia requests and practices relating to psychiatric patients; to generate recommendations for future research. Design Retrospective analysis of data obtained through medical file review. Setting Outpatient psychiatric clinical setting in the Dutch-speaking region of Belgium, between October 2007 and December 2011; follow-up at the end of December 2012. Participants 100 consecutive psychiatric patients requesting euthanasia based on psychological suffering associated with psychiatric disorders (77 women, 23 men; mean age 47 years; age range 21–80 years). Main outcome measures Patient sociodemographic characteristics; diagnoses; decisions on euthanasia requests; circumstances of euthanasia procedures; patient outcomes at follow-up. Results Most patients had been referred for psychiatric counselling by their physician (n=55) or by LEIF (Life End Information Forum) (n=36). 90 patients had >1 disorder; the most frequent diagnoses were depression (n=58) and personality disorder (n=50). 38 patients required further testing and/or treatment, including 13 specifically tested for autism spectrum disorder (ASD); 12 received an ASD diagnosis (all Asperger syndrome). In total, 48 of the euthanasia requests were accepted and 35 were carried out. Of the 13 remaining patients whose requests were accepted, 8 postponed or cancelled the procedure, because simply having this option gave them enough peace of mind to continue living. In December 2012, 43 patients had died, including 35 by euthanasia; others died by suicide (6), palliative sedation (1) and anorexia nervosa (1). Conclusions Depression and personality disorders are the most common diagnoses in psychiatric patients requesting euthanasia, with Asperger syndrome representing a neglected disease burden. Further research is needed, especially prospective quantitative and qualitative studies, to obtain a better understanding of patients with psychiatric disorders who request euthanasia due to unbearable psychological suffering. PMID:26216150

Early detection of breast cancer in Brazil: data from the National Health Survey, 2013

PubMed Central

Silva, Gulnar Azevedo e; de Souza-Júnior, Paulo Roberto Borges; Damacena, Giseli Nogueira; Szwarcwald, Célia Landmann

2017-01-01

ABSTRACT OBJECTIVE To analyze whether the actions of early detection of breast cancer, initiated with the medical request for mammography, differ between users of the Brazilian Unified Health System (SUS) and those who have private health insurance. METHODS From the data collected in the National Health Survey, we estimated the proportions of women who had medical request for mammography according to presence or absence of private health insurance. For assessing the factors related to having mammography medical request, we estimated crude and adjusted odds ratios and respective 95%CI by logistic regression. We also analyzed the main reasons reported for not having performed mammography after medical request, as well as the time between examination and result. RESULTS Of the women interviewed, 66.7% had a medical request for mammography (59.4% among SUS users and 83.9% among those with private health insurance). Having private health insurance, higher education level, and being white were positively associated with having the medical request. Only 5.4% (95%CI 4.8–6.0) of women who received medical request failed to perform mammography – 7.6% were SUS users and 1.7% had health insurance. The most reported reasons for not being able to perform the examination were: not thinking it was necessary; having the test scheduled, but not yet performed; and not being able to schedule it. More than 70% of women received the result with less than one month from its execution. CONCLUSIONS The barriers to access a medical request for mammographic screening for breast cancer are higher among women who depend exclusively on SUS. PMID:28591356

The dawn of open access to phylogenetic data.

PubMed

Magee, Andrew F; May, Michael R; Moore, Brian R

2014-01-01

The scientific enterprise depends critically on the preservation of and open access to published data. This basic tenet applies acutely to phylogenies (estimates of evolutionary relationships among species). Increasingly, phylogenies are estimated from increasingly large, genome-scale datasets using increasingly complex statistical methods that require increasing levels of expertise and computational investment. Moreover, the resulting phylogenetic data provide an explicit historical perspective that critically informs research in a vast and growing number of scientific disciplines. One such use is the study of changes in rates of lineage diversification (speciation--extinction) through time. As part of a meta-analysis in this area, we sought to collect phylogenetic data (comprising nucleotide sequence alignment and tree files) from 217 studies published in 46 journals over a 13-year period. We document our attempts to procure those data (from online archives and by direct request to corresponding authors), and report results of analyses (using Bayesian logistic regression) to assess the impact of various factors on the success of our efforts. Overall, complete phylogenetic data for [Formula: see text] of these studies are effectively lost to science. Our study indicates that phylogenetic data are more likely to be deposited in online archives and/or shared upon request when: (1) the publishing journal has a strong data-sharing policy; (2) the publishing journal has a higher impact factor, and; (3) the data are requested from faculty rather than students. Importantly, our survey spans recent policy initiatives and infrastructural changes; our analyses indicate that the positive impact of these community initiatives has been both dramatic and immediate. Although the results of our study indicate that the situation is dire, our findings also reveal tremendous recent progress in the sharing and preservation of phylogenetic data.

Pesticide intoxications in the Centre of Portugal: three years analysis.

PubMed

Teixeira, Helena; Proença, Paula; Alvarenga, Margarida; Oliveira, Margarida; Marques, Estela P; Vieira, Duarte Nuno

2004-07-16

Pesticides are used in most countries around the world to protect agricultural and horticultural crops against damage. Poisoning by these toxicant agents occurs as a result of misuse or accidental exposure, and also by oral ingestion (voluntary or not). In Portugal, pesticide intoxications are still a cause of death, found in a considerable number of cases. The authors retrospectively examined the cases of pesticide poisoning in the Centre of Portugal, from autopsies performed in the Forensic Pathology Service of Coimbra's Delegation of the National Institute of Legal Medicine (NILM) and from other autopsies carried out in the Centre of Portugal, as well as some samples taken in hospitals in cases of suspected intoxication. In this study, the positive cases have been especially studied, in order to identify the pesticide used, as well as the etiology. The frequency of intoxications and its distribution by sex and age were also analyzed. Between January 2000 and December 2002, the Forensic Toxicology Laboratory received 639 pesticide analysis requests. In 2000, in a total of 149 analysis requests, 30 cases were positive, 63.3% from male individuals and 36.7% from female. In 2001, the analysis requests increased to 240 as well as the positive cases (43), 74.4% from male individuals and 25.6% from female and in 2002, the total cases analyzed also increased to 250, with 38 positive (73.6% from male individuals and 26.4% from female). Among the pesticides, organophosphorus insecticides still constitute the most important class detected in forensic intoxications, representing 63% of the total positive cases, followed by herbicides, with 33% of the positive results. Quinalphos is the most important organophosphorus insecticide, present in 32 of the 111 positive cases, followed by the herbicide paraquat, detected in 31 cases. The study emphasizes the increasing number of pesticide analyses, particularly relevant for the organophosphorus compounds and herbicides. Intoxication suspicion, accidental or voluntary, seems to be the most common cause of the incidents, for which analyses are requested, but it is also evident that the putative cause is unknown in a large number of cases. Therefore, more stringent legislation and enforcement regarding the sale and distribution of these toxic substances are needed.

An Evaluation of the ROSE System

NASA Technical Reports Server (NTRS)

Usher, John M.

2002-01-01

A request-oriented scheduling engine, better known as ROSE, is under development within the Flight Projects Directorate for the purpose of planning and scheduling of the activities and resources associated with the science experiments to be performed aboard the International Space Station (ISS). ROSE is being designed to incrementally process requests from payload developers (PDs) to model and schedule the execution of their science experiments on the ISS. The novelty of the approach comes from its web-based interface permitting the PDs to define their request via the construction of a graphical model to represent their requirements. Based on an examination of the current ROSE implementation, this paper proposes several recommendations for changes to the modeling component and makes mention of other potential applications of the ROSE system.

X-ray requesting patterns before and after introduction of the Ottawa Knee Rules in a UK emergency department.

