32 CFR 148.10 - General.

Code of Federal Regulations, 2011 CFR

2011-07-01

... IMPLEMENTATION OF RECIPROCITY OF FACILITIES Guidelines for the Implementation and Oversight of the Policy on Reciprocity of use and Inspections of Facilities § 148.10 General. (a) Redundant, overlapping, and duplicative... excessive protection and unnecessary expenditure of funds. Lack of reciprocity has also impeded achievement...

32 CFR 148.10 - General.

Code of Federal Regulations, 2010 CFR

2010-07-01

... IMPLEMENTATION OF RECIPROCITY OF FACILITIES Guidelines for the Implementation and Oversight of the Policy on Reciprocity of use and Inspections of Facilities § 148.10 General. (a) Redundant, overlapping, and duplicative... excessive protection and unnecessary expenditure of funds. Lack of reciprocity has also impeded achievement...

32 CFR 148.10 - General.

Code of Federal Regulations, 2014 CFR

2014-07-01

... IMPLEMENTATION OF RECIPROCITY OF FACILITIES Guidelines for the Implementation and Oversight of the Policy on Reciprocity of use and Inspections of Facilities § 148.10 General. (a) Redundant, overlapping, and duplicative... excessive protection and unnecessary expenditure of funds. Lack of reciprocity has also impeded achievement...

32 CFR 148.10 - General.

Code of Federal Regulations, 2012 CFR

2012-07-01

... IMPLEMENTATION OF RECIPROCITY OF FACILITIES Guidelines for the Implementation and Oversight of the Policy on Reciprocity of use and Inspections of Facilities § 148.10 General. (a) Redundant, overlapping, and duplicative... excessive protection and unnecessary expenditure of funds. Lack of reciprocity has also impeded achievement...

32 CFR 148.10 - General.

Code of Federal Regulations, 2013 CFR

2013-07-01

... IMPLEMENTATION OF RECIPROCITY OF FACILITIES Guidelines for the Implementation and Oversight of the Policy on Reciprocity of use and Inspections of Facilities § 148.10 General. (a) Redundant, overlapping, and duplicative... excessive protection and unnecessary expenditure of funds. Lack of reciprocity has also impeded achievement...

USCYBERCOM: Right Solution, Wrong C2 Structure

DTIC Science & Technology

2012-05-04

March 26, 2012. 9 and literally, shutting the nation down and taking it off the global information grid ( GIG ). The would-be cyber terrorists...effective execution of approved OPLANs; effectiveness and economy of operation; and prevention or elimination of unnecessary duplication of facilities and

29 CFR 102.54 - Initiation of formal compliance proceedings; issuance of compliance specification and notice of...

Code of Federal Regulations, 2011 CFR

2011-07-01

... the purposes and policies of the Act or to avoid unnecessary costs or delay, the Regional Director may... policies of the Act or to avoid unnecessary costs or delay, the Regional Director may consolidate with a... formal proceeding, the Regional Director may issue and serve on all parties a compliance specification in...

29 CFR 102.54 - Initiation of formal compliance proceedings; issuance of compliance specification and notice of...

Code of Federal Regulations, 2010 CFR

2010-07-01

... the purposes and policies of the Act or to avoid unnecessary costs or delay, the Regional Director may... policies of the Act or to avoid unnecessary costs or delay, the Regional Director may consolidate with a... formal proceeding, the Regional Director may issue and serve on all parties a compliance specification in...

Duplicate editorial on duplicate publication.

PubMed

Corson, Stephen L; Decherney, Alan H

2005-04-01

The authors define and discuss the various forms taken by duplicate publications, and provide suggested remedies to help authors, editors, reviewers, and readers avoid this form of internal plagiarism.

14 CFR 16.202 - Powers of a hearing officer.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16.202 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL...) Issue subpoenas authorized by law and issue notices of deposition requested by the parties; (d) Limit... unnecessary and duplicative proceedings in the interest of prompt and fair resolution of the matters at issue...

14 CFR 16.202 - Powers of a hearing officer.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16.202 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL...) Issue subpoenas authorized by law and issue notices of deposition requested by the parties; (d) Limit... unnecessary and duplicative proceedings in the interest of prompt and fair resolution of the matters at issue...

14 CFR 16.202 - Powers of a hearing officer.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16.202 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL...) Issue subpoenas authorized by law and issue notices of deposition requested by the parties; (d) Limit... unnecessary and duplicative proceedings in the interest of prompt and fair resolution of the matters at issue...

14 CFR 16.202 - Powers of a hearing officer.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16.202 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL...) Issue subpoenas authorized by law and issue notices of deposition requested by the parties; (d) Limit... unnecessary and duplicative proceedings in the interest of prompt and fair resolution of the matters at issue...

14 CFR 16.202 - Powers of a hearing officer.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16.202 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL...) Issue subpoenas authorized by law and issue notices of deposition requested by the parties; (d) Limit... unnecessary and duplicative proceedings in the interest of prompt and fair resolution of the matters at issue...

77 FR 65477 - Repeal of Regulations on Marriages

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-29

... outdated and duplicative of other authorities that detail procedures for authentications and documentation... authentication of marriage documents. This section is unnecessary because the laws and regulations that apply to authentications in general also apply to marriage documents, and these functions are already covered in 22 CFR 92...

Reducing Unnecessary and Duplicate Ordering for Ovum and Parasite Examinations and Clostridium difficile PCR in Immunocompromised Patients by Using an Alert at the Time of Request in the Order Management System

PubMed Central

Shuptar, Susan L.; Milord, Philippe; Essick, Connor J.; Nevrekar, Reshma; Granovsky, Svetlana L.; Seo, Susan K.; Martin, Steven C.; Pessin, Melissa S.

2015-01-01

We implemented hospital information system (HIS) alerts to deter unnecessary test orders for ovum and parasite (O&P) exams and Clostridium difficile PCR. The HIS alerts decreased noncompliant O&P orders (orders after >72 h of hospitalization) from 49.8% to 30.9%, an overall decrease of 19%, and reduced noncompliant C. difficile PCR orders (orders <7 days after a previous positive result) from 30.6% to 19.2%, an overall decrease of 31.9%. PMID:26063860

Educational Excellence Study, Texas Southern University.

ERIC Educational Resources Information Center

Texas Southern Univ., Houston.

A proposed plan for review of the mission and goals of Texas Southern University (TSU) is presented that deals with improvements and resources needed to strengthen the university, unnecessary program duplication with other universities, new programs, institutional goals and timetables, improved planning at TSU, and sound human relations practices.…

Statewide Coordination of Community Junior Colleges.

ERIC Educational Resources Information Center

Stuckman, Jeffrey A.

The need for statewide coordinating agencies has become more evident as the number of junior colleges within each state continues to grow. These centralized agencies can assist in reducing unnecessary competition and duplication among junior colleges, and can improve the coordination of statewide educational needs with those of the individual…

A Model for Community College/High School Articulation.

ERIC Educational Resources Information Center

Wellsfry, Norval; Rosen, M. Frances

By initiating formal structures for cooperation and coordination of programming between themselves and local high schools, community colleges can reduce the amount of unnecessary duplication of efforts and programs and can benefit many students who, without such a program of articulation, would be unprepared for community college course work.…

42 CFR 495.208 - Avoiding duplicate payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) Unless a qualifying MA EP is entitled to a maximum payment for a year under the Medicare FFS EHR incentive program, payment for such an individual is only made under the MA EHR incentive program...

42 CFR 495.208 - Avoiding duplicate payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) CMS requires a qualifying MA organization that registers MA EPs for the purpose of participating in the MA EHR Incentive Program to notify each of the MA EPs for which it is claiming an incentive...

42 CFR 495.208 - Avoiding duplicate payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) Unless a qualifying MA EP is entitled to a maximum payment for a year under the Medicare FFS EHR incentive program, payment for such an individual is only made under the MA EHR incentive program...

42 CFR 495.208 - Avoiding duplicate payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) Unless a qualifying MA EP is entitled to a maximum payment for a year under the Medicare FFS EHR incentive program, payment for such an individual is only made under the MA EHR incentive program...

42 CFR 495.208 - Avoiding duplicate payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) CMS requires a qualifying MA organization that registers MA EPs for the purpose of participating in the MA EHR Incentive Program to notify each of the MA EPs for which it is claiming an incentive...

Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report

PubMed Central

Huh, Jong-Ki

2013-01-01

This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD. PMID:24010083

Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report.

PubMed

Huh, Jong-Ki; Shin, Su-Jung

2013-08-01

This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.

A Comparative Analysis of Postsecondary Technical Education in Texas. An Executive Summary.

ERIC Educational Resources Information Center

Groves, Cecil L.; And Others

In response to concerns of unnecessary duplication in programs offered by Texas community/junior colleges and the four campuses and five centers of Texas State Technical College (TSTC), TSTC undertook a study to examine curricula, enrollments, and outcomes for both systems. A literature review was conducted to determine potential differences…

Decisions to Transfer Nursing Home Residents to Emergency Departments: A Scoping Review of Contributing Factors and Staff Perspectives.

PubMed

Trahan, Lisa M; Spiers, Jude A; Cummings, Greta G

2016-11-01

Nursing home (NH) residents are a frail and vulnerable population often faced with iatrogenic effects of hospital stays when transferred to emergency departments for acute changes in health status. Avoidable or unnecessary transfers of care need to be identified and defined to prevent unintended harm. The aim of this scoping review was to identify characteristics of avoidable or unnecessary transitions of NH residents to emergency departments, and examine factors influencing decision-making by NH staff, residents, and their family members to transfer nursing home residents to emergency departments. The search strategy began with 5 electronic databases, and a hand search of gray literature. Published qualitative and quantitative studies were included that examined the definition of avoidable or unnecessary transfers, and/or reported factors associated with decision-making to transfer NH residents to emergency departments. Methods included quality assessments, data extraction, and synthesis using content analysis. A total of 783 titles and abstracts were retrieved and screened resulting in 19 included studies. Results describing "avoidable" or "unnecessary" transfers were grouped into 3 dimensions of factors: management of early-acute or low-acuity symptoms and chronic disease management in NHs, ambulatory care-sensitive indicators, and use of post hoc assessments. Five categories of factors contributing to decision-making to transfer were identified: nursing factors, physician factors, facility/resource factors, NH resident/family factors, and health system factors. A consensus on the definition of "avoidable" or "unnecessary" transfers was not found. Findings suggest that transfers of NH residents to emergency departments may be avoided with increased care capacity within NHs. The decision-making process involved in the transfer is influenced by many factors, with intentions of both improving clinical outcomes and maintaining quality of life for the NH resident. Acute changes in health status are contextually specific and decisions must consider not only the resident's acute condition, but also resources available in the NH, and resident and family members' preferences for care. A definition of "avoidable" or "unnecessary" transfer must include reliable measurement, yet remain flexible enough to be generalizable to various care facilities to meet the needs of NH residents and manage required care safely within the NH. Robust research aimed at improving the primary care of NH residents is essential to informing health policy reform and education of those providing care in NHs. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Voltage control on a train system

DOEpatents

Gordon, Susanna P.; Evans, John A.

2004-01-20

The present invention provides methods for preventing low train voltages and managing interference, thereby improving the efficiency, reliability, and passenger comfort associated with commuter trains. An algorithm implementing neural network technology is used to predict low voltages before they occur. Once voltages are predicted, then multiple trains can be controlled to prevent low voltage events. Further, algorithms for managing inference are presented in the present invention. Different types of interference problems are addressed in the present invention such as "Interference During Acceleration", "Interference Near Station Stops", and "Interference During Delay Recovery." Managing such interference avoids unnecessary brake/acceleration cycles during acceleration, immediately before station stops, and after substantial delays. Algorithms are demonstrated to avoid oscillatory brake/acceleration cycles due to interference and to smooth the trajectories of closely following trains. This is achieved by maintaining sufficient following distances to avoid unnecessary braking/accelerating. These methods generate smooth train trajectories, making for a more comfortable ride, and improve train motor reliability by avoiding unnecessary mode-changes between propulsion and braking. These algorithms can also have a favorable impact on traction power system requirements and energy consumption.

Method of managing interference during delay recovery on a train system

DOEpatents

Gordon, Susanna P.; Evans, John A.

2005-12-27

The present invention provides methods for preventing low train voltages and managing interference, thereby improving the efficiency, reliability, and passenger comfort associated with commuter trains. An algorithm implementing neural network technology is used to predict low voltages before they occur. Once voltages are predicted, then multiple trains can be controlled to prevent low voltage events. Further, algorithms for managing inference are presented in the present invention. Different types of interference problems are addressed in the present invention such as "Interference During Acceleration", "Interference Near Station Stops", and "Interference During Delay Recovery." Managing such interference avoids unnecessary brake/acceleration cycles during acceleration, immediately before station stops, and after substantial delays. Algorithms are demonstrated to avoid oscillatory brake/acceleration cycles due to interference and to smooth the trajectories of closely following trains. This is achieved by maintaining sufficient following distances to avoid unnecessary braking/accelerating. These methods generate smooth train trajectories, making for a more comfortable ride, and improve train motor reliability by avoiding unnecessary mode-changes between propulsion and braking. These algorithms can also have a favorable impact on traction power system requirements and energy consumption.

Efficient high density train operations

DOEpatents

Gordon, Susanna P.; Evans, John A.

2001-01-01

The present invention provides methods for preventing low train voltages and managing interference, thereby improving the efficiency, reliability, and passenger comfort associated with commuter trains. An algorithm implementing neural network technology is used to predict low voltages before they occur. Once voltages are predicted, then multiple trains can be controlled to prevent low voltage events. Further, algorithms for managing inference are presented in the present invention. Different types of interference problems are addressed in the present invention such as "Interference. During Acceleration", "Interference Near Station Stops", and "Interference During Delay Recovery." Managing such interference avoids unnecessary brake/acceleration cycles during acceleration, immediately before station stops, and after substantial delays. Algorithms are demonstrated to avoid oscillatory brake/acceleration cycles due to interference and to smooth the trajectories of closely following trains. This is achieved by maintaining sufficient following distances to avoid unnecessary braking/accelerating. These methods generate smooth train trajectories, making for a more comfortable ride, and improve train motor reliability by avoiding unnecessary mode-changes between propulsion and braking. These algorithms can also have a favorable impact on traction power system requirements and energy consumption.

Reducing Unnecessary and Duplicate Ordering for Ovum and Parasite Examinations and Clostridium difficile PCR in Immunocompromised Patients by Using an Alert at the Time of Request in the Order Management System.

PubMed

Otto, Caitlin C; Shuptar, Susan L; Milord, Philippe; Essick, Connor J; Nevrekar, Reshma; Granovsky, Svetlana L; Seo, Susan K; Babady, N Esther; Martin, Steven C; Tang, Yi-Wei; Pessin, Melissa S

2015-08-01

We implemented hospital information system (HIS) alerts to deter unnecessary test orders for ovum and parasite (O&P) exams and Clostridium difficile PCR. The HIS alerts decreased noncompliant O&P orders (orders after >72 h of hospitalization) from 49.8% to 30.9%, an overall decrease of 19%, and reduced noncompliant C. difficile PCR orders (orders <7 days after a previous positive result) from 30.6% to 19.2%, an overall decrease of 31.9%. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Gaia-GOSA: An interactive service for coordination of asteroid observation campaigns

NASA Astrophysics Data System (ADS)

Santana-Ros, Toni; Bartczak, Przemyslaw; Michalowski, Tadeusz; Marciniak, Anna; Butkiewicz-Bak, Magda; Dudziński, Grzegorz

2016-10-01

We describe the Gaia-Ground-based Observational Service for Asteroids (www.gaiagosa.eu), which is a website aiming to facilitate asteroid observers in contributing to the Gaia mission by gathering lightcurves of selected targets.There are many asteroids which lightcurves cannot be covered during one observing run, like slow rotators,with periods longer than 12 hours. There are also targets with periods commensurate with the Earth's day, sotheir lightcurves cannot be covered by observing from one site only. There are also targets of special interest,like binary objects, where a large amount of data is needed. For all targets like those mentioned above, acoordination of observers is needed, also to avoid unnecessary duplication of data gathering.To that end we have created Gaia-GOSA, a web service which allows coordination between observers, focuseson interesting targets and may avoid observers to unnecessary gather data of the same object at the sametime. Furthermore, it is not necessary to be an advanced observer to contribute to the project. The websiteprepares the observing plan, providing all the necessary information to point your telescope. Thesubscription is free and observers with any level of experience are welcome.All the data gathered by Gaia-GOSA users will be reduced and analyzed by astronomers from the Astronomical Observatory of Adam Mickiewicz University in Poznan (AO AMU). The resulting catalogue, containing all the lightcurves obtained, will be used to enhance the results of the Gaia (cornerstone European Space Agency's mission) inversion algorithm.The project has been developed under funding from the European Space Agency (ESA) and initially was only devoted to help users in planning photometric observations of asteroids. However, in this poster we also present an extended version of the website, which also aims to publish predictions of stellar occultations for selected targets. This work has been done in the framework of the Small Bodies: Near and Far (SBNAF) research project, which has received funding from the European Union's Horizon 2020 Research and Innovation Programme, under Grant Agreement no 687378.

A Comparative Analysis of Postsecondary Technical Education in Texas. Phase I, Volume II--Appendices.

ERIC Educational Resources Information Center

Groves, Cecil L.; And Others

In response to concerns of unnecessary duplication in programs offered by Texas community/junior colleges and the Texas State Technical College (TSTC) system, TSTC conducted an examination of curricula, enrollments, and outcomes for both systems. This document provides the second volume of the study, containing the data tables used to generate the…

75 FR 21662 - Access to Employee Exposure and Medical Records; Extension of the Office of Management and Budget...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

...] Access to Employee Exposure and Medical Records; Extension of the Office of Management and Budget's (OMB... Regulation on Access to Employee Exposure and Medical Records (29 CFR 1910.1020). DATES: Comments must be... operating small businesses, and to reduce to the maximum extent feasible unnecessary duplication of efforts...

Race-Neutral Campuses in Urban Areas: A Follow-Up Report on Merger and Joint Planning.

ERIC Educational Resources Information Center

Godard, James M.

Developments during the 1980-81 academic year concerning mergers/joint planning projects designed to eliminate unnecessary duplication of programs between historically black and white colleges in Nashville, Tennessee; Savannah, Georgia; and Norfolk, Virginia are examined. Site visits were made during the second year of operation of the programs at…

Healthcare Planning for the Olympics in London: A Qualitative Evaluation

PubMed Central

Black, Georgia; Kononovas, Kostas; Taylor, Jayne; Raine, Rosalind

2014-01-01

Background Mass gatherings, such as the Olympic and Paralympic Games, represent an enormous logistical challenge for the host city. Health service planners must deliver routine and emergency services and, in recent Games, health legacy initiatives, for the local and visiting population. However there is little evidence to support their planning decisions. We therefore evaluated the strategic health planning programme for the London 2012 Olympic and Paralympic Games to identify generalisable information for future Games. Methods We thematically analysed data from stakeholder interviews and documents. The data were prospectively collected in three phases, before, during and after the Games. Findings We identified five key themes: (1) Systemic Improvement for example in communications, (2) Effective relationships led to efficiencies and permanent gains, such as new relationships with the private sector (3) Difficult relationships led to inefficiencies, for instance, duplication in testing and exercising emergency scenarios, (4) Tendency to over-estimate demand for care, particularly emergency medicine, and (5) Difficulties establishing a health legacy due to its deprioritisation and lack of vision by the programme team. Interpretation Enduring improvements which are sustained after the Games are possible, such as the establishment of new and productive partnerships. Relationships must be established early on to avoid duplication, delay and unnecessary expense. There should be greater critical evaluation of the likely demand for health services to reduce the wasting of resources. Finally, if a health legacy is planned, then clear definitions and commitment to its measurement is essential. PMID:24647613

Healthcare planning for the Olympics in London: a qualitative evaluation.

PubMed

Black, Georgia; Kononovas, Kostas; Taylor, Jayne; Raine, Rosalind

2014-01-01

Mass gatherings, such as the Olympic and Paralympic Games, represent an enormous logistical challenge for the host city. Health service planners must deliver routine and emergency services and, in recent Games, health legacy initiatives, for the local and visiting population. However there is little evidence to support their planning decisions. We therefore evaluated the strategic health planning programme for the London 2012 Olympic and Paralympic Games to identify generalisable information for future Games. We thematically analysed data from stakeholder interviews and documents. The data were prospectively collected in three phases, before, during and after the Games. We identified five key themes: (1) Systemic Improvement for example in communications, (2) Effective relationships led to efficiencies and permanent gains, such as new relationships with the private sector (3) Difficult relationships led to inefficiencies, for instance, duplication in testing and exercising emergency scenarios, (4) Tendency to over-estimate demand for care, particularly emergency medicine, and (5) Difficulties establishing a health legacy due to its deprioritisation and lack of vision by the programme team. Enduring improvements which are sustained after the Games are possible, such as the establishment of new and productive partnerships. Relationships must be established early on to avoid duplication, delay and unnecessary expense. There should be greater critical evaluation of the likely demand for health services to reduce the wasting of resources. Finally, if a health legacy is planned, then clear definitions and commitment to its measurement is essential.

77 FR 29712 - Program for Allocation of Regulatory Responsibilities Pursuant to Rule 17d-2; Notice of Filing...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-18

... there is good cause not to make that assignment. (d) To the extent practicable, Allocation of Common... examinations of broker-dealers that maintain memberships in more than one SRO (``common members''). Such regulatory duplication would add unnecessary expenses for common members and their SROs. \\3\\ 15 U.S.C. 78s(g...

77 FR 29705 - Program for Allocation of Regulatory Responsibilities Pursuant to Rule 17d-2; Notice of Filing...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-18

... multiple examinations of broker-dealers that maintain memberships in more than one SRO (``common members''). Such regulatory duplication would add unnecessary expenses for common members and their SROs. \\3\\ 15 U... respect to a common member, Section 17(d)(1) authorizes the Commission, by rule or order, to relieve an...

Techniques for analyzing the impacts of certain electric-utility ratemaking and regulatory-policy concepts. Glossary

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

None

1980-08-01

This document, Glossary, is the first in a series of reports to identify, describe, and apply techniques for analyzing the impacts of certain electric utility concepts. This report was developed with a focus on the currently evolving issues of ratemaking, especially as they might be expected to arise under Sections 101, 111, 113, 114, 131, 132, and 210 of the P.U.R.P.A. of 1978. Because the evolutionary process of ratemaking has led to multiple proceedings and changes of inference in some terms, the glossary attempts to delineate these changes where appropriate. Definitions not uniquely related to ratemaking are included if theymore » are likely to be used in ratemaking proceedings. To avoid unnecessary duplication of effort and expense, the compilers relied heavily on previously developed, publicly available glossaries and definitions developed by organizations such as Edison Electric Institute, the Electric Power Research Institute, and the Institute of Electrical and Electronics Engineers. Existing definitions were revised and new ones were developed as appropriate.« less

Diagnostic medical imaging radiation exposure and risk of development of solid and hematologic malignancy.

PubMed

Fabricant, Peter D; Berkes, Marschall B; Dy, Christopher J; Bogner, Eric A

2012-05-01

Limiting patients' exposure to ionizing radiation during diagnostic imaging is of concern to patients and clinicians. Large single-dose exposures and cumulative exposures to ionizing radiation have been associated with solid tumors and hematologic malignancy. Although these associations have been a driving force in minimizing patients' exposure, significant risks are found when diagnoses are missed and subsequent treatment is withheld. Therefore, based on epidemiologic data obtained after nuclear and occupational exposures, dose exposure limits have been estimated. A recent collaborative effort between the US Food and Drug Administration and the American College of Radiology has provided information and tools that patients and imaging professionals can use to avoid unnecessary ionizing radiation scans and ensure use of the lowest feasible radiation dose necessary for studies. Further collaboration, research, and development should focus on producing technological advances that minimize individual study exposures and duplicate studies. This article outlines the research used to govern safe radiation doses, defines recent initiatives in decreasing radiation exposure, and provides orthopedic surgeons with techniques that may help decrease radiation exposure in their daily practice. Copyright 2012, SLACK Incorporated.

Efficient nonlinear equalizer for intra-channel nonlinearity compensation for next generation agile and dynamically reconfigurable optical networks.

PubMed

Malekiha, Mahdi; Tselniker, Igor; Plant, David V

2016-02-22

In this work, we propose and experimentally demonstrate a novel low-complexity technique for fiber nonlinearity compensation. We achieved a transmission distance of 2818 km for a 32-GBaud dual-polarization 16QAM signal. For efficient implantation, and to facilitate integration with conventional digital signal processing (DSP) approaches, we independently compensate fiber nonlinearities after linear impairment equalization. Therefore this algorithm can be easily implemented in currently deployed transmission systems after using linear DSP. The proposed equalizer operates at one sample per symbol and requires only one computation step. The structure of the algorithm is based on a first-order perturbation model with quantized perturbation coefficients. Also, it does not require any prior calculation or detailed knowledge of the transmission system. We identified common symmetries between perturbation coefficients to avoid duplicate and unnecessary operations. In addition, we use only a few adaptive filter coefficients by grouping multiple nonlinear terms and dedicating only one adaptive nonlinear filter coefficient to each group. Finally, the complexity of the proposed algorithm is lower than previously studied nonlinear equalizers by more than one order of magnitude.

75 FR 49005 - Program for Allocation of Regulatory Responsibilities Pursuant to Rule 17d-2; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

... examinations of broker-dealers that maintain memberships in more than one SRO (``common members''). Such regulatory duplication would add unnecessary expenses for common members and their SROs. \\3\\ 15 U.S.C. 78s(g... respect to a common member, Section 17(d)(1) authorizes the Commission, by rule or order, to relieve an...

75 FR 18920 - Program for Allocation of Regulatory Responsibilities Pursuant to Rule 17d-2; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-13

... examinations of broker-dealers that maintain memberships in more than one SRO (``common members''). Such regulatory duplication would add unnecessary expenses for common members and their SROs. \\3\\ 15 U.S.C. 78s(g... common member, Section 17(d)(1) authorizes the Commission, by rule or order, to relieve an SRO of the...

75 FR 18915 - Program for Allocation of Regulatory Responsibilities Pursuant to Rule 17d-2; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-13

... examinations of broker-dealers that maintain memberships in more than one SRO (``common members''). Such regulatory duplication would add unnecessary expenses for common members and their SROs. \\3\\ 15 U.S.C. 78s(g... common member, Section 17(d)(1) authorizes the Commission, by rule or order, to relieve an SRO of the...

Enterobius Vermicularis as a Cause of Intestinal Occlusion: How To Avoid Unnecessary Surgery.

PubMed

Adorisio, Ottavio; De Peppo, Francesco; Rivosecchi, Massimo; Silveri, Massimiliano

2016-04-01

Enterobius vermicularis may cause infections of the gastrointestinal tract and occurs approximately in 4% to 28% of children worldwide. It is most common in children aged 5 to 14 years.The most commonly reported symptoms are pruritus in the perianal region, abdominal pain, urinary tract infection, insomnia, irritability, salpingitis, and appendicitis, whereas intestinal obstruction is a very rare but would be considered to perform the right instrumental examination avoiding unnecessary surgical exploration.We report a case of an 8-year-old boy with an intestinal occlusion due to a colonic intussusception by Enterobius vermicularis managed conservatively.

78 FR 46665 - Program for Allocation of Regulatory Responsibilities Pursuant to Rule 17d-2; Notice of Filing...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-01

... Participant would be assigned to be the DOSR of that Common Member, unless there is good cause not to make...-dealers that maintain memberships in more than one SRO (``common members''). Such regulatory duplication would add unnecessary expenses for common members and their SROs. \\3\\ 15 U.S.C. 78s(g)(1). \\4\\ 15 U.S.C...

75 FR 9970 - Program for Allocation of Regulatory Responsibilities Pursuant to Rule 17d-2; Notice of Filing...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-04

... there is good cause not to make that assignment. (d) To the extent practicable, Allocation of Common... maintain memberships in more than one SRO (``common members''). Such regulatory duplication would add unnecessary expenses for common members and their SROs. \\3\\ 15 U.S.C. 78s(g)(1). \\4\\ 15 U.S.C. 78q(d). \\5\\ 15...

Not Another Budget Cut! Money-Saving Ideas for Campus Organizations.

ERIC Educational Resources Information Center

Oxendine, W. H. "Butch," Jr.

1997-01-01

Twenty ideas for reducing program costs are offered to campus activities programmers. They include using technology wisely, avoiding excess outlay of funds, trading for services, seeking donations and sponsors, co-sponsoring events, buying supplies in bulk, requesting discounts, avoiding unnecessary sales taxes, using telephone services…

Adverse events related to blood transfusion

PubMed Central

Sahu, Sandeep; Hemlata; Verma, Anupam

2014-01-01

The acute blood transfusion reactions are responsible for causing most serious adverse events. Awareness about various clinical features of acute and delayed transfusion reactions with an ability to assess the serious reactions on time can lead to a better prognosis. Evidence-based medicine has changed today's scenario of clinical practice to decrease adverse transfusion reactions. New evidence-based algorithms of transfusion and improved haemovigilance lead to avoidance of unnecessary transfusions perioperatively. The recognition of adverse events under anaesthesia is always challenging. The unnecessary blood transfusions can be avoided with better blood conservation techniques during surgery and with anaesthesia techniques that reduce blood loss. Better and newer blood screening methods have decreased the infectious complications to almost negligible levels. With universal leukoreduction of red blood cells (RBCs), selection of potential donors such as use of male donors only plasma and restriction of RBC storage, most of the non-infectious complications can be avoided. PMID:25535415

75 FR 5241 - Maritime Communications

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-02

... effective and efficient use of the spectrum available for maritime communications, accommodate technological innovation, avoid unnecessary regulatory burdens, and maintain consistency with international maritime...

The Exercise–Affect–Adherence Pathway: An Evolutionary Perspective

PubMed Central

Lee, Harold H.; Emerson, Jessica A.; Williams, David M.

2016-01-01

The low rates of regular exercise and overall physical activity (PA) in the general population represent a significant public health challenge. Previous research suggests that, for many people, exercise leads to a negative affective response and, in turn, reduced likelihood of future exercise. The purpose of this paper is to examine this exercise–affect–adherence relationship from an evolutionary perspective. Specifically, we argue that low rates of physical exercise in the general population are a function of the evolved human tendency to avoid unnecessary physical exertion. This innate tendency evolved because it allowed our evolutionary ancestors to conserve energy for physical activities that had immediate adaptive utility such as pursuing prey, escaping predators, and engaging in social and reproductive behaviors. The commonly observed negative affective response to exercise is an evolved proximate psychological mechanism through which humans avoid unnecessary energy expenditure. The fact that the human tendencies toward negative affective response to and avoidance of unnecessary physical activities are innate does not mean that they are unchangeable. Indeed, it is only because of human-engineered changes in our environmental conditions (i.e., it is no longer necessary for us to work for our food) that our predisposition to avoid unnecessary physical exertion has become a liability. Thus, it is well within our capabilities to reengineer our environments to once again make PA necessary or, at least, to serve an immediate functional purpose. We propose a two-pronged approach to PA promotion based on this evolutionary functional perspective: first, to promote exercise and other physical activities that are perceived to have an immediate purpose, and second, to instill greater perceived purpose for a wider range of physical activities. We posit that these strategies are more likely to result in more positive (or less negative) affective responses to exercise, better adherence to exercise programs, and higher rates of overall PA. PMID:27610096

Anagrelide

MedlinePlus

... platelet-reducing agents. It works by slowing the production of platelets in the body. ... plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. ...

A strategic outlook for coordination of ground-based measurement networks of atmospheric state variables and atmospheric composition

NASA Astrophysics Data System (ADS)

Bodeker, G. E.; Thorne, P.; Braathen, G.; De Maziere, M.; Thompson, A. M.; Kurylo, M. J., III

2016-12-01

There are a number of ground-based global observing networks that collectively aim to make key measurements of atmospheric state variables and atmospheric chemical composition. These networks include, but are not limited to:NDACC: Network for the Detection of Atmospheric Composition Change GUAN: GCOS Upper Air Network GRUAN: GCOS Reference Upper Air Network EARLINET: the European Aerosol Research Lidar Network GAW: Global Atmosphere Watch SHADOZ: Southern Hemisphere ADditional OZonesondes TCCON: Total Carbon Column Observing Network BSRN: Baseline Surface Radiation Network While each network brings unique capabilities to the global observing system, there are many instances where the activities and capabilities of the networks overlap. These commonalities across multiple networks can confound funding agencies when allocating scarce financial resources. Overlaps between networks may also result in some duplication of effort and a resultant sub-optimal use of funding resource for the global observing system. While some degree of overlap is useful for quality assurance, it is essential to identify the degree to which one network can take on a specific responsibility on behalf of all other networks to avoid unnecessary duplication, to identify where expertise in any one network may serve other networks, and to develop a long-term strategy for the evolution of these networks that clarifies to funding agencies where new investment is required. This presentation will briefly summarise the key characteristics of each network listed above, adopt a matrix approach to identify commonalities and, in particular, where there may be a danger of duplication of effort, and where gaps between the networks may be compromising the services that these networks are expected to collectively deliver to the global atmospheric and climate science research communities. The presentation will also examine where sharing of data and tools between networks may result in a more efficient delivery of records of essential climate variables to the global research community. There are aspects of underpinning research that are needed across all of these networks, such as laboratory spectroscopy, that often do not receive the attention they deserve. The presentation will also seek to identify where that underpinning research is lacking.

Bring real capitalism to electric utilities

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

Powers, B.F.

1991-01-15

This article examines the reasons that the electric utilities are price regulated and makes an argument for market-based economics to regulate prices and stimulate revolutionary improvements in the industry. The author examines and refutes the arguments that: The industry is a natural monopoly; Competition leads to unnecessary duplication of facilities; and The industry is so vital to the economy and security of the US that it cannot be trusted to the risks inherent in capitalism, including the success and failure of companies.

Nabumetone

MedlinePlus

... called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and ... plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. ...

The hospital based staffing agency.

PubMed

Manion, J; Reid, S B

1989-01-01

Before a hospital considers creating an internal staffing agency, a detailed business plan must be developed. By addressing marketing and operational issues in advance, nurse executives can avoid unnecessary business problems.

Fluorouracil Topical

MedlinePlus

... caused by years of too much exposure to sunlight). Fluorouracil cream and topical solution are also used ... plan to avoid unnecessary or prolonged exposure to sunlight and UV light (such as tanning booths) and ...

How to catch all those mutations--the report of the third Human Variome Project Meeting, UNESCO Paris, May 2010.

PubMed

Kohonen-Corish, Maija R J; Al-Aama, Jumana Y; Auerbach, Arleen D; Axton, Myles; Barash, Carol Isaacson; Bernstein, Inge; Béroud, Christophe; Burn, John; Cunningham, Fiona; Cutting, Garry R; den Dunnen, Johan T; Greenblatt, Marc S; Kaput, Jim; Katz, Michael; Lindblom, Annika; Macrae, Finlay; Maglott, Donna; Möslein, Gabriela; Povey, Sue; Ramesar, Raj; Richards, Sue; Seminara, Daniela; Sobrido, María-Jesús; Tavtigian, Sean; Taylor, Graham; Vihinen, Mauno; Winship, Ingrid; Cotton, Richard G H

2010-12-01

The third Human Variome Project (HVP) Meeting "Integration and Implementation" was held under UNESCO Patronage in Paris, France, at the UNESCO Headquarters May 10-14, 2010. The major aims of the HVP are the collection, curation, and distribution of all human genetic variation affecting health. The HVP has drawn together disparate groups, by country, gene of interest, and expertise, who are working for the common good with the shared goal of pushing the boundaries of the human variome and collaborating to avoid unnecessary duplication. The meeting addressed the 12 key areas that form the current framework of HVP activities: Ethics; Nomenclature and Standards; Publication, Credit and Incentives; Data Collection from Clinics; Overall Data Integration and Access-Peripheral Systems/Software; Data Collection from Laboratories; Assessment of Pathogenicity; Country Specific Collection; Translation to Healthcare and Personalized Medicine; Data Transfer, Databasing, and Curation; Overall Data Integration and Access-Central Systems; and Funding Mechanisms and Sustainability. In addition, three societies that support the goals and the mission of HVP also held their own Workshops with the view to advance disease-specific variation data collection and utilization: the International Society for Gastrointestinal Hereditary Tumours, the Micronutrient Genomics Project, and the Neurogenetics Consortium. © 2010 Wiley-Liss, Inc.

How to Catch All Those Mutations—The Report of the Third Human Variome Project Meeting, UNESCO Paris, May 2010

PubMed Central

Kohonen-Corish, Maija R.J.; Al-Aama, Jumana Y.; Auerbach, Arleen D.; Axton, Myles; Barash, Carol Isaacson; Bernstein, Inge; Béroud, Christophe; Burn, John; Cunningham, Fiona; Cutting, Garry R.; den Dunnen, Johan T.; Greenblatt, Marc S.; Kaput, Jim; Katz, Michael; Lindblom, Annika; Macrae, Finlay; Maglott, Donna; Möslein, Gabriela; Povey, Sue; Ramesar, Raj; Richards, Sue; Seminara, Daniela; Sobrido, María-Jesús; Tavtigian, Sean; Taylor, Graham; Vihinen, Mauno; Winship, Ingrid; Cotton, Richard G.H.

2011-01-01

The third Human Variome Project (HVP) Meeting “Integration and Implementation” was held under UNESCO Patronage in Paris, France, at the UNESCO Headquarters May 10–14, 2010. The major aims of the HVP are the collection, curation, and distribution of all human genetic variation affecting health. The HVP has drawn together disparate groups, by country, gene of interest, and expertise, who are working for the common good with the shared goal of pushing the boundaries of the human variome and collaborating to avoid unnecessary duplication. The meeting addressed the 12 key areas that form the current framework of HVP activities: Ethics; Nomenclature and Standards; Publication, Credit and Incentives; Data Collection from Clinics; Overall Data Integration and Access—Peripheral Systems/Software; Data Collection from Laboratories; Assessment of Pathogenicity; Country Specific Collection; Translation to Healthcare and Personalized Medicine; Data Transfer, Databasing, and Curation; Overall Data Integration and Access—Central Systems; and Funding Mechanisms and Sustainability. In addition, three societies that support the goals and the mission of HVP also held their own Workshops with the view to advance disease-specific variation data collection and utilization: the International Society for Gastrointestinal Hereditary Tumours, the Micronutrient Genomics Project, and the Neurogenetics Consortium. PMID:20960468

Studies Relevent to Catalytic Activation Co & other small Molecules

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

Ford, Peter C

2005-02-22

Detailed annual and triannual reports describing the progress accomplished during the tenure of this grant were filed with the Program Manager for Catalysis at the Office of Basic Energy Sciences. To avoid unnecessary duplication, the present report will provide a brief overview of the research areas that were sponsored by this grant and list the resulting publications and theses based on this DOE supported research. The scientific personnel participating in (and trained by) this grant's research are also listed. Research carried out under this DOE grant was largely concerned with the mechanisms of the homogeneous catalytic and photocatalytic activation ofmore » small molecules such as carbon monoxide, dihydrogen and various hydrocarbons. Much of the more recent effort has focused on the dynamics and mechanisms of reactions relevant to substrate carbonylations by homogeneous organometallic catalysts. A wide range of modern investigative techniques were employed, including quantitative fast reaction methodologies such as time-resolved optical (TRO) and time-resolved infrared (TRIR) spectroscopy and stopped flow kinetics. Although somewhat diverse, this research falls within the scope of the long-term objective of applying quantitative techniques to elucidate the dynamics and understand the principles of mechanisms relevant to the selective and efficient catalytic conversions of fundamental feedstocks to higher value materials.« less

Anal canal duplication and triplication: a rare entity with different presentations.

PubMed

Palazon, P; Julia, V; Saura, L; de Haro, I; Bejarano, M; Rovira, C; Tarrado, X

2017-05-01

Anal canal duplication (ACD) is the rarest of gastrointestinal duplications. Few cases have been reported. Most cases present as an opening in the midline, posterior to the normal anus. The aim of our revision is to contribute with eight new cases, some of them with unusual presentations: five presented as the typical form, one with a perianal nodule, and two presented as two separate orifices (anal canal triplication). Complete excision was performed in all patients with no complications. ACD is the most distal and the least frequent digestive duplication. Its treatment should be surgical excision, to avoid complications such as abscess, fistulization, or malignization. Anal canal triplication has never been described before.

Vanishing large ovarian cyst with thyroxine therapy.

PubMed

Dharmshaktu, Pramila; Kutiyal, Aditya; Dhanwal, Dinesh

2013-01-01

A 21-year-old female patient recently diagnosed with severe hypothyroidism was found to have a large ovarian cyst. In view of the large ovarian cyst, she was advised to undergo elective laparotomy in the gynaecology department. She was further evaluated in our medical out-patient department (OPD), and elective surgery was withheld. She was started on thyroxine replacement therapy, and within a period of 4 months, the size of the cyst regressed significantly, thereby improving the condition of the patient significantly. This case report highlights the rare and often missed association between hypothyroidism and ovarian cysts. Although very rare, profound hypothyroidism that can cause ovarian cysts in an adult should always be kept in the differential diagnosis to avoid unnecessary ovarian surgery. Hypothyroidism should be considered in the differential diagnosis of adult females presenting with multicystic ovarian tumours.Adequate thyroid hormone replacement therapy can prevent these patients from undergoing unnecessary and catastrophic ovarian resection.Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement.In younger women with ovarian cysts, it is also desirable to avoid unnecessary surgery so as to not compromise fertility in the future.

Vanishing large ovarian cyst with thyroxine therapy

PubMed Central

Dharmshaktu, Pramila; Kutiyal, Aditya; Dhanwal, Dinesh

2013-01-01

Summary A 21-year-old female patient recently diagnosed with severe hypothyroidism was found to have a large ovarian cyst. In view of the large ovarian cyst, she was advised to undergo elective laparotomy in the gynaecology department. She was further evaluated in our medical out-patient department (OPD), and elective surgery was withheld. She was started on thyroxine replacement therapy, and within a period of 4 months, the size of the cyst regressed significantly, thereby improving the condition of the patient significantly. This case report highlights the rare and often missed association between hypothyroidism and ovarian cysts. Although very rare, profound hypothyroidism that can cause ovarian cysts in an adult should always be kept in the differential diagnosis to avoid unnecessary ovarian surgery. Learning points Hypothyroidism should be considered in the differential diagnosis of adult females presenting with multicystic ovarian tumours.Adequate thyroid hormone replacement therapy can prevent these patients from undergoing unnecessary and catastrophic ovarian resection.Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement.In younger women with ovarian cysts, it is also desirable to avoid unnecessary surgery so as to not compromise fertility in the future. PMID:24683475

Are You Overworked . . . or Underorganized?

ERIC Educational Resources Information Center

Stegman, Wayne G.; Mackenzie, R. Alec

1985-01-01

Successful administrators practice time management by delegating effectively and scheduling blocks of time to work without interruption. In addition, they set clear goals for meetings, avoid unnecessary meetings, and use weekly and monthly calendars. (MLF)

GeoMapApp as a platform for visualizing marine data from Polar Regions

NASA Astrophysics Data System (ADS)

Nitsche, F. O.; Ryan, W. B.; Carbotte, S. M.; Ferrini, V.; Goodwillie, A. M.; O'hara, S. H.; Weissel, R.; McLain, K.; Chinhong, C.; Arko, R. A.; Chan, S.; Morton, J. J.; Pomeroy, D.

2012-12-01

To maximize the investment in expensive fieldwork the resulting data should be re-used as much as possible. In addition, unnecessary duplication of data collection effort should be avoided. This becomes even more important if access to field areas is as difficult and expensive as it is in Polar Regions. Making existing data discoverable in an easy to use platform is key to improve re-use and avoid duplication. A common obstacle is that use of existing data is often limited to specialists who know of the data existence and also have the right tools to view and analyze these data. GeoMapApp is a free, interactive, map based tool that allows users to discover, visualize, and analyze a large number of data sets. In addition to a global view, it provides polar map projections for displaying data in Arctic and Antarctic areas. Data that have currently been added to the system include Arctic swath bathymetry data collected from the USCG icebreaker Healy. These data are collected almost continuously including from cruises where bathymetry is not the main objective and for which existence of the acquired data may not be well known. In contrast, existence of seismic data from the Antarctic continental margin is well known in the seismic community. They are archived at and can be accessed through the Antarctic Seismic Data Library System (SDLS). Incorporating these data into GeoMapApp makes an even broader community aware of these data and the custom interface, which includes capabilities to visualize and explore these data, allows users without specific software or knowledge of the underlying data format to access the data. In addition to investigating these datasets, GeoMapApp provides links to the actual data sources to allow specialists the opportunity to re-use the original data. Important identification of data sources and data references are achieved on different levels. For access to the actual Antarctic seismic data GeoMapApp links to the SDLS site, where users have to register before downloading the data and where they are informed about data owners. For the swath bathymetry data GeoMapApp links to an IEDA/MGDS web page for each cruise containing detailed information about investigators and surveys.

48 CFR 6302.16 - Prehearing conference (Rule 16).

Code of Federal Regulations, 2010 CFR

2010-10-01

... case is to be submitted on the written record or be heard under any hearing procedure, the Board, upon..., understandings on matters already of record, or similar agreements which will avoid unnecessary proof; (3) The...

Making planes plain.

PubMed

O'Rahilly, R

1997-01-01

The major anatomical planes (horizontal, coronal, and sagittal, including the median plane) are discussed from a historical perspective, and their correct usage is clarified. Unofficial and unnecessary terms to be avoided (for reasons explained) include midsagittal, parasagittal, and midline.

Format conversion between CAD data and GIS data based on ArcGIS

NASA Astrophysics Data System (ADS)

Xie, Qingqing; Wei, Bo; Zhang, Kailin; Wang, Zhichao

2015-12-01

To make full use of the data resources and realize a sharing for the different types of data in different industries, a method of format conversion between CAD data and GIS data based on ArcGIS was proposed. To keep the integrity of the converted data, some key steps to process CAD data before conversion were made in AutoCAD. For examples, deleting unnecessary elements such as title, border and legend avoided the appearance of unnecessary elements after conversion, as layering data again by a national standard avoided the different types of elements to appear in a same layer after conversion. In ArcGIS, converting CAD data to GIS data was executed by the correspondence of graphic element classification between AutoCAD and ArcGIS. In addition, an empty geographic database and feature set was required to create in ArcGIS for storing the text data of CAD data. The experimental results show that the proposed method avoids a large amount of editing work in data conversion and maintains the integrity of spatial data and attribute data between before and after conversion.

Use of ATC to describe duplicate medications in primary care prescriptions.

PubMed

Lim, Chiao Mei; Aryani Md Yusof, Faridah; Selvarajah, Sharmini; Lim, Teck Onn

2011-10-01

We aimed to demonstrate the suitability of the Anatomical Therapeutic Chemical Classification (ATC) to describe duplicate drugs and duplicate drug classes in prescription data and describe the pattern of duplicates from public and private primary care clinics of Kuala Lumpur, Malaysia. We analyzed prescription data year 2005 from all 14 public clinics in Kuala Lumpur with 12,157 prescriptions, and a sample of 188 private clinics with 25,612 prescriptions. As ATC Level 5 code represents the molecule and Level 4 represents the pharmacological subgroup, we used repetitions of codes in the same prescription to describe duplicate drugs or duplicate drug classes and compared them between the public and private clinics. At Level 4 ATC, prescriptions with duplicates drug classes were 1.46% of all prescriptions in private and 0.04% in public clinics. At Level 5 ATC, prescriptions with duplicate drugs were 1.81% for private and 0.95% for public clinics. In private clinics at Level 5, 73.3% of prescriptions with duplicates involved systemic combination drugs; at Level 4, 40.3% involved systemic combination drugs. In the public sector at Level 5, 95.7% of prescriptions with duplicates involved topical products. Repetitions of the same ATC codes were mostly useful to describe duplicate medications; however, we recommend avoid using ATC codes for tropical products for this purpose due to ambiguity. Combination products were often involved in duplicate prescribing; redesign of these products might improve prescribing quality. Duplicates occurred more often in private clinics than public clinics in Malaysia.

Exploring Business Strategy in Health Information Exchange Organizations.

PubMed

Langabeer, James R; Champagne, Tiffany

2016-01-01

Unlike consumer goods industries, healthcare has been slow to implement technolo gies that support exchange of data in patients' health records. This results in avoid able medication errors, avoidable hospital readmissions, unnecessary duplicate testing, and other inefficient or wasteful practices. Community-based regional health information exchange (HIE) organizations have evolved in response to federal aims to encourage interoperability, yet little is known about their strategic approach. We use the lens of institutional and strategic management theories to empirically explore the differences in business strategies deployed in HIEs that are, to date, financially sustainable versus those that are not. We developed a 20-question survey targeted to CEOs to assess HIE business strategies. Our sample consisted of 60 community-based exchanges distributed throughout the United States, and we achieved a 58% response rate. Questions centered on competitive strategy and financial sustainability. We relied on logistic regression methods to explore relationships between variables. Our regression identified characteristics common to sustainable organizations. We defined sustainability as revenues exceeding operational costs. Seventeen of the 35 organizations (49%) defined themselves as currently sustainable. Focus and cost leadership strategies were significantly associated with sustainability. Growth strate gies, which were much more common than other strategies, were not associated with sustainability. We saw little evidence of a differentiation strategy (i.e., the basis of competition whereby the attributes of a product or service are unmatched by rivals). Most CEOs had a relatively optimistic outlook, with 60% stating they were confident of surviving over the next 5 years; however, nearly 9% of the organizations were in some phase of divestiture or exit from the market. HIEs are evolving differently based on local leadership decisions, yet their strategic approach is isomorphic (or similar). Further insight into successful business strategies could help ensure the long-term survival of HIEs.

Supply Chain Management in Disaster Response

DOT National Transportation Integrated Search

2009-09-01

In todays society that disasters seem to be striking all corners of the United States and the globe, the importance of emergency management is undeniable. Much human loss and unnecessary destruction of infrastructure can be avoided with more fores...

Dapsone

MedlinePlus

... are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking dapsone, call your doctor.plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Dapsone may make your skin sensitive to sunlight.

76 FR 18817 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Order Granting Approval of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-05

... investors the ability to more closely tailor investment strategies to the precise movement of the underlying... array of investment opportunities and the need to avoid unnecessary proliferation of options series and...

ICH guidelines--implementation of the 3Rs (refinement, reduction, and replacement): incorporating best scientific practices into the regulatory process.

PubMed

Ohno, Yasuo

2002-01-01

An overview of the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) is described. ICH was established through cooperation of the regulatory agencies and industrial parties of three main regions involved in pharmaceuticals: the European Union, the United States, and Japan. The purpose of the ICH is to make recommendations to achieve greater harmonization regarding interpretation and application of technical guidelines and requirements for product registration in an effort to reduce or obviate the need to duplicate the testing carried out during the research and development of new medicines. The main purpose of ICH was not to foster the 3Rs per se; however, harmonization of guidelines has eliminated duplications of similar tests to satisfy the specific requirements of each region. The ICH process has contributed to mutual understanding of the regulatory requirements and has decreased the number of unnecessary animal experiments. Specific examples of the contributions of ICH harmonization to the 3Rs are described.

Improved load rating of reinforced concrete slab bridges.

DOT National Transportation Integrated Search

2007-09-01

In New Mexico, many reinforced concrete slab (RCS) bridges provide service on interstates I-10, I-25, and I-40. An accurate strength evaluation of interstate bridges is essential to avoid unnecessary load restrictions. The AASHTO load rating factor f...

Duplicative medications in patients who visit multiple medical institutions among the insured of a corporate health insurance society in Japan.

PubMed

Kinoshita, Hiroki; Kobayashi, Yasuki; Fukuda, Takashi

2008-01-01

The objective of this paper is to describe the frequency of duplicative medication use and to estimate the drug cost associated with duplicative medications in patients who visit multiple medical institutions in Japan. The subjects of this study were insurants of a corporate health insurance society. We examined claims of insurants who received prescriptions from multiple medical institutions in April 2002. We examined characteristics of insurants who received duplicative medications and calculated the cost of duplicated drugs. 8.8% received drugs with the same mechanism of action for overlapping administration periods. In terms of comparison among three age groups, 0-19 years old, 20-69 years old, and 70 years old or older, the percentage was higher in 0-19-year-old patients than in the other age groups. The cost of duplicated drugs was found to be 0.7% or 0.5% of the total drug cost, when calculated with higher-priced drugs and lower-priced drugs, respectively. This study suggests that pediatric and teenage patients as well as elderly patients require prudent management of medication to avoid duplicative medications and that at least an estimated 5.2-7.2 billion yen may be saved if duplicative medications can be completely eliminated nationwide.

19 CFR 354.11 - Prehearing conference.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 3 2011-04-01 2011-04-01 false Prehearing conference. 354.11 Section 354.11 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE PROCEDURES FOR IMPOSING...) Obtaining stipulations of fact and of documents to avoid unnecessary proof; (iii) Settlement of the matter...

19 CFR 354.11 - Prehearing conference.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 3 2012-04-01 2012-04-01 false Prehearing conference. 354.11 Section 354.11 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE PROCEDURES FOR IMPOSING...) Obtaining stipulations of fact and of documents to avoid unnecessary proof; (iii) Settlement of the matter...

19 CFR 354.11 - Prehearing conference.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 3 2013-04-01 2013-04-01 false Prehearing conference. 354.11 Section 354.11 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE PROCEDURES FOR IMPOSING...) Obtaining stipulations of fact and of documents to avoid unnecessary proof; (iii) Settlement of the matter...

19 CFR 354.11 - Prehearing conference.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 3 2010-04-01 2010-04-01 false Prehearing conference. 354.11 Section 354.11 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE PROCEDURES FOR IMPOSING...) Obtaining stipulations of fact and of documents to avoid unnecessary proof; (iii) Settlement of the matter...

19 CFR 354.11 - Prehearing conference.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 3 2014-04-01 2014-04-01 false Prehearing conference. 354.11 Section 354.11 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE PROCEDURES FOR IMPOSING...) Obtaining stipulations of fact and of documents to avoid unnecessary proof; (iii) Settlement of the matter...

9 CFR 3.116 - Care in transit.

Code of Federal Regulations, 2010 CFR

2010-01-01

... such methods as intermittent spraying of water or application of a nontoxic emollient; (2) Assuring... related stress; and (5) Calming the marine mammals to avoid struggling, thrashing, and other unnecessary.../or warmed sufficiently to prevent overheating, hypothermia, or temperature related stress; and (2...

9 CFR 3.116 - Care in transit.

Code of Federal Regulations, 2011 CFR

2011-01-01

... such methods as intermittent spraying of water or application of a nontoxic emollient; (2) Assuring... related stress; and (5) Calming the marine mammals to avoid struggling, thrashing, and other unnecessary.../or warmed sufficiently to prevent overheating, hypothermia, or temperature related stress; and (2...

45 CFR 672.12 - Prehearing conference.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION ENFORCEMENT... consider: (1) The settlement of the case; (2) The simplification of issues and stipulation of facts not in..., documents, prepared testimony, and admissions or stipulations of fact which will avoid unnecessary proof; (5...

45 CFR 672.12 - Prehearing conference.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION ENFORCEMENT... consider: (1) The settlement of the case; (2) The simplification of issues and stipulation of facts not in..., documents, prepared testimony, and admissions or stipulations of fact which will avoid unnecessary proof; (5...

45 CFR 672.12 - Prehearing conference.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION ENFORCEMENT... consider: (1) The settlement of the case; (2) The simplification of issues and stipulation of facts not in..., documents, prepared testimony, and admissions or stipulations of fact which will avoid unnecessary proof; (5...

45 CFR 672.12 - Prehearing conference.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION ENFORCEMENT... consider: (1) The settlement of the case; (2) The simplification of issues and stipulation of facts not in..., documents, prepared testimony, and admissions or stipulations of fact which will avoid unnecessary proof; (5...

45 CFR 672.12 - Prehearing conference.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION ENFORCEMENT... consider: (1) The settlement of the case; (2) The simplification of issues and stipulation of facts not in..., documents, prepared testimony, and admissions or stipulations of fact which will avoid unnecessary proof; (5...

Can we ensure the safe use of known human teratogens? Introduction of generic isotretinoin in the US as an example.

PubMed

Honein, Margaret A; Moore, Cynthia A; Erickson, J David

2004-01-01

The prescription of known teratogenic medications requires a careful balance between allowing women access to medications that they might need and avoiding unnecessary exposure to these medications during pregnancy because of their devastating fetal effects. Isotretinoin, a potent human teratogen, is of particular concern because of its widespread use among reproductive-aged women and the dramatic increase in use from 1992 through 2000. A revised risk management system was implemented in 2002 because of concerns about the continued occurrence of isotretinoin-exposed pregnancies. However, the recent approval of three generic versions of isotretinoin in the US has further complicated risk management and raises concerns that use might increase further if the lower cost of generics serves to increase accessibility. There are now four separate isotretinoin risk management systems in the US, each with its own distinct packaging, though the requirements for and substance of each are identical. Some additional concrete steps could be taken to minimise any unnecessary use of isotretinoin and help allow an adequate assessment of the current risk management systems. In addition to being familiar with and following all aspects of the current risk management system, physicians could choose to limit the use of isotretinoin to those who meet the labelled indications in order to reduce the number of exposed pregnancies. All four companies currently marketing isotretinoin in the US could jointly and voluntarily establish a consolidated, mandatory registration and follow-up of all women of reproductive potential who receive an isotretinoin prescription. Mandatory registration has many challenges, but it could allow a clear accounting of the total number of women for whom follow-up information is and is not available. Although the companies cannot be legally compelled to use a consolidated approach, the use of a single registry for the originator's product and all generic brands would allow identification of duplicates and also avoid the confusion that is introduced by providing materials that not only look different, but also have different addresses, contact information and names for participation in follow-up surveys. This is particularly important because women might take more than one version of isotretinoin during a single course of therapy or might receive a different programme's materials from their doctor than from the pharmacy. Though the introduction of generic versions of isotretinoin further complicates risk management, the companies marketing isotretinoin have an opportunity to work together to demonstrate their commitment to both limit the occurrence of exposed pregnancies and conduct a meaningful evaluation of the occurrence of pregnancies exposed to isotretinoin.

Reorientation from Altered States: Please, More Carefully.

ERIC Educational Resources Information Center

Heikkinen, Charles A.

1989-01-01

Claims counselors too often appear to forget to reorient clients from altered states of consciousness used in counseling and that failure to reorient can result in unnecessary discomfort for clients. Provides suggestions for when and how to reorient to avoid unwanted, lingering aftereffects. (Author/ABL)

49 CFR 19.44 - Procurement procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

...)(1), (2) and (3) of this section apply. (1) Recipients avoid purchasing unnecessary items. (2) Where appropriate, an analysis is made of lease and purchase alternatives to determine which would be the most... timeframes for purchases and contracts to encourage and facilitate participation by small businesses...

43 CFR 3480.0-1 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Federal coal; ensure production practices that prevent wasting or loss of coal or other resources; avoid unnecessary damage to coal-bearing or mineral-bearing formations; ensure MER of Federal coal; ensure that... regulation of surface and underground coal mining operations; require an accurate record and accounting of...

43 CFR 3480.0-1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Federal coal; ensure production practices that prevent wasting or loss of coal or other resources; avoid unnecessary damage to coal-bearing or mineral-bearing formations; ensure MER of Federal coal; ensure that... regulation of surface and underground coal mining operations; require an accurate record and accounting of...

43 CFR 3480.0-1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Federal coal; ensure production practices that prevent wasting or loss of coal or other resources; avoid unnecessary damage to coal-bearing or mineral-bearing formations; ensure MER of Federal coal; ensure that... regulation of surface and underground coal mining operations; require an accurate record and accounting of...

43 CFR 3480.0-1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Federal coal; ensure production practices that prevent wasting or loss of coal or other resources; avoid unnecessary damage to coal-bearing or mineral-bearing formations; ensure MER of Federal coal; ensure that... regulation of surface and underground coal mining operations; require an accurate record and accounting of...

Savvy Spending

ERIC Educational Resources Information Center

Kennedy, Mike

2009-01-01

In the last several years, the growing demand that education institutions incorporate sustainable design and construction concepts in school facility plans has created a greater emphasis on using life-cycle costing. The use of long-lasting materials and equipment enables schools and universities to avoid the unnecessary consumption of energy and…

[The art of saying 'no': is it important inside or outside the consulting room?].

PubMed

Cals, Jochen W L

2015-01-01

This commentary discusses a report by the Health Council of the Netherlands on 'The art of saying no: factors contributing to the delivery of unnecessary health care'. In this report the Health Council identifies and discusses contributing factors in the areas of society, the organisation of health care and doctor-patient consultations. In its recommendations the Health Council calls upon doctors to avoid delivering unnecessary care and to set boundaries by using risk communication and decision aids. Yet again, this commentary argues that the current complex health system as created by the government and health insurance companies severely restricts health professionals' ability to do so.

Optimal Implantable Cardioverter Defibrillator Programming.

PubMed

Shah, Bindi K

Optimal programming of implantable cardioverter defibrillators (ICDs) is essential to appropriately treat ventricular tachyarrhythmias and to avoid unnecessary and inappropriate shocks. There have been a series of large clinical trials evaluating tailored programming of ICDs. We reviewed the clinical trials evaluating ICD therapies and detection, and the consensus statement on ICD programming. In doing so, we found that prolonged ICD detection times, higher rate cutoffs, and antitachycardia pacing (ATP) programming decreases inappropriate and painful therapies in a primary prevention population. The use of supraventricular tachyarrhythmia discriminators can also decrease inappropriate shocks. Tailored ICD programming using the knowledge gained from recent ICD trials can decrease inappropriate and unnecessary ICD therapies and decrease mortality.

Ground Radar and Guided Munitions: Increased Oversight and Cooperation Can Help Avoid Duplication among the Services’ Programs

DTIC Science & Technology

2014-12-01

requirement is for a guidance kit that attaches to the existing family of unguided Hydra -70 rockets.17 While the Army and Navy have similar needs, the...duplicative, efforts to meet their requirements. The Army plans to introduce competition for its Hydra -70 rocket guidance kit and consider other...because it does not believe that introducing competition to APKWS would be worth the investment of integrating and qualifying another Hydra -70

50 CFR 37.13 - Group participation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 9 2014-10-01 2014-10-01 false Group participation. 37.13 Section 37.13 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE... NATIONAL WILDLIFE REFUGE, ALASKA General Requirements § 37.13 Group participation. (a) To avoid unnecessary...

50 CFR 37.13 - Group participation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false Group participation. 37.13 Section 37.13 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE... NATIONAL WILDLIFE REFUGE, ALASKA General Requirements § 37.13 Group participation. (a) To avoid unnecessary...

50 CFR 37.13 - Group participation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false Group participation. 37.13 Section 37.13 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE... NATIONAL WILDLIFE REFUGE, ALASKA General Requirements § 37.13 Group participation. (a) To avoid unnecessary...

40 CFR 164.50 - Prehearing conference and primary discovery.

Code of Federal Regulations, 2012 CFR

2012-07-01

... possibility of obtaining stipulations of fact and documents which will avoid unnecessary delay; (4) Matters of... any party desires that questions of scientific fact be referred to a committee designated by the National Academy of Sciences. (2) Preparation of questions. On determining an affirmative intent, the...

40 CFR 164.50 - Prehearing conference and primary discovery.

Code of Federal Regulations, 2011 CFR

2011-07-01

... possibility of obtaining stipulations of fact and documents which will avoid unnecessary delay; (4) Matters of... any party desires that questions of scientific fact be referred to a committee designated by the National Academy of Sciences. (2) Preparation of questions. On determining an affirmative intent, the...

40 CFR 164.50 - Prehearing conference and primary discovery.

Code of Federal Regulations, 2010 CFR

2010-07-01

... possibility of obtaining stipulations of fact and documents which will avoid unnecessary delay; (4) Matters of... any party desires that questions of scientific fact be referred to a committee designated by the National Academy of Sciences. (2) Preparation of questions. On determining an affirmative intent, the...

40 CFR 164.50 - Prehearing conference and primary discovery.

Code of Federal Regulations, 2013 CFR

2013-07-01

... possibility of obtaining stipulations of fact and documents which will avoid unnecessary delay; (4) Matters of... any party desires that questions of scientific fact be referred to a committee designated by the National Academy of Sciences. (2) Preparation of questions. On determining an affirmative intent, the...

40 CFR 164.50 - Prehearing conference and primary discovery.

Code of Federal Regulations, 2014 CFR

2014-07-01

... possibility of obtaining stipulations of fact and documents which will avoid unnecessary delay; (4) Matters of... any party desires that questions of scientific fact be referred to a committee designated by the National Academy of Sciences. (2) Preparation of questions. On determining an affirmative intent, the...

32 CFR 2103.12 - Level of original classification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Level of original classification. 2103.12... DECLASSIFIED Original Classification § 2103.12 Level of original classification. Unnecessary classification, and classification at a level higher than is necessary, shall be avoided. If there is reasonable doubt...

A resolution to permit the Senate to avoid unnecessary delay and vote on matters for which floor debate has ceased.

THOMAS, 113th Congress

Sen. Lautenberg, Frank R. [D-NJ

2013-01-03

Senate - 01/03/2013 Submitted in the Senate. Placed on Senate Legislative Calendar under Over, Under the Rule. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Telehealth for paediatric burn patients in rural areas: a retrospective audit of activity and cost savings.

PubMed

McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona; Giles, Margaret

2016-11-01

Since 2005, the Western Australian paediatric burn unit has provided a state-wide clinical consultancy and support service for the assessment and management of acute and rehabilitative burn patients via its telehealth service. Since then, the use of this telehealth service has steadily increased as it has become imbedded in the model of care for paediatric burn patients. Primarily, the service involves acute and long term patient reviews conducted by the metropolitan-located burn unit in contact with health practitioners, advising patients and their families who reside outside the metropolitan area thereby avoiding unnecessary transfers and inpatient bed days. A further benefit of the paediatric burn service using telehealth is more efficient use of tertiary level burn unit beds, with only those patients meeting clinical criteria for admission being transferred. To conduct a retrospective audit of avoided transfers and bed days in 2005/06-2012/13 as a result of the use of the paediatric Burns Telehealth Service and estimate their cost savings in 2012/13. A retrospective chart audit identified activity, avoided unnecessary acute and scar review patient transfers, inpatient bed days and their associated avoided costs to the tertiary burn unit and patient travel funding. Over the period 2005/06-2012/13 the audit identified 4,905 avoided inpatient bed days, 364 avoided acute patient transfers and 1,763 avoided follow up review transfers for a total of 1,312 paediatric burn patients as a result of this telehealth service. This paper presents the derivation of these outcomes and an estimation of their cost savings in 2012/13 of AUD 1.89million. This study demonstrates avoided patient transfers, inpatient bed days and associated costs as the result of an integrated burns telehealth service. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Multidetector row computed tomography and ultrasound characteristics of caudal vena cava duplication in dogs.

PubMed

Bertolini, Giovanna; Diana, Alessia; Cipone, Mario; Drigo, Michele; Caldin, Marco

2014-01-01

Caudal vena cava duplication has been rarely reported in small animals. The purpose of this retrospective study was to describe characteristics of duplicated caudal vena cava in a large group of dogs. Computed tomography (CT) and ultrasound databases from two hospitals were searched for canine reports having the diagnosis "double caudal vena cava." One observer reviewed CT images for 71 dogs and two observers reviewed ultrasound images for 21 dogs. In all CT cases, the duplication comprised two vessels that were bilaterally symmetrical and approximately the same calibre (similar to Type I complete duplication in humans). In all ultrasound cases, the duplicated caudal vena cava appeared as a distinct vessel running on the left side of the abdominal segment of the descending aorta and extending from the left common iliac vein to the left renal vein. The prevalence of caudal vena cava duplication was 0.46% for canine ultrasound studies and 2.08% for canine CT studies performed at these hospitals. Median body weight for affected dogs was significantly lower than that of unaffected dogs (P < 0.0001). Breeds with increased risk for duplicated caudal vena cava were Yorkshire Terrier (odds ratio [OR] = 6.41), Poodle (OR = 7.46), West Highland White Terrier (OR = 6.33), and Maltese (OR = 3.87). Presence of a duplicated caudal vena cava was significantly associated with presence of extrahepatic portosystemic shunt(s) (P < 0.004). While uncommon in dogs, caudal vena cava duplication should be differentiated from other vascular anomalies when planning surgeries and for avoiding misdiagnoses. © 2014 American College of Veterinary Radiology.

Choosing the right diagnostic imaging modality in musculoskeletal diagnosis.

PubMed

Aagesen, Andrea L; Melek, Maged

2013-12-01

Radiological studies can confirm or rule out competing diagnoses for musculoskeletal injuries and pain. Obtaining a detailed history and physical examination is pivotal for localizing the pain generator and choosing the most appropriate imaging studies, based on the suspected injured tissue. Judicious use of imaging is important to avoid unnecessary radiation exposure, minimize cost, and avoid therapy targeting asymptomatic imaging abnormalities. This article compares and contrasts the diagnostic imaging commonly used for detecting musculoskeletal injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

29 CFR 4041A.12 - Contents of notice.

Code of Federal Regulations, 2010 CFR

2010-07-01

... material change in the assets or liabilities of the plan occurring after either the date of the actuarial... representative's knowledge and belief. (d) Avoiding duplication. Information described in paragraphs (a) and (b...

32 CFR 1701.30 - Policy and applicability.

Code of Federal Regulations, 2010 CFR

2010-07-01

... INTELLIGENCE ADMINISTRATION OF RECORDS UNDER THE PRIVACY ACT OF 1974 Routine Uses Applicable to More Than One... routine uses to foster simplicity and economy and to avoid redundancy or error by duplication in multiple...

40 CFR 305.26 - Prehearing conference.

Code of Federal Regulations, 2011 CFR

2011-07-01

... testimony, and admissions or stipulations of fact which will avoid unnecessary proof; (5) The limitation of... at the conference and shall serve that summary on all parties in the manner provided in § 305.5(b)(2... together with the conditions and terms thereof. (5) The Presiding Officer shall order depositions upon oral...

Quantitative Indicators for Behaviour Drift Detection from Home Automation Data.

PubMed

Veronese, Fabio; Masciadri, Andrea; Comai, Sara; Matteucci, Matteo; Salice, Fabio

2017-01-01

Smart Homes diffusion provides an opportunity to implement elderly monitoring, extending seniors' independence and avoiding unnecessary assistance costs. Information concerning the inhabitant behaviour is contained in home automation data, and can be extracted by means of quantitative indicators. The application of such approach proves it can evidence behaviour changes.

Student Rights, Safety, and Codes of Conduct

ERIC Educational Resources Information Center

Mawdsley, Ralph D.

2004-01-01

Community college students, like students in all of higher education, find their relationship with the college defined by contract. However, this contract is shaped and influenced by rights granted under state and federal constitutions and statutes. Knowing what these rights are can assist college officials in avoiding unnecessary litigation.

43 CFR 30.223 - What is a prehearing conference?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false What is a prehearing conference? 30.223... PROCEDURES Formal Probate Proceedings Depositions, Discovery, and Prehearing Conference § 30.223 What is a..., understandings on matters already of record, or similar agreements that will avoid unnecessary proof; (c) Limit...

12 CFR 19.5 - Authority of the administrative law judge.

Code of Federal Regulations, 2010 CFR

2010-01-01

... powers necessary to conduct a proceeding in a fair and impartial manner and to avoid unnecessary delay. (b) Powers. The administrative law judge shall have all powers necessary to conduct the proceeding in accordance with paragraph (a) of this section, including the following powers: (1) To administer oaths and...

12 CFR 509.5 - Authority of the administrative law judge.

Code of Federal Regulations, 2011 CFR

2011-01-01

... administrative law judge shall have all powers necessary to conduct a proceeding in a fair and impartial manner and to avoid unnecessary delay. (b) Powers. The administrative law judge shall have all powers... following powers: (1) To administer oaths and affirmations; (2) To issue subpoenas, subpoenas duces tecum...

Ask These Key Questions When You Review Child Abuse Reporting Policies.

ERIC Educational Resources Information Center

Rogers, Joy J.

1988-01-01

Urges policymakers to examine and update their school system's child abuse reporting policy. Such policies must be adequate to help endangered children, protect their right to privacy, and avoid overprotection. Advises on ways to protect staff against unnecessary accusations and develop inservice training programs discussing child abuse, state…

School Board Attorney: Friend in Need.

ERIC Educational Resources Information Center

Stover, Kermit M.

To keep abreast of newly enacted legislation and court opinions affecting school policies and regulation, school officials need prompt, competent, and reliable legal advice, and should be prepared to pay for it. By consulting a competent attorney, school officials can avoid unnecessary and costly delays resulting from litigation over procedural…

Determination of zilpaterol in sheep urine and tissues using immunochromatographic assay

USDA-ARS?s Scientific Manuscript database

Introduction: Zilpaterol is a feed additive used to increase weight gain, improve feed efficiency, and increase carcass leanness in cattle. An on-site analytical method is needed to determine zilpaterol exposure in animals to assist producer and trade groups in avoiding un-necessary animal or carca...

Assessing Patient and Caregiver Intent to Use Mobile Device Videoconferencing for Remote Mechanically-Ventilated Patient Management

ERIC Educational Resources Information Center

Smith, Brian R.

2017-01-01

The Michigan Medicine adult Assisted Ventilation Clinic (AVC) supports patients with neuromuscular disorders and spinal cord injuries and their caregivers at home, helping them avoid expensive emergency department visits, hospitalization, and unnecessary or excessive treatments. Mobile device videoconferencing provides an effective capability for…

43 CFR 30.223 - What is a prehearing conference?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 30.223 Public Lands: Interior Office of the Secretary of the Interior INDIAN PROBATE HEARINGS... prehearing conference? Before a hearing, the judge may order the parties to appear for a conference to: (a..., understandings on matters already of record, or similar agreements that will avoid unnecessary proof; (c) Limit...

Indoor Air vs. Indoor Construction: A New Beginning.

ERIC Educational Resources Information Center

Manicone, Santo

2000-01-01

Identifies the steps that can be taken to lessen the impact of indoor air pollution created from indoor renovation projects, including project management tips to help contractors avoid creating unnecessary air pollution. Final comments address air pollution control when installing new furniture, smoking restrictions, occupant relations, and the…

Faith community nursing demonstrates good stewardship of community benefit dollars through cost savings and cost avoidance.

PubMed

Brown, Ameldia R; Coppola, Patricia; Giacona, Marian; Petriches, Anne; Stockwell, Mary Ann

2009-01-01

Health systems seeking responsible stewardship of community benefit dollars supporting Faith Community Nursing Networks require demonstration of positive measurable health outcomes. Faith Community Nurses (FCNs) answer the call for measurable outcomes by documenting cost savings and cost avoidances to families, communities, and health systems associated with their interventions. Using a spreadsheet tool based on Medicare reimbursements and diagnostic-related groupings, 3 networks of FCNs have together shown more than 600 000 (for calendar year 2008) healthcare dollars saved by avoidance of unnecessary acute care visits and extended care placements. The cost-benefit ratio of support dollars to cost savings and cost avoidance demonstrates that support of FCNs is good stewardship of community benefit dollars.