PubMed

Atkinson, Paul; Boyle, Adrian; Chisholm, Edward

2004-08-01

To compare knee radiology requesting rates among junior doctors before and after the formal introduction of the Ottawa Knee Rules (OKR) in a UK emergency department (ED), and to test the validity of the OKR for decisions on the use of radiography for acute, isolated knee injuries. All junior doctors in a district general hospital ED seeing adult patients with isolated knee injuries completed a questionnaire before and after the introduction of the OKR. All patients were followed up to obtain a final diagnosis. The outcome measures were: adherence to the OKR, the presence of a fracture and whether a radiograph had been requested. The results were analysed to determine the sensitivity, specificity, positive and negative predictive values of the OKR. Comparisons between the request rate for knee radiography before and after the introduction of the OKR were made. A total of 130 patients were enrolled and followed up over a 3-month period; 58 before and 72 after OKR introduction. The OKR had a sensitivity of 100% (71.8-100%), a specificity of 55.1% (46.1-64.1%), a positive predictive value of 18.5% (9.03-27.9%) and a negative predictive value of 100% (87.8-100%) for the detection of bony injury. The introduction of the OKR did not result in a significant reduction in the number of radiographs performed (58.6-55.6%; P= 0.726). This study shows the OKR to be a highly sensitive clinical guide with a high negative predictive value in the setting of a UK ED. It suggests that the reduction in radiograph requests seen elsewhere may not be as apparent in this setting.

Flight 20 (STS-45) polysulfide gas path investigation

NASA Technical Reports Server (NTRS)

Bjorkman, Rey C.; Bown, Charles W.; Smith, Scott D.; Walters, Jerry L.; Kulkarni, Suresh B.; Cook, Roger V.; Sebahar, David A.; Walker, Craig S.; Haddock, M. Reed; Lindstrom, Robert E.

1992-01-01

This report documents the results of the investigation into causes of gas paths on the 20A and 20B case-to-nozzle joints on STS-42. The investigation was conducted by the Investigation Board appointed by the senior vice president and general manager of Space Operations, Mr. R. E. Lindstrom, on 7 Feb. 1992. The probability of gas path occurrence in the nozzle-to-case-joint polysulfide had been identified during joint redesign. However, actual flight gas path incidence has been limited to RSRM-11 and the 20A and 20B segments. The blow-by condition on the 20A segment was a first time occurrence which was a special concern. The investigation covered all technical aspects associated with the gas path and blow-by conditions: materials and processing history, design requirements and as-built compliance to the design, thermal and structural analyses, computer modeling, and laboratory experimentation with the materials involved. The investigation was coordinated with Mr. Ken Jones at NASA Marshall in bi-weekly teleconferences. The Board also supported Dr. James C. Blair's independent NASA investigation team by providing copies of collected data, conducting requested analyses, and supporting several all-day teleconferences to provide understanding and resolve issues. The Dr. Blair support requirement was successfully concluded on 4 Mar. 1992.

International study of risk-mitigating factors and in-flight allergic reactions to peanut and tree nut.

PubMed

Greenhawt, Matthew; MacGillivray, Fiona; Batty, Geraldine; Said, Maria; Weiss, Christopher

2013-03-01

Three studies have analyzed in-flight peanut/tree nut reactions, although the studies were conducted exclusively among Americans. We studied the international in-flight experience and determined the efficacy of certain risk-mitigation strategies. A 47-question on-line survey was distributed through the websites and social media outlets of the member organizations of the Food Allergy & Anaphylaxis Alliance. Both persons reporting an in-flight reaction and nonreactors were surveyed to assess details of air travel preparation and any reported reaction. Data were analyzed to determine the association among flying behaviors, reported reactions, and nationality. We found that 349 reactions were reported among 3273 respondents from 11 countries; 13.3% received epinephrine as treatment. Flight crews were notified about 50.1% of reactions. Sixty-nine percent of all respondents reported making a preflight accommodation request, although just 55% of reactors did so compared with 71.6% of nonreactors (P < .001). Adjusted odds of epinephrine use were increased with reported gastrointestinal or cardiovascular symptoms or with notifying the crew. Passengers who requested any accommodation, requested a peanut/tree nut-free meal, wiped their tray table, avoided airline pillows or blankets, requested a buffer zone, requested other passengers not consume peanut/tree nut-containing products, or reported not consuming airline-provided food had significantly lower adjusted odds of reporting a reaction. In-flight peanut and tree nut reactions occur internationally. Epinephrine was sparsely used to treat reactions. We identified 8 risk-mitigating behaviors associated with lower odds of a reported reaction. Future study is necessary to further validate the effectiveness of these passenger-initiated risk-mitigating behaviors. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Proposal to Accomplish Phase B Space Shuttle Program

NASA Technical Reports Server (NTRS)

Mead, Lawrence M.; Gavin, Joseph G., Jr.

1970-01-01

This proposal has been prepared in response to National Aeronautics and Space Administration Request for Proposal No. 10-8423, dated February 20, 1970, and Amendments No.1, 2, 3, & 4 thereto. It is firm for a period of not less than one hundred twenty (120) days from March 30, 1970. The executed certifications requested in Enclosures 5 and 6 of the Request for Proposal are appended at the end of this proposal. Grumman Aerospace Corporation, along with its associates -- the General Electric Company, Eastern Airlines, the Northrop Corporation, and the Aerojet-General Corporation -- are pleased to submit this proposal. This study must prove that technical challenges can be met at a cost commensurate with realistic national funding levels at an early date, (perferably prior to the late 1977 initial operating capability (IOC) indicated in the Statement of Work). We have assembled a team of extremely competent associates. Together, we are fully qualified to study all facets of the proposed Phase B study, and to develop and build the product. We believe we have already made a promising start toward defining the concept of the space shuttle system.

9 CFR 54.4 - Application by owners for indemnity payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Name, address, and social security number of the flock owner; (2) Number and breed(s) of animals in the... addressed to any sheep or goat registry associations that maintain records of the owner's sheep or goats requesting the associations to release to APHIS all records maintained by the association on sheep or goats...

9 CFR 54.4 - Application by owners for indemnity payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) Name, address, and social security number of the flock owner; (2) Number and breed(s) of animals in the... addressed to any sheep or goat registry associations that maintain records of the owner's sheep or goats requesting the associations to release to APHIS all records maintained by the association on sheep or goats...

75 FR 21567 - Federal Motor Vehicle Safety Standard No. 108; Lamp, Reflective Devices and Associated Equipment...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

... Federal Motor Vehicle Safety Standard No. 108; Lamp, Reflective Devices and Associated Equipment; Denial... Motor Vehicle Safety Standard (FMVSS) No. 108; Lamps, reflective devices, and associated equipment... physical filaments in the lamp. Specifically, BMW requested that paragraph S10.17.1.1.2 \\4\\ of the...

The National Education Association's Educational Computer Service. An Assessment.

ERIC Educational Resources Information Center

Software Publishers Association, Washington, DC.

The Educational Computer Service (ECS) of the National Education Association (NEA) evaluates and distributes educational software. An investigation of ECS was conducted by the Computer Education Committee of the Software Publishers Association (SPA) at the request of SPA members. The SPA found that the service, as it is presently structured, is…

Association between antinuclear antibody titers and connective tissue diseases in a Rheumatology Department.

PubMed

Menor Almagro, Raúl; Rodríguez Gutiérrez, Juan Francisco; Martín-Martínez, María Auxiliadora; Rodríguez Valls, María José; Aranda Valera, Concepción; de la Iglesia Salgado, José Luís

To determine the dilution titles at antinuclear antibodies (ANA) by indirect immunofluorescence observed in cell substrate HEp-2 and its association with the diagnosis of systemic connective tissue disease in ANA test requested by a Rheumatology Unit. Samples of patients attended for the first time in the rheumatology unit, without prior ANA test, between January 2010 and December 2012 were selected. The dilution titers, immunofluorescence patterns and antigen specificity were recorded. In January 2015 the diagnosis of the patients were evaluated and classified in systemic disease connective tissue (systemic lupus erythematosus, Sjögren's syndrome, systemic sclerosis, undifferentiated connective, antiphospholipid syndrome, mixed connective tissue and inflammatory myophaty) or not systemic disease connective tissue. A total of 1282 ANA tests requested by the Rheumatology Unit in subjects without previous study, 293 were positive, predominance of women (81.9%). Patients with systemic connective tissue disease were recorded 105, and 188 without systemic connective tissue disease. For 1/640 dilutions the positive predictive value in the connective was 73.3% compared to 26.6% of non-connective, and for values ≥1/1,280 85% versus 15% respectively. When performing the multivariate analysis we observed a positive association between 1/320 dilution OR 3.069 (95% CI: 1.237-7.614; P=.016), 1/640 OR 12.570 (95% CI: 3.659-43.187; P=.000) and ≥1/1,280 OR 42.136 (95% CI: 8.604-206.345; P=.000). These results show association titles dilution ≥1/320 in ANA's first test requested by a Rheumatology Unit with patients with systemic connective tissue disease. The VPP in these patients was higher than previous studies requested by other medical specialties. This may indicate the importance of application of the test in a targeted way. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Automation of a Large Analytical Chemistry Laboratory

DTIC Science & Technology

1990-12-01

Division Brooks Air Force Base , Texas 78235-5501 NOTICES When Government drawings, specifications, or other data are used for any purpose other than a...been reviewed and is approved for publication. Air Force installations may direct requests for copies of this report to: Air Force Occupational and...remaining for the analyses. Our laboratory serves worldwide Air Force installations and therefore comes up against these sample holding time requirements

Characteristics of complaints resulting in disciplinary actions against Danish GPs.

PubMed

Birkeland, Søren; Depont Christensen, Rene; Damsbo, Niels; Kragstrup, Jakob

2013-09-01

The risk of being disciplined in connection with a complaint case causes distress to most general practitioners. The present study examined the characteristics of complaint cases resulting in disciplinary action. The Danish Patients' Complaints Board's decisions concerning general practice in 2007 were examined. Information on the motives for complaining, as well as patient and general practitioner characteristics, was extracted and the association with case outcome (disciplinary or no disciplinary action) was analysed. Variables included complaint motives, patient gender and age, urgency of illness, cancer diagnosis, healthcare settings (daytime or out-of-hours services), and general practitioner gender and professional seniority. Cases where the complaint motives involved a wish for placement of responsibility (OR = 2.35, p = 0.01) or a wish for a review of the general practitioner's competence (OR = 1.95, p = 0.02) were associated with increased odds of the general practitioner being disciplined. The odds of discipline decreased when the complaint was motivated by a feeling of being devalued (OR = 0.39, p = 0.02) or a request for an explanation (OR = 0.46, p = 0.01). With regard to patient and general practitioner characteristics, higher general practitioner professional seniority was associated with increased odds of discipline (OR = 1.97 per 20 additional years of professional seniority, p = 0.01). None of the other characteristics was statistically significantly associated with discipline in the multiple logistic regression model. Complaint motives and professional seniority were associated with decision outcomes. Further research is needed on the impact of professional seniority on performance.

Cesarean delivery on maternal request: wise use of finite resources? A view from the trenches.

PubMed

Druzin, Maurice L; El-Sayed, Yasser Y

2006-10-01

Cesarean section rates are rising in the United States and were at an all time high of 29 percent in 2004. Within this context, the issue of cesarean section on maternal request has been described as being part of a "perfect storm" of medical, legal and personal choice issues, and the lack of an opposing view. An increasing cesarean section rate adds an economic burden on already highly stressed medical systems. There is an incremental cost of cesarean section compared to vaginal delivery. The issue of cost must also be considered more broadly. Rising cesarean section rates are associated with a longer length of stay and a higher occupancy rate. This high occupancy rate leads to the diversion of critical care obstetric transports and has dramatically reduced patient satisfaction. These diversions, and the resultant inability to provide needed care to pregnant women, represent a profound societal cost. These critical care diversions and reduced patient satisfaction also negatively impact a health care institution's financial bottom line and competitiveness. The impact of a rising cesarean section rate on both short and long-term maternal and neonatal complications, and their associated costs, must also be taken into account. The incidence of placenta accreta is increasing in conjunction with the rising cesarean section rate. The added costs associated with this complication (MRI, Interventional Radiology, transfusion, hysterectomy, and intensive care admission) can be prohibitive. It has also been demonstrated that infants born by scheduled cesarean delivery are more likely to require advanced nursery support (with all its associated expense) than infants born to mothers attempting vaginal delivery. The practice of maternal request cesarean section, with limited good data and obvious inherent risk and expense, is increasing in the USA. Patient autonomy and a woman's right to choose her mode of delivery should be respected. However, in our opinion, based on the current evidence regarding cesarean delivery on maternal request, promotion of primary cesarean section on request as a standard of care or as a mandated part of patient counseling for delivery will result in a highly questionable use of finite resources. As of 2004, 46 million Americans did not even have basic health insurance. It is critical that we not allow ourselves to be dragged into the eye of a "perfect storm." This conference is an important step in the rational and objective analysis of this issue.

12 CFR 611.1124 - Territorial adjustments.

Code of Federal Regulations, 2010 CFR

2010-01-01

....1124 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ORGANIZATION Mergers... apply to any request submitted to the Farm Credit Administration to modify association charters for the... date of the territory transfer to inform the transferor association of their decision to remain with...

7 CFR 400.767 - Requester obligations.

Code of Federal Regulations, 2011 CFR

2011-01-01

....gov; or (iv) By overnight delivery to the Associate Administrator, Risk Management Agency, United... subpart must: (1) Be submitted: (i) In writing by certified mail, to the Associate Administrator, Risk Management Agency, United States Department of Agriculture, Stop Code 0801, 1400 Independence Avenue, SW...

76 FR 37894 - Amendment of a Savings Association's Bylaws

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-28

... DEPARTMENT OF THE TREASURY Office of Thrift Supervision Amendment of a Savings Association's Bylaws AGENCY: Office of Thrift Supervision (OTS), Treasury. ACTION: Notice and request for comment... Office of Thrift Supervision within the Department of the Treasury will submit the proposed information...

76 FR 36626 - Amendment of a Federal Savings Association Charter

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-22

... DEPARTMENT OF THE TREASURY Office of Thrift Supervision Amendment of a Federal Savings Association Charter AGENCY: Office of Thrift Supervision (OTS), Treasury. ACTION: Notice and request for comment...; and Information Collection Comments, Chief Counsel's Office, Office of Thrift Supervision, 1700 G...

7 CFR 400.767 - Requester obligations.

Code of Federal Regulations, 2010 CFR

2010-01-01

....gov; or (iv) By overnight delivery to the Associate Administrator, Risk Management Agency, United... subpart must: (1) Be submitted: (i) In writing by certified mail, to the Associate Administrator, Risk Management Agency, United States Department of Agriculture, Stop Code 0801, 1400 Independence Avenue, SW...

Exposure to violence among women with unwanted pregnancies and the association with post-traumatic stress disorder, symptoms of anxiety and depression.

PubMed

Tinglöf, Soile; Högberg, Ulf; Lundell, Inger Wallin; Svanberg, Agneta Skoog

2015-06-01

The objective was to examine lifetime exposure to violence, physical and sexual, among women seeking termination of pregnancy (TOP) and its association with socio-demographic factors, PTSD, symptoms of anxiety and depression. The design of the study was a Swedish multi-centre study targeting women requesting TOP. All women requesting TOP with a gestational length less than 12 pregnancy weeks were approached for participation in the study. The questionnaire comprised the following research instruments: Screen Questionnaire-Post traumatic Stress Disorder (SQ-PTSD) and Hospital Anxiety and Depression Scale (HADS). The response rate was 57% and the final sample was 1514 women. Descriptive and analytic statistics were applied. Lifetime exposure to violence was common among women seeking abortion. Exposure to violence was associated with low education, single marital status, smoking and high alcohol consumption. Exposure to violence was associated with the occurrence of signs of PTSD and symptoms of anxiety and depression. Among those having PTSD, all had been exposed to sexual violence and almost all had been exposed to physical violence, while for those with symptoms of anxiety and depression almost half had been exposed to either physical or sexual violence. Exposure to physical and sexual abuse was common among women requesting TOP, and was strongly associated with the occurrence of PTSD, symptoms of anxiety and depression. This underscores the importance for health professionals to recognize and offer support to those women exposed to violence. Copyright © 2014. Published by Elsevier B.V.