Ongoing research in occupational health and environmental epidemiology in developing countries

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

Levy, B.S.; Kjellstrom, T.; Forget, G.

Research in occupational health and environmental epidemiology can play an important role in furthering our understanding of occupational and environmental health problems. Research guides us in the recognition, management, and prevention of health problems. However, in developing countries, where rates of occupational and environmental illnesses and injuries are higher and where these problems are often more severe than in developed countries, research capabilities are less developed. In mid-1990, a project was undertaken to (a) document ongoing research in occupational health and environmental epidemiology in developing countries, (b) facilitate the exchange of information among researchers in this field, (c) stimulate research,more » and (d) avoid unnecessary duplication among researchers in this field. A questionnaire was mailed, the purpose of which was to learn the current status of research in developing countries and to develop a directory of such ongoing research. The questionnaire was sent to 1,528 individuals. Of the 500 research projects identified, 77% were investigating chemical hazards; 26%, physical hazards; 10%, biological hazards; 10%, psychosocial hazards (some projects addressed multiple hazards). The chemical hazards studied most frequently were dusts, pesticides, and lead. The greatest number of research projects were identified in China, India, Brazil, Korea, and Thailand. Most projects were descriptive or cross-sectional epidemiologic studies or industrial hygiene or exposure-assessment studies. The World Health Organization has published a directory of the specific research projects that were identified in this survey.« less

Leveraging Resources to Address Transportation Needs: Transportation Pooled Fund Program

DOT National Transportation Integrated Search

2004-05-28

This brochure describes the Transportation Pooled Fund (TPF) Program. The objectives of the TPF Program are to leverage resources, avoid duplication of effort, undertake large-scale projects, obtain greater input on project definition, achieve broade...

The Noncommissioned Officer and Petty Officer: Backbone of the Armed Forces

DTIC Science & Technology

2014-01-01

cherish, and others may envy. The patriotic flame that burns within every Servicemember is sometimes threatened and can occasionally flicker from the...their crews. “You Have to Go Out but You Don’t Have to Come Back.” Coast- guardsmen are taught to avoid or mitigate unnecessary risk, but this historic

Less Heat, More Light: Resolving Our Differences in the Community. Handbook on Religion in the Public Schools.

ERIC Educational Resources Information Center

Indiana Civil Liberties Union, Inc., Indianapolis.

This handbook assists teachers, administrators, and other members of the educational community in avoiding inappropriate religious activities in the public schools as well as unnecessary interference with legitimate private religious expression by clarifying existing law. Participants in the Task Force on Religion and the Constitution represented…

Re-Using Today's Metadata for Tomorrow's Research: Five Practical Examples for Enhancing Access to Digital Collections

ERIC Educational Resources Information Center

Tzoc, Elias

2011-01-01

According to the "Framework of Guidance for Building Good Digital Collections," a good collection is broadly available and avoids unnecessary impediments to use. Two challenges, however, are the constant change in users' expectations and the increasing volume of information in local repositories. Therefore, as academic and research…

Sonographic Spectrum of Tunica Albuginea Cyst

PubMed Central

Alvarez, Daniel M.; Bhatt, Shweta; Dogra, Vikram S.

2011-01-01

Tunica albuginea (TA) cyst is the most common extratesticular benign mass, which is usually palpable. Ultrasound examination is the imaging modality of choice to characterize palpable testicular lesions. This pictorial essay presents the spectrum of sonographic features of TA cysts in order to assist radiologists in making the correct diagnosis and avoid unnecessary surgeries. PMID:21915386

Unnecessary roughness? Testing the hypothesis that predators destined for molecular gut-content analysis must be hand-collected to avoid cross-contamination

USDA-ARS?s Scientific Manuscript database

Molecular gut-content analysis enables direct detection of arthropod predation with minimal disruption of on-going ecosystem processes. Mass-collection methods, such as sweep-netting, vacuum sampling, and foliage beating, could lead to regurgitation or even rupturing of predators along with uneaten ...

Mental health crisis and respite services: service user and carer aspirations.

PubMed

Lyons, C; Hopley, P; Burton, C R; Horrocks, J

2009-06-01

There is emerging evidence that crisis resolution services can provide alternatives to hospital admission, reducing demand on inpatient beds. Following a public consultation exercise in Lancashire (England), a team of nurses undertook a study, using interactive research methodology, to gain an understanding of how users and carers define a crisis and what range of crisis services, resources and interventions service users and carers thought would help avoid unnecessary hospital admission. Data collection comprised postal questionnaires and 24 group meetings with service users and carers, which were held during 2006. Data were analysed, and seven themes were identified: (1) definitions of a crisis; (2) access to services; (3) interventions; (4) range of services required (before, during and after crisis); (5) place of treatment; (6) recovery and rehabilitation; and (7) community support. We conclude that expressed preferences of service users and carers for pre-emptive services that are delivered flexibly will present a challenge for service commissioners and providers, particularly where stringent access criteria are used. Home-based pre-emptive services that reduce the need for unnecessary hospital treatment may avoid progression to social exclusion of service users.

Pluralist social constraints on the development of a health care system: the case of Israel.

PubMed

Palley, H A; Yishai, Y; Ever-Hadani, P

1983-01-01

The effectiveness of Israel's health care system is hindered by pluralism, in terms both of its many separate health service institutions and of the particularism of those institutions. Although the health care system provides modern health care to a widely insured population, it does so inefficiently and at unnecessary expense. The lack of vertical and horizontal integration of the health care system has led to problems of fragmentation, duplication, and lack of coordination of services. Because of its limited resources, Israel must work to surmount this pluralism and achieve integrated planning if it is to succeed in providing the efficient and cost-effective care its population needs.

Antibiotics may not decrease prostate-specific antigen levels or prevent unnecessary prostate biopsy in patients with moderately increased prostate-specific antigen levels: A meta-analysis.

PubMed

Yang, Lu; Zhu, Yuchun; Tang, Zhuang; Chen, Yongji; Gao, Liang; Liu, Liangren; Han, Ping; Li, Xiang; Wei, Qiang

2015-05-01

To evaluate the effect of empiric antibiotics on decreasing prostate-specific antigen (PSA) levels and the possibility of avoiding unnecessary prostate biopsies (PBs). A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared effects of empiric antibiotics with no treatment or placebo on lowering PSA levels and minimizing unnecessary PBs in patients with moderately increased PSA levels. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis. The inclusion criteria for the study were met by 6 RCTs (1 placebo controlled and 5 no treatment controlled) involving 656 patients. The synthesized data from these RCTs indicated that there were no significant differences between the antibiotic and control groups in the PSA levels after treatment (mean difference [MD] = 0.15, 95% CI:-0.50 to 0.81, P = 0.65], number of patients with decreased PSA levels after treatment (relative risk [RR] = 1.22, 95% CI: 0.90-1.65, P = 0.20], prostate-specific antigen density levels after treatment (MD =-0.04, 95% CI:-0.15 to 0.07, P = 0.47), f/t% PSA after treatment (MD =-1.47, 95% CI:-4.65 to 1.71, P = 0.37), number of patients with responsive PSA (RR = 1.02, 95% CI: 0.58-1.81, P = 0.94), and individual Pca-positiverate in these patients (RR = 1.07, 95% CI: 0.53-2.16, P = 0.86), and Pca-positiverates (RR = 0.85, 95% CI: 0.48-1.50, P = 0.57). However, the antibiotic group had a significant change in the net PSA decrease after treatment compared with the control group (MD = 1.44, 95% CI: 0.70-2.17, P = 0.0001). The use of empiric antibiotics may not significantly decrease PSA levels or avoid unnecessary PBs. Copyright © 2015 Elsevier Inc. All rights reserved.

A case of isolated abducens nerve paralysis in maxillofacial trauma

PubMed Central

Keskin, Elif Seda; Keskin, Ekrem; Atik, Bekir; Koçer, Abdülkadir

2015-01-01

Nervus abducens is a pure motor nerve located in the pons. It retracts the eyeball laterally by stimulating rectus lateralis muscle. In case of their paralysis, diplopia and restriction in the eye movements while looking sideways, are seen. Since the same signs are seen due to the muscle entrapment in blowout fractures, its differential diagnosis has importance in terms of the treatment protocol and avoiding unnecessary operations. In this article, we present a 22-year-old male patient who was referred to our department due to the prediagnosis of blowout fracture following maxillofacial trauma. However, he was diagnosed with abducens nerve paralysis after the consultations and analysis and his restriction of movement was resolved via systemic steroid treatment instead of unnecessary operation. PMID:26981484

Value of diagnostic imaging for the symptomatic male breast: Can we avoid unnecessary biopsies?

PubMed

Foo, Eric T; Lee, Amie Y; Ray, Kimberly M; Woodard, Genevieve A; Freimanis, Rita I; Joe, Bonnie N

To review the use of diagnostic breast imaging and outcomes for symptomatic male patients. We retrospectively evaluated 122 males who underwent diagnostic imaging for breast symptoms at our academic center. The majority (94%) of cases had negative or benign imaging, with gynecomastia being the most common diagnosis (78%). There were two malignancies, both of which had positive imaging. Fifteen patients underwent percutaneous biopsy, and over half (53%) were palpation-guided biopsies initiated by the referring clinician despite negative imaging. Diagnostic imaging demonstrated 100% sensitivity and 96% specificity for identifying cancer. Malignancy is rarely a cause of male breast symptoms. Diagnostic breast imaging is useful to establish benignity and avert unnecessary biopsies. Copyright © 2017 Elsevier Inc. All rights reserved.

Rib fractures induced by coughing: an unusual cause of acute chest pain.

PubMed

De Maeseneer, M; De Mey, J; Debaere, C; Meysman, M; Osteaux, M

2000-03-01

We report three patients with stress fractures of the ribs induced by coughing. Standard radiographs of the chest and ribs did not reveal evidence of rib fractures in any of the patients. Bone scintigraphy, performed 1 to 2 weeks after initial onset of symptoms, showed a focal area of increased uptake along the chest wall in all cases. Thin section angulated helical CT directly visualized the subtle rib fractures. Initial diagnosis of a cough-induced fracture of the rib may be difficult because of the associated underlying disorder, and unnecessary examinations are commonly performed. Identification of a cough-induced fracture of the rib using helical CT may be clinically important to avoid unnecessary concern and additional examinations.

Inguinal Hernia and Airport Scanners: An Emerging Indication for Repair?

PubMed Central

Cawich, Shamir O.; Maharaj, Ravi; Dan, Dilip

2013-01-01

The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency. PMID:24368923

An Empirical Study on Non-English Majors' Ability to Express Chinese Culture in English

ERIC Educational Resources Information Center

Zhang, Min

2014-01-01

Cross-cultural communicative ability is an important ability that college students should have in modern society. A successful cross-cultural communication is based on several factors. The basic one is the understanding of the target language culture. In order to avoid unnecessary misunderstandings it is necessary for college students to know…

Teaching CAD at the University: Specifically Written or Commercial Software?

ERIC Educational Resources Information Center

Garcia, Ramon Rubio; Quiros, Javier Suarez; Santos, Ramon Gallego; Penin, Pedro I. Alvarez

2007-01-01

At most universities throughout the world Computer Aided Design is taught using commercial programs more suitable for business and industry than for teaching. This led us to write our own design program (GIcad) starting from the best-known standards on the market, but always avoiding unnecessary commands in the first steps of the learning process.…

Superior herniation of the mediastinum presenting as an anterior neck mass on straining.

PubMed

McDougall, Catherine M; Culham, Gordon; Seear, Michael D; Chilvers, Mark A

2012-07-01

We report an infant with an anterior neck mass present only on straining. Airway fluoroscopy revealed this to be due to superior mediastinal herniation. Neck masses apparent only during Valsalva maneuver are rare and awareness of the differential diagnosis is important to avoid unnecessary investigation or surgery. Copyright © 2012 Wiley Periodicals, Inc.

Therapeutic risk management of clinical-legal dilemmas: should it be a core competency?

PubMed

Simon, Robert I; Shuman, Daniel W

2009-01-01

Therapeutic risk management of clinical-legal dilemmas achieves an optimal alignment between clinical competence and an understanding of legal concerns applicable to psychiatric practice. Understanding how psychiatry and law interact in frequently occurring clinical situations is essential for effective patient care. Successful management of clinical-legal dilemmas also avoids unnecessary, counterproductive defensive practices.

Long-term performance of minimum-input oak restoration plantings

Treesearch

Elizabeth Bernhardt; Tedmund J. Swiecki

2015-01-01

Starting in 1989, we used minimum-input methods to restore native oaks to parts of their former ranges in Vacaville, California. Each restoration site was analyzed, and only those inputs deemed necessary to overcome expected limiting factors for oak establishment were used. We avoided unnecessary inputs that added to cost and could have unintended negative consequences...

Inguinal hernia and airport scanners: an emerging indication for repair?

PubMed

Naraynsingh, Vijay; Cawich, Shamir O; Maharaj, Ravi; Dan, Dilip

2013-01-01

The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency.

Better Federal Program Administration Can Contribute to Improving State Foster Care Programs.

ERIC Educational Resources Information Center

Comptroller General of the U.S., Washington, DC.

The Adoption Assistance and Child Welfare Act of 1980 provides for annual federal incentive payments to states if they improve foster care programs by (1) avoiding unnecessary removal of children from their homes; (2) preventing extended stays in foster care; and (3) reunifying children with their families or placing them for adoption. To be…

Urine Culture Follow-up and Antimicrobial Stewardship in a Pediatric Urgent Care Network.

PubMed

Saha, Dipanwita; Patel, Jimisha; Buckingham, Don; Thornton, David; Barber, Terry; Watson, Joshua R

2017-04-01

Empiric antibiotic therapy for presumed urinary tract infection (UTI) leads to unnecessary antibiotic exposure in many children whose urine culture results fail to confirm the diagnosis. The objective of this quality improvement study was to improve follow-up management of negative urine culture results in the off-campus urgent care network of Nationwide Children's Hospital to reduce inappropriate antibiotic exposure in children. A multidisciplinary task force developed and implemented a protocol for routine nurse and clinician follow-up of urine culture results, discontinuation of unnecessary antibiotics, and documentation in the electronic medical record. Monthly antibiotic discontinuation rates were tracked in empirically treated patients with negative urine culture results from July 2013 through December 2015. Statistical process control methods were used to track improvement over time. Fourteen-day return visits for UTIs were monitored as a balancing measure. During the study period, 910 patients received empiric antibiotic therapy for UTIs but had a negative urine culture result. The antibiotic discontinuation rate increased from 4% to 84%, avoiding 3429 (40%) of 8648 antibiotic days prescribed. Among patients with discontinued antibiotics, none was diagnosed with a UTI within 14 days of the initial urgent care encounter. Implementation of a standard protocol for urine culture follow-up and discontinuation of unnecessary antibiotics was both effective and safe in a high-volume pediatric urgent care network. Urine culture follow-up management is an essential opportunity for improved antimicrobial stewardship in the outpatient setting that will affect many patients by avoiding a substantial number of antibiotic days. Copyright © 2017 by the American Academy of Pediatrics.

48 CFR 970.1707-2 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... commercialization; (c) Maintain facility core competencies; (d) Enhance the science and technology capabilities at... REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Special Contracting Methods 970.1707-2 Purpose. The purpose... accomplishing goals that may otherwise be unattainable and to avoid the possible duplication of effort at...

21 CFR 888.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES General Provisions § 888.1 Scope. (a) This part sets forth the classification of orthopedic... to other devices, as required by § 807.87. (c) To avoid duplicative listings, an orthopedic device...

21 CFR 888.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES General Provisions § 888.1 Scope. (a) This part sets forth the classification of orthopedic... to other devices, as required by § 807.87. (c) To avoid duplicative listings, an orthopedic device...

21 CFR 888.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES General Provisions § 888.1 Scope. (a) This part sets forth the classification of orthopedic... to other devices, as required by § 807.87. (c) To avoid duplicative listings, an orthopedic device...

21 CFR 888.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES General Provisions § 888.1 Scope. (a) This part sets forth the classification of orthopedic... to other devices, as required by § 807.87. (c) To avoid duplicative listings, an orthopedic device...

Probe Measures Fouling As In Heat Exchangers

NASA Technical Reports Server (NTRS)

Marner, Wilbur J.; Macdavid, Kenton S.

1990-01-01

Combustion deposits reduce transfer of heat. Instrument measures fouling like that on gas side of heat exchanger in direct-fired boiler or heat-recovery system. Heat-flux probe includes tube with embedded meter in outer shell. Combustion gases flow over probe, and fouling accumulates on it, just as fouling would on heat exchanger. Embedded heat-flow meter is sandwich structure in which thin Chromel layers and middle alloy form thermopile. Users determine when fouling approaches unacceptable levels so they schedule cleaning and avoid decreased transfer of heat and increased drop in pressure fouling causes. Avoids cost of premature, unnecessary maintenance.

A Case of Munchausen Syndrome Presenting with Hematemesis: A Case Report

PubMed Central

Aadil, Muhammad; Faraz, Aniqa; Anwar, Muhammad Jahanzaib; Nasir, Usama; Akhlaq, Anum

2017-01-01

Munchausen syndrome (MS) was first reported in 1951 by Richard Alan John Asher as a factitious disorder. It is a condition in which the patient intentionally produces symptoms to assume a sick role and gain medical attention. Underdiagnosis of this disorder results in the unnecessary use of medical resources, i.e. unnecessary medical tests and evaluations. This makes it one of the most challenging diagnosis in any medical set up. We present this rare case of a patient with chronic factitious disorder who presented to the emergency with hematemesis. The patient was successfully treated with psychotherapy with no recurrence. It is the need of the hour to create awareness amongst the medical and nonmedical population about factitious disorders so that they can easily be diagnosed and treated with efficiency. Further research is needed to find the risks leading to this syndrome and discover the cultural and social aspects of this disease, which may help us explore treatment strategies and avoid unnecessary tests and treatment.​ PMID:28979830

43 CFR 11.23 - Preassessment screen-general.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSESSMENTS Preassessment Phase § 11.23 Preassessment screen—general. (a) Requirement. Before beginning any... potentially at risk, of this part. (e) Criteria. Based on information gathered pursuant to the preassessment... satisfied by that process, the processes may be combined to avoid duplication. (g) Preassessment phase costs...

21 CFR 892.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES General Provisions § 892.1 Scope. (a) This part sets forth the classification of radiology devices... devices, as required by § 807.87. (c) To avoid duplicative listings, a radiology device that has two or...

Focusing a Transition: A Report by the Defense Business Board

DTIC Science & Technology

2009-01-01

2. NEAR-TERM OBSTACLES THAT COULD HAMPER LONG -TERM SUCCESS .................................................................25 Lowering the Overhead...requiring immediate att ention, (2) near-term obstacles that could hamper long -term success, (3) organizational issues for the Department to address for...begin early – long before January 20th - to avoid major leadership gaps (see Figure 1-2) and unnecessary vulnerabilities to the Department. Department

How to Handle Difficult Parents: Proven Solutions for Teachers. Second Edition

ERIC Educational Resources Information Center

Tingley, Suzanne Capek

2012-01-01

"How to Handle Difficult Parents" is a funny, but practical, guide to working effectively with parents and avoiding unnecessary conflict. Whether you're a teacher (regular or special education) or a coach, this book will give you practical suggestions regarding what to say and how to say it to parents who question your lesson plans, challenge your…

Alternative Fuels Data Center: Techniques for Drivers to Conserve Fuel

Science.gov Websites

techniques to save fuel and money. The amount of fuel your vehicle consumes depends heavily on how you drive and money. Vehicles use the most energy when accelerating. Using cruise control on the highway can trips can save you time and money by avoiding unnecessary stopping and starting of your vehicle, which

[Herpes zoster infection with acute urinary retention].

PubMed

Jakab, G; Komoly, S; Juhász, E

1990-03-11

The history of a young female patient is presented. She developed urine retention of sudden onset as a complication of herpes zoster infection manifested in the sacral dermatomes. Symptomatic and antiviral treatments were introduced with full recovery of bladder function. The correct diagnosis of this rare and benign complication of herpes zoster infection can help to avoid unnecessary and invasive examinations.

The Hundred Person Wellness Project and Google's Baseline Study: medical revolution or unnecessary and potentially harmful over-testing?

PubMed

Diamandis, Eleftherios P

2015-01-09

The Hundred Person Wellness Project is an ambitious pilot undertaking, which aims to intensely monitor 100 individuals over 10 months. Patients with abnormal findings will be treated, in hopes that this early intervention will avoid, or delay, symptomatic disease. Google's "Baseline Study" is of similar scope and will enroll 10,000 people over 2 to 3 years. I here speculate that these approaches will likely not be effective in preventing disease, but instead, lead to unnecessary and potentially harmful interventions. Examples from the cancer screening experience over the last 30 years are provided, which show that intensive testing may uncover indolent disease or incidental findings which, when treated, may cause more harm than good. Additional examples show that aggressive treatments for cancer and other diseases do not always lead to better patient outcomes. I conclude that the recent advances in omics provide us with unprecedented opportunities for high content clinical testing, but such testing should be used with caution to avoid the harmful consequences of over-diagnosis and over-treatment. Despite the detailed rebuttals by Hood and colleagues in another commentary in BMC Medicine, time will show the actual benefits and harms of these ambitious initiatives.

Innovative Designs for the Smart ICU.

PubMed

Halpern, Neil A

2014-03-01

Successfully designing a new ICU requires clarity of vision and purpose and the recognition that the patient room is the core of the ICU experience for patients, staff, and visitors. The ICU can be conceptualized into three components: the patient room, central areas, and universal support services. Each patient room should be designed for single patient use and be similarly configured and equipped. The design of the room should focus upon functionality, ease of use, healing, safety, infection control, communications, and connectivity. All aspects of the room, including its infrastructure; zones for work, care, and visiting; environment, medical devices, and approaches to privacy; logistics; and waste management, are important elements in the design process. Since most medical devices used at the ICU bedside are really sophisticated computers, the ICU needs to be capable of supporting the full scope of medical informatics. The patient rooms, the central ICU areas (central stations, corridors, supply rooms, pharmacy, laboratory, staff lounge, visitor waiting room, on-call suite, conference rooms, and offices), and the universal support services (infection prevention, finishings and flooring, staff communications, signage and wayfinding, security, and fire and safety) work best when fully interwoven. This coordination helps establish efficient and safe patient throughput and care and fosters physical and social cohesiveness within the ICU. A balanced approach to centralized and decentralized monitoring and logistics also offers great flexibility. Synchronization of the universal support services in the ICU with the hospital's existing systems maintains unity of purpose and continuity across the enterprise and avoids unnecessary duplication of efforts. Copyright © 2014 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Policy outcomes of applying different nutrient profiling systems in recreational sports settings: the case for national harmonization in Canada.

PubMed

Olstad, Dana Lee; Poirier, Kelly; Naylor, Patti-Jean; Shearer, Cindy; Kirk, Sara F L

2015-08-01

To assess agreement among three nutrient profiling systems used to evaluate the healthfulness of vending machine products in recreation and sport settings in three Canadian provinces. We also assessed whether the nutritional profile of vending machine items in recreation and sport facilities that were adhering to nutrition guidelines (implementers) was superior to that of facilities that were not (non-implementers). Trained research assistants audited the contents of vending machines. Three provincial nutrient profiling systems were used to classify items into each province's most, moderately and least healthy categories. Agreement among systems was assessed using weighted κ statistics. ANOVA assessed whether the average nutritional profile of vending machine items differed according to province and guideline implementation status. Eighteen recreation and sport facilities in three Canadian provinces. One-half of facilities were implementing nutrition guidelines. Snacks (n 531) and beverages (n 618) within thirty-six vending machines were audited. Overall, the systems agreed that the majority of items belonged within their respective least healthy categories (66-69 %) and that few belonged within their most healthy categories (14-22 %). Agreement among profiling systems was moderate to good, with κ w values ranging from 0·49 to 0·69. Implementers offered fewer of the least healthy items (P<0·05) and these items had a better nutritional profile compared with items in non-implementing facilities. The policy outcomes of the three systems are likely to be similar, suggesting there may be scope to harmonize nutrient profiling systems at a national level to avoid unnecessary duplication and support food reformulation by industry.

Costs and benefits of rapid screening of methicillin-resistant Staphylococcus aureus carriage in intensive care units: a prospective multicenter study

PubMed Central

2012-01-01

Introduction Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs). Methods Embedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT. Results A total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n = 5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of €327.84 (IDI) and €252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were €136.04 (IDI) and €121.76 (GeneXpert). Conclusions In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of €121.76 to €136.04 per isolation day avoided. PMID:22314204

21 CFR 872.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES General Provisions § 872.1 Scope. (a) This part sets forth the classification of dental devices intended... devices, as required by § 807.87. (c) To avoid duplicative listings, a dental device that has two or more...

21 CFR 872.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES General Provisions § 872.1 Scope. (a) This part sets forth the classification of dental devices intended... devices, as required by § 807.87. (c) To avoid duplicative listings, a dental device that has two or more...

25 CFR 20.200 - What contact will the Bureau maintain with State, tribal, county, local, and other Federal agency...

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Welfare Reform... agency programs? We will coordinate all financial assistance and social services programs with state... social services program avoids duplication of assistance. ...

25 CFR 20.200 - What contact will the Bureau maintain with State, tribal, county, local, and other Federal agency...

Code of Federal Regulations, 2011 CFR

2011-04-01

..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Welfare Reform... agency programs? We will coordinate all financial assistance and social services programs with state... social services program avoids duplication of assistance. ...

25 CFR 20.200 - What contact will the Bureau maintain with State, tribal, county, local, and other Federal agency...

Code of Federal Regulations, 2013 CFR

2013-04-01

..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Welfare Reform... agency programs? We will coordinate all financial assistance and social services programs with state... social services program avoids duplication of assistance. ...

25 CFR 20.200 - What contact will the Bureau maintain with State, tribal, county, local, and other Federal agency...

Code of Federal Regulations, 2012 CFR

2012-04-01

..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Welfare Reform... agency programs? We will coordinate all financial assistance and social services programs with state... social services program avoids duplication of assistance. ...

25 CFR 20.200 - What contact will the Bureau maintain with State, tribal, county, local, and other Federal agency...

Code of Federal Regulations, 2014 CFR

2014-04-01

..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Welfare Reform... agency programs? We will coordinate all financial assistance and social services programs with state... social services program avoids duplication of assistance. ...

45 CFR 1304.40 - Family partnerships.

Code of Federal Regulations, 2010 CFR

2010-10-01

... visits and group socialization activities (see 45 CFR 1306.33(b)). (3) To avoid duplication of effort, or... in counseling programs or to receive information on mental health issues that place families at risk... an assessment of nutritional status as well as nutrition counseling and food assistance, if necessary...

Federal Coal Mine Health and Safety Act of 1969, Title IV, as amended (The Black Lung Benefits Act); payment of benefits--withholding Part B benefits where Part C payments are made for the same period. Social Security Administration. Final rule.

PubMed

1982-05-04

This regulation confirms the interim rule authorizing the Social Security Administration to withhold payment of Part B Black Lung benefits where Part C Black Lung benefits administered by the Dept. of Labor are paid for the same period. We are doing this by expanding the definition of "overpayment" in 20 CFR 410.560(a) to include these duplicate payments under Part C. This regulation provides a quick and efficient means of avoiding unjustified duplicate payments.

Treatment philosophy and retreatment rates following piezoelectric lithotripsy.

PubMed

Fegan, J; Camp, L A; Wilson, W T; Miller, G L; Preminger, G M

1993-01-01

Second generation lithotriptors offer the advantage of anesthesia-free fragmentation of renal and ureteral calculi but they frequently require multiple treatments to attain a stone-free status. However, excessive single lithotripsy sessions or multiple treatments may be associated with significant damage to the kidney. For some clinicians a common treatment philosophy involves evaluation of serial plain abdominal films every 24 hours after lithotripsy and immediate retreatment of all patients with incomplete fragmentation. To avoid unnecessary retreatments and, thus, minimize potential renal damage, we prospectively evaluated 100 patients undergoing lithotripsy on a Wolf Piezolith 2300 device. Patients were routinely treated with 4,000 shocks at 1,100 bar. Serial plain abdominal films were obtained at 1 day and 2 weeks after lithotripsy. The need for retreatment was determined by the plain abdominal film results. Additional therapy was considered necessary if there was no stone fragmentation or if residual fragments measured greater than 4 mm. Of the patients whose plain abdominal film at 24 hours indicated the need for a repeat treatment 43% were stone-free on the 2-week film. Thus, these patients were spared an unnecessary treatment by allowing adequate time for the stone fragments to pass spontaneously. Our data suggest that repeat treatments on second generation lithotriptors should not be performed within 24 hours. Rather, the patient should be reevaluated at least 1 to 2 weeks later to avoid unnecessary retreatment with the attendant potential for renal injury. In addition, when comparing the retreatment rates of various lithotriptors, one should also consider the treatment philosophy used at the particular institution and the timing of the radiographic studies used to determine the stone-free status.

Age-Specific Cutoff Value for the Application of Percent Free Prostate-Specific Antigen (PSA) in Chinese Men with Serum PSA Levels of 4.0-10.0 ng/ml.

PubMed

Chen, Rui; Huang, Yiran; Cai, Xiaobing; Xie, Liping; He, Dalin; Zhou, Liqun; Xu, Chuanliang; Gao, Xu; Ren, Shancheng; Wang, Fubo; Ma, Lulin; Wei, Qiang; Yin, Changjun; Tian, Ye; Sun, Zhongquan; Fu, Qiang; Ding, Qiang; Zheng, Junhua; Ye, Zhangqun; Ye, Dingwei; Xu, Danfeng; Hou, Jianquan; Xu, Kexin; Yuan, Jianlin; Gao, Xin; Liu, Chunxiao; Pan, Tiejun; Sun, Yinghao

2015-01-01

The influence of age on the performance of percent free prostate-specific antigen (%fPSA) in diagnosing prostate cancer (PCa) in East Asians is controversial. We tested the diagnostic performance of %fPSA in a multi-center biopsy cohort in China and identified the proper age-specific cutoff values to avoid unnecessary biopsies. Consecutive patients with a prostate-specific antigen (PSA) level of 4.0-10.0 ng/ml or 10.1-20.0 ng/ml who underwent transrectal ultrasound-guided or transperineal prostate biopsy were enrolled from 22 Chinese medical centers from Jan 1, 2010 to Dec 31, 2013. The diagnostic accuracy of PSA and %fPSA was determined using the area under the receiver operating characteristic (ROC) curve (AUC). Age-specific cutoff values were calculated using ROC curve analysis. The median %fPSA was much lower in younger patients compared with older patients with a PSA level of 4.0-10.0 ng/ml or 10.1-20.0 ng/ml. The AUC of %fPSA was higher than PSA only in older patients. In patients aged 50 to 59 years, %fPSA failed to improve the diagnosis compared with PSA in these two PSA ranges. Age-specific cutoff values were 24%, 27% and 32% for patients aged 60-69, 70-79 and ≥80 years, respectively, to reduce unnecessary biopsies in men with PSA levels of 4.0-10.0 ng/ml to detect 90% of all PCa. The effectiveness of %fPSA is correlated with age in the Chinese population. Age-specific cutoff values would help avoid unnecessary biopsies in the Chinese population.

Age-Specific Cutoff Value for the Application of Percent Free Prostate-Specific Antigen (PSA) in Chinese Men with Serum PSA Levels of 4.0–10.0 ng/ml

PubMed Central

Xie, Liping; He, Dalin; Zhou, Liqun; Xu, Chuanliang; Gao, Xu; Ren, Shancheng; Wang, Fubo; Ma, Lulin; Wei, Qiang; Yin, Changjun; Tian, Ye; Sun, Zhongquan; Fu, Qiang; Ding, Qiang; Zheng, Junhua; Ye, Zhangqun; Ye, Dingwei; Xu, Danfeng; Hou, Jianquan; Xu, Kexin; Yuan, Jianlin; Gao, Xin; Liu, Chunxiao; Pan, Tiejun; Sun, Yinghao

2015-01-01

Objective The influence of age on the performance of percent free prostate-specific antigen (%fPSA) in diagnosing prostate cancer (PCa) in East Asians is controversial. We tested the diagnostic performance of %fPSA in a multi-center biopsy cohort in China and identified the proper age-specific cutoff values to avoid unnecessary biopsies. Methods Consecutive patients with a prostate-specific antigen (PSA) level of 4.0–10.0 ng/ml or 10.1–20.0 ng/ml who underwent transrectal ultrasound-guided or transperineal prostate biopsy were enrolled from 22 Chinese medical centers from Jan 1, 2010 to Dec 31, 2013. The diagnostic accuracy of PSA and %fPSA was determined using the area under the receiver operating characteristic (ROC) curve (AUC). Age-specific cutoff values were calculated using ROC curve analysis. Results The median %fPSA was much lower in younger patients compared with older patients with a PSA level of 4.0–10.0 ng/ml or 10.1–20.0 ng/ml. The AUC of %fPSA was higher than PSA only in older patients. In patients aged 50 to 59 years, %fPSA failed to improve the diagnosis compared with PSA in these two PSA ranges. Age-specific cutoff values were 24%, 27% and 32% for patients aged 60–69, 70–79 and ≥80 years, respectively, to reduce unnecessary biopsies in men with PSA levels of 4.0–10.0 ng/ml to detect 90% of all PCa. Conclusions The effectiveness of %fPSA is correlated with age in the Chinese population. Age-specific cutoff values would help avoid unnecessary biopsies in the Chinese population. PMID:26091007

Enhancing search efficiency by means of a search filter for finding all studies on animal experimentation in PubMed

PubMed Central

Hooijmans, Carlijn R; Tillema, Alice; Leenaars, Marlies; Ritskes-Hoitinga, Merel

2010-01-01

Collecting and analysing all available literature before starting an animal experiment is important and it is indispensable when writing a systematic review (SR) of animal research. Writing such review prevents unnecessary duplication of animal studies and thus unnecessary animal use (Reduction). One of the factors currently impeding the production of ‘high-quality’ SRs in laboratory animal science is the fact that searching for all available literature concerning animal experimentation is rather difficult. In order to diminish these difficulties, we developed a search filter for PubMed to detect all publications concerning animal studies. This filter was compared with the method most frequently used, the PubMed Limit: Animals, and validated further by performing two PubMed topic searches. Our filter performs much better than the PubMed limit: it retrieves, on average, 7% more records. Other important advantages of our filter are that it also finds the most recent records and that it is easy to use. All in all, by using our search filter in PubMed, all available literature concerning animal studies on a specific topic can easily be found and assessed, which will help in increasing the scientific quality and thereby the ethical validity of animal experiments. PMID:20551243

Enhancing search efficiency by means of a search filter for finding all studies on animal experimentation in PubMed.

PubMed

Hooijmans, Carlijn R; Tillema, Alice; Leenaars, Marlies; Ritskes-Hoitinga, Merel

2010-07-01

Collecting and analysing all available literature before starting an animal experiment is important and it is indispensable when writing a systematic review (SR) of animal research. Writing such review prevents unnecessary duplication of animal studies and thus unnecessary animal use (Reduction). One of the factors currently impeding the production of 'high-quality' SRs in laboratory animal science is the fact that searching for all available literature concerning animal experimentation is rather difficult. In order to diminish these difficulties, we developed a search filter for PubMed to detect all publications concerning animal studies. This filter was compared with the method most frequently used, the PubMed Limit: Animals, and validated further by performing two PubMed topic searches. Our filter performs much better than the PubMed limit: it retrieves, on average, 7% more records. Other important advantages of our filter are that it also finds the most recent records and that it is easy to use. All in all, by using our search filter in PubMed, all available literature concerning animal studies on a specific topic can easily be found and assessed, which will help in increasing the scientific quality and thereby the ethical validity of animal experiments.

30 CFR 905.773 - Requirements for permits and permit processing.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., 42 U.S.C. 7401 et seq California Air Pollution Control Laws, Cal. Health & Safety Code section 39000..., DEPARTMENT OF THE INTERIOR PROGRAMS FOR THE CONDUCT OF SURFACE MINING OPERATIONS WITHIN EACH STATE CALIFORNIA... responsibilities under the following Federal laws with the relevant California State laws to avoid duplication...

30 CFR 905.773 - Requirements for permits and permit processing.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., 42 U.S.C. 7401 et seq California Air Pollution Control Laws, Cal. Health & Safety Code section 39000..., DEPARTMENT OF THE INTERIOR PROGRAMS FOR THE CONDUCT OF SURFACE MINING OPERATIONS WITHIN EACH STATE CALIFORNIA... responsibilities under the following Federal laws with the relevant California State laws to avoid duplication...

30 CFR 905.773 - Requirements for permits and permit processing.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., 42 U.S.C. 7401 et seq California Air Pollution Control Laws, Cal. Health & Safety Code section 39000..., DEPARTMENT OF THE INTERIOR PROGRAMS FOR THE CONDUCT OF SURFACE MINING OPERATIONS WITHIN EACH STATE CALIFORNIA... responsibilities under the following Federal laws with the relevant California State laws to avoid duplication...

42 CFR 438.360 - Nonduplication of mandatory activities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Nonduplication of mandatory activities. (a) General rule. To avoid duplication, the State may use, in place of a... quality strategy, the State identifies the standards for which the EQR will use information from Medicare... information obtained from the Medicare program in place of information produced by the State, its agent, or...

Library and Classroom Use of Copyrighted Videotapes and Computer Software.

ERIC Educational Resources Information Center

Reed, Mary Hutchings; Stanek, Debra

1986-01-01

This pullout guide addresses issues regarding library use of copyrighted videotapes and computer software. Guidelines for videotapes cover in-classroom use, in-library use in public library, loan, and duplication. Guidelines for computer software cover purchase conditions, avoiding license restrictions, loaning, archival copies, and in-library and…

77 FR 6571 - Information Collection Request to Office of Management and Budget

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-08

... Office of Management and Budget AGENCY: Coast Guard, DHS. ACTION: Sixty-day notice requesting comments... Information Collection Request (ICR) to the Office of Management and Budget (OMB), Office of Information and... Management Facility (DMF) at the U.S. Department of Transportation (DOT). To avoid duplicate submissions...

Developing and Using Ada Parts in Real-Time Embedded Applications

DTIC Science & Technology

1990-04-27

ARCHTECTURAL DESIGN Guideline #3-a: Avoid duplication of data types packages. Guideline #3-b: Minimize variant proliferation. Concentrate on developing a...of SOFTWARE REUSE DEVELOPING and USING ADA PARTS in RTE APPUCATIONS ARCHTECTURAL DESIGN Table 5-10 illustrates the use of this more strongly data typed

Autoimmune pancreatitis associated with renal lesions mimicking metastatic tumours

PubMed Central

Rudmik, Lucas; Trpkov, Kiril; Nash, Carla; Kinnear, Susan; Falck, Vincent; Dushinski, John; Dixon, Elijah

2006-01-01

Autoimmune pancreatitis is a chronic inflammatory disorder that is often misdiagnosed as pancreatic cancer. Since autoimmune pancreatitis is benign and responds to steroid management, it is important to diagnose it to avoid unnecessary surgical intervention. We describe a novel case of IgG4-associated autoimmune pancreatitis presenting with tubulointerstitial nephritis as renal lesions mimicking metastatic tumours but with no change in renal function. PMID:16908897

Endobronchial Ultrasound (EBUS) - Update 2017.

PubMed

Darwiche, Kaid; Özkan, Filiz; Wolters, Celina; Eisenmann, Stephan

2018-02-01

Endobronchial ultrasound (EBUS) has revolutionized the diagnosis of lung cancer over the last decade. This minimally invasive diagnostic method has also become increasingly important in the case of other diseases such as sarcoidosis, thereby helping to avoid unnecessary diagnostic interventions. This review article provides an update regarding EBUS and discusses current and future developments of this method. © Georg Thieme Verlag KG Stuttgart · New York.

[Prevention and multimodal therapy of hyperthyroidism].

PubMed

Palitzsch, K-D

2008-12-01

Subclinical and overt hyperthyroidism have been associated with various negative clinical outcomes as for example an increased risk of atrial fibrillation or increased cardiovascular mortality, especially in old age. In order to avoid hyperthyroidism it is strongly recommended not to start any iodine containing drug therapy or to avoid application of contrast agents unless the patient presents with an unremarkable clinical course. TSH suppressive therapy for the treatment of endemic goiter or differentiated low risk thyroid carcinoma is unnecessary, since it favours the development of subclinical hyperthyroidism. Overt hyperthyroidism is treated with antithyroid drugs and/or radioiodine therapy or surgery according to the underlying disease (toxic nodular goiter, Graves' disease).

Correcting prominent ears with the island technique.

PubMed

DeMoura, L F

1977-01-01

A surgical procedure is described which corrects the ansiform ear by repositioning and reconstructing the anthelix and the anterior crus with the formation of the triangular fossa. This corrects the scaphoconchal angle and improves the cephaloauricular angle, overcoming the problem of prominent ears. Correction in early childhood is recommended in order to avoid personality problems that may result from the deformity, particularly in boys. The technique employed yields important advantages: (1) prolonged use of the helmet-type of surgical dressing is unnecessary; (2) scars are less conspicuous; (3) the outcome is attractive and normal; (4) bleeding and inflammatory complications are avoided; and (5) recurrence of the malformation is unlikely.

A Case of Familial Mediterranean Fever Having Intermittent Leukopenia.

PubMed

Beyitler, Ilke; Kavukcu, Salih

2018-03-01

Familial Mediterranean fever (FMF) is a genetically inherited autoinflammatory disorder characterized by inflammatory attacks and may result in amyloidosis as a severe complication. Elevation of acute phase reactants, including leukocytosis, is seen during attack periods. Here we describe a 13-year-old female patient with a very rare clinical presentation of FMF, who would experience FMF attacks when she did not regularly take her colchicine. During these attacks she had leukopenia and neutropenia instead of leukocytosis. The leukocyte count returned to normal when she continued the medication and avoided attacks. Ethnicity and clinical signs are important in leukopenic patientsand should be investigated for FMF to avoid unnecessary procedures and complications.

Why Patient Matching Is a Challenge: Research on Master Patient Index (MPI) Data Discrepancies in Key Identifying Fields

PubMed Central

Just, Beth Haenke; Marc, David; Munns, Megan; Sandefer, Ryan

2016-01-01

Patient identification matching problems are a major contributor to data integrity issues within electronic health records. These issues impede the improvement of healthcare quality through health information exchange and care coordination, and contribute to deaths resulting from medical errors. Despite best practices in the area of patient access and medical record management to avoid duplicating patient records, duplicate records continue to be a significant problem in healthcare. This study examined the underlying causes of duplicate records using a multisite data set of 398,939 patient records with confirmed duplicates and analyzed multiple reasons for data discrepancies between those record matches. The field that had the greatest proportion of mismatches (nondefault values) was the middle name, accounting for 58.30 percent of mismatches. The Social Security number was the second most frequent mismatch, occurring in 53.54 percent of the duplicate pairs. The majority of the mismatches in the name fields were the result of misspellings (53.14 percent in first name and 33.62 percent in last name) or swapped last name/first name, first name/middle name, or last name/middle name pairs. The use of more sophisticated technologies is critical to improving patient matching. However, no amount of advanced technology or increased data capture will completely eliminate human errors. Thus, the establishment of policies and procedures (such as standard naming conventions or search routines) for front-end and back-end staff to follow is foundational for the overall data integrity process. Training staff on standard policies and procedures will result in fewer duplicates created on the front end and more accurate duplicate record matching and merging on the back end. Furthermore, monitoring, analyzing trends, and identifying errors that occur are proactive ways to identify data integrity issues. PMID:27134610

Triple ectopic thyroid: A rare entity

PubMed Central

Nilegaonkar, Sujit; Naik, Chetna; Sonar, Sameer; Hirawe, Deepti

2011-01-01

Ectopic thyroid tissue is an uncommon congenital aberration. It is extremely rare to have three ectopic foci at three different sites. The thyroid scan has been used successfully to diagnose ectopic thyroid tissue. We report a case of ectopic thyroid tissue at base of tongue, another at the level of hyoid and third one as aberrant tissue at suprahyoid location in a 16 year old female who presented with swelling in front of neck. This patient was clinically diagnosed as thyroglossal cyst and was being planned for surgery. Preoperative thyroid scan helped in establishing diagnosis of ectopic thyroid which was the only functioning thyroid tissue. Thus, it prevented unnecessary surgery. Therefore it is suggested that thyroid scan and USG/CT scan must be done as routine work up in neck swellings pre operatively to avoid unnecessary surgeries. PMID:23559716

A space efficient flexible pivot selection approach to evaluate determinant and inverse of a matrix.

PubMed

Jafree, Hafsa Athar; Imtiaz, Muhammad; Inayatullah, Syed; Khan, Fozia Hanif; Nizami, Tajuddin

2014-01-01

This paper presents new simple approaches for evaluating determinant and inverse of a matrix. The choice of pivot selection has been kept arbitrary thus they reduce the error while solving an ill conditioned system. Computation of determinant of a matrix has been made more efficient by saving unnecessary data storage and also by reducing the order of the matrix at each iteration, while dictionary notation [1] has been incorporated for computing the matrix inverse thereby saving unnecessary calculations. These algorithms are highly class room oriented, easy to use and implemented by students. By taking the advantage of flexibility in pivot selection, one may easily avoid development of the fractions by most. Unlike the matrix inversion method [2] and [3], the presented algorithms obviate the use of permutations and inverse permutations.

Prevention of healthcare-associated infections in neonates: room for improvement.

PubMed

Legeay, C; Bourigault, C; Lepelletier, D; Zahar, J R

2015-04-01

Infants in neonatal intensive care units (NICUs) are highly susceptible to infection due to the immaturity of their immune systems. Healthcare-associated infections (HCAIs) are associated with prolonged hospital stay, and represent a significant risk factor for neurological development problems and death. Improving HCAI control is a priority for NICUs. Many factors contribute to the occurrence of HCAIs in neonates such as poor hand hygiene, low nurse-infant ratios, environmental contamination and unnecessary use of antibiotics. Prevention is based on improving neonatal management, avoiding unnecessary use of central venous catheters, restricting use of antibiotics and H2 blockers, and introducing antifungal prophylaxis if necessary. Quality improvement interventions to reduce HCAIs in neonates seem to be the cornerstone of infection control. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

National toxicology program review of current DHHS, DOE, and EPA research related to toxicology, fiscal year 1996

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

NONE

1996-11-01

The Annual Plan for the National Toxicology Program requires an annual review of toxicology-related research supported by DHHS agencies. Four of the five Public Health Service Agencies support research related to toxicology. Within the National Institutes of Health alone, sixteen separate institutes and several other components support relevant research. Toxicology-related research is also conducted by other Federal agencies--particularly the Department of Energy (DOE) and the Environmental Protection Agency (EPA). An overall review is thought to be of considerable interest to research managers for purposes of coordinating research and reducing unnecessary duplication. This is the seventeenth review responding to this requirement.more » For the fifteenth time a survey of similar research at DOE and the EPA is included.« less

78 FR 52204 - Proposed Collection; 60-day Comment Request: NIH NCI Central Institutional Review Board (CIRB...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-22

... for public comment on proposed data collection projects, the National Cancer Institute (NCI), National... the public and affected agencies are invited on one or more of the following points: (1) Whether the... cost efficient approach avoiding duplication of effort at each institution. The CIRB provides the...

Studies and Reports Relating to Training and Education, FY 1968.

ERIC Educational Resources Information Center

Civil Service Commission, Washington, DC.

The 1968 directory of Federal training and education programs has been compiled to encourage wider use of findings by other agencies, to avoid duplication of research efforts, and to stimulate experimentation needed to keep pace with technological progress. Federal agencies report both completed and in-progress studies and include such agencies as…

75 FR 32866 - Special Local Regulations for Marine Events; Patuxent River, Solomons, MD

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-10

...-9329. To avoid duplication, please use only one of these four methods. See the ``Public Participation... four methods specified under ADDRESSES. Please explain why you believe a public meeting would be... Patuxent River, MD. The start and finish lines will be located near the Solomon's Pier. A large spectator...

75 FR 1068 - Information Collection Request to Office of Management and Budget; OMB Control Numbers: 1625-0087

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-08

... DEPARTMENT OF HOMELAND SECURITY Coast Guard [USCG-2009-1064] Information Collection Request to... March 9, 2010. ADDRESSES: To avoid duplicate submissions to the docket [USCG-2009- 1064], please use... include the docket number [USCG-2009-1064], indicate the specific section of the document to which each...

The Program Evaluator's Role in Cross-Project Pollination.

ERIC Educational Resources Information Center

Yasgur, Bruce J.

An expanded duties role of the multiple-program evaluator as an integral part of the ongoing decision-making process in all projects served is defended. Assumptions discussed included that need for projects with related objectives to pool resources and avoid duplication of effort and the evaluator's unique ability to provide an objective…

Improving Open Access through Prior Learning Assessment

ERIC Educational Resources Information Center

Yin, Shuangxu; Kawachi, Paul

2013-01-01

This paper explores and presents new data on how to improve open access in distance education through using prior learning assessments. Broadly there are three types of prior learning assessment (PLAR): Type-1 for prospective students to be allowed to register for a course; Type-2 for current students to avoid duplicating work-load to gain…

77 FR 31551 - Hazardous Materials; Miscellaneous Amendments Pertaining to DOT Specification Cylinders (RRR)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-29

... comment. To avoid duplication, please use only one of these four methods. All comments received will be... Sec. 180.205(f) (visual inspection) to permit the shot blasting \\d\\ of cylinders to remove surface... conducted by an authorized facility in accordance with Sec. 180.212. \\d\\ Shot blasting aluminum cylinders...

The health fraud battle. Education is the best defense.

PubMed

Johnson, G C; Gottesman, R A

1989-06-01

Despite the regulatory and educational efforts of the Food and Drug Administration and other agencies and organizations, large numbers of American consumers continue to be fooled by unsubstantiated "miracle cure" claims made by manufacturers of fraudulent medical products. Physicians who are familiar with the language of health fraud advertising and product labels may be able to help patients avoid unnecessary expense, false hope, and physical and emotional harm.

Potential applications of prefield land use and canopy cover data: Examples from nonforest and nonsampled forest inventory plots

Treesearch

Sara A. Goeking

2012-01-01

The Forest Inventory and Analysis (FIA) prefield workflow involves interpreting aerial imagery to determine whether each plot in a given inventory year may meet FIA’s definition of forest land. The primary purpose of this determination is to minimize inventory costs by avoiding unnecessary ground surveys of plots that are obviously in nonforest areas. Since the...

Avoiding emergency department visits for COPD, pneumonia, and heart failure: when should patients go to the emergency department?

PubMed

Fritz, Deborah; McKenzie, Patricia

2014-01-01

Patients with pneumonia, chronic obstructive pulmonary disease (COPD), and heart failure make frequent visits to the emergency department. Heart failure alone is the reason for more than 1 million emergency department visits annually in the United States. This article describes strategies home care clinicians can use to prevent unnecessary emergency department visits for patients with pneumonia, COPD and heart failure.

MRI of the knee.

PubMed

Skinner, Sarah

2012-11-01

Magnetic resonance imaging (MRI) is the gold standard in noninvasive investigation of knee pain. It has a very high negative predictive value and may assist in avoiding unnecessary knee arthroscopy; its accuracy in the diagnosis of meniscal and anterior cruciate ligament (ACL) tears is greater than 89%; it has a greater than 90% sensitivity for the detection of medial meniscal tears; and it is probably better at assessing the posterior horn than arthroscopy.

Application of Optical Disc Databases and Related Technology to Public Access Settings

DTIC Science & Technology

1992-03-01

users to download and retain data. A Video Graphics Adapter (VGA) monitor was included. No printer was provided. 2. CD-ROM Product Computer Select, a...download facilities, without printer support, satisfy user needs? 38 A secondary, but significant, objective was avoidance of unnecessary Reader...design of User Log sheets and mitigated against attachment of a printer to the workstation. F. DATA COLLECTION This section describes the methodology

[Imaging center - optimization of the imaging process].

PubMed

Busch, H-P

2013-04-01

Hospitals around the world are under increasing pressure to optimize the economic efficiency of treatment processes. Imaging is responsible for a great part of the success but also of the costs of treatment. In routine work an excessive supply of imaging methods leads to an "as well as" strategy up to the limit of the capacity without critical reflection. Exams that have no predictable influence on the clinical outcome are an unjustified burden for the patient. They are useless and threaten the financial situation and existence of the hospital. In recent years the focus of process optimization was exclusively on the quality and efficiency of performed single examinations. In the future critical discussion of the effectiveness of single exams in relation to the clinical outcome will be more important. Unnecessary exams can be avoided, only if in addition to the optimization of single exams (efficiency) there is an optimization strategy for the total imaging process (efficiency and effectiveness). This requires a new definition of processes (Imaging Pathway), new structures for organization (Imaging Center) and a new kind of thinking on the part of the medical staff. Motivation has to be changed from gratification of performed exams to gratification of process quality (medical quality, service quality, economics), including the avoidance of additional (unnecessary) exams. © Georg Thieme Verlag KG Stuttgart · New York.

America's Opioid Epidemic: Supply and Demand Considerations.

PubMed

Clark, David J; Schumacher, Mark A

2017-11-01

America is in the midst of an opioid epidemic characterized by aggressive prescribing practices, highly prevalent opioid misuse, and rising rates of prescription and illicit opioid overdose-related deaths. Medical and lay public sentiment have become more cautious with respect to prescription opioid use in the past few years, but a comprehensive strategy to reduce our reliance on prescription opioids is lacking. Addressing this epidemic through reductions in unnecessary access to these drugs while implementing measures to reduce demand will be important components of any comprehensive solution. Key supply-side measures include avoiding overprescribing, reducing diversion, and discouraging misuse through changes in drug formulations. Important demand-side measures center around educating patients and clinicians regarding the pitfalls of opioid overuse and methods to avoid unnecessary exposure to these drugs. Anesthesiologists, by virtue of their expertise in the use of these drugs and their position in guiding opioid use around the time of surgery, have important roles to play in reducing patient exposure to opioids and providing education about appropriate use. Aside from the many immediate steps that can be taken, clinical and basic research directed at understanding the interaction between pain and opioid misuse is critical to identifying the optimal use of these powerful pain relievers in clinical practice.

Value of percutaneous needle biopsy of small renal tumors in patients referred for cryoablation.

PubMed

Iguchi, Toshihiro; Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Sakurai, Jun; Matsui, Yusuke; Araki, Motoo; Nasu, Yasutomo; Kanazawa, Susumu

2017-04-01

To retrospectively evaluate the safety and diagnostic yield of needle biopsy of small renal tumors, and the clinical consequences of performing needle biopsy in patients referred for percutaneous cryoablation before their treatment. Biopsy was performed for 120 tumors (mean diameter, 2.2 cm) in 119 patients. All procedures were divided into diagnostic and non-diagnostic biopsies. Various variables were compared between the two groups. All cryoablation procedures were divided into two groups: procedures with or without simultaneous biopsy. The rates of benign or non-diagnostic tumors in each group were compared. After performing 120 initial and eight repeat biopsies, Grade 1 bleedings occurred in 44 cases. Six tumors were non-diagnostic and 114 were pathologically diagnosed. There were no significant variables between the diagnostic and non-diagnostic biopsies. Unnecessary cryoablation was avoided in nine benign lesions by performing biopsy in advance. Cryoablation performed simultaneously with biopsy included significantly more benign or non-diagnostic tumors than cryoablation performed after biopsy (15.2% vs. 1.4%; p = .01). Percutaneous biopsy of small renal tumors referred for cryoablation was a safe procedure with high diagnostic yield. The confirmation of pathological diagnosis prior to cryoablation is necessary because patients with benign tumors can avoid unnecessary treatment.

Engineered nanomaterial risk. Lessons learnt from completed nanotoxicology studies: potential solutions to current and future challenges.

PubMed

Johnston, Helinor; Pojana, Giulio; Zuin, Stefano; Jacobsen, Nicklas Raun; Møller, Peter; Loft, Steffen; Semmler-Behnke, Manuela; McGuiness, Catherine; Balharry, Dominique; Marcomini, Antonio; Wallin, Håkan; Kreyling, Wolfgang; Donaldson, Ken; Tran, Lang; Stone, Vicki

2013-01-01

PARTICLE_RISK was one of the first multidisciplinary projects funded by the European Commission's Framework Programme that was responsible for evaluating the implications of nanomaterial (NM) exposure on human health. This project was the basis for this review which identifies the challenges that exist within the assessment of NM risk. We have retrospectively reflected on the findings of completed nanotoxicology studies to consider what progress and advances have been made within the risk assessment of NMs, as well as discussing the direction that nanotoxicology research is taking and identifying the limitations and failings of existing research. We have reflected on what commonly encountered challenges exist and explored how these issues may be resolved. In particular, the following is discussed (i) NM selection (ii) NM physico-chemical characterisation; (iii) NM dispersion; (iv) selection of relevant doses and concentrations; (v) identification of relevant models, target sites and endpoints; (vi) development of alternatives to animal testing; and (vii) NM risk assessment. These knowledge gaps are relatively well recognised by the scientific community and recommendations as to how they may be overcome in the future are provided. It is hoped that this will help develop better defined hypothesis driven research in the future that will enable comprehensive risk assessments to be conducted for NMs. Importantly, the nanotoxicology community has responded and adapted to advances in knowledge over recent years to improve the approaches used to assess NM hazard, exposure and risk. It is vital to learn from existing information provided by ongoing or completed studies to avoid unnecessary duplication of effort, and to offer guidance on aspects of the experimental design that should be carefully considered prior to the start of a new study.

Act on the Registration and Evaluation of Chemicals (K-REACH) and replacement, reduction or refinement best practices

PubMed Central

2016-01-01

Objectives Korea’s Act on the Registration and Evaluation of Chemicals (K-REACH) was enacted for the protection of human health and the environment in 2015. Considering that about 2000 new substances are introduced annually across the globe, the extent of animal testing requirement could be overwhelming unless regulators and companies work proactively to institute and enforce global best practices to replace, reduce or refine animal use. In this review, the way to reduce the animal use for K-REACH is discussed. Methods Background of the enforcement of the K-REACH and its details was reviewed along with the papers and regulatory documents regarding the limitation of animal experiments and its alternatives in order to discuss the regulatory adoption of alternative tests. Results Depending on the tonnage of the chemical used, the data required ranges from acute and other short-term studies for a single exposure route to testing via multiple exposure routes and costly, longer-term studies such as a full two-generation reproducibility toxicity. The European Registration, Evaluation, Authorization and Restriction of Chemicals regulation provides for mandatory sharing of vertebrate test data to avoid unnecessary duplication of animal use and test costs, and obligation to revise data requirements and test guidelines “as soon as possible” after relevant, validated replacement, reduction or refinement (3R) methods become available. Furthermore, the Organization for Economic Cooperation and Development actively accepts alternative animal tests and 3R to chemical toxicity tests. Conclusions Alternative tests which are more ethical and efficient than animal experiments should be widely used to assess the toxicity of chemicals for K-REACH registration. The relevant regulatory agencies will have to make efforts to actively adopt and uptake new alternative tests and 3R to K-REACH. PMID:28118702

An Efficient Two-Tier Causal Protocol for Mobile Distributed Systems

PubMed Central

Dominguez, Eduardo Lopez; Pomares Hernandez, Saul E.; Gomez, Gustavo Rodriguez; Medina, Maria Auxilio

2013-01-01

Causal ordering is a useful tool for mobile distributed systems (MDS) to reduce the non-determinism induced by three main aspects: host mobility, asynchronous execution, and unpredictable communication delays. Several causal protocols for MDS exist. Most of them, in order to reduce the overhead and the computational cost over wireless channels and mobile hosts (MH), ensure causal ordering at and according to the causal view of the Base Stations. Nevertheless, these protocols introduce certain disadvantage, such as unnecessary inhibition at the delivery of messages. In this paper, we present an efficient causal protocol for groupware that satisfies the MDS's constraints, avoiding unnecessary inhibitions and ensuring the causal delivery based on the view of the MHs. One interesting aspect of our protocol is that it dynamically adapts the causal information attached to each message based on the number of messages with immediate dependency relation, and this is not directly proportional to the number of MHs. PMID:23585828

Not all pustules are infective in nature: acute generalised exanthematous pustulosis causing pustular eruptions in an elderly woman.

PubMed

Kwah, Y C; Leow, Y H

2005-07-01

Acute generalised exanthematous pustulosis (AGEP) is an adverse drug reaction that can occur in any age group. It is commonly mistaken as pustular psoriasis or cutaneous infection, resulting in unnecessary commencement of medications such as methotrexate and antibiotics that can cause harm to the patient or interact and adversely affect the efficacy of other medications. Early diagnosis of AGEP avoids unnecessary investigations and treatment, which not only can harm the patient but also escalate health care, as the condition is self-limiting. This case report illustrates AGEP secondary to Cefaclor occurring in a 72-year-old Chinese woman. Although the literature has documented the occurrence of AGEP with Cefaclor, the unique feature of this case is the occurrence of AGEP following repeated uneventful courses of Cefaclor. This case highlights that AGEP must never be forgotten in the work-up for pustular eruptions in an elderly patient.

Ensuring Interoperability between UAS Detect-and-Avoid and Manned Aircraft Collision Avoidance

NASA Technical Reports Server (NTRS)

Thipphavong, David; Cone, Andrew; Lee, Seung Man; Santiago, Confesor

2017-01-01

The UAS community in the United States has identified the need for a collision avoidance region in which UAS Detect-and-Avoid (DAA) vertical guidance is restricted to preclude interoperability issues with manned aircraft collision avoidance system vertical resolution advisories (RAs). This paper documents the process by which the collision avoidance region was defined. Three candidate definitions were evaluated on 1.3 million simulated pairwise encounters between UAS and manned aircraft covering a wide range of horizontal and vertical closure rates, angles, and miss distances. They were evaluated with regard to UAS DAA interoperability with manned aircraft collision avoidance systems in terms of: 1) the primary objective of restricting DAA vertical guidance before RAs when the aircraft are close, and 2) the secondary objective of avoiding unnecessary restrictions of DAA vertical guidance at a DAA alert when the aircraft are further apart. The collision avoidance region definition that fully achieves the primary objective and best achieves the secondary objective was recommended to and accepted by the UAS community in the United States. By this definition, UAS and manned aircraft are in the collision avoidance region--during which DAA vertical guidance is restricted--when the time to closest point of approach is less than 50 seconds and either the time to co-altitude is less than 50 seconds or the current vertical separation is less than 800 feet.

Ensuring Interoperability Between Unmanned Aircraft Detect-and-Avoid and Manned Aircraft Collision Avoidance

NASA Technical Reports Server (NTRS)

Thipphavong, David; Cone, Andrew; Lee, Seungman

2017-01-01

The Unmanned Aircraft Systems (UAS) community in the United States has identified the need for a collision avoidance region in which UAS Detect-and-Avoid (DAA) vertical guidance is restricted to preclude interoperability issues with manned aircraft collision avoidance system vertical resolution advisories (RAs). This paper documents the process by which the collision avoidance region was defined. Three candidate definitions were evaluated on 1.3 million simulated pairwise encounters between UAS and manned aircraft covering a wide range of horizontal and vertical closure rates, angles, and miss distances. Each definition was evaluated with regard to UAS DAA interoperability with manned aircraft collision avoidance in terms of how well it achieved: 1) the primary objective of restricting DAA vertical guidance prior to RAs when the aircraft are close, and 2) the secondary objective of avoiding unnecessary restrictions of DAA vertical guidance at DAA alerts when the aircraft are further apart. The collision avoidance region definition that fully achieves the primary objective and best achieves the secondary objective was recommended to and accepted by the UAS community in the United States. By this definition, UAS and manned aircraft are in the collision avoidance region where DAA vertical guidance is restricted when the time to closest point of approach (CPA) is less than 50 seconds and either the time to co-altitude is less than 50 seconds or the current vertical separation is less than 800 feet.

78 FR 21380 - Agency Information Collection Activities: Submission to OMB for Review and Approval; Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-10

... associations plan events and report the details of their events to BCRS so that they can be added to the state-by-state map of events. In order to avoid duplication of effort, eliminate confusion regarding... Collection Request Title: Corps Community Day Event Form (OMB No. 0915-xxxx)--[NEW] Abstract: Corps Community...

76 FR 44877 - Special Local Regulations for Marine Events; Temporary Change of Dates for Recurring Marine...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-27

...-9329. To avoid duplication, please use only one of these four methods. See the ``Public Participation... the event, the effect of this regulation will not be significant due to the limited duration that the regulated area will be in effect. Extensive advance notification will be made to the maritime community via...

76 FR 35802 - Special Local Regulations for Marine Events; Patuxent River, Solomons, MD

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... number is 202-366-9329. To avoid duplication, please use only one of these four methods. See the ``Public... four methods specified under ADDRESSES. Please explain why you believe a public meeting would be.... Naval Air Station Patuxent River, MD. The start and finish lines will be located near the Solomon's Pier...

78 FR 14586 - Agency Information Collection Activities: Application for Civil Surgeon Designation Registration...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-06

... include the OMB Control Number 1615-0114 in the subject box, the agency name and Docket ID USCIS-XXXX- XXXX. To avoid duplicate submissions, please use only one of the following methods to submit comments... e-Docket ID number USCIS-XXXX-XXXX; (2) Email. Submit comments to [email protected] ; (3...

Assessing the Causes of Encapsulant Delamination in PV Modules

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

Wohlgemuth, John H.; Hacke, Peter; Bosco, Nick

Delamination of the encapsulant is one of the most prevalent PV module field failures. This paper will present examples of various types of delaminations that have been observed in the field. It will then discuss the development of accelerated stress tests designed to duplicate those field failures and thus provide tools for avoiding them in the future.

Worldwide Report, Epidemiology, No. 332

DTIC Science & Technology

1983-09-14

Patients Die, by Arne Soderlund ANIMAL DISEASES COLOMBIA New Foot-and-Mouth Foci Detected; Vaccination Campaign Discussed (EL TIEMPO, 23 Jul 83... Vaccination "Therefore it is so important for those who are homosexuals with many partners to go to the public health service and be thoroughly checked even...unnecessary anguish can be avoided." Geo von Krogh regards mass vaccination of all homosexual men against B-hepa- titis as one of the many measures to

Energy Efficient Approach in RFID Network

NASA Astrophysics Data System (ADS)

Mahdin, Hairulnizam; Abawajy, Jemal; Salwani Yaacob, Siti

2016-11-01

Radio Frequency Identification (RFID) technology is among the key technology of Internet of Things (IOT). It is a sensor device that can monitor, identify, locate and tracking physical objects via its tag. The energy in RFID is commonly being used unwisely because they do repeated readings on the same tag as long it resides in the reader vicinity. Repeated readings are unnecessary because it only generate duplicate data that does not contain new information. The reading process need to be schedule accordingly to minimize the chances of repeated readings to save the energy. This will reduce operational cost and can prolong the tag's battery lifetime that cannot be replaced. In this paper, we propose an approach named SELECT to minimize energy spent during reading processes. Experiments conducted shows that proposed algorithm contribute towards significant energy savings in RFID compared to other approaches.

Sources of avoidance motivation: Valence effects from physical effort and mental rotation.

PubMed

Morsella, Ezequiel; Feinberg, Giles H; Cigarchi, Sepeedeh; Newton, James W; Williams, Lawrence E

2011-09-01

When reaching goals, organisms must simultaneously meet the overarching goal of conserving energy. According to the law of least effort, organisms will select the means associated with the least effort. The mechanisms underlying this bias remain unknown. One hypothesis is that organisms come to avoid situations associated with unnecessary effort by generating a negative valence toward the stimuli associated with such situations. Accordingly, merely using a dysfunctional, 'slow' computer mouse causes participants to dislike ambient neutral images (Study 1). In Study 2, nonsense shapes were liked less when associated with effortful processing (135° of mental rotation) versus easier processing (45° of rotation). Complementing 'fluency' effects found in perceptuo-semantic research, valence emerged from action-related processing in a principled fashion. The findings imply that negative valence associations may underlie avoidance motivations, and have practical implications for educational/workplace contexts in which effort and positive affect are conducive to success.

The complete mitochondrial genome of the enigmatic bigheadedturtle (Platysternon): description of unusual genomic features and thereconciliation of phylogenetic hypotheses based on mitochondrial andnuclear DNA

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

Parham, James F.; Feldman, Chris R.; Boore, Jeffrey L.

2005-12-28

The big-headed turtle (Platysternon megacephalum) from east Asia is the sole living representative of a poorly-studied turtle lineage (Platysternidae). It has no close living relatives, and its phylogenetic position within turtles is one of the outstanding controversies in turtle systematics. Platysternon was traditionally considered to be close to snapping turtles (Chelydridae) based on some studies of its morphology and mitochondrial (mt) DNA, however, other studies of morphology and nuclear (nu) DNA do not support that hypothesis. We sequenced the complete mt genome of Platysternon and the nearly complete mt genomes of two other relevant turtles and compared them to turtlemore » mt genomes from the literature to form the largest molecular dataset used to date to address this issue. The resulting phylogeny robustly rejects the placement of Platysternon with Chelydridae, but instead shows that it is a member of the Testudinoidea, a diverse, nearly globally-distributed group that includes pond turtles and tortoises. We also discovered that Platysternon mtDNA has large-scale gene rearrangements and possesses two, nearly identical, control regions, features that distinguish it from all other studied turtles. Our study robustly determines the phylogenetic placement of Platysternon and provides a well-resolved outline of major turtle lineages, while demonstrating the significantly greater resolving power of comparing large amounts of mt sequence over that of short fragments. Earlier phylogenies placing Platysternon with chelydrids required a temporal gap in the fossil record that is now unnecessary. The duplicated control regions and gene rearrangements of the Platysternon mt DNA probably resulted from the duplication of part of the genome and then the subsequent loss of redundant genes. Although it is possible that having two control regions may provide some advantage, explaining why the control regions would be maintained while some of the duplicated genes were eroded, examples of this are rare. So far, duplicated control regions have been reported for mt genomes from just 12 clades of metazoans, including Platysternon.« less

Failure of third-generation implantable cardioverter defibrillators to abort shock therapy for nonsustained ventricular tachycardia due to shortcomings of the VF confirmation algorithm.

PubMed

Grimm, W; Menz, V; Hoffmann, J; Maisch, B

1998-04-01

Unnecessary shocks by ICDs for rhythms other than sustained VT or VF have been described as the most frequent adverse event in ICD patients. To avoid unnecessary shocks for self-terminating arrhythmias, the third-generation Jewel PCD defibrillators 7202, 7219, and 7220 Plus use a specially designed VF confirmation algorithm after charge end. The purpose of this study was to determine the ability of this VF confirmation algorithm to recognize nonsustained VT, and to analyze the reasons for failure of the PCD device to abort shock therapy for nonsustained VT despite use of this VF confirmation algorithm. Analysis of stored electrograms of electrical events triggering high voltage capacitor charging in the programmed VF zone of the device showed 36 spontaneous episodes of nonsustained VT (227 +/- 21 beats/min) during 18 +/- 7 months follow-up in 15 patients who had a Jewel PCD implanted at our hospital. Intracardiac electrogram recordings and simultaneously retrieved marker channels demonstrated that the ICD shock was appropriately aborted according to the VF confirmation algorithm in 24 (67%) of 36 episodes of nonsustained VT. Twelve episodes (33%) of nonsustained VT, however, were followed by spontaneous ICD shock in 6 (40%) of the 15 study patients. The only reason for all 12 shocks for sustained VT was the inability of the device to recognize the absence of VT after charge end due to shortcomings of the VF confirmation algorithm: 11 of the 12 shocks for nonsustained VT were triggered by the occurrence of paced beats during the VF confirmation period and 1 shock for nonsustained VT was triggered by the occurrence of 2 premature beats after charge end. Thus, better VF confirmation algorithms need to be incorporated in future PCD devices to avoid unnecessary shocks for nonsustained VT.

Volvo and Infiniti drivers' experiences with select crash avoidance technologies.

PubMed

Braitman, Keli A; McCartt, Anne T; Zuby, David S; Singer, Jeremiah

2010-06-01

Vehicle-based crash avoidance systems can potentially reduce crashes, but success depends on driver acceptance and understanding. This study gauged driver use, experience, and acceptance among early adopters of select technologies. Telephone interviews were conducted in early 2009 with 380 owners of Volvo vehicles equipped with forward collision warning with autobrake, lane departure warning, side-view assist, and/or active bi-xenon headlights and 485 owners of Infiniti vehicles with lane departure warning/prevention. Most owners kept systems turned on most of the time, especially forward collision warning with autobrake and side-view assist. The exception was lane departure prevention; many owners were unaware they had it, and the system must be activated each time the vehicle is started. Most owners reported being safer with the technologies and would want them again on their next vehicles. Perceived false or unnecessary warnings were fairly common, particularly with side-view assist. Some systems were annoying, especially lane departure warning. Many owners reported safer driving behaviors such as greater use of turn signals (lane departure warning), increased following distance (forward collision warning), and checking side mirrors more frequently (side-view assist), but some reported driving faster at night (active headlights). Despite some unnecessary or annoying warnings, most Volvo and Infiniti owners use crash avoidance systems most of the time. Among early adopters, the first requirement of effective warning systems (that owners use the technology) seems largely met. Systems requiring activation by drivers for each trip are used less often. Owner experience with the latest technologies from other automobile manufacturers should be studied, as well as for vehicles on which technologies are standard (versus optional) equipment. The effectiveness of technologies in preventing and mitigating crashes and injuries, and user acceptance of interfaces, should be examined as more vehicles with advanced technologies penetrate the fleet.

15 CFR 744.8 - Restrictions on exports and reexports to persons designated pursuant to Executive Order 13382...

Code of Federal Regulations, 2010 CFR

2010-01-01

... Chapter V with the bracketed suffix [NPWMD]. This section imposes export and reexport license requirements... Chapter V with the bracketed suffix [NPWMD]. (2) BIS authorization. (i) To avoid duplication, U.S. persons... in Appendix A to 31 CFR Chapter V with the bracketed suffix [NPWMD] of an item subject to the EAR. If...

15 CFR 744.8 - Restrictions on exports and reexports to persons designated pursuant to Executive Order 13382...

Code of Federal Regulations, 2011 CFR

2011-01-01

... chapter V with the bracketed suffix [NPWMD]. This section imposes export and reexport license requirements... chapter V with the bracketed suffix [NPWMD]. (2) BIS authorization. (i) To avoid duplication, U.S. persons... in appendix A to 31 CFR chapter V with the bracketed suffix [NPWMD] of an item subject to the EAR. If...