A Comparison of the Request Process and Outcomes in Adult and Pediatric Organ Donation

PubMed Central

Siminoff, Laura A.; Molisani, Anthony J.

2015-01-01

BACKGROUND AND OBJECTIVES: Although existing studies suggest that factors affecting families’ decisions regarding pediatric organ donation mirror those for adult patients, health professionals working in this area maintain that pediatric and adult decision-makers differ in significant ways. This study compared the request process, experiences, and authorization decisions between family decision-makers (FDMs) of adult and pediatric donors and nondonors. METHODS: Perceptions of the donation request were collected via telephone interviews with 1601 FDMs approached by staff from 9 US organ procurement organizations (OPOs). Authorization regarding donation (ie, authorized/refused) was obtained from FDM reports and verified by using OPO records. Tests of association were used to estimate differences between FDMs of adult and pediatric patients. A logistic regression analysis was conducted to identify variables predicting FDM authorization. RESULTS: FDMs of children were significantly more likely to authorize donation than were FDMs of adults (89.7% vs 83.2%; χ2 = 6.2, P = .01). Differences were found between pediatric and adult families’ initial feelings toward donation, donation-related topics discussed, communication behaviors and techniques used, perceptions of the request, and receipt and preference of grief information. The likelihood of FDM authorization increased with the number of topics discussed and communication skills employed during requests. Authorization was not predicted by patient age (ie, adult versus pediatric). CONCLUSIONS: FDMs of children are willing to donate and experience no more psychological distress from the request for donation than do FDMs of adults. Communication emerged as a critical factor of family authorization, reinforcing its importance in requests for donation. PMID:26034251

A Comparison of the Request Process and Outcomes in Adult and Pediatric Organ Donation.

PubMed

Siminoff, Laura A; Molisani, Anthony J; Traino, Heather M

2015-07-01

Although existing studies suggest that factors affecting families' decisions regarding pediatric organ donation mirror those for adult patients, health professionals working in this area maintain that pediatric and adult decision-makers differ in significant ways. This study compared the request process, experiences, and authorization decisions between family decision-makers (FDMs) of adult and pediatric donors and nondonors. Perceptions of the donation request were collected via telephone interviews with 1601 FDMs approached by staff from 9 US organ procurement organizations (OPOs). Authorization regarding donation (ie, authorized/refused) was obtained from FDM reports and verified by using OPO records. Tests of association were used to estimate differences between FDMs of adult and pediatric patients. A logistic regression analysis was conducted to identify variables predicting FDM authorization. FDMs of children were significantly more likely to authorize donation than were FDMs of adults (89.7% vs 83.2%; χ(2) = 6.2, P = .01). Differences were found between pediatric and adult families' initial feelings toward donation, donation-related topics discussed, communication behaviors and techniques used, perceptions of the request, and receipt and preference of grief information. The likelihood of FDM authorization increased with the number of topics discussed and communication skills employed during requests. Authorization was not predicted by patient age (ie, adult versus pediatric). FDMs of children are willing to donate and experience no more psychological distress from the request for donation than do FDMs of adults. Communication emerged as a critical factor of family authorization, reinforcing its importance in requests for donation. Copyright © 2015 by the American Academy of Pediatrics.

Method and apparatus of prefetching streams of varying prefetch depth

DOEpatents

Gara, Alan [Mount Kisco, NY; Ohmacht, Martin [Yorktown Heights, NY; Salapura, Valentina [Chappaqua, NY; Sugavanam, Krishnan [Mahopac, NY; Hoenicke, Dirk [Seebruck-Seeon, DE

2012-01-24

Method and apparatus of prefetching streams of varying prefetch depth dynamically changes the depth of prefetching so that the number of multiple streams as well as the hit rate of a single stream are optimized. The method and apparatus in one aspect monitor a plurality of load requests from a processing unit for data in a prefetch buffer, determine an access pattern associated with the plurality of load requests and adjust a prefetch depth according to the access pattern.

Probing Aircraft Flight Test Hazard Mitigation for the Alternative Fuel Effects on Contrails & Cruise Emissions (ACCESS) Research Team

NASA Technical Reports Server (NTRS)

Kelly, Michael J.

2013-01-01

The Alternative Fuel Effects on Contrails & Cruise Emissions (ACCESS) Project Integration Manager requested in July 2012 that the NASA Engineering and Safety Center (NESC) form a team to independently assess aircraft structural failure hazards associated with the ACCESS experiment and to identify potential flight test hazard mitigations to ensure flight safety. The ACCESS Project Integration Manager subsequently requested that the assessment scope be focused predominantly on structural failure risks to the aircraft empennage raft empennage.

"We need to talk!" Barriers to GPs' communication about the option of physician-assisted suicide and their ethical implications: results from a qualitative study.

PubMed

Otte, Ina C; Jung, Corinna; Elger, Bernice; Bally, Klaus

2017-06-01

GPs usually care for their patients for an extended period of time, therefore, requests to not only discontinue a patient's treatment but to assist a patient in a suicide are likely to create intensely stressful situations for physicians. However, in order to ensure the best patient care possible, the competent communication about the option of physician assisted suicide (PAS) as well as the assessment of the origin and sincerity of the request are very important. This is especially true, since patients' requests for PAS can also be an indicator for unmet needs or concerns. Twenty-three qualitative semi-structured interviews were conducted to in-depth explore this multifaceted, complex topic while enabling GPs to express possible difficulties when being asked for assistance. The analysis of the gathered data shows three main themes why GPs may find it difficult to professionally communicate about PAS: concerns for their own psychological well-being, conflicting personal values or their understanding of their professional role. In the discussion part of this paper we re-assess these different themes in order to ethically discuss and analyse how potential barriers to professional communication concerning PAS could be overcome.

Legionella (Legionnaires' Disease and Pontiac Fever): Diagnosis

MedlinePlus

... Outbreaks Preventing Healthcare-associated Disease Environmental Resources Communications Resources Request CDC Assistance For Laboratories Prevention with Water Management Programs Overview of Water Management Programs Water ...

A System for Automatically Generating Scheduling Heuristics

NASA Technical Reports Server (NTRS)

Morris, Robert

1996-01-01

The goal of this research is to improve the performance of automated schedulers by designing and implementing an algorithm by automatically generating heuristics by selecting a schedule. The particular application selected by applying this method solves the problem of scheduling telescope observations, and is called the Associate Principal Astronomer. The input to the APA scheduler is a set of observation requests submitted by one or more astronomers. Each observation request specifies an observation program as well as scheduling constraints and preferences associated with the program. The scheduler employs greedy heuristic search to synthesize a schedule that satisfies all hard constraints of the domain and achieves a good score with respect to soft constraints expressed as an objective function established by an astronomer-user.

Gender-partitioned patient medians of serum albumin requested by general practitioners for the assessment of analytical stability.

PubMed

Hansen, Steen Ingemann; Petersen, Per Hyltoft; Lund, Flemming; Fraser, Callum G; Sölétormos, György

2018-04-25

Recently, the use of separate gender-partitioned patient medians of serum sodium has revealed potential for monitoring analytical stability within the optimum analytical performance specifications for laboratory medicine. The serum albumin concentration depends on whether a patient is sitting or recumbent during phlebotomy. We therefore investigated only examinations requested by general practitioners (GPs) to provide data from sitting patients. Weekly and monthly patient medians of serum albumin requested by GP for both male and female patients were calculated from the raw data obtained from three analysers in the hospital laboratory on examination of samples from those >18 years. The half-range of medians were applied as an estimate of the maximum bias. Further, the ratios between the two medians were calculated (females/males). The medians for male and female patients were closely related despite considerable variation due to the current analytical variation. This relationship was confirmed by the calculated half-range for the monthly ratio between the genders of 0.44%, which surpasses the optimum analytical performance specification for bias of serum albumin (0.72%). The weekly ratio had a half-range of 1.83%, which surpasses the minimum analytical performance specifications of 2.15%. Monthly gender-partitioned patient medians of serum albumin are useful for monitoring of long-term analytical stability, where the gender medians are two independent estimates of changes in (delta) bias: only results requested by GP are of value in this application to ensure that all patients are sitting during phlebotomy.