15 CFR 744.13 - Restrictions on exports and reexports to persons designated pursuant to Executive Order 12947...

Code of Federal Regulations, 2013 CFR

2013-01-01

... pursuant to Executive Order 12947 (Specially Designated Terrorist) (SDT). Consistent with the purpose of... applies to the export or reexport to an SDT of any item subject to the EAR. (2) To avoid duplication, U.S... subject both to the EAR and to OFAC's Terrorism Sanctions Regulations in 31 CFR part 595. Therefore, if...

15 CFR 744.13 - Restrictions on exports and reexports to persons designated pursuant to Executive Order 12947...

Code of Federal Regulations, 2014 CFR

2014-01-01

... pursuant to Executive Order 12947 (Specially Designated Terrorist) (SDT). Consistent with the purpose of... applies to the export or reexport to an SDT of any item subject to the EAR. (2) To avoid duplication, U.S... subject both to the EAR and to OFAC's Terrorism Sanctions Regulations in 31 CFR part 595. Therefore, if...

15 CFR 744.13 - Restrictions on exports and reexports to persons designated pursuant to Executive Order 12947...

Code of Federal Regulations, 2011 CFR

2011-01-01

... pursuant to Executive Order 12947 (Specially Designated Terrorist) (SDT). Consistent with the purpose of... applies to the export or reexport to an SDT of any item subject to the EAR. (2) To avoid duplication, U.S... subject both to the EAR and to OFAC's Terrorism Sanctions Regulations in 31 CFR part 595. Therefore, if...

15 CFR 744.13 - Restrictions on exports and reexports to persons designated pursuant to Executive Order 12947...

Code of Federal Regulations, 2010 CFR

2010-01-01

... pursuant to Executive Order 12947 (Specially Designated Terrorist) (SDT). Consistent with the purpose of... applies to the export or reexport to an SDT of any item subject to the EAR. (2) To avoid duplication, U.S... subject both to the EAR and to OFAC's Terrorism Sanctions Regulations in 31 CFR part 595. Therefore, if...

15 CFR 744.13 - Restrictions on exports and reexports to persons designated pursuant to Executive Order 12947...

Code of Federal Regulations, 2012 CFR

2012-01-01

... pursuant to Executive Order 12947 (Specially Designated Terrorist) (SDT). Consistent with the purpose of... applies to the export or reexport to an SDT of any item subject to the EAR. (2) To avoid duplication, U.S... subject both to the EAR and to OFAC's Terrorism Sanctions Regulations in 31 CFR part 595. Therefore, if...

Clinical anophthalmos.

PubMed Central

O'Keefe, M; Webb, M; Pashby, R C; Wagman, R D

1987-01-01

We report on 15 patients (10 boys, 5 girls) with clinical anophthalmos. Two of them had bilateral anophthalmos, 10 had systemic anomalies, and six had abnormalities of their remaining eye. Only two appeared to have an associated underlying aetiology. Fourteen patients underwent orbital reconstruction or socket enlargement with varying degrees of success. Our own experience suggests that unnecessary lid procedures should be avoided, but we recommend early prosthetic fittings. We feel that a multidisciplinary approach is necessary to attain useful rehabilitation. Images PMID:3651379

Empowering Physicians with Financial Literacy.

PubMed

Bar-Or, Yuval

2015-01-01

Most doctors complete their medical training without sufficient knowledge of business and finance. This leads to inefficient financial decisions, avoidable losses, and unnecessary anxiety. A big part of the problem is that the existing options for gaining financial knowledge are flawed. The ideal solution is to provide a simple framework of financial literacy to all students: one that can be adapted to their specific circumstances. That framework must be delivered by an objective expert to young physicians before they complete medical training.

High Velocity Firings of Slug Projectiles in a Double-Travel 120-MM Gun System

DTIC Science & Technology

1991-04-01

constraints presented by TBD. This charge configuration was then tested using aluminium slug projectiles to avoid the unnecessary expenditure of APFSDS...test projectile was a depleted uranium alloy (U-.75Ti) rod with a standard, four piece, aluminum sabot assembly. The launch package had a nominal...the rod is shown in Figure 2. Figure 2. Scaled, Long Rod Penetrator. Figure 3. Aluminium Slug Projectile. The aluminium slug rounds, fired at Range 18

Three dimensional PNS solutions of hypersonic internal flows with equilibrium chemistry

NASA Technical Reports Server (NTRS)

Liou, May-Fun

1989-01-01

An implicit procedure for solving parabolized Navier-Stokes equations under the assumption of a general equation of state for a gas in chemical equilibrium is given. A general and consistent approach for the evaluation of Jacobian matrices in the implicit operator avoids the use of unnecessary auxiliary quantities and approximations, and leads to a simple expression. Applications to two- and three-dimensional flow problems show efficiency in computer time and economy in storage.

Nipple piercing may be contraindicated in male patients with chest implants.

PubMed

de Kleer, N; Cohen, M; Semple, J; Simor, A; Antonyshyn, O

2001-08-01

The authors present a man who underwent chest augmentation and nipple piercing. The patient developed chronic nipple infection, which led to unnecessary invasive diagnostic procedures, serious implant infection, and eventually urgent explantation. This unfavorable scenario illustrates the distinct features of the procedure in men, which includes close proximity of the nipple to the implant and reduced awareness by health care providers. Based on this case the authors recommend avoiding nipple piercing in men with chest implants.

Diagnostic accuracy of fine-needle aspiration cytology of thyroid gland lesions: A study of 200 cases in Himalayan belt.

PubMed

Sharma, Reetika; Verma, Neelam; Kaushal, Vijay; Sharma, Dev Raj; Sharma, Dhruv

2017-01-01

The study is undertaken to correlate the fine-needle aspiration cytology (FNAC) findings with histopathology in a spectrum of thyroid lesions and to find the diagnostic accuracy of fine-needle aspiration (FNA) so that unnecessary thyroidectomies can be avoided in benign lesions. This study was carried out over the period of 1-year (May 1, 2012-April, 30 2013). FNA specimens obtained from 200 patients were analyzed. Of these, only 40 patients underwent surgery and their thyroid specimens were subjected to histopathological examination. The age of the patients ranged from 9 to 82 years with mean age being 43 years. There was female preponderance, with male to female ratio being 1:7. On cytology out of 200 cases, 148 (74%) were benign, 25 (12.5%) were malignant, 16 (8%) were indeterminate, and 11 (5.5%) were nondiagnostic. Only 40 patients underwent surgery. On histopathology, 21 (52.5%) cases were benign and 19 (47.5%) were malignant. The statistical analysis of cytohistological correlation for both benign and malignant lesions revealed sensitivity, specificity, and diagnostic accuracy of 84%, 100% and 90%, respectively. FNAC is a minimally invasive, highly accurate and cost-effective procedure for the assessment of patients with thyroid lesions and has high -sensitivity and specificity. It acts as a good screening test and avoids unnecessary thyroidectomies.

Localized primary amyloidosis of the breast: a case report and review of the literature.

PubMed

Tsuji, Wakako; Takeuchi, Eiji; Oka, Satoshi; Yamashita, Taro; Yotsumoto, Fumiaki

2016-09-13

Primary amyloidosis of the breast is an unusual benign disease that mostly occurs in postmenopausal elderly women. Amyloidosis is the deposition of amorphous protein within tissues. Breast biopsy is necessary to make a definite diagnosis in order to avoid unnecessary surgical methods. Localized primary amyloidosis of the breast has a good prognosis. However, secondary amyloidosis is a systemic disease and has a poor prognosis. We report the case of a 77-year-old female with primary amyloidosis of the breast. She noticed a lump in her left breast. Mammographic and ultrasonographic examinations indicated breast cancer. However, core needle biopsy showed amyloidosis, not cancer of the breast. For further examinations, the patient visited the outpatient clinics of the hematology, dermatology, and gastroenterology departments. She underwent bone marrow aspiration, computed tomography, cardiac ultrasonography, random skin biopsy, gastrofiberscopy, and colonofiberscopy. Plasma cell myeloma and systemic amyloidosis were ruled out, and localized breast amyloidosis was highly suspected. Lumpectomy was performed to make a definite diagnosis, and histological evaluations revealed that this patient had localized amyloidosis of the breast, and the deposited amyloid protein was of the amyloid light chain kappa type. Breast biopsy is necessary in order to avoid unnecessary surgical technique. A diagnosis should be achieved only through a histological evaluation. The main treatment of localized primary amyloidosis of the breast is surgical removal.

A maneuver for improved positioning of a tourniquet in the obese patient.

PubMed

Krackow, K A

1982-08-01

Proximal positioning of an arterial tourniquet will be greatly facilitated by having an assistant firmly draw the skin and subcutaneous tissue distally prior to positioning the cast padding and tourniquet. This simple maneuver is clearly not part of current practice or training, despite the simplicity and effectiveness. Excessive tourniquet tightening should be avoided prior to fixing the Velcro fasteners, a practice which is commonly employed and is not only ineffective in maintaining proximal tourniquet positioning, but also deleterious in that it creates a "venous tourniquet" effect. Loosening of the restraining adhesive tapes and unnecessary traction of adhesive tape on sensitive skin can be avoided by bringing the extremity to its resting position before fastening the tape proximal to the tourniquet.

Hyalinizing Trabecular Tumor of the Thyroid Gland, a Diagnostic Challenge in Fine-Needle Aspiration Cytology: Case Report.

PubMed

Rhee, Ye-Young; Jung, Hong Kyu; Kim, Se Hoon; Kim, Soo Hee

2018-06-11

Hyalinizing trabecular tumor (HTT) is a rare thyroid tumor with low to minimal malignant potential. HTT is often misinterpreted as other thyroid tumors, including papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC), on fine-needle aspiration (FNA) cytology, because of its overlapping cytologic features, such as nuclear grooves and intranulcear pseudoinclusions. Although cytopathologists cannot definitely conclude HTT by FNA cytology, suspicion of HTT is necessary to avoid misdiagnosing HTT as PTC or MTC and to avoid unnecessary aggressive treatment. Here, we report a case of HTT with novel cytologic features in CellPrep liquid based cytology that was diagnosed as suspicious for papillary carcinoma by FNA and finally diagnosed as HTT in the surgical specimen.

Assessment of light stability of drugs in blood and plasma.

PubMed

de Vries, Ronald; Diels, Luc; Dillen, Lieve; Sips, Luc; Van Roosbroek, Dirk; Verhaeghe, Tom; Timmerman, Philip

2016-10-01

A procedure was developed for the assessment of photochemical stability of drugs in blood and plasma under standardized conditions. The procedure avoids a variable outcome of photochemical stability experiments and tests relevant worst case conditions so that unnecessary light protection is avoided. Results/methodology: Blood and plasma were spiked with a mixture of drugs and incubated in a Suntest CPS(+), in the laboratory on the bench and near the window on a sunny summer day. The results were compared. No protection from light, limited protection from light and full protection from light are advised for drugs that are stable in plasma in the Suntest CPS(+) at 250 W/m(2) for at least 30 min, for 5-30 min and for <5 min, respectively.

A giant ovarian cyst in a neonate.

PubMed

Soccorso, Giampiero; Walker, Jenny

2009-06-01

Antenatally diagnosed abdominal cysts are common, and frequently are ovarian in origin, which usually regress spontaneously. Surgery is indicated in the infantile period in case of very large, persisting or symptomatic cysts. Many surgeons feel that watchful waiting can be justified in newborns with simple and complex cysts. We present a neonate with an ovarian cyst diagnosed antenatally by ultrasound (US) and showing persistent enlargement within 3 months after birth when reached a diameter of 13 cm. Assessment and treatment is described. The extremely large, non-resolving ovarian cysts in neonates present a major challenge for clinicians and should be treated by surgery to avoid complications. We advocate laparotomy and cystectomy when possible to avoid unnecessary loss of functional ovarian tissue.

Chromium and iron content in duplicate meals at a university residence: daily intake and dialysability.

PubMed

Cabrera-Vique, Carmen; Mesías, Marta

2011-05-01

The objective of the present study was to determine total Cr and Fe content and the corresponding mineral dialysable fraction in a total of sixty-three duplicate meals. Samples of breakfast, lunch and dinner were taken over twenty-one consecutive days at a female university residence in Granada (Spain). Cr content in the duplicate daily meals ranged from 98·50 to 120·80 μg, with a mean of 110·00 μg, and Fe levels ranged from 9·50 to 40·00 mg, with a mean content of 18·50 mg. The mean Cr and Fe dialysable fractions ranged from 0·50 to 1·50 % and from 7·75 to 11·80 %, respectively. Possible correlations with energy and other nutrient intakes were also evaluated. Adherence of the meals to the Mediterranean dietary patterns was tested, and these findings reveal that a balanced and varied diet based on a Mediterranean-style diet plan provides adequate levels and bioaccessibility of Cr and Fe for young women, which is especially important to avoid mineral deficiencies.

Adaptation of the Sensititre broth microdilution technique to antimicrobial susceptibility testing of Mycoplasma hyopneumoniae.

PubMed

Tanner, A C; Erickson, B Z; Ross, R F

1993-09-01

A broth microdilution technique is described for determining the antimicrobial susceptibility of Mycoplasma hyopneumoniae, using commercially prepared Sensititre plates. Twenty-five field isolates and two reference strains (J & 232), were tested against seven antimicrobials. Field isolates were tested in duplicate and reference strains, four times to estimate reproducibility. Ninety-seven percent of the duplicate MIC results for the field isolates were in agreement, or within one log2 dilution. Similar results were obtained with the reference strains. The isolates were susceptible to lincomycin-spectinomycin, tylosin and oxytetracycline or resistant to amoxycillin, apramycin and erythromycin. Susceptibility to furaltadone varied. This method retains the accuracy and reproducibility of broth MIC determinations, while avoiding the lengthy preparation of antimicrobial dilutions normally associated with more traditional methods.

Brain–immune interactions and the neural basis of disease-avoidant ingestive behaviour

PubMed Central

Pacheco-López, Gustavo; Bermúdez-Rattoni, Federico

2011-01-01

Neuro–immune interactions are widely manifested in animal physiology. Since immunity competes for energy with other physiological functions, it is subject to a circadian trade-off between other energy-demanding processes, such as neural activity, locomotion and thermoregulation. When immunity is challenged, this trade-off is tilted to an adaptive energy protecting and reallocation strategy that is identified as ‘sickness behaviour’. We review diverse disease-avoidant behaviours in the context of ingestion, indicating that several adaptive advantages have been acquired by animals (including humans) during phylogenetic evolution and by ontogenetic experiences: (i) preventing waste of energy by reducing appetite and consequently foraging/hunting (illness anorexia), (ii) avoiding unnecessary danger by promoting safe environments (preventing disease encounter by olfactory cues and illness potentiation neophobia), (iii) help fighting against pathogenic threats (hyperthermia/somnolence), and (iv) by associative learning evading specific foods or environments signalling danger (conditioned taste avoidance/aversion) and/or at the same time preparing the body to counteract by anticipatory immune responses (conditioning immunomodulation). The neurobiology behind disease-avoidant ingestive behaviours is reviewed with special emphasis on the body energy balance (intake versus expenditure) and an evolutionary psychology perspective. PMID:22042916

Computer-Aided Structural Engineering (CASE) Project: Investigation and Design of U-Frame Structures Using Program CUFRBC. Volume C. User’s Guide for Channels

DTIC Science & Technology

1990-05-01

1988) or ACI 318-83 (1983). Actual calculations for section strength are made using subroutines taken from the CASE program CSTR (Hamby and Price...validity of the design of their par- ticular structure. Thus, it is essential that the user of the program under- stand the design algorithm included...modes. However, several restrictions were placed on the design mode to avoid unnecessary com- plications of the design algorithm for cases rarely

Round pneumonia in an adult.

PubMed

Zhang, Yi; Yu, Yong-Sheng; Tang, Zheng-Hao; Chen, Xiao-Hua; Zang, Guo-Qing

2014-01-01

Round pneumonia is an uncommon form of pulmonary infection usually found in children. It may resemble pulmonary neoplasm on radiographs. We present a case of round pneumonia in a 43-year-old male with a history of smoking and a family history of lung cancer. The patient was treated with antibiotics for more than two weeks, after which the infection resolved completely both clinically and radiologically. Clinicians should consider this uncommon type of pneumonia in the differential diagnosis of spherical pulmonary masses to avoid unnecessary diagnostic tests.

[Practical approach to management of gynecomastia: six questions to be answered by the paediatrician regarding a patient with gynecomastia].

PubMed

2011-08-01

Pubertal gynecomastia is a common concern in the consultation of the adolescent. Usually, it is accompanied by an emotional component that can lead to changes in everyday attitudes of youth. The responsability of the pediatrician is to rule out other etiologies, to avoid unnecessary additional studies, to limit active therapeutic attitudes, and to reaffirm the variation of normality. We briefly describe six eminently practical questions to be answered by the physician.

Harlequin color change after abdominal paracentesis in a newborn with neonatal hemochromatosis.

PubMed

Cizmeci, Mehmet N; Alagoz, Demet; Avsar, Mehmet I; Alis, Gulten; Tutanc, Murat

2014-01-01

Harlequin color change is a distinctive cutaneous phenomenon presenting as a well-demarcated color change, with half of the body displaying erythema and the other half pallor. Only a few cases have been reported, possibly because of under-recognition. Recognition of this benign, self-limited condition may enable physicians to avoid unnecessary interventions. Herein we describe a neonate with nonimmune hydrops fetalis due to neonatal hemochromatosis who developed Harlequin color change after abdominal paracentesis. © 2014 Wiley Periodicals, Inc.

An interdisciplinary assessment of regional-scale nonpoint source ground-water vulnerability; theory and application

USGS Publications Warehouse

Bernknopf, Richard L.; Dinitz, Laura B.; Loague, Keith

2001-01-01

An integrated earth science-economics model, developed within a geographic information system (GIS), combines a regional-scale nonpoint source vulnerability assessment with a specific remediation measure to avoid unnecessary agricultural production costs associated with the use of agrochemicals in the Pearl Harbor basin on the island of Oahu, Hawaii. This approach forms the core of a risk-based regulation for the application of agrochemicals and estimates the benefits of an information-based approach to decisionmaking.

Avoidable interruptions during drug administration in an intensive rehabilitation ward: improvement project.

PubMed

Buchini, Sara; Quattrin, Rosanna

2012-04-01

To record the frequency of interruptions and their causes, to identify 'avoidable' interruptions and to build an improvement project to reduce 'avoidable' interruptions. In Italy each year 30,000-35,000 deaths per year are attributed to health-care system errors, of which 19% are caused by medication errors. The factors that contribute to drug management error also include interruptions and carelessness during treatment administration. A descriptive study design was used to record the frequency of interruptions and their causes and to identify 'avoidable' interruptions in an intensive rehabilitation ward in Northern Italy. A data collection grid was used to record the data over a 6-month period. A total of 3000 work hours were observed. During the study period 1170 interruptions were observed. The study identified 14 causes of interruption. The study shows that of the 14 cases of interruptions at least nine can be defined as 'avoidable'. An improvement project has been proposed to reduce unnecessary interruptions and distractions to avoid making errors. An additional useful step to reduce the incidence of treatment errors would be to implement the use of a single patient medication sheet for the recording of drug prescription, preparation and administration and also the incident reporting. © 2011 Blackwell Publishing Ltd.

Double-blind placebo-controlled food challenges in children with alleged cow's milk allergy: prevention of unnecessary elimination diets and determination of eliciting doses.

PubMed

Dambacher, Wendy M; de Kort, Ellen H M; Blom, W Marty; Houben, Geert F; de Vries, Esther

2013-02-08

Children with cow's milk allergy (CMA) need a cow's milk protein (CMP) free diet to prevent allergic reactions. For this, reliable allergy-information on the label of food products is essential to avoid products containing the allergen. On the other hand, both overzealous labeling and misdiagnosis that result in unnecessary elimination diets, can lead to potentially hazardous health situations. Our objective was to evaluate if excluding CMA by double-blind placebo-controlled food challenge (DBPCFC) prevents unnecessary elimination diets in the long term. Secondly, to determine the minimum eliciting dose (MED) for an acute allergic reaction to CMP in DBPCFC positive children. All children with suspected CMA under our care (Oct'05-Jun'09) were prospectively enrolled in a DBPCFC. Placebo and verum feedings were administered on two randomly assigned separate days. The MED was determined by noting the 'lowest observed adverse effect level' (LOAEL) in DBPCFC-positive children. Based on the outcomes of the DBPCFC a dietary advice was given. Parents were contacted by phone several months later about the diet of their child. 116 children were available for analysis. In 76 children CMA was rejected. In 60 of them CMP was successfully reintroduced, in 2 the parents refused introduction, in another 3 the parents stopped reintroduction. In 9 children CMA symptoms reappeared. In 40 children CMA was confirmed. Infants aged ≤ 12 months in our study group have a higher cumulative distribution of MED than older children. Excluding CMA by DBPCFC successfully stopped unnecessary elimination diets in the long term in most children. The MEDs form potential useful information for offering dietary advice to patients and their caretakers.

Genetically-Adjusted PSA Values May Prevent Delayed Biopsies in African-American Men

PubMed Central

Donin, Nicholas; Loeb, Stacy; Cooper, Phillip R.; Roehl, Kimberly A.; Baumann, Nikola A.; J.Catalona, William; Helfand, Brian T.

2014-01-01

Purpose Genetic variants called PSA-single nucleotide polymorphisms (PSA-SNPs) have been associated with serum PSA levels. We previously demonstrated that genetic correction of serum PSA in Caucasian men could reduce both potentially unnecessary biopsies by 15% to 20% and potentially delayed biopsies by 3%. Our objective was to evaluate whether genetic correction with the PSA-SNPs could reduce potentially unnecessary and/or delayed biopsies in African-American (AA) men. Materials and Methods We compared the genotypes of 4 PSA-SNPs between 964 Caucasian and 363 AA men without known PC. We adjusted PSA values based upon an individual's PSA-SNP carrier status, and calculated the percentage of men that would meet commonly used PSA thresholds for biopsy (≥2.5 or ≥4.0ng/mL) before and after genetic correction. Potentially unnecessary and delayed biopsies were defined as those men who went below and above the biopsy threshold after genetic correction, respectively. Results Overall, 349 (96.1%) and 354 (97.5%) AA men had measured PSA levels <2.5 and <4.0 ng/mL. Genetic correction in AA men did not avoid any potentially unnecessary biopsies, but resulted in a significant (p<0.001) reduction in potentially delayed biopsies by 2.5% and 3.9% based upon the biopsy threshold cutoff. Conclusions There are significant differences in the influence of the PSA-SNPs between AA and Caucasian men without known PC, as genetic correction resulted in an increased proportion of AA men crossing the threshold for biopsy. These results raise the question whether genetic differences in PSA might contribute to delayed PC diagnosis in AA patients. PMID:24712975

A unified approach to computer analysis and modeling of spacecraft environmental interactions

NASA Technical Reports Server (NTRS)

Katz, I.; Mandell, M. J.; Cassidy, J. J.

1986-01-01

A new, coordinated, unified approach to the development of spacecraft plasma interaction models is proposed. The objective is to eliminate the unnecessary duplicative work in order to allow researchers to concentrate on the scientific aspects. By streamlining the developmental process, the interchange between theories and experimentalists is enhanced, and the transfer of technology to the spacecraft engineering community is faster. This approach is called the UNIfied Spacecraft Interaction Model (UNISIM). UNISIM is a coordinated system of software, hardware, and specifications. It is a tool for modeling and analyzing spacecraft interactions. It will be used to design experiments, to interpret results of experiments, and to aid in future spacecraft design. It breaks a Spacecraft Ineraction analysis into several modules. Each module will perform an analysis for some physical process, using phenomenology and algorithms which are well documented and have been subject to review. This system and its characteristics are discussed.

A Technique for Presenting a Deceptive Dynamic Network Topology

DTIC Science & Technology

2013-03-01

Comment RIP Routing Information Protocol SNOS Systemic Network Obfuscation System SSH Secure Shell TCP Transmission Control Protocol TTL time to live...because it sacrifices elements available in Transmission Control Protocol ( TCP ) such as ordered delivery of packets, delivery confirmation and duplication...avoidance [4]. Of note, some traceroute implementations use TCP packets since they are able to pass through firewalls which are typically configured

Operation Inherent Resolve

DTIC Science & Technology

2015-04-01

suggestions for reducing this burden, to Washington Headquarters Services , Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway... Service Auditors General to coordinate their oversight and avoid duplication of effort. Section 8L provides a new mandate for the three Lead IG...SUMMARY 7 • Medical Support Service in Iraq (DoS OIG). DoS OIG issued a manage- ment assistance report on concerns with oversight of medical support

Cervical adenopathy secondary to toxoplasmosis.

PubMed

Rafaty, F M

1977-09-01

Toxoplasmosis is not a rare disease. Infestation occurs in 75% of the general world population and in 35% of the US population. Lymphadenopathy, primarily of the cervical type, is one of the most common signs of acquired toxoplasmosis. During the past 15 years a great number of reports have appeared in the medical literature regarding toxoplasmosis. However, it seems that most clinicians do not consider this disease as a possibility when they encounter patients with unexplained cervical adenopathy in whom the usual tests for infectious mononucleosis are negative. In fact, the majority of such patients come to the operating room with a suspected diagnosis of malignant neoplasm, particularly of malignant lymphoma. Thus, a great deal of unnecessary anxiety is generated and, at times, unnecessary surgery is performed. These may be avoidable. A total of 38 cases of acquired toxoplasmosis manifested by lymphadenopathy (82% in the cervical region) are analyzed with respect to symptomatology, differential diagnosis, clinical and laboratory diagnosis, and treatment. Toxoplasmosis should be included in the differential diagnosis of patients with cervical tumors.

Committee Opinion No. 723 Summary: Guidelines for Diagnostic Imaging During Pregnancy and Lactation.

PubMed

2017-10-01

Imaging studies are important adjuncts in the diagnostic evaluation of acute and chronic conditions. However, confusion about the safety of these modalities for pregnant and lactating women and their infants often results in unnecessary avoidance of useful diagnostic tests or the unnecessary interruption of breastfeeding. Ultrasonography and magnetic resonance imaging are not associated with risk and are the imaging techniques of choice for the pregnant patient, but they should be used prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient. With few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm. If these techniques are necessary in addition to ultrasonography or magnetic resonance imaging or are more readily available for the diagnosis in question, they should not be withheld from a pregnant patient. Breastfeeding should not be interrupted after gadolinium administration.

Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation.

PubMed

2017-10-01

Imaging studies are important adjuncts in the diagnostic evaluation of acute and chronic conditions. However, confusion about the safety of these modalities for pregnant and lactating women and their infants often results in unnecessary avoidance of useful diagnostic tests or the unnecessary interruption of breastfeeding. Ultrasonography and magnetic resonance imaging are not associated with risk and are the imaging techniques of choice for the pregnant patient, but they should be used prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient. With few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm. If these techniques are necessary in addition to ultrasonography or magnetic resonance imaging or are more readily available for the diagnosis in question, they should not be withheld from a pregnant patient. Breastfeeding should not be interrupted after gadolinium administration.

[Food allergy in children: recommendations for diagnosis and treatment].

PubMed

2018-02-01

Food allergy arises from a specific immune response induced by food exposure. It is the first cause of anaphylaxis in childhood. Its prevalence increased exponentially in western countries. The proteins most frequently involved in infants are cow's milk and hen's egg; and in adults, seafood. Peanuts have the same frequency in both groups. The clinical manifestations and methodology of study are directly related to the pathophysiology of the disease. Clinical history, skin prick test, patch test, and food oral challenge are essential to arrive at a correct diagnosis, that will avoid unnecessary exclusions or exposures that carry life risk. The treatment is based on the correct avoidance of responsible food (considering hidden allergens), besides patient and their care giver's education, to maintain a good quality of life. Sociedad Argentina de Pediatría.

Using technology to develop and distribute patient education storyboards across a health system.

PubMed

Kisak, Anne Z; Conrad, Kathryn J

2004-01-01

To describe the successful implementation of a centrally designed and managed patient education storyboard project using Microsoft PowerPoint in a large multihospital system and physician-based practice settings. Journal articles, project evaluation, and clinical and educational experience. The use of posters, bulletin boards, and storyboards as educational strategies has been reported widely. Two multidisciplinary committees applied new technology to develop storyboards for patient, family, and general public education. Technology can be used to coordinate centralized development of patient education posters, improving accuracy and content of patient education across a healthcare system while streamlining the development and review process and avoiding duplication of work effort. Storyboards are excellent sources of unit-based current, consistent patient education; reduce duplication of efforts; enhance nursing computer competencies; market nursing expertise; and promote nurse educators.

Justice and health care: When “ordinary” is extraordinary†

PubMed Central

McTavish, James

2016-01-01

In some Asian countries, the poor are often denied access to health care. In the Philippines, we have thousands of Catholic doctors, Catholic nurses, even Catholic administrators, but not a Catholic, understood as “universal,” healthcare system available to all. This is a scandal and places heavy emotional and financial burdens on many families who need to pay the healthcare costs of sick loved ones. The Church teaches the principles of ordinary and extraordinary care, with only the former being morally obligatory. Extraordinary care, that involving excessive burden or cost may be foregone. Many families and healthcare professionals are uncertain about these principles and their application in practice. It would be helpful to more widely disseminate the Catholic Church teaching regarding ordinary and extraordinary care, especially in poor countries, to also avoid unnecessary or futile treatments, especially in critical or end-of-life situations. Lay Summary: The poor have limited access to health care in many countries. Even one episode of sickness often places the patient and their family under considerable financial strain. Many times they simply cannot afford even basic treatments. This is a scandal and an injustice which is the concern of us all. The Church teaches that when a treatment becomes very expensive it may be considered “extraordinary care” and not morally obligatory. It would be helpful to more widely disseminate this Catholic Church teaching, helping families to avoid unnecessary treatments especially in critical or end-of-life situations. PMID:27833180

Choosing Wisely: The Top-5 Recommendations from the Italian Panel of the National Guidelines for the Management of Acute Pharyngitis in Children.

PubMed

Chiappini, Elena; Bortone, Barbara; Di Mauro, Giuseppe; Esposito, Susanna; Galli, Luisa; Landi, Massimo; Novelli, Andrea; Marchisio, Paola; Marseglia, Gian Luigi; Principi, Nicola; de Martino, Maurizio

2017-03-01

With the aim to reduce waste in the health care system and avoid risks associated with unnecessary treatment, the Italian Panel of the National Guidelines for the Management of Acute Pharyngitis in Children joined the Choosing Wisely initiative. An ad hoc Choosing Wisely task force was selected to develop a candidate list of items for the top-5 list on pharyngitis medicine. Through a process of literature review and consensus, the final list of 5 items was chosen. Drafted recommendations were formulated and then reviewed by the task force members until a final consensus was reached. The 5 recommendations approved are: blood exams should not be performed; antibiotics should not be administrated unless microbiologic confirmation of streptococcal infection has been carried out; if a throat culture is performed, susceptibility tests on isolates should not be executed; antibiotic course should not be shortened; because penicillin V is not available in Italy, amoxicillin (50 mg/kg/d in 2-3 doses orally) for 10 days is the first choice treatment; and steroids should not be administered for the risk of masking possible underlying severe condition. This top-5 list can be a novel tool to spread the key messages of guidelines and to avoid unnecessary diagnostic procedures, and to promote a rational use of antibiotics in children. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

Navy Perspective on Joint Force Interdependence

DTIC Science & Technology

2015-01-01

commanders, or produce unaffordable options for the Nation. Rather than expending our finite energy on rehashing roles and missions, or com- mitting...unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 JFQ 76, 1st Quarter 2015 Greenert 11 preserve our...avoiding unaf- fordable duplicative efforts by teaming on the promising capabilities of the electromagnetic railgun, a game-changer in defeating cruise

Accessory replicative helicases and the replication of protein-bound DNA.

PubMed

Brüning, Jan-Gert; Howard, Jamieson L; McGlynn, Peter

2014-12-12

Complete, accurate duplication of the genetic material is a prerequisite for successful cell division. Achieving this accuracy is challenging since there are many barriers to replication forks that may cause failure to complete genome duplication or result in possibly catastrophic corruption of the genetic code. One of the most important types of replicative barriers are proteins bound to the template DNA, especially transcription complexes. Removal of these barriers demands energy input not only to separate the DNA strands but also to disrupt multiple bonds between the protein and DNA. Replicative helicases that unwind the template DNA for polymerases at the fork can displace proteins bound to the template. However, even occasional failures in protein displacement by the replicative helicase could spell disaster. In such circumstances, failure to restart replication could result in incomplete genome duplication. Avoiding incomplete genome duplication via the repair and restart of blocked replication forks also challenges viability since the involvement of recombination enzymes is associated with the risk of genome rearrangements. Organisms have therefore evolved accessory replicative helicases that aid replication fork movement along protein-bound DNA. These helicases reduce the dangers associated with replication blockage by protein-DNA complexes, aiding clearance of blocks and resumption of replication by the same replisome thus circumventing the need for replication repair and restart. This review summarises recent work in bacteria and eukaryotes that has begun to delineate features of accessory replicative helicases and their importance in genome stability. Copyright © 2014. Published by Elsevier Ltd.

Clinical application of 'Justification' and 'Optimization' principle of ALARA in pediatric CT imaging: "How many children can be protected from unnecessary radiation?".

PubMed

Sodhi, Kushaljit S; Krishna, Satheesh; Saxena, Akshay K; Sinha, Anindita; Khandelwal, Niranjan; Lee, Edward Y

2015-09-01

Practice of ALARA (as low as reasonably achievable) principle in the developed world is currently well established. However, there is striking lack of published data regarding such experience in the developing countries. Therefore, the goal of this study is to prospectively evaluate CT request forms to assess how many children could be protected from harmful radiation exposure if 'Justification' and 'Optimization' principles of ALARA are applied before obtaining CT imaging in a developing country. This can save children from potential radiation risks including development of brain cancer and leukemia. Consecutive CT request forms over a six month study period (May 16, 2013 to November 15, 2013) in a tertiary pediatric children's hospital in India were prospectively reviewed by two pediatric radiologists before obtaining CT imaging. First, 'Justification' of CT was evaluated and then 'Optimization' was applied for evaluation of appropriateness of the requested CT studies. The number (and percentage) of CT studies avoided by applying 'Justification' and 'Optimization' principle of ALARA were calculated. The difference in number of declined and optimized CT requests between CT requests from inpatient and outpatient departments was compared using Chi-Square test. A total of 1302 consecutive CT request forms were received during the study period. Some of the request forms (n=86; 6.61%) had requests for more than one (multiple) anatomical regions, hence, a total of 1392 different anatomical CT requests were received. Based on evaluation of the CT request forms for 'Justification' and 'Optimization' principle of ALARA by pediatric radiology reviewers, 111 individual anatomic part CT requests from 105 pediatric patients were avoided. Therefore, 8.06% (105 out of 1302 pediatric patients) were protected from unnecessary or additional radiation exposure.The rates of declined or optimized CT requests from inpatient department was significantly higher than that from outpatient departments (p<0.05). A substantial number of pediatric patients, particularly coming from outpatient departments, can be protected from unnecessary or additional radiation exposure from CT imaging when 'Justification' and 'Optimization' principle of ALARA are applied before obtaining CT imaging in a developing country. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Inadvertent transposition of defibrillator coil terminal pins causing inappropriate ICD therapies.

PubMed

Issa, Ziad F

2008-06-01

We report the case of a 65-year-old man with chronic atrial fibrillation (AF) and severe ischemic cardiomyopathy who underwent implantation of a prophylactic single-chamber implantable cardioverter-defibrillator (ICD). The patient experienced inappropriate ICD therapies due to oversensing of pectoral muscle myopotential secondary to reversal of the defibrillator coil terminal pins in the ICD header. Recognizing this possibility is important to avoid misinterpretation of spontaneous oversensing as hardware failure (e.g., lead fracture or insulation breech) and potentially unnecessary ICD system surgical intervention, including lead extraction.

Human Cell Line Activation Test of the Novel Energetics 2,6-pyrazinediamine 3,5-dinitro 1 -oxide (LLM-105) and 2,4,6-trinitro-3-bromoanisole (TNBA)

DTIC Science & Technology

2017-11-06

substances early in the RDT&E process to avoid unnecessary costs, conserve physical resources, and sustain the health of those potentially exposed. The SERDP...pyrazinediamine 3,5-dinitro 1 –oxide (LLM-105) and 2,4,6-trinitro-3-bromoanisole (TNBA) Prepared by: Emily Reinke, Ph.D. Health Effects Division...Toxicology Directorate Army Public Health Center ARIMS designation: 500c Use of trademarked name(s) does not imply endorsement by the U.S

SAPHO: What radiologists should know.

PubMed

Depasquale, R; Kumar, N; Lalam, R K; Tins, B J; Tyrrell, P N M; Singh, J; Cassar-Pullicino, V N

2012-03-01

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is an umbrella acronym for inflammatory clinical conditions whose common denominator is aseptic osteoarticular involvement with characteristic skin lesions. It involves all ages, can involve any skeletal site, and has variable imaging appearances depending on the stage/age of the lesion and imaging method. It mimics important differentials including infection and neoplasia. Awareness of the imaging features, especially in the spine, facilitates early diagnosis, prevents repeated biopsies, and avoids unnecessary surgery, while initiating appropriate treatment. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Tattoo pigment in axillary lymph node mimicking calcification of breast cancer

PubMed Central

Matsika, Admire; Srinivasan, Bhuvana; Gray, Janet Meryl; Galbraith, Christine Ruth

2013-01-01

A tattoo is defined as the intentional or accidental deposit of pigment into the skin. The phenomenon of skin tattooing is on the rise worldwide and complications of tattooing are increasingly being recognised in diagnostic and clinical medicine. We describe a case of calcification-like changes on mammography resembling that of breast malignancy as a result of tattoo pigment deposition in an axillary lymph node. Recognition of such changes in routine breast screening is crucial to avoid further unnecessary invasive investigations and surgery in such patients. PMID:23929611

Retrorectal Tumors

PubMed Central

Neale, Jeffrey A.