Informal medicine: ethical analysis

PubMed Central

Leavitt, F; Peleg, R; Peleg, A

2005-01-01

Context: Doctors have been known to treat or give consultation to patients informally, with none of the usual record keeping or follow up. They may wish to know whether this practice is ethical. Objective: To determine whether this practice meets criteria of medical ethics. Design: Informal medicine is analysed according to standard ethical principles: autonomy, beneficence and non-maleficence, distributive and procedural justice, and caring. Setting: Hospital, medical school, and other settings where patients may turn to physicians for informal help. Conclusion: No generalisation can be made to the effect that informal medicine is or is not ethical. Each request for informal consultation must be considered on its own merits. Guidelines: Informal medicine may be ethical if no payment is involved, and when the patient is fully aware of the benefits and risks of a lack of record keeping. When an informal consultation does not entail any danger to the patient or others, the physician may agree to the request. If, however, any danger to the patient or others is foreseen, then the physician must insist on professional autonomy, and consider refusing the request and persuading the patient to accept formal consultation. If a reportable infectious disease, or other serious danger to the community, is involved, the physician should refuse informal consultation or treatment, or at least make a proper report even if the consultation was informal. If agreeing to the request will result in an unfair drain on the physician's time or energy, he or she should refuse politely. PMID:16319228

78 FR 71704 - Request for Comments on Draft SBA Strategic Plan for FY 2014-2018

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-29

... AGENCY: Office of Associate Administrator for Performance Management & Chief Financial Officer, Small.... Carver, Associate Administrator for Performance Management & Chief Financial Officer. [FR Doc. 2013-28623...-7274. Mail: U.S. Small Business Administration, Office of Performance Management & Chief Financial...

76 FR 21801 - Amendment of a Federal Savings Association Charter

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-18

... DEPARTMENT OF THE TREASURY Office of Thrift Supervision Amendment of a Federal Savings Association Charter AGENCY: Office of Thrift Supervision (OTS), Treasury. ACTION: Notice and request for comment... Office of Thrift Supervision within the Department of the Treasury will submit the proposed information...

77 FR 37959 - Financial Management Service; Proposed Collection of Information: Pools and Associations-Annual...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-25

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Pools and Associations--Annual Letter AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and request for comments. SUMMARY: The Financial Management Service, as part of...

76 FR 71573 - Medicare Program; Request for Nominations for Members for the Medicare Evidence Development...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-18

... individual qualifications and not as representatives of professional associations or societies. We wish to... subspecialties, administrative medicine, public health, biological and physical sciences, epidemiology and... as representatives of professional associations or societies. We wish to ensure adequate...

Research Perspectives on the Health Impacts of Wildfires and Wildfire Smoke

EPA Science Inventory

The webinar was requested by the National Association of County and City Heath Officials. From their website, The National Association of County Health Officials (NACHO) was founded in 1965. In early 1984, the organization experienced remarkable growth in membership and the org...

Ambiguity, ambivalence, and apprehensions of taking HIV-1 pre-exposure prophylaxis among male couples in San Francisco: a mixed methods study.

PubMed

Saberi, Parya; Gamarel, Kristi E; Neilands, Torsten B; Comfort, Megan; Sheon, Nicolas; Darbes, Lynae A; Johnson, Mallory O

2012-01-01

We conducted a mixed-methods study to examine serodiscordant and seroconcordant (HIV-positive/HIV-positive) male couples' PrEP awareness, concerns regarding health care providers offering PrEP to the community, and correlates of PrEP uptake by the HIV-negative member of the couple. Qualitative sub-study included one-on-one interviews to gain a deeper understanding of participants' awareness of and experiences with PrEP and concerns regarding health care providers offering PrEP to men who have sex with men (MSM). Quantitative analyses consisted of a cross-sectional study in which participants were asked about the likelihood of PrEP uptake by the HIV-negative member of the couple and level of agreement with health care providers offering PrEP to anyone requesting it. We used multivariable regression to examine associations between PrEP questions and covariates of interest and employed an inductive approach to identify key qualitative themes. Among 328 men (164 couples), 62% had heard about PrEP, but approximately one-quarter were mistaking it with post-exposure prophylaxis. The majority of participants had low endorsement of PrEP uptake and 40% were uncertain if health care providers should offer PrEP to anyone requesting it. Qualitative interviews with 32 men suggest that this uncertainty likely stems from concerns regarding increased risk compensation. Likelihood of future PrEP uptake by the HIV-negative member of the couple was positively associated with unprotected insertive anal intercourse but negatively correlated with unprotected receptive anal intercourse. Findings suggest that those at greatest risk may not be receptive of PrEP. Those who engage in moderate risk express more interest in PrEP; however, many voice concerns of increased risk behavior in tandem with PrEP use. Results indicate a need for further education of MSM communities and the need to determine appropriate populations in which PrEP can have the highest impact.

Standards of resuscitation during inter-hospital transportation: the effects of structured team briefing or guideline review - a randomised, controlled simulation study of two micro-interventions.

PubMed

Høyer, Christian B; Christensen, Erika F; Eika, Berit

2011-03-03

Junior physicians are sometimes sent in ambulances with critically ill patients who require urgent transfer to another hospital. Unfamiliar surroundings and personnel, time pressure, and lack of experience may imply a risk of insufficient treatment during transportation as this can cause the physician to loose the expected overview of the situation. While health care professionals are expected to follow complex algorithms when resuscitating, stress can compromise both solo-performance and teamwork. To examine whether inter-hospital resuscitation improved with a structured team briefing between physician and ambulance crew in preparation for transfer vs. review of resuscitation guidelines. The effect parameters were physician team leadership (requesting help, delegating tasks), time to resuscitation key elements (chest compressions, defibrillation, ventilations, medication, or a combination of these termed "the first meaningful action"), and hands-off ratio. 46 physicians graduated within 5 years. A simulation intervention study with a control group and two interventions (structured team briefing or review of guidelines). Scenario: Cardiac arrest during simulated inter-hospital transfer. Forty-six candidates participated: 16 (control), 13 (review), and 17 (team briefing). Reviewing guidelines delayed requesting help to 162 seconds, compared to 21 seconds in control and team briefing groups (p = 0.021). Help was not requested in 15% of cases; never requesting help was associated with an increased hands-off ratio, from 39% if the driver's assistance was requested to 54% if not (p < 0.01). No statistically significant differences were found between groups regarding time to first chest compression, defibrillation, ventilation, drug administration, or the combined "time to first meaningful action". Neither review nor team briefing improved the time to resuscitation key elements. Review led to an eight-fold increase in the delay to requesting help. The association between never requesting help and an increased hands-off ratio underpins the importance of prioritising available resources. Other medical and non-medical domains have benefited from the use of guidelines reviews and structured team briefings. Reviewing guidelines may compromise the ability to focus on aspects such as team leading and delegating tasks and warrants the need for further studies focusing on how to avoid this cognitive impairment.

Standards of resuscitation during inter-hospital transportation: the effects of structured team briefing or guideline review - A randomised, controlled simulation study of two micro-interventions

PubMed Central

2011-01-01

Background Junior physicians are sometimes sent in ambulances with critically ill patients who require urgent transfer to another hospital. Unfamiliar surroundings and personnel, time pressure, and lack of experience may imply a risk of insufficient treatment during transportation as this can cause the physician to loose the expected overview of the situation. While health care professionals are expected to follow complex algorithms when resuscitating, stress can compromise both solo-performance and teamwork. Aim To examine whether inter-hospital resuscitation improved with a structured team briefing between physician and ambulance crew in preparation for transfer vs. review of resuscitation guidelines. The effect parameters were physician team leadership (requesting help, delegating tasks), time to resuscitation key elements (chest compressions, defibrillation, ventilations, medication, or a combination of these termed "the first meaningful action"), and hands-off ratio. Methods Participants: 46 physicians graduated within 5 years. Design: A simulation intervention study with a control group and two interventions (structured team briefing or review of guidelines). Scenario: Cardiac arrest during simulated inter-hospital transfer. Results Forty-six candidates participated: 16 (control), 13 (review), and 17 (team briefing). Reviewing guidelines delayed requesting help to 162 seconds, compared to 21 seconds in control and team briefing groups (p = 0.021). Help was not requested in 15% of cases; never requesting help was associated with an increased hands-off ratio, from 39% if the driver's assistance was requested to 54% if not (p < 0.01). No statistically significant differences were found between groups regarding time to first chest compression, defibrillation, ventilation, drug administration, or the combined "time to first meaningful action". Conclusion Neither review nor team briefing improved the time to resuscitation key elements. Review led to an eight-fold increase in the delay to requesting help. The association between never requesting help and an increased hands-off ratio underpins the importance of prioritising available resources. Other medical and non-medical domains have benefited from the use of guidelines reviews and structured team briefings. Reviewing guidelines may compromise the ability to focus on aspects such as team leading and delegating tasks and warrants the need for further studies focusing on how to avoid this cognitive impairment. PMID:25928019

Meta-analytic evidence of low convergence between implicit and explicit measures of the needs for achievement, affiliation, and power

PubMed Central

Köllner, Martin G.; Schultheiss, Oliver C.

2014-01-01

The correlation between implicit and explicit motive measures and potential moderators of this relationship were examined meta-analytically, using Hunter and Schmidt's (2004) approach. Studies from a comprehensive search in PsycINFO, data sets of our research group, a literature list compiled by an expert, and the results of a request for gray literature were examined for relevance and coded. Analyses were based on 49 papers, 56 independent samples, 6151 subjects, and 167 correlations. The correlations (ρ) between implicit and explicit measures were 0.130 (CI: 0.077–0.183) for the overall relationship, 0.116 (CI: 0.050–0.182) for affiliation, 0.139 (CI: 0.080–0.198) for achievement, and 0.038 (CI: −0.055–0.131) for power. Participant age did not moderate the size of these relationships. However, a greater proportion of males in the samples and an earlier publication year were associated with larger effect sizes. PMID:25152741

Impact of the Federal School-Based Student Mentoring Program. NCEE Evaluation Brief. NCEE 2009-4074

ERIC Educational Resources Information Center

National Center for Education Evaluation and Regional Assistance, 2009

2009-01-01

The Office of Management and Budget requested that the Institute of Education Sciences (IES) oversee an independent impact evaluation of the federal Student Mentoring Program, and in 2005 IES contracted with Abt Associates and its team of subcontractors (Branch Associates, Moore and Associates, and the Center for Resource Management) to conduct…

76 FR 13126 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-10

.... Other government agencies and businesses use this information for market research, product development... private businesses, trade organizations, professional associations, and other business research and...

Legionella (Legionnaires' Disease and Pontiac Fever): Fast Facts

MedlinePlus

... Outbreaks Preventing Healthcare-associated Disease Environmental Resources Communications Resources Request CDC Assistance For Laboratories Prevention with Water Management Programs Overview of Water Management Programs Water ...

Correlates of parental antibiotic knowledge, demand, and reported use.

PubMed

Kuzujanakis, Marianne; Kleinman, Ken; Rifas-Shiman, Sheryl; Finkelstein, Jonathan A

2003-01-01

Clinicians cite parental misconceptions and requests for antibiotics as reasons for inappropriate prescribing. To identify misconceptions regarding antibiotics and predictors of parental demand for antibiotics and to determine if parental knowledge and attitudes are associated with use. Survey of parents in 16 Massachusetts communities. Domains included antibiotic-related knowledge, attitudes about antibiotics, antibiotic use during a 12-month period, demographics, and access to health information. Bivariate and multivariate analyses evaluated predictors of knowledge and proclivity to demand antibiotics. A multivariate model evaluated the associations of knowledge, demand, and demographic factors with parent-reported antibiotic use. A total of 1106 surveys were returned (response rates: 54% and 32% for commercially-insured and Medicaid-insured families). Misconceptions were common regarding bronchitis (92%) and green nasal discharge (78%). Two hundred sixty-five (24%) gave responses suggesting a proclivity to demand antibiotics. Antibiotic knowledge was associated with increased parental age and education, having more than 1 child, white race, and receipt of media information on resistance. Factors associated with a proclivity to demand antibiotics included decreased knowledge, pressure from day-care settings, lack of alternatives offered by clinicians, and lack of access to media information. Among all respondents, reported antibiotic use was associated with younger child age and day-care attendance. Among Medicaid-insured children only, less antibiotic knowledge and tendency to demand antibiotics were associated with higher rates of antibiotic use. Misconceptions regarding antibiotic use are widespread and potentially modifiable by clinicians and media sources. Particular attention should be paid to Medicaid-insured patients in whom such misconceptions may contribute to inappropriate prescribing.

Statistical Analysis of Fort Hood Quality-of-Life Questionnaire.

DTIC Science & Technology

1978-10-01

The objective of this work was to provide supplementary data analyses of data abstracted from the Quality - of - Life questionnaire developed earlier at...the Fort Hood Field Unit at the request of Headquarters, TRADOC Combined Arms Test Activity (TCATA). The Quality - of - Life questionnaire data were...to the Quality - of - Life questionnaire. These data were then intensively analyzed using analysis of variance and correlational techniques. The results

Clinical lead poisoning in England: an analysis of routine sources of data.

PubMed

Elliott, P; Arnold, R; Barltrop, D; Thornton, I; House, I M; Henry, J A

1999-12-01

To examine the occurrence of clinical lead poisoning in England based on routine sources of data. Three routine data sources were examined, over different periods according to availability of data: (a) mortality for England, 1981-96; (b) hospital episode statistics data for England, for the 3 years 1 April 1992-31 March 1995; (c) statutory returns to the Health and Safety Executive under the reporting of injuries, diseases, and dangerous occurrences regulations (RIDDOR), also for the period 1 April 1992-31 March 1995. Also, analyses of blood lead concentrations carried out by the Medical Toxicology Unit, Guy's and St Thomas' Hospital Trust in London during the period 1 January 1991-31 December 1997 were examined. The analyses were performed both for industrial screening purposes and in response to clinicians' requests where lead poisoning was suspected. This is one of several laboratories carrying out such analyses in the United Kingdom. One death, of a 2 year old girl, was coded to lead poisoning in England during 1981-96. Analysis of hospital episode statistics data identified 83 hospital cases (124 admissions) over 3 years with any mention of lead poisoning, excluding two with admissions dating from 1965 and 1969. For these 83 cases the median hospital stay per admission was 3 days (range 0-115 days). Five were coded as having received intravenous treatment. Further clinical details of these cases beyond what is routinely recorded on the hospital episode statistics database were not available, except for blood lead concentrations in cases also identified on the Medical Toxicology Unit database. Eighteen cases (22%) were below 5 years of age of whom 10 (56%) came from the most deprived quintile of electoral wards. There was evidence to suggest spatial clustering of cases (p = 0.02). Six occupational cases were reported under RIDDOR in England during the period of study, two of whom were identified on the hospital episode statistics database. One further occupational case was identified on hospital episode statistics. Blood lead analyses for 4424 people carried out by the Medical Toxicology Unit (estimated at about 5% of such analyses in England over 7 years) found that among 547 children aged 0-4, 45 (8.2%) had a blood lead concentration in excess of 25 micrograms/dl, the action level in the United Kingdom for investigation, or removal of environmental sources of lead. At all ages, there were 419 (9.5%) such people, including 106 adults with no mention of industrial exposure. Both mortality and hospital admission ascribed to lead poisoning in England are rare, but cases continue to occur and some, at least, seem to be associated with considerable morbidity. Lead poisoning was confirmed as a probable cause of clinical signs and symptoms in only a small proportion of those in whom a blood lead concentration was requested. Where indicated, appropriate remedial action for the safe removal of environmental sources of lead should be taken.