2011-01-01

Tumors that arise in the retrorectal (presacral) space are uncommon lesions that present with nonspecific signs and symptoms, which lead to difficult diagnoses. For complete evaluation of the lesion, cross-sectional imaging is required to determine the extent of resection and the appropriate surgical approach. Surgical removal leads to favorable outcomes for patients with benign purely cystic retrorectal tumors. Preoperative tissue diagnosis with transperineal and transsacral biopsies of solid or heterogeneous cystic lesions, are essential to determine the necessity of neoadjuvant therapy, which may decrease local recurrence after surgery and avoid an unnecessary delay in systemic therapy. PMID:22942797

Manufacturing of polylactic acid nanocomposite 3D printer filaments for smart textile applications

NASA Astrophysics Data System (ADS)

Hashemi Sanatgar, R.; Cayla, A.; Campagne, C.; Nierstrasz, V.

2017-10-01

In this paper, manufacturing of polylactic acid nanocomposite 3D printer filaments was considered for smart textile applications. 3D printing process was applied as a novel process for deposition of nanocomposites on PLA fabrics to introduce more flexible, resourceefficient and cost effective textile functionalization processes than conventional printing process like screen and inkjet printing. The aim is to develop an integrated or tailored production process for smart and functional textiles which avoid unnecessary use of water, energy, chemicals and minimize the waste to improve ecological footprint and productivity.

Toward Reliable and Energy Efficient Wireless Sensing for Space and Extreme Environments

NASA Technical Reports Server (NTRS)

Choi, Baek-Young; Boyd, Darren; Wilkerson, DeLisa

2017-01-01

Reliability is the critical challenge of wireless sensing in space systems operating in extreme environments. Energy efficiency is another concern for battery powered wireless sensors. Considering the physics of wireless communications, we propose an approach called Software-Defined Wireless Communications (SDC) that dynamically decide a reliable channel(s) avoiding unnecessary redundancy of channels, out of multiple distinct electromagnetic frequency bands such as radio and infrared frequencies.We validate the concept with Android and Raspberry Pi sensors and pseudo extreme experiments. SDC can be utilized in many areas beyond space applications.

Laser treatment for retinopathy of prematurity through the incubator wall.

PubMed

Dogra, Mangat R; Vinekar, Anand; Viswanathan, Kavitha; Sangtam, Tiakumzuk; Das, Pranab; Gupta, Amod; Dutta, Sourab

2008-01-01

In this era of early treatment for retinopathy of prematurity, sick infants who develop aggressive diseases or remain oxygen and temperature dependent may be treated while they are inside the incubator itself, thus avoiding unnecessary delays. This article describes the treatment of eight infants with retinopathy of prematurity who were dependent on an incubator by using a laser indirect ophthalmoscope delivery system through the slanting transparent wall of the incubator. In this series, which is the largest to date, the relative advantages and disadvantages of the procedure are discussed.

Factitious Disorders and Cardiothoracic Surgery: The Ongoing Multidisciplinary Challenges of a Complex Case

PubMed Central

Firstenberg, Michael S.; Sirak, John H.; Sun, Benjamin; Kasick, David P.

2009-01-01

Chronic factitious disorder, Munchausen's syndrome, can be challenging to manage—particularly when complaints and symptoms suggest medical or surgical emergencies. We present a patient whose problems have spanned many years and a great distance. Hopefully, with a greater awareness of this disease, as this patient continues to seek health care in many different hospitals, the implications of timely access to information, good histories and physical exams, and an index of suspicion can assist in potentially avoiding unnecessary, expensive, and invasive evaluations. PMID:20029640

Electrocardiogram artifact caused by rigors mimicking narrow complex tachycardia: a case report.

PubMed

Matthias, Anne Thushara; Indrakumar, Jegarajah

2014-02-04

The electrocardiogram (ECG) is useful in the diagnosis of cardiac and non-cardiac conditions. Rigors due to shivering can cause electrocardiogram artifacts mimicking various cardiac rhythm abnormalities. We describe an 80-year-old Sri Lankan man with an abnormal electrocardiogram mimicking narrow complex tachycardia during the immediate post-operative period. Electrocardiogram changes caused by muscle tremor during rigors could mimic a narrow complex tachycardia. Identification of muscle tremor as a cause of electrocardiogram artifact can avoid unnecessary pharmacological and non-pharmacological intervention to prevent arrhythmias.

Through the looking glass: Basics and principles of reflectance confocal microscopy.

PubMed

Que, Syril Keena T; Fraga-Braghiroli, Naiara; Grant-Kels, Jane M; Rabinovitz, Harold S; Oliviero, Margaret; Scope, Alon

2015-08-01

Reflectance confocal microscopy (RCM) offers high-resolution, noninvasive skin imaging and can help avoid obtaining unnecessary biopsy specimens. It can also increase efficiency in the surgical setting by helping to delineate tumor margins. Diagnostic criteria and several RCM algorithms have been published for the differentiation of benign and malignant neoplasms. We provide an overview of the basic principles of RCM, characteristic RCM features of normal skin and cutaneous neoplasms, and the limitations and future directions of RCM. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Re: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers".

PubMed

Durand-Moreau, Quentin; Loddé, Brice; Dewitte, Jean-Dominique

2015-03-01

Madsen et al (1) recently published a secondary analysis on data provided by the Project on Burnout, Motivation and Job Satisfaction (PUMA). The aim of their study, published in the Scandinavian Journal of Work, Environment & Health was to examine the associations between unnecessary work tasks and a decreased level of mental health. Though the topic was quite novel, reading this work proved disturbing and raised issues. Based on the results of this study, the authors stated that there is an association between unnecessary work tasks (assessed by a single question) and a decreased level of mental health, idem [assessed by the Mental Health Inventory (MHI-5)], in the specific population included in this PUMA survey. The authors point out a limitation of the study, namely that unnecessary work tasks were evaluated using one single question: "Do you sometimes have to do things in your job which appear to be unnecessary?". Semmer defines unnecessary work task as "tasks that should not be carried out at all because they do not make sense or because they could have been avoided, or could be carried out with less effort if things were organized more efficiently" (2). De facto, qualifying what an unnecessary task is requires stating or explaining whether the task makes sense. Making sense or not is not an objective notion. It is very difficult for either a manager or an employee to say if a task is necessary or not. Most important is that it makes sense from the worker's point of view. Making sense and being necessary are not synonyms. Some tasks do not make sense but are economically necessary (eg, when, as physicians, we are reporting our activity using ICD-10 on computers instead of being at patients' bedsides or reading this journal). Thus, there is a wide gap between Semmer's definition and the question used by the authors to evaluate his concept. A secondary analysis based on a single question is not adequate to evaluate unnecessary tasks. Nowadays, the general trend is to reduce the size of questionnaires because they are too long and cannot be used in a routine practice. But an analysis performed on a single question is quite risky: in psychometrics, redundancy is used to confirm a measurement. We lose precision on what exactly we are testing by asking a single question. Madsen et al's results show that among workers saying they are always or often performing unnecessary tasks, the MHI mean score was 74.00 versus 78.20 for people who never or almost never perform unnecessary tasks (P=0.0038). Even though it is a statistically significant result, its clinical relevance is never questioned. What is the impact of losing 4.20 points at MHI test instead of losing 20 points for instance? Statistical difference does not mean clinical relevance. These results show a statistical association, not a causality relationship. The authors did not show that performing unnecessary tasks lowers the level of mental health. It may be the exact opposite. Maybe having poorer mental health (eg, depression, with anhedonia) may make the workers think that what they're doing is useless. In their conclusion, Madsen et al suggest that the elimination of unnecessary work tasks may be beneficial for employees' mental health. To our mind, on the contrary, it may increase psychic suffering. If we suggest to fight unnecessary tasks in workplaces, this may encourage reduction of the margin of manoeuvre (3). The principle of removing unnecessary tasks is part of a Taylorized organization. Some tasks may seem unnecessary or bothersome, but may correspond to work periods that allow for temporary rest. Concretely, in the workplace, managers rather than the employee will be the ones to decide whether a task is useless or not. To improve well-being in the workplace, a global vision of work organization is required. From our point of view, the conclusion drawn from this study should not be that we must eliminate unnecessary tasks, but that we should focus on what makes sense for the worker, with a global view on his work and - as usual - the aim of carrying out further studies on this subject. Conflicts of interest The authors declare no conflict of interest. References 1. Madsen IEH, Tripathi M, Borritz M, Rugulies R, Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers, Scand J Work Environ Health. 2014;40(6):631-8. http://dx.doi.org/10.5271/sjweh.3453.  2. Semmer NK, Tschan F, Meier LL, Facchin S, Jacobshagen N, Illegitimate tasks and counterproductive work behavior, Appl Psychol. 2010;59:70-96. http://dx.doi.org/10.1111/j.1464-0597.2009.00416.x.  3. Durand MJ, Vézina N, Baril R, Loisel P, Richard MC, Ngomo S, Margin of manoeuvre indicators in the workplace during the rehabilitation process: a qualitative analysis, J Occup Rehab. 2009;19:194-202. http://dx.doi.org/10.1007/s10926-009-9173-4.

Food protein-induced enterocolitis syndrome by fish: Not necessarily a restricted diet.

PubMed

Infante, S; Marco-Martín, G; Sánchez-Domínguez, M; Rodríguez-Fernández, A; Fuentes-Aparicio, V; Alvarez-Perea, A; Cabrera-Freitag, P; Morales-Cabeza, C; Zubeldia, J M; Zapatero, L

2018-03-01

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow's milk or soy. Recent researches show that fish is 1 of the most important triggers of FPIES in the Mediterranean countries. Due to the risk of multiple-food FPIES, avoiding foods in the same category or that often occur together may be reasonable. The aim of this study was to evaluate the evolution and follow-up of FPIES related to fish over a period of 20 years. We describe the clinical features of our population, discuss different approaches to oral food challenges, and analyze the possibility of introducing the culprit fish or other nonrelated fish to avoid unnecessary restricted diets. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

The 3D Elevation Program: summary for Alaska

USGS Publications Warehouse

Carswell, William J.

2013-01-01

Coordination by SDMI and AMEC avoids duplication of effort and ensures a unified approach to consistent, statewide data acquisition; the enhancement of existing data; and support for emerging applications. The 3D Elevation Program (3DEP) initiative, managed by the U.S. Geological Survey (USGS), responds to the growing need for high-quality topographic data and a wide range of other three-dimensional representations of the Nation’s natural and constructed features.

The 31 Initiatives: A Study in Air Force - Army Cooperation

DTIC Science & Technology

1987-01-01

Monroe, which supplied many docnments from the Papers of General Wiliiam DePuy and other files concerning the TAC- TRADOC Dialogue. MSgt. Roger Jernigan...Charles A. Gabriel and John T. Chain, Jr., who took time from their busy schedules to read and comment on the manuscript. v I viii i...fighting issues affecting both services. The expense of new weapons provided additional incentive 1 THE 31 INITIATIVES for the services to avoid duplication

Implementation of Telemedicine Consultation to Assess Unplanned Transfers in Rural Long-Term Care Facilities, 2012-2015: A Pilot Study.

PubMed

Hofmeyer, Joshua; Leider, Jonathon P; Satorius, Jennifer; Tanenbaum, Erin; Basel, David; Knudson, Alana

2016-11-01

Public and private entities in the United States spend billions of dollars each year on potentially avoidable hospitalizations. This is a common occurrence in long-term care (LTC) facilities, especially in rural jurisdictions. This article details the creation of a telemedicine approach to assess residents from rural LTC facilities for potential transfer to hospitals. An electronic LTC (eLTC) pilot was conducted in 20 pilot LTC facilities from 2012-2015. Each site underwent technologic assessment and upgrading to ensure that 2-way video communication was possible. A new central "hub" was staffed with advanced practice providers and registered nurses. Long-term care pilot sites were trained and rolled out over 3 years. This article reports development and implementation of the pilot, as well as descriptive statistics associated with provider assessments and averted transfers. Over 3 years, 736 eLTC consultations occurred in pilot sites. One-quarter of consultations occurred between 10 pm and 9 am. Overall, approximately 31% of cases were transferred. This decreased from 54% of cases in 2013 to 17% in 2015. Rural pilot facilities had an average of 23 eLTC consults per site per year. Averted transfers represent a dramatic benefit to the residents, as potentially avoidable hospitalizations cause undue stress and allow for nosocomial infections, among other risks. In addition, averting these unnecessary transfers likely saved the taxpayers of the United States over $5 million in admission-related charges to Centers for Medicare and Medicaid Services (511 avoided transfers × $11,000 per average hospitalization from a LTC facility). Overall, the eLTC pilot showed promise as a proof-of-concept. The pilot's implementation resulted in increasing utilization and promising reductions in unnecessary transfers to emergency departments and hospitalizations. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

Professional perspectives on systemic barriers to admission avoidance: learning from a system dynamics study of older people's admission pathways.

PubMed

Walsh, Bronagh; Lattimer, Valerie; Wintrup, Julie; Brailsford, Sally

2015-06-01

There is debate worldwide about the best way to manage increased healthcare demand within ageing populations, particularly rising rates of unplanned and avoidable hospital admissions. To understand health and social care professionals' perspectives on barriers to admission avoidance throughout the admissions journey, in particular: the causes of avoidable admissions in older people; drivers of admission and barriers to use of admission avoidance strategies; and improvements to reduce unnecessary admissions. A qualitative framework analysis of interview data from a System dynamics (SD) modelling study. Semi-structured interviews were conducted with twenty health and social care professionals with experience of older people's admissions. The interviews were used to build understanding of factors facilitating or hindering admission avoidance across the admissions system. Data were analysed using framework analysis. Three overarching themes emerged: understanding the needs of the patient group; understanding the whole system; and systemwide access to expertise in care of older people. There were diverse views on the underlying reasons for avoidable admissions and recognition of the need for whole-system approaches to service redesign. Participants recommended system redesign that recognises the specific needs of older people, but there was no consensus on underlying patient needs or specific service developments. Access to expertise in management of older and frailer patients was seen as a barrier to admission avoidance throughout the system. Providing access to expertise and leadership in care of frail older people across the admissions system presents a challenge for service managers and nurse educators but is seen as a prerequisite for effective admission avoidance. System redesign to meet the needs of frail older people requires agreement on causes of avoidable admission and underlying patient needs. © 2014 John Wiley & Sons Ltd.

[Diagnostic and therapeutic activity moderation. Quaternary and genetic prevention].

PubMed

Gérvas, Juan

2006-03-01

Medical activities have more positive than negative outcomes. Because this balance, medicine has a great social recognition. But with new technology and more aggressive diagnostic and therapeutic interventions, there is a decreasing gap in between benefits and harms. Risk increases because more interventions, and because placing patients in more technology environments. As a consecuence, patient safety decreases. Quantity becomes as important as quality, and the place of care is crucial for patient safety. Medical activities should be of , performed in the low level of care possible. Then, quaternary prevention (to avoid unnecessary use and risk of medical interventions) should be a continuous parallel clinical activity. I consider four examples of needed quaternary prevention, with Spanish data: 1) cardiovascular prevention (where there is an inverse use of resources, as patients who need more receive less); 2) use of new antidepressants (which has provoke an artificial epidemic of

Sonographic Appearance of Testicular Adrenal Rest Tumour in a Patient with Congenital Adrenal Hyperplasia.

PubMed

Deshpande, Saurabh S; Shetty, Devdas; Saifi, Shenaz

2017-01-01

Testicular adrenal rest tumours (TARTs) are benign testicular masses that are found in inadequately treated patients with congenital adrenal hyperplasia (CAH). Recognizing this association and identifying characteristic ultrasound features of TARTs is important so as to avoid misdiagnosing them as malignancies, which can lead to unnecessary interventions. We describe a case of a 9-year-old boy, with a diagnosis of CAH and precocious puberty, who was referred to our department for an ultrasound evaluation of the abdomen and scrotum. On ultrasound, there were well-defined, heterogeneous, predominantly hypoechoic, round-to-oval masses in both testes. Taking into account the presence of CAH and a typical sonographic appearance of bilateral testicular masses, a diagnosis of testicular adrenal rest tumour was made; biopsy was deferred and hormonal treatment was modified. Prompt diagnosis of testicular adrenal rest tumours is essential, as it only indicates inadequate hormonal control. Moreover, it can prevent unnecessary biopsies and orchidectomies, and can maintain fertility. TARTs have a typical imaging appearance that every radiologist must be aware of.

Sonographic Appearance of Testicular Adrenal Rest Tumour in a Patient with Congenital Adrenal Hyperplasia

PubMed Central

Shetty, Devdas; Saifi, Shenaz

2017-01-01

Summary Background Testicular adrenal rest tumours (TARTs) are benign testicular masses that are found in inadequately treated patients with congenital adrenal hyperplasia (CAH). Recognizing this association and identifying characteristic ultrasound features of TARTs is important so as to avoid misdiagnosing them as malignancies, which can lead to unnecessary interventions. Case Report We describe a case of a 9-year-old boy, with a diagnosis of CAH and precocious puberty, who was referred to our department for an ultrasound evaluation of the abdomen and scrotum. On ultrasound, there were well-defined, heterogeneous, predominantly hypoechoic, round-to-oval masses in both testes. Taking into account the presence of CAH and a typical sonographic appearance of bilateral testicular masses, a diagnosis of testicular adrenal rest tumour was made; biopsy was deferred and hormonal treatment was modified. Conclusions Prompt diagnosis of testicular adrenal rest tumours is essential, as it only indicates inadequate hormonal control. Moreover, it can prevent unnecessary biopsies and orchidectomies, and can maintain fertility. TARTs have a typical imaging appearance that every radiologist must be aware of. PMID:29662583

Optimization of Multiple Related Negotiation through Multi-Negotiation Network

NASA Astrophysics Data System (ADS)

Ren, Fenghui; Zhang, Minjie; Miao, Chunyan; Shen, Zhiqi

In this paper, a Multi-Negotiation Network (MNN) and a Multi- Negotiation Influence Diagram (MNID) are proposed to optimally handle Multiple Related Negotiations (MRN) in a multi-agent system. Most popular, state-of-the-art approaches perform MRN sequentially. However, a sequential procedure may not optimally execute MRN in terms of maximizing the global outcome, and may even lead to unnecessary losses in some situations. The motivation of this research is to use a MNN to handle MRN concurrently so as to maximize the expected utility of MRN. Firstly, both the joint success rate and the joint utility by considering all related negotiations are dynamically calculated based on a MNN. Secondly, by employing a MNID, an agent's possible decision on each related negotiation is reflected by the value of expected utility. Lastly, through comparing expected utilities between all possible policies to conduct MRN, an optimal policy is generated to optimize the global outcome of MRN. The experimental results indicate that the proposed approach can improve the global outcome of MRN in a successful end scenario, and avoid unnecessary losses in an unsuccessful end scenario.

[Shall all lobular intraepithelial neoplasia diagnosed on image-guided biopsy require a surgical management?].

PubMed

Fischer-Hunsinger, Maeva; Guinebretière, Jean-Marc; Lasry, Serge; Langer, Adriana; Berment, Hélène; Nekka, Ibtissem; Nodiot, Philippe; Cherel, Pascal

2016-05-01

Lobular intraepithelial neoplasia (LIN) diagnosed on image-guided biopsy may be associated with an undiagnosed cancer. This is called under-diagnosis. The consequence is that management of these lesions is often surgical. But many surgeries finally are unnecessary. The aim of our study was to define criteria to avoid unnecessary surgery. This is a single-center, retrospective after a database collected prospectively study. Fourteen thousand biopsies were analyzed, including 456 diagnosed NLI. Under-diagnosis rates were analyzed according to many criteria. The average duration of following was 45 months. For atypical lobular hyperplasia (ALH), we obtained 7.6% under-diagnosis and combining several criteria, we got a low risk of cancer (2%). For LCIS, this rate was 23% and any low-risk group could be identified. ALH with calcifications≤20 mm, without any atypical lesion associated, histologically focal and whose removal is representative may be safely observed. For other LIN, surgery remains indicated. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Consequences of following the new American Academy of Pediatrics guidelines for imaging children with urinary tract infection.

PubMed

Ristola, Marko Tapani; Hurme, Timo

2015-01-01

Urinary tract infections (UTIs) and vesicoureteral reflux (VUR) are assumed to predispose children to renal damage. Awareness of the significance of VUR and the possibility of reducing UTI recurrence and renal damage has warranted guidelines on which patients should undergo imaging after UTI. An authoritative guideline has been issued by the American Academy of Pediatrics (AAP). This study assessed the applicability of the AAP guidelines to a subpopulation of patients with UTI, 2-24-month-old children with febrile UTI. The records of 394 children aged 2-24 months with their first UTI were reviewed. Data were recorded on the indications for renal and bladder ultrasonography (RBUS) and voiding cystourethrography (VCUG) according to the AAP guidelines, RBUS results, VCUG results, use of antimicrobial prophylaxis, antireflux procedures and other urological treatment, and UTI recurrence. An indication for RBUS was seen in 344 patients. RBUS results were abnormal in 87, including 53 with urinary tract dilatation. An unnecessary RBUS would have been avoided in 43 patients. Seven patients with an abnormal RBUS would not have undergone RBUS. An indication for VCUG was seen in 126 patients. VCUG was performed in 206 patients; VUR was found in 72 patients, including 36 with high-grade VUR. An unnecessary VCUG would have been avoided in 82 patients. High-grade VUR would have been missed in six patients. Five patients would not have undergone surgery. The AAP guidelines for imaging studies in children aged 2-24 months with febrile UTI seem applicable to clinical practice.

Mobile phone-based telemedicine system for the home follow-up of patients undergoing ambulatory surgery.

PubMed

Martínez-Ramos, Carlos; Cerdán, María Teresa; López, Rodrigo S

2009-01-01

A pilot study was done to address the efficacy of a General Packet Radio Service mobile phone-based telemedicine system used to improve follow-up after ambulatory surgery. The method involves sending images of surgical wounds or other areas from the patient's home, to assess local complications and avoid unnecessary hospital visits. Ninety-six (N = 96) patients were enrolled in the study. The phone used was a Nokia 6600, which provides images in Joint Photographic Experts Group format. These images were sent via e-mail and visualized on a standard 17-inch screen of a personal computer. After the follow-up period, self-reported patient satisfaction was assessed by analyzing the replies to a 9-item questionnaire. Thirty of the 96 patients (31.3%) reported local problems including: hematoma in 20 (66.7%) patients, surgical bandage blood-stained in 7 (23.3%), exudates in 1 (3.3%), allergic skin reactions in 1 (3.3%), and bandage too tight in 1 (3.3%). In total, 225 photographs were evaluated by 3 physicians. In all cases, it was possible to identify and assess the postoperative problem with consensus among the 3 physicians. Images served to resolve patients' concerns in 20 individuals (66.7%). In 10 patients (33.3%), concerns were satisfied but it was suggested that follow-up images be sent in the following days. Only 1 patient (3.3%) was asked to visit the hospital. The telemedicine system proposed increases the efficiency of home follow-up to ambulatory surgery, avoids unnecessary hospital visits, and clearly improves patient satisfaction.

Rationale and design of the Clinical Evaluation of Magnetic Resonance Imaging in Coronary heart disease 2 trial (CE-MARC 2): A prospective, multicenter, randomized trial of diagnostic strategies in suspected coronary heart disease

PubMed Central

Ripley, David P.; Brown, Julia M.; Everett, Colin C.; Bijsterveld, Petra; Walker, Simon; Sculpher, Mark; McCann, Gerry P.; Berry, Colin; Plein, Sven; Greenwood, John P.

2015-01-01

Background A number of investigative strategies exist for the diagnosis of coronary heart disease (CHD). Despite the widespread availability of noninvasive imaging, invasive angiography is commonly used early in the diagnostic pathway. Consequently, approximately 60% of angiograms reveal no evidence of obstructive coronary disease. Reducing unnecessary angiography has potential financial savings and avoids exposing the patient to unnecessary risk. There are no large-scale comparative effectiveness trials of the different diagnostic strategies recommended in international guidelines and none that have evaluated the safety and efficacy of cardiovascular magnetic resonance. Trial Design CE-MARC 2 is a prospective, multicenter, 3-arm parallel group, randomized controlled trial of patients with suspected CHD (pretest likelihood 10%-90%) requiring further investigation. A total of 1,200 patients will be randomized on a 2:2:1 basis to receive 3.0-T cardiovascular magnetic resonance–guided care, single-photon emission computed tomography–guided care (according to American College of Cardiology/American Heart Association appropriate-use criteria), or National Institute for Health and Care Excellence guidelines–based management. The primary (efficacy) end point is the occurrence of unnecessary angiography as defined by a normal (>0.8) invasive fractional flow reserve. Safety of each strategy will be assessed by 3-year major adverse cardiovascular event rates. Cost-effectiveness and health-related quality-of-life measures will be performed. Conclusions The CE-MARC 2 trial will provide comparative efficacy and safety evidence for 3 different strategies of investigating patients with suspected CHD, with the intension of reducing unnecessary invasive angiography rates. Evaluation of these management strategies has the potential to improve patient care, health-related quality of life, and the cost-effectiveness of CHD investigation. PMID:25497243

The use of animals in national high school student science fair projects in the United States.

PubMed

Miller-Spiegel, Crystal

2004-06-01

Science fair projects can provide a sound opportunity to teach students the value of scientific methodology without relying on the routine and unnecessary use of animals. Unfortunately, students are often encouraged to use animals in an expendable manner that both duplicates previous experiments and neglects the opportunity to "think outside the box" in order to generate new hypotheses/theories about human health, physiological processes or basic biological concepts. Although at least one national science fair sponsor has changed its policy regarding students' utilisation of vertebrate animals, others continue to encourage the more traditional in vivo experimental projects. This paper will review the guidelines of two major national science fairs in the USA; types of projects conducted that involve animals; numbers of animals involved; interview responses by some student finalists who used vertebrates in their projects; successful initiatives by animal advocates in the USA to eliminate the use of animals in science fairs; and potential areas of outreach to science educators, science fair sponsors, high schools and students.

Low-Cost Avoidance Behaviors are Resistant to Fear Extinction in Humans

PubMed Central

Vervliet, Bram; Indekeu, Ellen

2015-01-01

Elevated levels of fear and avoidance are core symptoms across the anxiety disorders. It has long been known that fear serves to motivate avoidance. Consequently, fear extinction has been the primary focus in pre-clinical anxiety research for decades, under the implicit assumption that removing the motivator of avoidance (fear) would automatically mitigate the avoidance behaviors as well. Although this assumption has intuitive appeal, it has received little scientific scrutiny. The scarce evidence from animal studies is mixed, while the assumption remains untested in humans. The current study applied an avoidance conditioning protocol in humans to investigate the effects of fear extinction on the persistence of low-cost avoidance. Online danger-safety ratings and skin conductance responses documented the dynamics of conditioned fear across avoidance and extinction phases. Anxiety- and avoidance-related questionnaires explored individual differences in rates of avoidance. Participants first learned to click a button during a predictive danger signal, in order to cancel an upcoming aversive electrical shock (avoidance conditioning). Next, fear extinction was induced by presenting the signal in the absence of shocks while button-clicks were prevented (by removing the button in Experiment 1, or by instructing not to click the button in Experiment 2). Most importantly, post-extinction availability of the button caused a significant return of avoidant button-clicks. In addition, trait-anxiety levels correlated positively with rates of avoidance during a predictive safety signal, and with the rate of pre- to post-extinction decrease during this signal. Fear measures gradually decreased during avoidance conditioning, as participants learned that button-clicks effectively canceled the shock. Preventing button-clicks elicited a sharp increase in fear, which subsequently extinguished. Fear remained low during avoidance testing, but danger-safety ratings increased again when button-clicks were subsequently prevented. Together, these results show that low-cost avoidance behaviors can persist following fear extinction and induce increased threat appraisal. On the other hand, fear extinction did reduce augmented rates of unnecessary avoidance during safety in trait-anxious individuals, and instruction-based response prevention was more effective than removal of response cues. More research is needed to characterize the conditions under which fear extinction might mitigate avoidance. PMID:26733837

Duplication of the External Auditory Canal: Two Cases and a Review of the Literature

PubMed Central

Goudakos, John K.; Blioskas, Sarantis; Psillas, George; Vital, Victor; Markou, Konstantinos

2012-01-01

The objective of the present paper is to describe the clinical presentation, diagnostic process, surgical treatment, and outcome of 2 patients with first branchial cleft anomaly. The first case was an 8-year-old girl presented with an elastic lesion located in the left infra-auricular area, in close relation with the lobule, duplicating the external auditory canal. The magnetic resonance imaging revealed a lesion, appearing as a rather well-circumscribed mass within the left parotid gland and duplicating the ear canal. A superficial parotidectomy was subsequently performed, with total excision of the cyst. The second patient was a 15-year-old girl presented with a congenital fistula of the right lateral neck. At superficial parotidectomy, a total excision of the fistula was performed. During the operation the tract was recorded to lay between the branches of the facial nerve, extending with a blind ending canal parallel to the external acoustic meatus. Conclusively, first branchial cleft anomalies are rare malformations with cervical, parotid, or auricular clinical manifestations. Diagnosis of first branchial cleft lesions is achieved mainly through careful physical examination. Complete surgical excision with wide exposure of the lesion is essential in order to achieve permanent cure and avoid recurrence. PMID:23213587

Exact Algorithms for Duplication-Transfer-Loss Reconciliation with Non-Binary Gene Trees.

PubMed

Kordi, Misagh; Bansal, Mukul S

2017-06-01

Duplication-Transfer-Loss (DTL) reconciliation is a powerful method for studying gene family evolution in the presence of horizontal gene transfer. DTL reconciliation seeks to reconcile gene trees with species trees by postulating speciation, duplication, transfer, and loss events. Efficient algorithms exist for finding optimal DTL reconciliations when the gene tree is binary. In practice, however, gene trees are often non-binary due to uncertainty in the gene tree topologies, and DTL reconciliation with non-binary gene trees is known to be NP-hard. In this paper, we present the first exact algorithms for DTL reconciliation with non-binary gene trees. Specifically, we (i) show that the DTL reconciliation problem for non-binary gene trees is fixed-parameter tractable in the maximum degree of the gene tree, (ii) present an exponential-time, but in-practice efficient, algorithm to track and enumerate all optimal binary resolutions of a non-binary input gene tree, and (iii) apply our algorithms to a large empirical data set of over 4700 gene trees from 100 species to study the impact of gene tree uncertainty on DTL-reconciliation and to demonstrate the applicability and utility of our algorithms. The new techniques and algorithms introduced in this paper will help biologists avoid incorrect evolutionary inferences caused by gene tree uncertainty.

Is Exercise Really Medicine? An Evolutionary Perspective.

PubMed

Lieberman, Daniel E

2015-01-01

An evolutionary perspective helps evaluate the extent to which exercise is medicine and to explain the exercise paradox: why people tend to avoid exercise despite its benefits. Many lines of evidence indicate that humans evolved to be adapted for regular, moderate amounts of endurance physical activity into late age. However, because energy from food was limited, humans also were selected to avoid unnecessary exertion, and most anatomical and physiological systems evolved to require stimuli from physical activity to adjust capacity to demand. Consequently, selection never operated to cope with the long-term effects of chronic inactivity. However, because all adaptations involve trade-offs, there is no evolutionary-determined dose or type of physical activity that will optimize health. Furthermore, because humans evolved to be active for play or necessity, efforts to promote exercise will require altering environments in ways that nudge or even compel people to be active and to make exercise fun.

Nodular fasciitis of the external auditory canal in six Egyptian children.

PubMed

Abdel-Aziz, Mosaad; Khattab, Hany; El-bosraty, Hussam; El-hoshy, Hassan; Hesham, Ahmed; Al-taweel, Hayam W

2008-05-01

Nodular fasciitis of external auditory canal may mimic a malignant tumor due to its progressive course, so it was the aim of this study to focus on a new etiology for aural masses to avoid unnecessary aggressive treatment. Retrospective study on six children presented with aural masses that were diagnosed pathologically to have nodular fasciitis. Presentation of the cases clinically, radiologically and pathologically was carried out. Surgical excision of the lesions was done through the external canal with follow up of the cases for 1 year. Recurrence was detected in two cases, one after 2 months and the other after 4 months. Re-excision was carried out without recurrence till the end of the follow up period. Proper diagnosis of this lesion is mandatory to avoid aggressive treatment (radical surgery and/or radiotherapy) as the disease has favorable prognosis with local excision.

Can the Ottawa and Pittsburgh rules reduce requests for radiography in patients referred to acute knee clinics?

PubMed Central

Zang, TT; Tamimi, N; Haddad, FS

2013-01-01

Our aim was to study the role of the Ottawa and Pittsburgh rules to reduce the unnecessary use of radiographs following knee injury. We prospectively reviewed 106 patients who were referred to our clinic over a 3-month period. The Ottawa and Pittsburgh rules were applied to individual patients to evaluate the need for radiography. One hundred and one patients (95%) had radiography of their knee. Five patients (5%) had a fracture of their knee and in all cases, the Ottawa and Pittsburgh knee rules were fulfilled. Using the Ottawa rules, 27 radiographs (25%) could have been avoided without missing a fracture. Using the Pittsburgh rules, 32 radiographs (30%) could have been avoided. The Ottawa and Pittsburgh rules have a high sensitivity for the detection of knee fractures. Their use can aid efficient clinical evaluation without adverse clinical outcome and may reduce healthcare costs. PMID:23827289

Can the Ottawa and Pittsburgh rules reduce requests for radiography in patients referred to acute knee clinics?

PubMed

Konan, S; Zang, T T; Tamimi, N; Haddad, F S

2013-04-01

Our aim was to study the role of the Ottawa and Pittsburgh rules to reduce the unnecessary use of radiographs following knee injury. We prospectively reviewed 106 patients who were referred to our clinic over a 3-month period. The Ottawa and Pittsburgh rules were applied to individual patients to evaluate the need for radiography. One hundred and one patients (95%) had radiography of their knee. Five patients (5%) had a fracture of their knee and in all cases, the Ottawa and Pittsburgh knee rules were fulfilled. Using the Ottawa rules, 27 radiographs (25%) could have been avoided without missing a fracture. Using the Pittsburgh rules, 32 radiographs (30%) could have been avoided. The Ottawa and Pittsburgh rules have a high sensitivity for the detection of knee fractures. Their use can aid efficient clinical evaluation without adverse clinical outcome and may reduce healthcare costs.

How to educate prescribers in antimicrobial stewardship practices

PubMed Central

Pulcini, Céline; Gyssens, Inge C.

2013-01-01

Widespread antimicrobial use has compromised its value, leading to a crisis of antimicrobial resistance. A major cause of misuse is insufficient knowledge of prescribing of antimicrobials in many categories of professionals. An important principle of antimicrobial stewardship is avoiding selection pressure in the patient, both on pathogen and commensal by avoiding unnecessary use, choosing the least broad-spectrum antibiotic, adequate doses, a good timing and the shortest possible duration. Up to now, most educational efforts have been targeted at professionals (mostly medical doctors) after their training and at the adult public. In the past few years, progress has been made in educating children. It is now crucial that academia and ministries of Health and Education jointly focus on an adapted undergraduate medical/professional curriculum that teaches all necessary principles of microbiology, infectious diseases and clinical pharmacology, with emphasis on the principles of prudent prescribing. PMID:23361336

Brucella taxonomy and evolution

PubMed Central

Ficht, Thomas

2010-01-01

Taxonomy and nomenclature represent man-made systems designed to enhance understanding of the relationship between organisms by comparison of discrete sets of properties. Initial efforts at bacterial taxonomy were flawed as a result of the previous use of nonsystematic approaches including common names resulting in confusing and inaccurate nomenclature. A decision was made to start afresh with bacterial nomenclature and to avoid the hazards experienced in the taxonomic classification of higher organisms. This was achieved by developing new rules designed to simplify classification and avoid unnecessary and confusing changes. This article reviews the work of a number of scientists attempting to reconcile new molecular data describing the phylogenetic relationship between Brucella organisms and a broader family of organisms with widely variant phenotypes that include human virulence and host range against a backdrop of strict regulatory requirements that fail to recognize significant differences between organisms with similar nomenclature. PMID:20521932

[Doctor shopping: the difficult-to-manage patient].

PubMed

de Zwaan, Martina; Müller, Astrid

2006-08-01

Medically unexplained symptoms and bodily dysfunctions are the single most prevalent class of symptoms in primary care. Differences in opinion as to the cause of the illness between the patients and the health care professionals make somatoform disorders a challenge for the patient-doctor relationship, and frequently produce negative feelings in health care professionals. The patients are usually reluctant to consider psychosocial aspects of their illness to be a factor. Early recognition of patients with somatization tendencies would be beneficial so that more effective treatment could begin sooner and unnecessary treatment be avoided. In order not to reinforce the patient's symptomatology, physicians should schedule appointments in a time contingent rather than a symptom contingent manner. Repetition of different tests should be avoided despite patients' demands in order not to further exacerbate the disorder. In many patients, psychotherapy should be recommended, although motivational work should already be initiated at the primary care stage.

Enhanced Avoidance Habits in Obsessive-Compulsive Disorder

PubMed Central

Gillan, Claire M.; Morein-Zamir, Sharon; Urcelay, Gonzalo P.; Sule, Akeem; Voon, Valerie; Apergis-Schoute, Annemieke M.; Fineberg, Naomi A.; Sahakian, Barbara J.; Robbins, Trevor W.