76 FR 1598 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-11

... purpose of the Cell Phone and Debit Card Test is to research alternative survey designs that could....S. Census Bureau. Title: National Survey of Fishing, Hunting, and Wildlife-Associated Recreation... clearance number 1018-0088) the 2011 National Survey of Fishing, Hunting, and Wildlife-Associated Recreation...

77 FR 48995 - Draft National Toxicology Program (NTP) Monograph on Developmental Effects and Pregnancy Outcomes...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-15

... Program (NTP) Monograph on Developmental Effects and Pregnancy Outcomes Associated With Cancer Chemotherapy Use During Pregnancy; Request for Comments; Peer Review Panel Meeting AGENCY: Division of the... Monograph on Developmental Effects and Pregnancy Outcomes Associated with Cancer Chemotherapy Use during...

7 CFR 993.62 - Diversion privileges.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing...) Voluntary principle. No producer shall be required to divert all or any portion of the prune plums produced... marketing association shall be issued by the committee to the association if it so requests. To the extent...

78 FR 63986 - Medicare Program; Request for Nominations for Members for the Medicare Evidence Development...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

... individual qualifications and not as representatives of professional associations or societies. We wish to..., administrative medicine, public health, biological and physical sciences, epidemiology and biostatistics... individual qualifications and not as representatives of professional associations or societies. We wish to...

Legionella (Legionnaires' Disease and Pontiac Fever): Signs and Symptoms

MedlinePlus

... Outbreaks Preventing Healthcare-associated Disease Environmental Resources Communications Resources Request CDC Assistance For Laboratories Prevention with Water Management Programs Overview of Water Management Programs Water ...

The privilege and burden of peer review.

PubMed

Blume, Arthur W; Schmaling, Karen B

2016-01-01

Peer review is a core value and method of quality control in psychological research, academic psychology, and other disciplines, but little is known about the peer-reviewing behavior of ethnic minority reviewers in particular. The purpose of this study was to examine the self-identified ethnicity of those invited to peer review articles for 76 journals that utilized the American Psychological Association's Journals Back Office (JBO) system from 2003 to 2012. It was hypothesized that a modest increase in the ratio of requests for reviews from self-identified ethnic minority reviewers would be observed over time, that self-identified ethnic minority reviewers would be less likely to refuse a review request than those who do not self-identify as an ethnic minority, and finally that increases in reviewer burden would be evident in significant increases in declines to requests by all reviewers. Reviewer requests and responses were examined among the 76 journals that used the JBO system over a 10-year period. Using hierarchical linear models, the percentage of review invitations extended to ethnic minorities was found to significantly increase over time: Initially, an estimated 8.34% of review requests were made to ethnic minority reviewers, and that percentage increased an average of 0.41% per year. Ethnic minority reviewers were significantly less likely to refuse a review request than ethnic majority reviewers. Results are discussed in terms of perceived pressure to demonstrate scholastic impact and the disproportionate service burden often borne by ethnic minority psychologists. (c) 2016 APA, all rights reserved).

Socio-demographic and structural barriers to being tested for chlamydia in general practice.

PubMed

Lau, Andrew; Spark, Simone; Tomnay, Jane; Smith, Meredith T; Fairley, Christopher K; Guy, Rebecca J; Donovan, Basil; Hocking, Jane S

2016-02-15

To investigate socio-demographic and structural factors associated with not providing a specimen for chlamydia testing following a request by a general practitioner. Cross-sectional analysis of chlamydia testing data for men and women aged 16-29 years attending general practice clinics participating in a cluster randomised controlled trial evaluating the effectiveness of a chlamydia testing intervention. The study period was the 2013 calendar year. The proportion of chlamydia test requests for which the patient did not provide a specimen for testing. During the study period, there were 13 225 chlamydia test requests, for which a chlamydia test was not performed in 2545 instances (19.2%; 95% CI, 16.5-22.3%). Multivariate analysis indicated that the odds for not undertaking a requested test were higher for men (adjusted odds ratio [aOR], 1.4; 95% CI, 1.3-1.6), those aged 16-19 years (aOR, 1.3; 95% CI, 1.1-1.4), those living in areas of greater socio-economic disadvantage (aOR, 1.2; 95% CI, 1.1-1.4 for each additional quintile of Index of Relative Socio-economic Disadvantage), and those attending clinics without on-site pathology collection (aOR, 1.4; 95% CI, 1.0-1.9). One in five young people did not submit a specimen for chlamydia testing despite their GP requesting it. This highlights the need for clinics to establish systems which ensure that men and those aged 16-19 years undertake chlamydia tests requested by a GP.

Influence of peer review on the reporting of primary outcome(s) and statistical analyses of randomised trials.

PubMed

Hopewell, Sally; Witt, Claudia M; Linde, Klaus; Icke, Katja; Adedire, Olubusola; Kirtley, Shona; Altman, Douglas G

2018-01-11

Selective reporting of outcomes in clinical trials is a serious problem. We aimed to investigate the influence of the peer review process within biomedical journals on reporting of primary outcome(s) and statistical analyses within reports of randomised trials. Each month, PubMed (May 2014 to April 2015) was searched to identify primary reports of randomised trials published in six high-impact general and 12 high-impact specialty journals. The corresponding author of each trial was invited to complete an online survey asking authors about changes made to their manuscript as part of the peer review process. Our main outcomes were to assess: (1) the nature and extent of changes as part of the peer review process, in relation to reporting of the primary outcome(s) and/or primary statistical analysis; (2) how often authors followed these requests; and (3) whether this was related to specific journal or trial characteristics. Of 893 corresponding authors who were invited to take part in the online survey 258 (29%) responded. The majority of trials were multicentre (n = 191; 74%); median sample size 325 (IQR 138 to 1010). The primary outcome was clearly defined in 92% (n = 238), of which the direction of treatment effect was statistically significant in 49%. The majority responded (1-10 Likert scale) they were satisfied with the overall handling (mean 8.6, SD 1.5) and quality of peer review (mean 8.5, SD 1.5) of their manuscript. Only 3% (n = 8) said that the editor or peer reviewers had asked them to change or clarify the trial's primary outcome. However, 27% (n = 69) reported they were asked to change or clarify the statistical analysis of the primary outcome; most had fulfilled the request, the main motivation being to improve the statistical methods (n = 38; 55%) or avoid rejection (n = 30; 44%). Overall, there was little association between authors being asked to make this change and the type of journal, intervention, significance of the primary outcome, or funding source. Thirty-six percent (n = 94) of authors had been asked to include additional analyses that had not been included in the original manuscript; in 77% (n = 72) these were not pre-specified in the protocol. Twenty-three percent (n = 60) had been asked to modify their overall conclusion, usually (n = 53; 88%) to provide a more cautious conclusion. Overall, most changes, as a result of the peer review process, resulted in improvements to the published manuscript; there was little evidence of a negative impact in terms of post hoc changes of the primary outcome. However, some suggested changes might be considered inappropriate, such as unplanned additional analyses, and should be discouraged.

A nationwide genetic testing survey in Italy, year 2007.