2014-01-01

Background Obsessive-compulsive disorder (OCD) is a psychiatric condition that typically manifests in compulsive urges to perform irrational or excessive avoidance behaviors. A recent account has suggested that compulsivity in OCD might arise from excessive stimulus-response habit formation, rendering behavior insensitive to goal value. We tested if OCD patients have a bias toward habits using a novel shock avoidance task. To explore how habits, as a putative model of compulsivity, might relate to obsessions and anxiety, we recorded measures of contingency knowledge, explicit fear, and physiological arousal. Methods Twenty-five OCD patients and 25 control subjects completed a shock avoidance task designed to induce habits through overtraining, which were identified using goal-devaluation. The relationship between habitual behavior, erroneous cognitions, and physiological arousal was assessed using behavior, questionnaires, subjective report, and skin conductance responses. Results A devaluation sensitivity test revealed that both groups could inhibit unnecessary behavioral responses before overtraining. Following overtraining, OCD patients showed greater avoidance habits than control subjects. Groups did not differ in conditioned arousal (skin conductance responses) at any stage. Additionally, groups did not differ in contingency knowledge or explicit ratings of shock expectancy following the habit test. Habit responses were associated with a subjective urge to respond. Conclusions These data indicate that OCD patients have a tendency to develop excessive avoidance habits, providing support for a habit account of OCD. Future research is needed to fully characterize the causal role of physiological arousal and explicit fear in habit formation in OCD. PMID:23510580

Bone tumor mimickers: A pictorial essay

PubMed Central

Mhuircheartaigh, Jennifer Ni; Lin, Yu-Ching; Wu, Jim S

2014-01-01

Focal lesions in bone are very common and many of these lesions are not bone tumors. These bone tumor mimickers can include numerous normal anatomic variants and non-neoplastic processes. Many of these tumor mimickers can be left alone, while others can be due to a significant disease process. It is important for the radiologist and clinician to be aware of these bone tumor mimickers and understand the characteristic features which allow discrimination between them and true neoplasms in order to avoid unnecessary additional workup. Knowing which lesions to leave alone or which ones require workup can prevent misdiagnosis and reduce patient anxiety. PMID:25114385

Gas Bubbles in the Bone: A Case Report

PubMed Central

Abbasi, Bita; Seilanian-Toosi, Farrokh; Nekooei, Sirous; Kakhki, Behrang Rezvani

2016-01-01

Intraosseous pneumatocysts are benign gas-filled cavities within bones which are most commonly found in ilium, sacrum and vertebrae. The lesions are asymptomatic and found incidentally while evaluating for other injuries. Here, we present an intraosseous pneumatocyst of ilium in a 23-year-old male patient. Although once thought to be rare, intraossseous pneumatocyst are now believed to be more common. Thus, familiarity with their appearance is essential to avoid unnecessary workup. Intraosseous pneumatocysts are differentiated from more clinically significant differential diagnoses like osteonecrosis and osteomyelitis by their characteristic appearance of intraosseous air collections with sclerotic rim. PMID:27630918

Diagnosis of Food Allergy.

PubMed

Gupta, Malika; Cox, Amanda; Nowak-Węgrzyn, Anna; Wang, Julie

2018-02-01

Food allergy diagnosis remains challenging. Most standard methods are unable to differentiate sensitization from clinical allergy. Recognizing food allergy is of utmost importance to prevent life-threatening reactions. On the other hand, faulty interpretation of tests leads to overdiagnosis and unnecessary food avoidances. Highly predictive models have been established for major food allergens based on skin prick testing and food-specific immunoglobulin E but are lacking for most other foods. Although many newer diagnostic techniques are improving the accuracy of food allergy diagnostics, an oral food challenge remains the only definitive method of confirming a food allergy. Copyright © 2017 Elsevier Inc. All rights reserved.

[A CASE OF DEXTRANOMER-HYALURONIC ACID COPOLYMER (Deflux®) IMPLANTS CALCIFICATION MIMICKING DISTAL URETERAL CALCULI].

PubMed

Matsumoto, Fumi; Matsui, Futoshi; Yazawa, Koji; Shimada, Kenji

2017-01-01

Since 2011, endoscopic correction of vesicoureteral reflux using dextranomer-hyaluronic acid copolymer (Deflux ® ) has been widely accepted in Japan due to its safety and minimally invasive nature. However, long-term complications are unknown. We present a case of Deflux ® implants calcification mimicking distal ureteral calculi in a 12-year-old boy with a history of Deflux ® injection performed at three years of age for primary VUR. We should be aware of this complication to avoid misdiagnosis and unnecessary invasive examination such as radiological imaging or endoscopy.

Male tawny dragons use throat patterns to recognize rivals.

PubMed

Osborne, Louise; Umbers, Kate D L; Backwell, Patricia R Y; Keogh, J Scott

2012-10-01

The ability to distinguish between familiar and unfamiliar conspecifics is important for many animals, especially territorial species since it allows them to avoid unnecessary interactions with individuals that pose little threat. There are very few studies, however, that identify the proximate cues that facilitate such recognition in visual systems. Here, we show that in tawny dragons (Ctenophorus decresii), males can recognize familiar and unfamiliar conspecific males based on morphological features alone, without the aid of chemical or behavioural cues. We further show that it is the colour pattern of the throat patches (gular) that facilitates this recognition.

International Conference on Harmonisation; guidance on S7A safety pharmacology studies for human pharmaceuticals; availability. Notice.

PubMed

2001-07-13

The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "S7A Safety Pharmacology Studies for Human Pharmaceuticals." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The guidance provides a definition, general principles, and recommendations for the nonclinical safety pharmacology studies. The guidance is intended to help protect clinical trial participants and patients receiving marketed products from potential adverse effects of pharmaceuticals, while avoiding unnecessary use of animals and other resources.

Accelerating Drug Development: Antiviral Therapies for Emerging Viruses as a Model.

PubMed

Everts, Maaike; Cihlar, Tomas; Bostwick, J Robert; Whitley, Richard J

2017-01-06

Drug discovery and development is a lengthy and expensive process. Although no one, simple, single solution can significantly accelerate this process, steps can be taken to avoid unnecessary delays. Using the development of antiviral therapies as a model, we describe options for acceleration that cover target selection, assay development and high-throughput screening, hit confirmation, lead identification and development, animal model evaluations, toxicity studies, regulatory issues, and the general drug discovery and development infrastructure. Together, these steps could result in accelerated timelines for bringing antiviral therapies to market so they can treat emerging infections and reduce human suffering.

Sources of variation in an enzyme-linked immunoassay of bluetongue virus in Culicoides variipennis (Diptera: Ceratopogonidae).

PubMed

Tabachnick, W J; Mecham, J O

1991-03-01

An enzyme-linked immunoassay for detecting bluetongue virus in infected Culicoides variipennis was evaluated using a nested analysis of variance to determine sources of experimental error in the procedure. The major source of variation was differences among individual insects (84% of the total variance). Storing insects at -70 degrees C for two months contributed to experimental variation in the ELISA reading (14% of the total variance) and should be avoided. Replicate assays of individual insects were shown to be unnecessary, since variation among replicate wells and plates was minor (2% of the total variance).

Eosinophilic pustular folliculitis in infancy: report of a new case.

PubMed

Alonso-Castro, L; Pérez-García, B; González-García, C; Jaén-Olasolo, P

2012-10-15

We report a new case of eosinophilic pustular folliculitis in a 23-month-old boy. He presented with a seven-month history of recurrent episodes of pustular lesions on the scalp after having been treated with oral antifungal and topic antibiotics without response. The diagnosis was based on the clinical course and typical histopathological findings. Eosinophilic pustular folliculitis in infancy is an idiopathic and rare inflammatory disease characterized by recurrent crops of sterile pustules involving mainly the scalp. Because it is a benign, self-limiting condition an accurate diagnosis is essential to avoid unnecessary therapies.

Spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma associated with primary hypothyroidism

PubMed Central

Kanza, Rene Epunza; Gagnon, Sylvain; Villeneuve, Helene; Laverdiere, David; Rousseau, Isabelle; Bordeleau, Edith; Berube, Michel

2013-01-01

We report an unusual case of spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma in an adult, non-pregnant woman. Her condition was triggered by unrecognized primary hypothyroidism, which regressed after thyroid hormone replacement therapy. This case highlights the need for clinicians and radiologists to familiarize themselves with the clinical and imaging features detected in case of these complications of primary hypothyroidism, which are not well known in the medical and radiological profession. Such improved knowledge will help avoid delays in diagnosis, progression to life-threatening complications, and unnecessary surgery. PMID:23494012

Biological Effects and Safety in Magnetic Resonance Imaging: A Review

PubMed Central

Hartwig, Valentina; Giovannetti, Giulio; Vanello, Nicola; Lombardi, Massimo; Landini, Luigi; Simi, Silvana

2009-01-01

Since the introduction of Magnetic Resonance Imaging (MRI) as a diagnostic technique, the number of people exposed to electromagnetic fields (EMF) has increased dramatically. In this review, based on the results of a pioneer study showing in vitro and in vivo genotoxic effects of MRI scans, we report an updated survey about the effects of non-ionizing EMF employed in MRI, relevant for patients’ and workers’ safety. While the whole data does not confirm a risk hypothesis, it suggests a need for further studies and prudent use in order to avoid unnecessary examinations, according to the precautionary principle. PMID:19578460

Gold(I)-Catalysed Direct Thioetherifications Using Allylic Alcohols: an Experimental and Computational Study

PubMed Central

Herkert, Lorena; Green, Samantha L J; Barker, Graeme; Johnson, David G; Young, Paul C; Macgregor, Stuart A; Lee, Ai-Lan

2014-01-01

A gold(I)-catalysed direct thioetherification reaction between allylic alcohols and thiols is presented. The reaction is generally highly regioselective (SN2′). This dehydrative allylation procedure is very mild and atom economical, producing only water as the by-product and avoiding any unnecessary waste/steps associated with installing a leaving or activating group on the substrate. Computational studies are presented to gain insight into the mechanism of the reaction. Calculations indicate that the regioselectivity is under equilibrium control and is ultimately dictated by the thermodynamic stability of the products. PMID:25080400

Research of improved banker algorithm

NASA Astrophysics Data System (ADS)

Yuan, Xingde; Xu, Hong; Qiao, Shijiao

2013-03-01

In the multi-process operating system, resource management strategy of system is a critical global issue, especially when many processes implicating for the limited resources, since unreasonable scheduling will cause dead lock. The most classical solution for dead lock question is the banker algorithm; however, it has its own deficiency and only can avoid dead lock occurring in a certain extent. This article aims at reducing unnecessary safety checking, and then uses the new allocation strategy to improve the banker algorithm. Through full analysis and example verification of the new allocation strategy, the results show the improved banker algorithm obtains substantial increase in performance.

Nonpalpable testes: Ultrasound and contralateral testicular hypertrophy predict the surgical access, avoiding unnecessary laparoscopy.

PubMed

Berger, Christoph; Haid, Bernhard; Becker, Tanja; Koen, Mark; Roesch, Judith; Oswald, Josef

2018-04-01

In up to 20% of patients presenting with undescended testes, one or both are non-palpable. Whereas the most reliable means to exclude an abdominal testis is laparoscopy, there has been a lot of debate about the role of inguinal ultrasound (US) in detecting non-palpable inguinal testis. While we do not aim to add another paper claiming the benefits of US, we wanted to determine the excess capability of US to determine the correct surgical approach - inguinal or laparoscopy. In the light of avoiding unnecessary diagnostic laparoscopies, even the cost-effectiveness raised in many current papers might be called into question. Of a total of 684 boys who underwent surgery for undescended testes at our department between 2011 and 2014, in 58 (8.5%), one or both testes were neither palpable preoperatively nor under general anesthesia. These boys were examined by two experienced pediatric urologists clinically as well as by US. Besides the size of the contralateral testis, the presence of a testis in the inguinal channel was investigated. The additional impact of US over clinical exam and consideration of the size of the contralateral testis was assessed by means of intra-individual comparisons using Cochran-Q as well as McNemar tests. Clinical exam without considering the size of the contralateral testis had a sensitivity of 9% (95% CI 2-24%) and a specificity of 100% (95% CI 86-100%) to accurately predict the surgical approach deemed appropriate postoperatively. The consideration of the size of the contralateral testis - taken as an isolated factor - accurately predicted the surgical approach with a sensitivity of 21% (95% CI 9-38%) and a specificity of 88% (95% CI 68-97%). Ultrasound accounted for a sensitivity of 53% (95% CI 35-70%) and a specificity of 100% (95% CI 86-100%). The addition of US increased the sensitivity to correctly predict an inguinal incision from 29% to 71% and specificity slightly increased from 88% to 92%. This difference is significant (p = 0.008) in the bilateral McNemar test (Figure). Inguinal US of non-palpable testes and measurement of the contralateral testis are synergistic in predicting the surgical approach. The addition of ultrasound to a clinical exam, performed also under general anesthesia and by an experienced pediatric urologist significantly increases the prediction of the correct surgical approach. Our results translate into five boys needing an US of the NPT to prevent one laparoscopy. Whereas cost-effectiveness of US might be debatable in regard to different healthcare systems, it is proven to be an effective, non-harmful tool to avoid unnecessary diagnostic laparoscopies. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Single nucleotide polymorphism (SNP) discovery in duplicated genomes: intron-primed exon-crossing (IPEC) as a strategy for avoiding amplification of duplicated loci in Atlantic salmon (Salmo salar) and other salmonid fishes

PubMed Central

Ryynänen, Heikki J; Primmer, Craig R

2006-01-01

Background Single nucleotide polymorphisms (SNPs) represent the most abundant type of DNA variation in the vertebrate genome, and their applications as genetic markers in numerous studies of molecular ecology and conservation of natural populations are emerging. Recent large-scale sequencing projects in several fish species have provided a vast amount of data in public databases, which can be utilized in novel SNP discovery in salmonids. However, the suggested duplicated nature of the salmonid genome may hamper SNP characterization if the primers designed in conserved gene regions amplify multiple loci. Results Here we introduce a new intron-primed exon-crossing (IPEC) method in an attempt to overcome this duplication problem, and also evaluate different priming methods for SNP discovery in Atlantic salmon (Salmo salar) and other salmonids. A total of 69 loci with differing priming strategies were screened in S. salar, and 27 of these produced ~13 kb of high-quality sequence data consisting of 19 SNPs or indels (one per 680 bp). The SNP frequency and the overall nucleotide diversity (3.99 × 10-4) in S. salar was lower than reported in a majority of other organisms, which may suggest a relative young population history for Atlantic salmon. A subset of primers used in cross-species analyses revealed considerable variation in the SNP frequencies and nucleotide diversities in other salmonids. Conclusion Sequencing success was significantly higher with the new IPEC primers; thus the total number of loci to screen in order to identify one potential polymorphic site was six times less with this new strategy. Given that duplication may hamper SNP discovery in some species, the IPEC method reported here is an alternative way of identifying novel polymorphisms in such cases. PMID:16872523

Ethical dilemmas in journal publication.

PubMed

Babalola, Olubukola; Grant-Kels, Jane M; Parish, Lawrence Charles

2012-01-01

Physicians often face tremendous pressures and incentives to publish, sometimes leading to a compromise of ethical standards, either consciously or unconsciously. From the vantage of ethical authorship, we discuss what constitutes authorship; avoidance of ghost authorship; plagiarism, as well as self-plagiarism and duplicate publication; falsification; and fabrication. Editors also face ethical challenges, including how best to manage peer-review bias, to address reviewer tardiness, and to locate reviewers with appropriate expertise and professionalism. Editors need to deal with authors who fragment their work into multiple publications to enhance their curriculum vitae ("salami factor"), as well as to manage the financial benefits of advertising and to avoid conflicts of interest for the journal. Both authors and editors should be straightforward and principled throughout the publication process. Copyright © 2012 Elsevier Inc. All rights reserved.

Role of 3D power Doppler ultrasound in the further characterization of suspicious breast masses.

PubMed

Kupeli, Ali; Kul, Sibel; Eyuboglu, Ilker; Oguz, Sukru; Mungan, Sevdegul

2016-01-01

To investigate effectiveness of vascular indices obtained with 3D power Doppler ultrasound in the further characterization of breast masses and prevention of unnecessary biopsies. Between April 2013 and March 2014, 109 patients (age range, 17-85 years; mean age, 47 years) with 117 radiologically or clinically suspicious breast masses were prospectively evaluated with 3DPDUS before biopsy. Mass volume (MV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated using Virtual Organ Computer-aided Analysis (VOCAL) software and they were correlated with the final diagnosis. Cutoff values of vascular indices were determinated and diagnostic efficacy was calculated with receiver operating curve (ROC) analysis. All vascular indices, age of patients and tumor volume were significantly lower in benign masses compared with malignant ones (p<0.001). AUCs were 0.872, 0.867 and 0.789 for VI, VFI and FI, respectively. The diagnostic efficacy of VI (for cutoff 1.1; 83% sensitivity, 82% specificity and 82% accuracy) and VFI (for cutoff 0.4; 80% sensitivity, 83% specificity and 80% accuracy) were significantly higher than FI (for cutoff 33,9; 73% sensitivity, 69% specificity and 71% accuracy). It was found that with the use of vascular indices of 3DPDUS in the further characterization of suspicious breast masses between 24% to 37% of unnecessary biopsies could have been avoided. The vascular indices obtained with 3DPDUS seem reliable in the further characterization of suspicious breast masses and might be used to decrease unnecessary biopsies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

EDOVE: Energy and Depth Variance-Based Opportunistic Void Avoidance Scheme for Underwater Acoustic Sensor Networks

PubMed Central

Eun, Yongsoon

2017-01-01

Underwater Acoustic Sensor Network (UASN) comes with intrinsic constraints because it is deployed in the aquatic environment and uses the acoustic signals to communicate. The examples of those constraints are long propagation delay, very limited bandwidth, high energy cost for transmission, very high signal attenuation, costly deployment and battery replacement, and so forth. Therefore, the routing schemes for UASN must take into account those characteristics to achieve energy fairness, avoid energy holes, and improve the network lifetime. The depth based forwarding schemes in literature use node’s depth information to forward data towards the sink. They minimize the data packet duplication by employing the holding time strategy. However, to avoid void holes in the network, they use two hop node proximity information. In this paper, we propose the Energy and Depth variance-based Opportunistic Void avoidance (EDOVE) scheme to gain energy balancing and void avoidance in the network. EDOVE considers not only the depth parameter, but also the normalized residual energy of the one-hop nodes and the normalized depth variance of the second hop neighbors. Hence, it avoids the void regions as well as balances the network energy and increases the network lifetime. The simulation results show that the EDOVE gains more than 15% packet delivery ratio, propagates 50% less copies of data packet, consumes less energy, and has more lifetime than the state of the art forwarding schemes. PMID:28954395

EDOVE: Energy and Depth Variance-Based Opportunistic Void Avoidance Scheme for Underwater Acoustic Sensor Networks.

PubMed

Bouk, Safdar Hussain; Ahmed, Syed Hassan; Park, Kyung-Joon; Eun, Yongsoon

2017-09-26

Underwater Acoustic Sensor Network (UASN) comes with intrinsic constraints because it is deployed in the aquatic environment and uses the acoustic signals to communicate. The examples of those constraints are long propagation delay, very limited bandwidth, high energy cost for transmission, very high signal attenuation, costly deployment and battery replacement, and so forth. Therefore, the routing schemes for UASN must take into account those characteristics to achieve energy fairness, avoid energy holes, and improve the network lifetime. The depth based forwarding schemes in literature use node's depth information to forward data towards the sink. They minimize the data packet duplication by employing the holding time strategy. However, to avoid void holes in the network, they use two hop node proximity information. In this paper, we propose the Energy and Depth variance-based Opportunistic Void avoidance (EDOVE) scheme to gain energy balancing and void avoidance in the network. EDOVE considers not only the depth parameter, but also the normalized residual energy of the one-hop nodes and the normalized depth variance of the second hop neighbors. Hence, it avoids the void regions as well as balances the network energy and increases the network lifetime. The simulation results show that the EDOVE gains more than 15 % packet delivery ratio, propagates 50 % less copies of data packet, consumes less energy, and has more lifetime than the state of the art forwarding schemes.

Gaps, inexperience, inconsistencies, and overlaps: crisis in the regulation of genetically modified plants and animals.

PubMed

Mandal, Gregory N

2004-04-01

The regulation of genetically modified products pursuant to statutes enacted decades prior to the advent of biotechnology has created a regulatory system that is passive rather than proactive about risks, has difficulty adapting to biotechnology advances, and is highly fractured and inefficient--transgenic plants and animals are governed by at least twelve different statutes and five different agencies or services. The deficiencies resulting from this piecemeal approach to regulation unnecessarily expose society and the environment to adverse risks of biotechnology and introduce numerous inefficiencies into the regulatory system. These risks and inefficiencies include gaps in regulation, duplicative and inconsistent regulation, unnecessary increases in the cost of and delay in the development and commercialization of new biotechnology products. These deficiencies also increase the risk of further unnecessary biotechnology scares, which may cause public overreaction against biotechnology products, preventing the maximization of social welfare. With science and society poised to soar from first-generation biotechnology (focused on crops modified for agricultural benefit), to next-generation developments (including transgenic fish, insects, and livestock, and pharmaceutical-producing and industrial compound-producing plants and animals), it is necessary to establish a comprehensive, efficient, and scientifically rigorous regulatory system. This Article details how to achieve such a result through fixing the deficiencies in, and risks created by, the current regulatory structure. Ignoring many details, the solutions can be summarized in two categories. First, statutory and regulatory gaps that are identified must be closed with new legislation and regulation. Second, regulation of genetically modified products must be shifted from a haphazard model based on statutes not intended to cover biotechnology to a system based upon agency expertise in handling particular types of risks.

Laparoscopic Excision of an Unusual Presentation of a Nabothian Cyst: Case Report and Review of the Literature.

PubMed

Nassif, Joseph; Nahouli, Hasan; Mourad, Ali; Yammine, Ryan; Khoury, Sally; Khalil, Ali

2017-12-22

Nabothian cysts are mucinous retention cysts formed through the accumulation of cervical mucus inside blocked cervical crypts leading to non-neoplastic mucinous cystic lesion in relation to the uterine cervix. The formation of Nabothian cysts is a common gynecological benign condition in women of reproductive age. While the presence of small-sized Nabothian cysts is usually clinically asymptomatic and requires no treatment or intervention, the diagnosis of larger Nabothian cysts can be mistaken with malignant tumors, including mucin producing carcinomas such as Adenoma malignum. In this study, we report the case of a large Nabothian cyst that was correctly diagnosed preoperatively using ultrasonography and magnetic resonance imaging (MRI), and successfully treated through laparoscopic excision, avoiding the performance of unnecessary hysterectomy. A 44-year old Lebanese patient presented with chronic dyspareunia and pelvic pain. An ultrasound was performed and revealed an 8cm multiloculated anechoic pelvic cystic lesion with no solid components. An MRI was performed and showed an 8cm mass lateral to the right vaginal wall, suggestive of a Nabothian cyst. The patient was scheduled for laparoscopic removal of the Nabothian cyst. The patient tolerated the procedure well and was discharged under stable condition a few hours after the operation. Careful preoperative examination, including the use of imaging methods such as ultrasonogoraphy and MRI, is crucial for diagnosis and differentiation of atypical presentation of benign, but large and complex, Nabothian cysts from other differential conditions of malignancies, consequently avoiding unnecessary hysterectomy. Use of laparoscopy as a minimally-invasive technique to excise such cysts is considered a valid option, allowing for a fast recovery for the patients.

An evaluation of the relationship between Enterobius vermicularis infestation and acute appendicitis in a paediatric population--A retrospective cohort study.

PubMed

Fleming, C A; Kearney, D E; Moriarty, P; Redmond, H P; Andrews, E J

2015-06-01

Enterobius vermicularis is an often unexpected finding in appendectomy specimen, most commonly seen in paediatric cases. Predicting the presence of E. vermicularis in the setting of appendectomy is important to avoid unnecessary appendectomy and associated morbidity. We sought to identify the incidence of E. vermicularis in a paediatric population undergoing appendectomy for clinically suspected acute appendicitis and identify predictive factors for E. vermicularis. This study was performed in an 800-bed University Teaching Hospital, in the Republic of Ireland. We identified all paediatric appendectomies performed at our institute from January to December 2012 using prospectively maintained operating theatre logbooks. In-hospital Histopathology database, medical notes and operative findings were reviewed for each patient and relevant data recorded. Statistical analysis was performed using IBM SPSS, version 21. In total 182 paediatric appendectomies were performed during the year 2012 for clinically suspected acute appendicitis. Demographics included: Mean age 11.14 years (3-16), gender 1M: 1F. 58.8% of procedures were completed laparoscopically, 39% open and 2.2% were converted. The negative appendectomy rate was 22.5%. The annual incidence of E. vermicularis in acute appendicitis specimen from a paediatric cohort at our institute was 7% (1 in 14). In specimen containing E. vermicularis, 69% had no evidence of appendicitis and of those that had, no gangrene or perforation was seen. The presence of E. vermicularis in paediatric patients with RIF pain may be predicted by Eosinophilia (p = 0.016), normal WCC (p = 0.034) and normal Neutrophil count (p = 0.014). E. vermicularis is responsible for 7% of acute appendicitis. It is responsible for a significantly higher negative appendectomy rate which if predicted may avoid unnecessary appendectomy and associated morbidity. Copyright © 2015. Published by Elsevier Ltd.

The Prostate Health Index in predicting initial prostate biopsy outcomes in Asian men with prostate-specific antigen levels of 4-10 ng/mL.

PubMed

Ng, C F; Chiu, Peter K F; Lam, N Y; Lam, H C; Lee, Kim W M; Hou, Simon S M

2014-04-01

To investigate the role of the Prostate Health Index (phi) in prostate cancer (PCa) detection in patients with a prostate-specific antigen (PSA) level of 4-10 ng/mL receiving their first prostatic biopsy in an Asian population. This was a retrospective study of archived serum samples from patients enlisted in our tissue bank. Patients over 50 years old, with PSA level of 4-10 ng/mL, a negative digital rectal examination, and received their first prostatic biopsy between April 2008 and April 2013, were recruited. The serum sample collected before biopsy was retrieved for the measurement of various PSA derivatives and the phi value was calculated for each patient. The performance of these parameters in predicting the prostatic biopsy results was assessed. Two hundred and thirty consecutive patients, with 21 (9.13 %) diagnosed with PCa, were recruited for this study. Statistically significant differences between PCa patients and non-PCa patients were found for total PSA, PSA density, [-2]proPSA (p2PSA), free-to-total PSA ratio (%fPSA), p2PSA-to-free PSA ratio (%p2PSA), and phi. The areas under the curve of the receiver operating characteristic curve for total PSA, PSA density, %fPSA, %p2PSA, and phi were 0.547, 0.634, 0.654, 0.768, and 0.781, respectively. The phi was the best predictor of the prostatic biopsies results. At a sensitivity of 90 %, the use of the phi could have avoided unnecessary biopsies in 104 (45.2 %) patients. Use of the phi could improve the accuracy of PCa detection in patients with an elevated PSA level and thus avoid unnecessary prostatic biopsies.

A NEW CLINICAL PREDICTION CRITERION ACCURATELY DETERMINES A SUBSET OF PATIENTS WITH BILATERAL PRIMARY ALDOSTERONISM BEFORE ADRENAL VENOUS SAMPLING.

PubMed

Kocjan, Tomaz; Janez, Andrej; Stankovic, Milenko; Vidmar, Gaj; Jensterle, Mojca

2016-05-01

Adrenal venous sampling (AVS) is the only available method to distinguish bilateral from unilateral primary aldosteronism (PA). AVS has several drawbacks, so it is reasonable to avoid this procedure when the results would not affect clinical management. Our objective was to identify a clinical criterion that can reliably predict nonlateralized AVS as a surrogate for bilateral PA that is not treated surgically. A retrospective diagnostic cross-sectional study conducted at Slovenian national endocrine referral center included 69 consecutive patients (mean age 56 ± 8 years, 21 females) with PA who underwent AVS. PA was confirmed with the saline infusion test (SIT). AVS was performed sequentially during continuous adrenocorticotrophic hormone (ACTH) infusion. The main outcome measures were variables associated with nonlateralized AVS to derive a clinical prediction rule. Sixty-seven (97%) patients had a successful AVS and were included in the statistical analysis. A total of 39 (58%) patients had nonlateralized AVS. The combined criterion of serum potassium ≥3.5 mmol/L, post-SIT aldosterone <18 ng/dL, and either no or bilateral tumor found on computed tomography (CT) imaging had perfect estimated specificity (and thus 100% positive predictive value) for bilateral PA, saving an estimated 16% of the patients (11/67) from unnecessary AVS. The best overall classification accuracy (50/67 = 75%) was achieved using the post-SIT aldosterone level <18 ng/dL alone, which yielded 74% sensitivity and 75% specificity for predicting nonlateralized AVS. Our clinical prediction criterion appears to accurately determine a subset of patients with bilateral PA who could avoid unnecessary AVS and immediately commence with medical treatment.

Rotifer rDNA-specific R9 retrotransposable elements generate an exceptionally long target site duplication upon insertion.

PubMed

Gladyshev, Eugene A; Arkhipova, Irina R

2009-12-15

Ribosomal DNA genes in many eukaryotes contain insertions of non-LTR retrotransposable elements belonging to the R2 clade. These elements persist in the host genomes by inserting site-specifically into multicopy target sites, thereby avoiding random disruption of single-copy host genes. Here we describe R9 retrotransposons from the R2 clade in the 28S RNA genes of bdelloid rotifers, small freshwater invertebrate animals best known for their long-term asexuality and for their ability to survive repeated cycles of desiccation and rehydration. While the structural organization of R9 elements is highly similar to that of other members of the R2 clade, they are characterized by two distinct features: site-specific insertion into a previously unreported target sequence within the 28S gene, and an unusually long target site duplication of 126 bp. We discuss the implications of these findings in the context of bdelloid genome organization and the mechanisms of target-primed reverse transcription.

Development of an Operational TS Dataset Production System for the Data Assimilation System

NASA Astrophysics Data System (ADS)

Kim, Sung Dae; Park, Hyuk Min; Kim, Young Ho; Park, Kwang Soon

2017-04-01

An operational TS (Temperature and Salinity) dataset production system was developed to provide near real-time data to the data assimilation system periodically. It collects the latest 15 days' TS data of the north western pacific area (20°N - 55°N, 110°E - 150°E), applies QC tests to the archived data and supplies them to numerical prediction models of KIOST (Korea Institute of Ocean Science and Technology). The latest real-time TS data are collected from Argo GDAC and GTSPP data server every week. Argo data are downloaded from /latest_data directory of Argo GDAC. Because many duplicated data exist when all profile data are extracted from all Argo netCDF files, DB system is used to avoid duplication. All metadata (float ID, location, observation date and time, etc) of all Argo floats is stored into Database system and a Matlab program was developed to manipulate DB data, to check the duplication and to exclude duplicated data. GTSPP data are downloaded from /realtime directory of GTSPP data service. The latest data except ARGO data are extracted from the original data. Another Matlab program was coded to inspect all collected data using 10 QC tests and produce final dataset which can be used by the assimilation system. Three regional range tests to inspect annual, seasonal and monthly variations are included in the QC procedures. The C program was developed to provide regional ranges to data managers. It can calculate upper limit and lower limit of temperature and salinity at depth from 0 to 1550m. The final TS dataset contains the latest 15 days' TS data in netCDF format. It is updated every week and transmitted to numerical modeler of KIOST for operational use.

biobambam: tools for read pair collation based algorithms on BAM files

PubMed Central

2014-01-01

Background Sequence alignment data is often ordered by coordinate (id of the reference sequence plus position on the sequence where the fragment was mapped) when stored in BAM files, as this simplifies the extraction of variants between the mapped data and the reference or of variants within the mapped data. In this order paired reads are usually separated in the file, which complicates some other applications like duplicate marking or conversion to the FastQ format which require to access the full information of the pairs. Results In this paper we introduce biobambam, a set of tools based on the efficient collation of alignments in BAM files by read name. The employed collation algorithm avoids time and space consuming sorting of alignments by read name where this is possible without using more than a specified amount of main memory. Using this algorithm tasks like duplicate marking in BAM files and conversion of BAM files to the FastQ format can be performed very efficiently with limited resources. We also make the collation algorithm available in the form of an API for other projects. This API is part of the libmaus package. Conclusions In comparison with previous approaches to problems involving the collation of alignments by read name like the BAM to FastQ or duplication marking utilities our approach can often perform an equivalent task more efficiently in terms of the required main memory and run-time. Our BAM to FastQ conversion is faster than all widely known alternatives including Picard and bamUtil. Our duplicate marking is about as fast as the closest competitor bamUtil for small data sets and faster than all known alternatives on large and complex data sets.

Oxygen in the critically ill: friend or foe?

PubMed

Damiani, Elisa; Donati, Abele; Girardis, Massimo

2018-04-01

To examine the potential harmful effects of hyperoxia and summarize the results of most recent clinical studies evaluating oxygen therapy in critically ill patients. Excessive oxygen supplementation may have detrimental pulmonary and systemic effects because of enhanced oxidative stress and inflammation. Hyperoxia-induced lung injury includes altered surfactant protein composition, reduced mucociliary clearance and histological damage, resulting in atelectasis, reduced lung compliance and increased risk of infections. Hyperoxemia causes vasoconstriction, reduction in coronary blood flow and cardiac output and may alter microvascular perfusion. Observational studies showed a close relationship between hyperoxemia and increased mortality in several subsets of critically ill patients. In absence of hypoxemia, the routine use of oxygen therapy in patients with myocardial infarction, stroke, traumatic brain injury, cardiac arrest and sepsis, showed no benefit but rather it seems to be harmful. In patients admitted to intensive care unit, a conservative oxygen therapy aimed to maintain arterial oxygenation within physiological range has been proved to be well tolerated and may improve outcome. Liberal O2 use and unnecessary hyperoxia may be detrimental in critically ill patients. The current evidence supports the use of a conservative strategy in O2 therapy to avoid patient exposure to unnecessary hyperoxemia.

Improving outcome of trauma patients by implementing patient blood management.

PubMed

Füllenbach, Christoph; Zacharowski, Kai; Meybohm, Patrick

2017-04-01

Patient blood management aims to improve patient outcome and safety by reducing the number of unnecessary red blood cell transfusions and vitalizing patient-specific anemia reserves. While this is increasingly recognized as best clinical practice in elective surgery, the implementation in the setting of trauma is restrained because of typically nonelective (emergency) surgery and, in specific circumstances, allogeneic blood transfusions as life-saving therapy. Viscoelastic diagnostics allow a precise identification of trauma-induced coagulopathy. A coagulation factor concentrate-based therapy is increasingly recognized as a fast and effective concept to correct coagulopathy and minimize blood loss. Using smaller tubes has a great potential to reduce the severity of phlebotomy-induced anemia. Washed cell salvage may reduce the number of allogeneic blood transfusions. Intravenous iron (with or without erythropoietin) may result in an increase of hemoglobin levels and reduced red blood cell transfusion requirements. Although a restrictive transfusion strategy is recommended in general, a target hemoglobin level of 7-9 g/dl is recommended in acute bleeding patients. In the setting of trauma, options to avoid unnecessary blood loss and reduce blood transfusion are manifold. These are likely to improve safety and outcome of trauma patients while potentially reducing therapeutic costs.

Knowing and avoiding plagiarism during scientific writing.

PubMed

Kumar, P Mohan; Priya, N Swapna; Musalaiah, Svvs; Nagasree, M

2014-09-01

Plagiarism has become more common in both dental and medical communities. Most of the writers do not know that plagiarism is a serious problem. Plagiarism can range from simple dishonesty (minor copy paste/any discrepancy) to a more serious problem (major discrepancy/duplication of manuscript) when the authors do cut-copy-paste from the original source without giving adequate credit to the main source. When we search databases like PubMed/MedLine there is a lot of information regarding plagiarism. However, it is still a current topic of interest to all the researchers to know how to avoid plagiarism. It's time to every young researcher to know ethical guidelines while writing any scientific publications. By using one's own ideas, we can write the paper completely without looking at the original source. Specific words from the source can be added by using quotations and citing them which can help in not only supporting your work and amplifying ideas but also avoids plagiarism. It is compulsory to all the authors, reviewers and editors of all the scientific journals to know about the plagiarism and how to avoid it by following ethical guidelines and use of plagiarism detection software while scientific writing.

Knowing and Avoiding Plagiarism During Scientific Writing

PubMed Central

Kumar, P Mohan; Priya, N Swapna; Musalaiah, SVVS; Nagasree, M

2014-01-01

Plagiarism has become more common in both dental and medical communities. Most of the writers do not know that plagiarism is a serious problem. Plagiarism can range from simple dishonesty (minor copy paste/any discrepancy) to a more serious problem (major discrepancy/duplication of manuscript) when the authors do cut-copy-paste from the original source without giving adequate credit to the main source. When we search databases like PubMed/MedLine there is a lot of information regarding plagiarism. However, it is still a current topic of interest to all the researchers to know how to avoid plagiarism. It's time to every young researcher to know ethical guidelines while writing any scientific publications. By using one's own ideas, we can write the paper completely without looking at the original source. Specific words from the source can be added by using quotations and citing them which can help in not only supporting your work and amplifying ideas but also avoids plagiarism. It is compulsory to all the authors, reviewers and editors of all the scientific journals to know about the plagiarism and how to avoid it by following ethical guidelines and use of plagiarism detection software while scientific writing. PMID:25364588

Expansion of banana (Musa acuminata) gene families involved in ethylene biosynthesis and signalling after lineage-specific whole-genome duplications.