PubMed

Dallapiccola, Bruno; Torrente, Isabella; Agolini, Emanuele; Morena, Arnaldo; Mingarelli, Rita

2010-02-01

The aim of this study was to collect the practices of cytogenetic and molecular genetic testing and genetic counseling activities in Italy in the year 2007 and provide guidance to the national and regional health systems to improve the organization of genetic services. A web-based survey was carried out to assess the total number and the type of analyses, the number and type of genetic counseling sessions, and the personnel attending these activities. The quality management system of the responding structures, in terms of certification and accreditation standards, was also investigated. The appropriateness of requests for genetic testing was evaluated for six disorders. Data were collected from 278 responding centers, half of which were located in the northern regions of the country. Twenty-eight percent of the total were certified according to quality standards. A total of 217 molecular genetic and 171 cytogenetic laboratories, and 102 clinical genetic services were surveyed. About 560,000 genetic tests, including 311,069 cytogenetic and 248,691 molecular genetic analyses of 556 genes, were recorded. The fetal karyotype was examined on either trophoblast or amniocytes in about one of every 4.4 pregnancies. Only 11.5% of cytogenetic analyses and 13.5% of molecular tests were accompanied by genetic counseling. Concerning the appropriateness of a request for genetic testing, a low congruity was found between the clinical diagnosis and the laboratory results. This study highlights the need for reorganizing the genetic structure network in Italy, which at present is oversized, improving the quality management systems, expanding the availability of testing for rare disease genes, and improving access to pretest and posttest genetic counseling.

The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review.

PubMed

Olieman, Renske M; Siemonsma, Femke; Bartens, Margaux A; Garthus-Niegel, Susan; Scheele, Fedde; Honig, Adriaan

2017-06-19

Obstetricians are often reluctant to grant requests for an elective cesarean section (ECS) due to childbirth fear. To date, it is unknown if an ECS on request improves mental well-being in the mother in the peripartum period and if possible beneficial effects on anxiety and depression could outweigh the increased risk of complications associated with a surgical delivery. A systematic review was conducted to explore the effect of ECS on request on peripartum anxiety and depression. We searched on PubMed, PsychoInfo and Embase. Studies were included with primary data on anxiety and/or depression postpartum in women with childbirth fear who had requested an ECS. After full-text evaluation of 65 papers and quality analysis of four papers, three papers were included. Of one paper additional and yet unpublished data were provided. Studies varied in outcome measures, hence no meta-analysis was performed. Women who requested an ECS had higher antepartum depression and anxiety levels but no different postpartum depression levels than women who delivered vaginally. One study of good quality examined the effect of vaginal delivery in women preferring ECS: These women had significantly higher symptom levels of post-traumatic stress disorder (PTSD) and depression than women with normal vaginal delivery. The prospect of an ECS does not lower antepartum anxiety and/or depression levels in women requesting an ECS. If women resolutely persist in wishing an ECS despite adequate counselling and/or psychiatric treatment, the risk of developing depressive and PTSD symptoms in case of vaginal delivery should be taken into account, and an ECS may be considered as a valid alternative.

Epidural analgesia during labour, routinely or on request: a cost-effectiveness analysis.

PubMed

Bonouvrié, Kimberley; van den Bosch, Anouk; Roumen, Frans J M E; van Kuijk, Sander M; Nijhuis, Jan G; Evers, Silvia M A A; Wassen, Martine M L H

2016-12-01

To assess the cost-effectiveness of routine labour epidural analgesia (EA), from a societal perspective, as compared with labour analgesia on request. Women delivering of a singleton in cephalic presentation beyond 36+0 weeks' gestation were randomly allocated to routine labour EA or analgesia on request in one university and one non-university teaching hospital in the Netherlands. Costs included all medical, non-medical and indirect costs from randomisation to 6 weeks postpartum. Effectiveness was defined as a non-operative, spontaneous vaginal delivery without EA-related maternal adverse effects. Incremental cost-effectiveness ratio (ICER) was defined as the ratio of the difference in costs and the difference in effectiveness between both groups. Data were analysed according to intention to treat and divided into a base case analysis and a sensitivity analysis. Total delivery costs in the routine EA group (n=233) were higher than in the labour on request group (n=255) (difference -€ 322, 95% CI -€ 60 to € 355) due to more medication costs (including EA), a longer stay in the labour ward, and more operations including caesarean sections. Total postpartum hospital costs in the routine EA group were lower (difference -€ 344, 95% CI -€ 1338 to € 621) mainly due to less neonatal admissions (difference -€ 472, 95% CI -€ 1297 to € 331), whereas total postpartum home and others costs were comparable (difference -€ 20, 95% CI -€ 267 to € 248, and -€ 1, 95% CI -€ 67 to € 284, respectively). As a result, the overall mean costs per woman were comparable between the routine EA group and the analgesia on request group (€ 8.708 and € 8.710, respectively, mean difference -€ 2, 95% CI -€ 1.012 to € 916). Routine labour EA resulted in more deliveries with maternal adverse effects, nevertheless the ICER remained low (€ 8; bootstrap 95% CI -€ 6.120 to € 8.659). The cost-effectiveness acceptability curve indicated a low probability that routine EA is cost-effective. Routine labour EA generates comparable costs as analgesia on request, but results in more operative deliveries and more EA-related maternal adverse effects. Based on cost-effectiveness, no preference can be given to routine labour EA as compared with analgesia on request. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Nationwide survey to evaluate the decision-making process in euthanasia requests in Belgium: do specifically trained 2nd physicians improve quality of consultation?

PubMed Central

2014-01-01

Background Following the 2002 enactment of the Belgian law on euthanasia, which requires the consultation of an independent second physician before proceeding with euthanasia, the Life End Information Forum (LEIF) was founded which provides specifically trained physicians who can act as mandatory consultants in euthanasia requests. This study assesses quality of consultations in Flanders and Brussels and compares these between LEIF and non-LEIF consultants. Methods A questionnaire was sent in 2009 to a random sample of 3,006 physicians in Belgium from specialties likely involved in the care of dying patients. Several questions about the last euthanasia request of one of their patients were asked. As LEIF serves the Flemish speaking community (i.e. region of Flanders and the bilingual Brussels Capital Region) and no similar counterpart is present in Wallonia, analyses were limited to Flemish speaking physicians in Flanders and Brussels. Results Response was 34%. Of the 244 physicians who indicated having received a euthanasia request seventy percent consulted a second physician in their last request; in 30% this was with a LEIF physician. Compared to non-LEIF physicians, LEIF physicians were more often not a colleague (69% vs 42%) and not a co-attending physician (89% vs 66%). They tended to more often discuss the request with the attending physician (100% vs 95%) and with the family (76% vs 69%), and also more frequently helped the attending physician with performing euthanasia (44% vs 24%). No significant differences were found in the extent to which they talked to the patient (96% vs 93%) and examined the patient file (94% vs 97%). Conclusion In cases of explicit euthanasia requests in Belgium, the consultation procedure of another physician by the attending physician is not optimal and can be improved. Training and putting at disposal consultants through forums such as LEIF seems able to improve this situation. Adding stipulations in the law about the necessary competencies and tasks of consulting physicians may additionally incite improvement. Irrespective of whether euthanasia is a legal practice within a country, similar services may prove useful to also improve quality of consultations in various other difficult end-of-life decision-making situations. PMID:25030375

46 CFR 531.12 - Recordkeeping and audit.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... Every NVOCC shall maintain original signed NSAs, amendments, and their associated records in an... each NSA. These records must be kept in a form that is readily available and usable to the Commission... of requested original NSAs or their associated records within thirty (30) days of the date of the...

46 CFR 531.12 - Recordkeeping and audit.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... Every NVOCC shall maintain original signed NSAs, amendments, and their associated records in an... each NSA. These records must be kept in a form that is readily available and usable to the Commission... of requested original NSAs or their associated records within thirty (30) days of the date of the...

46 CFR 531.12 - Recordkeeping and audit.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... Every NVOCC shall maintain original signed NSAs, amendments, and their associated records in an... each NSA. These records must be kept in a form that is readily available and usable to the Commission... of requested original NSAs or their associated records within thirty (30) days of the date of the...