PubMed

Jourda, Cyril; Cardi, Céline; Mbéguié-A-Mbéguié, Didier; Bocs, Stéphanie; Garsmeur, Olivier; D'Hont, Angélique; Yahiaoui, Nabila

2014-05-01

Whole-genome duplications (WGDs) are widespread in plants, and three lineage-specific WGDs occurred in the banana (Musa acuminata) genome. Here, we analysed the impact of WGDs on the evolution of banana gene families involved in ethylene biosynthesis and signalling, a key pathway for banana fruit ripening. Banana ethylene pathway genes were identified using comparative genomics approaches and their duplication modes and expression profiles were analysed. Seven out of 10 banana ethylene gene families evolved through WGD and four of them (1-aminocyclopropane-1-carboxylate synthase (ACS), ethylene-insensitive 3-like (EIL), ethylene-insensitive 3-binding F-box (EBF) and ethylene response factor (ERF)) were preferentially retained. Banana orthologues of AtEIN3 and AtEIL1, two major genes for ethylene signalling in Arabidopsis, were particularly expanded. This expansion was paralleled by that of EBF genes which are responsible for control of EIL protein levels. Gene expression profiles in banana fruits suggested functional redundancy for several MaEBF and MaEIL genes derived from WGD and subfunctionalization for some of them. We propose that EIL and EBF genes were co-retained after WGD in banana to maintain balanced control of EIL protein levels and thus avoid detrimental effects of constitutive ethylene signalling. In the course of evolution, subfunctionalization was favoured to promote finer control of ethylene signalling. © 2014 CIRAD New Phytologist © 2014 New Phytologist Trust.

Prospective multi-center study for quantification of chemotherapies and CTX-related direct medication costs avoided by use of biomarkers uPA and PAI-1 in primary breast cancer.

PubMed

Jacobs, Volker R; Augustin, Doris; Wischnik, Arthur; Kiechle, Marion; Höss, Cornelia; Steinkohl, Oliver; Rack, Brigitte; Kapitza, Thomas; Krase, Peter

2013-08-01

Biomarkers uPA/PAI-1 as recommended by ASCO and AGO are used in primary breast cancer to avoid unnecessary CTX in medium risk-recurrence patients. This study verified how many CTX cycles and CTX-related direct medication costs can be avoided by uPA/PAI-1 testing. A prospective, non-interventional, multi-center study was performed among six Certified Breast Centers to analyze application of uPA/PAI-1 and consecutive decision-making. CTX avoided were identified and direct costs for CTX, CTX-related concomitant medication and febrile neutropenia (FN) prophylaxis with G-CSF calculated. In n = 93 breast cancers n = 35 CTX (37.6%) with 210 CTX cycles were avoided according to uPA/PAI-1 test result. uPA/PAI-1 testing saved direct medication costs for CTX of 177,453 €, CTX-related concomitant medication of 27,482 € and FN prophylaxis of 20,599 €, overall 225,534 €. At test costs at 287.50 € uPA/PAI-1 testing resulted in additional costs of 26,737.50 €. uPA/PAI-1 has proven to be cost-effective at a return-on-investment ratio of 8.4:1. Indirect cost savings further increase this ROI. These results support decision-making for cost-effective diagnostics and therapy in breast cancer. Copyright © 2013 Elsevier Ltd. All rights reserved.

Doctor, my child is bullied: food allergy management in schools.

PubMed

Egan, Maureen; Sicherer, Scott

2016-06-01

Studies suggest that food allergies have increased in prevalence, resulting in most school classrooms having more than one child affected. Children with food allergies are vulnerable for experiencing potentially life-threatening allergic reactions, as well as social consequences such as bullying. Management recommendations for food allergies in schools should incorporate knowledge of both issues. Current recommendations for food allergy management in schools focus on appropriate avoidance measures and prompt recognition and treatment of allergic reactions. Guidelines focus upon a school-wide approach, with comprehensive involvement of many stakeholders, but individual students require specific emergency action plans. Special risk groups include young children who need additional supervision and adolescents who may take risks. Based on the observation that anaphylaxis can occur in persons without a prior diagnosis, having epinephrine available for prompt first-aid management of any student in need is now recommended. To promote socialization, avoidance measures should minimize separation of children with food allergies from their peers. Parents and schools need to be aware of bullying and implement intervention and prevention measures. Management recommendations for food allergies in schools should ensure the safety of the child, address bullying, and avoid unnecessary isolation.

Ventilator-associated pneumonia management in critical illness.

PubMed

Albertos, Raquel; Caralt, Berta; Rello, Jordi

2011-03-01

Ventilator-associated pneumonia (VAP) is a frequent adverse event in the intensive care unit.We review recent publications about the management and prevention of VAP. The latest care bundles introduced standard interventions to facilitate implementation of evidence-based clinical guidelines and to improve the outcome of patients. Recent studies find that prevention management of ventilated patients decreases the risk of VAP. Enteral feeding, considered a risk factor for VAP, currently has been recommended, with appropriate administration, for all critical ill patients if no contraindications exist. In view of the recently available data, it can be concluded that the implementation of care bundles on the general management of ventilated patients in daily practice has reduced the VAP rates. The main pharmacological measures to prevent VAP are proper hands hygiene, high nurse-to-patient ratio, avoid unnecessary transfer of ventilated patients, use of noninvasive mechanical ventilation, shortening weaning period, avoid the use of nasal intubation, prevent bio-film deposition in endotracheal tube, aspiration of subglottic secretions, maintenance of adequate pressure of endotracheal cuffs, avoid manipulation of ventilator circuits, semi-recumbent position and adequate enteral feeding.In addition, updated guidelines incorporate more comprehensive diagnostic protocols to the evidence-based management of VAP.

Pharmacokinetic-pharmacodynamic (PK-PD) modeling and the rational selection of dosage regimes for the prudent use of antimicrobial drugs.

PubMed

Papich, Mark G

2014-07-16

One of the strategies to decrease inappropriate antimicrobial use in veterinary medicine is to apply pharmacokinetic-pharmacodynamic (PK-PD) principles to dosing regimens. If antimicrobials are used appropriately by applying these principles to attain targets for area-under-the-curve to MIC ratio (AUC/MIC), peak concentration to MIC ratio (CMAX/MIC), and time above MIC (T>MIC), more effective antibiotic therapy is possible, thus avoiding ineffective administration. Another mechanism whereby inappropriate antibiotic administration can be avoided is to use accurate Interpretive Criteria established by the Clinical Laboratory Standards Institute (CLSI) for breakpoint selection. Inaccurate breakpoints will encourage antibiotic administration that is likely to be ineffective. For newly approved antimicrobials, three criteria are used for determining breakpoints: PK-PD criteria, MIC distributions, and clinical response. For older (often generic drugs) evaluated by the CLSI, recent clinical data may not be available and breakpoints are derived from PK-PD principles, wild-type distributions, and Monte Carlo simulations. It is the goal of the CLSI subcommittee that these revised breakpoints will encourage more effective antimicrobial use and avoid unnecessary antimicrobial administration. Copyright © 2014 Elsevier B.V. All rights reserved.

Cytological Diagnosis of Primary Thyroid Tuberculosis.

PubMed

Goyal, P; Mittal, D; Ghosh, S; Agrawal, D; Sehgal, S; Singh, S

2015-01-01

Primary thyroid tuberculosis is an extremely rare disease, even in countries where other forms of tuberculosis are abundant. TT has no age bar but usually affects women in fourth and fifth decade. Hereby, we report a case of 16-years-old girl presented with complaint of progressively increasing, painful thyroid swelling. Diagnosis of TT was made on cytology and there was no evidence of involvement of any other organ by tuberculosis. Despite of its rarity, TT is usually misdiagnosed. So, a clinician should always consider this entity in the differential diagnosis of thyroid swelling. Fine needle aspiration cytology is the best diagnostic method and can result in the avoidance of unnecessary thyroid surgeries.

Delayed diagnosis of Alport syndrome without hematuria.

PubMed

Yin-Yin, Chen; You-Ming, Peng; Yu-Mei, Liang

2014-05-01

Alport syndrome is a progressive hereditary disease caused by mutations in the genes encoding type IV collagen. Persistent microscopic hematuria is the hallmark of Alport syndrome, occurring in almost all boys according to previous reports. We report the case of a 20-year-old man presented with proteinuria but no hematuria that was initially misdiagnosed with refractory nephrotic syndrome and was eventually diagnosed with Alport syndrome following kidney and skin biopsy. During the follow-up period, he experienced a rapid progression to end-stage renal disease. Timely diagnosis of Alport syndrome is important, because patients may benefit from early intervention and avoid suffering from unnecessary nephrotoxic drug use.

FORMATOMATIC: a program for converting diploid allelic data between common formats for population genetic analysis.

PubMed

Manoukis, Nicholas C

2007-07-01

There has been a great increase in both the number of population genetic analysis programs and the size of data sets being studied with them. Since the file formats required by the most popular and useful programs are variable, automated reformatting or conversion between them is desirable. formatomatic is an easy to use program that can read allelic data files in genepop, raw (csv) or convert formats and create data files in nine formats: raw (csv), arlequin, genepop, immanc/bayesass +, migrate, newhybrids, msvar, baps and structure. Use of formatomatic should greatly reduce time spent reformatting data sets and avoid unnecessary errors.

Two Cases of Transiently Elevated Serum CEA Levels in Severe Hypothyroidism without Goiter.

PubMed

Sekizaki, Tomonori; Yamamoto, Chiho; Nomoto, Hiroshi

2018-04-27

Carcinoembryonic antigen (CEA), the level of which is known to increase in both patients with gastrointestinal cancers and those with non-neoplastic conditions, is one of the most widely-used tumor markers. Hypothyroidism is a common endocrinological disorder in which CEA levels can rise, and is sometimes overlooked as a diagnosis in the absence of typical symptoms or thyroid enlargement. We report the cases of two patients with non-goiterous severe hypothyroidism with markedly elevated CEA levels that effectively decreased with levothyroxine replacement therapy alone. Hypothyroidism should be considered as an important cause of unexplained high serum CEA levels in order to avoid unnecessary medical examination.

Aberrant hepatic arterial anatomy and the whipple procedure: lessons learned.

PubMed

Chamberlain, Ronald S; El-Sedfy, Abraham; Rajkumar, Dhiraj

2011-05-01

Appreciation and study of hepatic arterial anatomical variability is essential to the performance of a pancreaticoduodenectomy to avoid surgical complications such as bleeding, hepatic ischemia/failure, and anastomotic leak/stricture. Awareness of this variability permits the surgeon to adapt the surgical technique to deal with anomalies identified preoperatively or intraoperatively thereby preventing unnecessary surgical morbidity and mortality. The objective of our study is to provide a comprehensive review of the anatomic arterial anomalies and discuss surgical strategies that will equip the surgeon to deal with all anomalies that may be encountered a priori or en passant during the course of a Whipple procedure.

Collagenous spherulosis presenting as a mass of the breast.

PubMed

Jan, Yee-Jee; Li, Mu-Chun; Ho, William L

2002-10-01

Collagenous spherulosis (CS) is a rare benign lesion which typically presents as an incidental microscopic finding accompanying other breast lesions. Pathologists who are not familiar with this entity occasionally misdiagnose CS as adenoid cystic carcinoma (ACC), cribriform ductal carcinoma in situ (C-DCIS), or atypical intraductal hyperplasia (AIH), especially when it presents as a mass. It is of utmost importance to differentiate benign CS from its malignant mimics in order to avoid unnecessary treatment. We report an unusual case of CS manifested as a mass in the right breast of a 45-year-old female and discuss the problems of differential diagnosis and histogenesis.

Bilateral optic disc drusen mimicking papilledema.

PubMed

Sahin, Alparslan; Cingü, Abdullah Kürşat; Ari, Seyhmus; Cinar, Yasin; Caça, Ihsan

2012-06-01

Optic disc drusen, which are calcified deposits that form anterior to the lamina cribrosa in the optic nerve, may mimic papilledema. We report herein three cases referred to us with suspicion of disc swelling and papilledema. Following ophthalmologic evaluation with B-scan ultrasound, red-free fundus photography, and computed tomography, the diagnosis of papilledema was excluded in all cases and optic disc drusen was diagnosed. Clinical suspicion of optic disc drusen in cases presenting with swelling of the optic nerve head is important in order to avoid unnecessary interventions and anxiety. The reported cases highlight the commonly encountered clinical presentations and the practical aspects of diagnosis and management of optic disc drusen.

Prenatal Diagnosis of Congenital Adrenal Hyperplasia.

PubMed

Yau, Mabel; Khattab, Ahmed; New, Maria I

2016-06-01

Congenital adrenal hyperplasia (CAH) owing to 21-hydroxylase deficiency is a monogenic disorder of adrenal steroidogenesis. To prevent genital ambiguity, in girls, prenatal dexamethasone treatment is administered early in the first trimester. Prenatal genetic diagnosis of CAH and fetal sex determination identify affected female fetuses at risk for genital virilization. Advancements in prenatal diagnosis are owing to improved understanding of the genetic basis of CAH and improved technology. Cloning of the CYP21A2 gene ushered in molecular genetic analysis as the current standard of care. Noninvasive prenatal diagnosis allows for targeted treatment and avoids unnecessary treatment of males and unaffected females. Copyright © 2016 Elsevier Inc. All rights reserved.

Teledermatology via a social networking web site: a pilot study between a general hospital and a rural clinic.

PubMed

Garcia-Romero, Maria Teresa; Prado, Fernanda; Dominguez-Cherit, Judith; Hojyo-Tomomka, Maria Teresa; Arenas, Roberto

2011-10-01

Teledermatology via a free public social networking Web site is a practical tool to provide attention to patients who do not have access to dermatologic care. In this pilot study, a general practitioner sent consults to a dermatology department at a general hospital via Facebook(®). Forty-four patients were seen and treatment was installed. We identified both simple-to-treat, common skin diseases and rare congenital diseases that require genetic counseling and more complex treatment. The majority of patients (75%) benefited with the diagnoses and treatments offered, thus avoiding unnecessary expenses or transportation to urban areas.

Another Setting for Stewardship: High Rate of Unnecessary Antimicrobial Use in a VA Long-Term Care Facility

PubMed Central

Peron, Emily P.; Hirsch, Amy A.; Jury, Lucy A.; Jump, Robin L.P.; Donskey, Curtis J.

2015-01-01

BACKGROUND/OBJECTIVE Antimicrobials are frequently prescribed in long-term care facilities (LTCFs). In order to develop effective stewardship interventions, there is a need for data on current patterns of unnecessary antimicrobial prescribing among LTCF residents. The objective of this study was to examine the frequency of, reasons for, and adverse effects of unnecessary antimicrobial use in our Veterans Affairs (VA) LTCF. DESIGN Retrospective chart review. SETTING Cleveland VA Medical Center LTCF. PARTICIPANTS Randomly selected patients receiving antimicrobial therapy from October 1, 2008 to March 31, 2009. MEASUREMENTS Days of necessary and unnecessary antimicrobial therapy determined using Infectious Diseases Society of America guidelines, syndromes treated with unnecessary antimicrobials, and the frequency of development of Clostridium difficile infection (CDI), colonization or infection with antimicrobial resistant pathogens, and other adverse effects. RESULTS Of 1351 days of therapy prescribed in 100 regimens, 575 days (42.5%) were deemed unnecessary. Of the 575 unnecessary days of therapy, 334 (58%) were for antimicrobial regimens that were entirely unnecessary (n=42). Asymptomatic bacteriuria was the most common reason for entirely unnecessary regimens (n=21), resulting in 173 days of unnecessary therapy. Regimens that were partially unnecessary resulted in 241 (42%) days of unnecessary therapy, with longer than recommended treatment duration accounting for 226 (94%) unnecessary days of therapy. Within 30 days of completing the antimicrobial regimens, 5 patients developed CDI, 5 had colonization or infection with antimicrobial-resistant pathogens, and 10 experienced other adverse drug events. CONCLUSIONS In our VA LTCF, 43% of all days of antimicrobial therapy were unnecessary. Our findings suggest that antimicrobial stewardship interventions in LTCFs should focus on improving adherence to recommended treatment durations and eliminating inappropriate treatment of asymptomatic bacteriuria. PMID:23405923

PUBLISHER'S NOTE: Microfabrication by localized electrochemical deposition: experimental investigation and theoretical modelling

NASA Astrophysics Data System (ADS)

Said, R. A.

2004-07-01

During 2003, Dr R A Said published essentially duplicate versions of a paper in two archival journals: Nanotechnology and the Journal of The Electrochemical Society. The papers in question were: `Microfabrication by localized electrochemical deposition: experimental investigation and theoretical modelling' (2003 Nanotechnology 14 523) and `Shape formation of microstructures fabricated by localized electrochemical deposition' (2003 J. Electrochem. Soc. 150 C549). The two papers were submitted, revised, and published at essentially the same time. The papers used the same figures and neither paper referenced the other. Nanotechnology requires a signed copyright-transfer form assigning copyright in articles published to Institute of Physics Publishing, and the Journal of The Electrochemical Society requires the same for The Electrochemical Society. It is a tradition of long standing, stated in the information for contributors, that submission implies that the work has not been submitted, copyrighted, or accepted for publication elsewhere. Hence, duplicate publication not only raises legal questions and represents a serious breach of scientific ethics, but also leads to an unnecessary imposition on readers', referees', and editors' time. We regard this infraction as a serious matter. An apology from the author for this grave error is printed below. Author's apology I have mistakenly published similar results in two manuscripts in Nanotechnology and in the Journal of The Electrochemical Society, as stated above. I am responsible for this error. I agree with the Editors that such a practice should not have occurred, and I would like to sincerely apologize to Nanotechnology and the Journal of The Electrochemical Society, their publishers, and their readers for this matter. I will take actions in the future to prevent the occurrence of similar incidents. R A Said

Cross-sectional investigation of drug-related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud.

PubMed

Wang, Hue-Yu; Yeh, Ming-Kung; Ho, Chung-Han; Hu, Ming-Kuan; Huang, Yaw-Bin

2017-01-01

To analyze and characterize data regarding the prevalence and types of outpatient drug-related problems (DRPs) found by clinical pharmacists after implementation of the Virtual Medicine Record in Cloud System (VMRCS). A cross-sectional study regarding outpatient pharmaceutical care was conducted at a medical center in Taiwan. Patients aged >20 years old with multiple chronic diseases and polypharmacy were enrolled. In Stage I (1 October-31 December 2014), patients received pharmaceutical care according to prescription data accessed online in the VMRCS. In Stage II (1 June-31 August 2015), the VMRCS were pre-download and arranged to the institute's required format, facilitated DRP detection. Clinical pharmacists then reviewed and evaluated the prescription data through pre-downloaded VMRCS. Overall, 1539 and 1600 prescriptions were evaluated in these two stages, respectively. DRPs were recorded using the Pharmaceutical Care Network Europe (PCNE)-DRP. DRPs were found for 50.2% of patients in Stage I and 55.2% in Stage II (p < 0.05) and were most frequently encountered for "Drugs for the cardiovascular system" and caused by "Inappropriate duplication of therapeutic group or active ingredient." In terms of problems, incidence of "Unnecessary drug treatment" was highest. Duplicate medications were most frequently seen for "Drugs for acid-related disorders." The efficiency to identify DRPs was at least 2.4 times higher with pre-downloaded prescription data than with real-time online queries. With VMRCS, DRPs were more easily identified whether patients received medical care in the same hospital or not. DRPs could be efficiently prevented through the use of pre-downloaded patient prescription data. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

WITHDRAWN: Inspiratory muscle training with threshold or incentive spirometry: Which is the most effective?

PubMed

Paiva, Dulciane Nunes; Assmann, Laíse Bender; Bordin, Diogo Fanfa; Gass, Ricardo; Jost, Renan Trevisan; Filho, Mario Bernardo; França, Rodrigo Alves; Cardoso, Dannuey Machado

2014-07-22

This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.05.005. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy. Copyright © 2014 Sociedade Portuguesa de Pneumologia. Publicado por Elsevier España, S.L.U. All rights reserved.

NASTRAN as a resource in code development

NASA Technical Reports Server (NTRS)

Stanton, E. L.; Crain, L. M.; Neu, T. F.

1975-01-01

A case history is presented in which the NASTRAN system provided both guidelines and working software for use in the development of a discrete element program, PATCHES-111. To avoid duplication and to take advantage of the wide spread user familiarity with NASTRAN, the PATCHES-111 system uses NASTRAN bulk data syntax, NASTRAN matrix utilities, and the NASTRAN linkage editor. Problems in developing the program are discussed along with details on the architecture of the PATCHES-111 parametric cubic modeling system. The system includes model construction procedures, checkpoint/restart strategies, and other features.

Avoid Ethical Misconduct in Manuscript Preparation.

PubMed

Hicks, Rodney W; Harris, Ruth

2016-01-01

In order for nurses and other health care professionals to make important contributions to the literature, there must be an awareness of the many areas where unintentional ethical conflicts can arise. Leading ethical concerns include plagiarism, duplicate submission, authorship standards, bias, and conflicts of interest. Although many sources are available on the variety of ethical concerns, this article takes the position to identify the area of concern and describe why it is an ethical violation. Solutions are posed for resolving the conflict, including why medical librarians can help in the publishing process.

Minimal acceptable care as a vital component to Missouri's trauma system.

PubMed

Helling, Thomas S

2002-07-01

Immediate attention to life-threatening injuries and expeditious transfer of major and complex wounds to tertiary care trauma centers are the cornerstones of any trauma system. Rapid assessment and "minimalization" of care should be the buzz-word of rural (Level III) and suburban (Level II) trauma centers in order to provide quickest treatment of injuries by timely referral of patients for definitive attention. This concept is called minimal acceptable care and may serve to improve patient outcome by reducing the interval to ultimate treatment and avoidance of duplication of services.

Men's preferences and trade-offs for prostate cancer screening: a discrete choice experiment.

PubMed

Howard, Kirsten; Salkeld, Glenn P; Patel, Manish I; Mann, Graham J; Pignone, Michael P

2015-12-01

Prostate cancer screening using prostate-specific antigen (PSA) remains controversial. In deciding about screening, men must weigh the benefits and harms: little is known about benefit: harm trade-offs men are willing to accept. The objective of this study was to assess men's preferences for PSA screening, and the trade-offs between benefits and harms men are willing to accept when deciding about screening. Preferences of 662 men aged 40-69 were assessed using a discrete choice experiment. PSA screening was described by six attributes: prostate cancer deaths, prostate cancer diagnoses, unnecessary biopsies from false-positive PSA tests, impotence, urinary incontinence/bowel problems and cost. A mixed logit model was used to examine the influence of attributes on men's preferences for PSA testing; benefit: harm trade-offs were also calculated. Men's preferences were significantly influenced by test characteristics, particularly potential mortality benefit, unnecessary biopsies and likelihood of urinary incontinence or bowel problems; preferences were also influenced by age, prior PSA testing experience and perceived risk of prostate cancer. Men were willing to accept between 65 and 233 of 10 000 extra men with unnecessary biopsies, and between 31 and 72 of 10 000 extra men with incontinence/bowel problems to avoid one prostate cancer death. Differences in valuations of attributes and trade-offs acceptable to men of different ages suggest a one size fits all approach to PSA testing, regardless of age, may not reflect men's preferences. Our results can be used by policymakers to ensure screening programmes are in line with men's preferences and by clinicians and patients to facilitate informed discussions of the most relevant benefits and downsides of PSA screening for an individual man. © 2014 John Wiley & Sons Ltd.

Teaching high-value, cost-conscious care to residents: the Alliance for Academic Internal Medicine–American College of Physicians Curriculum.

PubMed

Smith, Cynthia D

2012-08-21

Health care expenditures are projected to reach nearly 20% of the U.S. gross domestic product by 2020. Up to $765 billion of this spending has been identified as potentially avoidable; many of the avoidable costs have been attributed to unnecessary services. Postgraduate trainees have historically received little specific training in the stewardship of health care resources and minimal feedback on resource utilization and its effect on the cost of care. This article describes a new curriculum that was developed collaboratively by the Alliance for Academic Internal Medicine and the American College of Physicians to address this training gap. The curriculum introduces a simple, stepwise framework for delivering high-value care and focuses on teaching trainees to incorporate high-value, cost-conscious care principles into their clinical practice. It consists of ten 1-hour, case-based, interactive sessions designed to be flexibly incorporated into the existing conference structure of a residency training program.

Analysis of Compression Algorithm in Ground Collision Avoidance Systems (Auto-GCAS)

NASA Technical Reports Server (NTRS)

Schmalz, Tyler; Ryan, Jack

2011-01-01

Automatic Ground Collision Avoidance Systems (Auto-GCAS) utilizes Digital Terrain Elevation Data (DTED) stored onboard a plane to determine potential recovery maneuvers. Because of the current limitations of computer hardware on military airplanes such as the F-22 and F-35, the DTED must be compressed through a lossy technique called binary-tree tip-tilt. The purpose of this study is to determine the accuracy of the compressed data with respect to the original DTED. This study is mainly interested in the magnitude of the error between the two as well as the overall distribution of the errors throughout the DTED. By understanding how the errors of the compression technique are affected by various factors (topography, density of sampling points, sub-sampling techniques, etc.), modifications can be made to the compression technique resulting in better accuracy. This, in turn, would minimize unnecessary activation of A-GCAS during flight as well as maximizing its contribution to fighter safety.

Transcranial Doppler ultrasound in the diagnosis of brain death. Is it useful or does it delay the diagnosis?

PubMed

Escudero, D; Otero, J; Quindós, B; Viña, L

2015-05-01

Transcranial Doppler ultrasound is able to demonstrate cerebral circulatory arrest associated to brain death, being especially useful in sedated patients, or in those in which complete neurological exploration is not possible. Transcranial Doppler ulstrasound is a portable, noninvasive and high-availability technique. Among its limitations, mention must be made of the absence of acoustic windows and false-negative cases. In patients clinically diagnosed with brain death, with open skulls or with anoxia as the cause of death, cerebral blood flow can be observed by ultrasound, since cerebral circulatory arrest is not always synchronized to the clinical diagnosis. The diagnostic rate is therefore time-dependent, and this fact that must be recognized in order to avoid delays in death certification. Despite its limitations, transcranial Doppler ulstrasound helps solve common diagnostic problems, avoids the unnecessary consumption of resources, and can optimize organ harvesting for transplantation. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

On the Choice of Adequate Randomization Ranges for Limiting the Use of Unwanted Cues in Same-Different, Dual-Pair, and Oddity Tasks

PubMed Central

Dai, Huanping; Micheyl, Christophe

2010-01-01

A major concern when designing a psychophysical experiment is that participants may use another stimulus feature (“cue”) than that intended by the experimenter. One way to avoid this involves applying random variations to the corresponding feature across stimulus presentations, to make the “unwanted” cue unreliable. An important question facing experimenters who use this randomization (“roving”) technique is: How large should the randomization range be to ensure that participants cannot achieve a certain proportion correct (PC) by using the unwanted cue, while at the same time avoiding unnecessary interference of the randomization with task performance? Previous publications have provided formulas for the selection of adequate randomization ranges in yes-no and multiple-alternative, forced-choice tasks. In this article, we provide figures and tables, which can be used to select randomization ranges that are better suited to experiments involving a same-different, dual-pair, or oddity task. PMID:20139466

Network architecture for global biomedical monitoring service.

PubMed

Lopez-Casado, Carmen; Tejero-Calado, Juan; Bernal-Martin, Antonio; Lopez-Gomez, Miguel; Romero-Romero, Marco; Quesada, Guillermo; Lorca, Julio; Garcia, Eugenia

2005-01-01

Most of the patients who are in hospitals and, increasingly, patients controlled remotely from their homes, at-home monitoring, are continuously monitored in order to control their evolution. The medical devices used up to now, force the sanitary staff to go to the patients' room to control the biosignals that are being monitored, although in many cases, patients are in perfect conditions. If patient is at home, it is he or she who has to go to the hospital to take the record of the monitored signal. New wireless technologies, such as BlueTooth and WLAN, make possible the deployment of systems that allow the display and storage of those signals in any place where the hospital intranet is accessible. In that way, unnecessary displacements are avoided. This paper presents a network architecture that allows the identification of the biosignal acquisition device as IP network nodes. The system is based on a TCP/IP architecture which is scalable and avoids the deployment of a specific purpose network.

Vesico-vaginal fistula -- a major cause of unnecessary and avoidable suffering.

PubMed

1999-01-01

Vesico-vaginal fistula is a serious disability that can be experienced by women after childbirth. It is defined as a hole that develops between the vagina and the bladder, resulting in uncontrollable leaking of urine through the vagina. The most common cause of vesico-vaginal fistula is obstructed labor, early marriage, poverty, and women's limited control over the use of family resources. Women and girls with this disability are often abandoned by their husbands and isolated from the community due to the smell and associated shame of urine leakage. However, this type of disability can be avoided by changing the attitudes of the community to women. Better nutrition, delaying first pregnancy, using a partograph during labor, and the availability of emergency obstetric care can also reduce the likelihood of having the disability. But for those who already have this condition, understanding and support of husbands and the community is needed in order for them to be restored to good health.

[Developing a home care nursing information system by utilizing wire-wireless network and mobile computing system].

PubMed

Park, Jung-Ho; Park, Sung-Ae; Yoon, Soon-Nyoung; Kang, Sung-Rye

2004-04-01

The purpose of this study was to develop a home care nursing network system for operating home care effectively and efficiently by utilizing a wire-wireless network and mobile computing in order to record and send patients' data in real time, and by combining the headquarter office and the local offices with home care nurses over the Internet. It complements the preceding research from 1999 by adding home care nursing standard guidelines and upgrading the PDA program. Method/1 and Prototyping were adopted to develop the main network system. The detailed research process is as follows : 1)home care nursing standard guidelines for Diabetes, cancer and peritoneal-dialysis were added in 12 domains of nursing problem fields with nursing assessment/intervention algorithms. 2) complementing the PDA program was done by omitting and integrating the home care nursing algorithm path which is unnecessary and duplicated. Also, upgrading the PDA system was done by utilizing the machinery and tools where the PDA and the data transmission modem are integrated, CDMX-1X base construction, in order to reduce a transmission error or transmission failure.

LCS Master Console Event Message Reduction

NASA Technical Reports Server (NTRS)

Nguyen, Uyen

2014-01-01

System monitoring and control (SMC) message browsers receive so many messages daily that operators are unable to keep track all of them. Important messages are often mixed up among the less important ones. My job is to reduce the messages so that warning and emergency messages can be seen easily and therefore, responded promptly. There are multiple methods to achieve this. Firstly, messages that look the same should not appear many times in the message browser. Instead, the message should appear only once but with a number that counts the times that it appears. This method is called duplicate message suppression. Messages that display "normal" or "advisory" alarm level should be suppressed. Secondly, messages that update the most recent status of a system should replace the old-status messages. This method is called state based message correlation. Thirdly, some unnecessary messages should be sent straight to history after being displayed or not displayed at all. For an example, normal messages that are not a response to an operator's action should not be displayed. I also work on fixing messages that are not color-coded and formatted properly.

Origin and functional diversification of an amphibian defense peptide arsenal.

PubMed

Roelants, Kim; Fry, Bryan G; Ye, Lumeng; Stijlemans, Benoit; Brys, Lea; Kok, Philippe; Clynen, Elke; Schoofs, Liliane; Cornelis, Pierre; Bossuyt, Franky

2013-01-01

The skin secretion of many amphibians contains an arsenal of bioactive molecules, including hormone-like peptides (HLPs) acting as defense toxins against predators, and antimicrobial peptides (AMPs) providing protection against infectious microorganisms. Several amphibian taxa seem to have independently acquired the genes to produce skin-secreted peptide arsenals, but it remains unknown how these originated from a non-defensive ancestral gene and evolved diverse defense functions against predators and pathogens. We conducted transcriptome, genome, peptidome and phylogenetic analyses to chart the full gene repertoire underlying the defense peptide arsenal of the frog Silurana tropicalis and reconstruct its evolutionary history. Our study uncovers a cluster of 13 transcriptionally active genes, together encoding up to 19 peptides, including diverse HLP homologues and AMPs. This gene cluster arose from a duplicated gastrointestinal hormone gene that attained a HLP-like defense function after major remodeling of its promoter region. Instead, new defense functions, including antimicrobial activity, arose by mutation of the precursor proteins, resulting in the proteolytic processing of secondary peptides alongside the original ones. Although gene duplication did not trigger functional innovation, it may have subsequently facilitated the convergent loss of the original function in multiple gene lineages (subfunctionalization), completing their transformation from HLP gene to AMP gene. The processing of multiple peptides from a single precursor entails a mechanism through which peptide-encoding genes may establish new functions without the need for gene duplication to avoid adaptive conflicts with older ones.

Centralized Duplicate Removal Video Storage System with Privacy Preservation in IoT.

PubMed

Yan, Hongyang; Li, Xuan; Wang, Yu; Jia, Chunfu

2018-06-04

In recent years, the Internet of Things (IoT) has found wide application and attracted much attention. Since most of the end-terminals in IoT have limited capabilities for storage and computing, it has become a trend to outsource the data from local to cloud computing. To further reduce the communication bandwidth and storage space, data deduplication has been widely adopted to eliminate the redundant data. However, since data collected in IoT are sensitive and closely related to users' personal information, the privacy protection of users' information becomes a challenge. As the channels, like the wireless channels between the terminals and the cloud servers in IoT, are public and the cloud servers are not fully trusted, data have to be encrypted before being uploaded to the cloud. However, encryption makes the performance of deduplication by the cloud server difficult because the ciphertext will be different even if the underlying plaintext is identical. In this paper, we build a centralized privacy-preserving duplicate removal storage system, which supports both file-level and block-level deduplication. In order to avoid the leakage of statistical information of data, Intel Software Guard Extensions (SGX) technology is utilized to protect the deduplication process on the cloud server. The results of the experimental analysis demonstrate that the new scheme can significantly improve the deduplication efficiency and enhance the security. It is envisioned that the duplicated removal system with privacy preservation will be of great use in the centralized storage environment of IoT.

Prenatal and accurate perinatal diagnosis of type 2 H or ductular duplicate gallbladder.

PubMed

Maggi, Umberto; Farris, Giorgio; Carnevali, Alessandra; Borzani, Irene; Clerici, Paola; Agosti, Massimo; Rossi, Giorgio; Leva, Ernesto

2018-02-07

Double gallbladder is a rare biliary anomaly. Perinatal diagnosis of the disorder has been reported in only 6 cases, and in 5 of them the diagnosis was based on ultrasound imaging only. However, the ultrasound technique alone does not provide a sufficiently precise description of cystic ducts and biliary anatomy, an information that is crucial for a correct classification and for a possible future surgery. At 21 weeks of gestational age of an uneventful pregnancy in a 38 year old primipara mother, a routine ultrasound screening detected a biliary anomaly in the fetus suggestive of a double gallbladder. A neonatal abdominal ultrasonography performed on postnatal day 2 confirmed the diagnosis. On day 12 the newborn underwent a Magnetic Resonance Cholangiopancreatography (MRCP) that clearly characterized the anatomy of the anomaly: both gallbladders had their own cystic duct and both had a separate insertion in the main biliary duct. We report a case of early prenatal suspected duplicate gallbladder that was confirmed by a neonatal precise diagnosis of a Type 2, H or ductular duplicate gallbladder, using for the first time 3D images of Magnetic resonance cholangiopancreatography in a newborn. An accurate anatomical diagnosis is mandatory in patients undergoing a possible future cholecystectomy, to avoid surgical complications or reoperations. Therefore, in case of a perinatal suspicion of a double gallbladder, neonates should undergo a Magnetic resonance cholangiopancreatography. A review of the Literature about this variant is included.

Origin and Functional Diversification of an Amphibian Defense Peptide Arsenal

PubMed Central

Roelants, Kim; Fry, Bryan G.; Ye, Lumeng; Stijlemans, Benoit; Brys, Lea; Kok, Philippe; Clynen, Elke; Schoofs, Liliane; Cornelis, Pierre; Bossuyt, Franky

2013-01-01

The skin secretion of many amphibians contains an arsenal of bioactive molecules, including hormone-like peptides (HLPs) acting as defense toxins against predators, and antimicrobial peptides (AMPs) providing protection against infectious microorganisms. Several amphibian taxa seem to have independently acquired the genes to produce skin-secreted peptide arsenals, but it remains unknown how these originated from a non-defensive ancestral gene and evolved diverse defense functions against predators and pathogens. We conducted transcriptome, genome, peptidome and phylogenetic analyses to chart the full gene repertoire underlying the defense peptide arsenal of the frog Silurana tropicalis and reconstruct its evolutionary history. Our study uncovers a cluster of 13 transcriptionally active genes, together encoding up to 19 peptides, including diverse HLP homologues and AMPs. This gene cluster arose from a duplicated gastrointestinal hormone gene that attained a HLP-like defense function after major remodeling of its promoter region. Instead, new defense functions, including antimicrobial activity, arose by mutation of the precursor proteins, resulting in the proteolytic processing of secondary peptides alongside the original ones. Although gene duplication did not trigger functional innovation, it may have subsequently facilitated the convergent loss of the original function in multiple gene lineages (subfunctionalization), completing their transformation from HLP gene to AMP gene. The processing of multiple peptides from a single precursor entails a mechanism through which peptide-encoding genes may establish new functions without the need for gene duplication to avoid adaptive conflicts with older ones. PMID:23935531

Jaguar (Panthera onca Linnaeus, 1758) roadkill in Brazilian Atlantic Forest and implications for species conservation.

PubMed

Srbek-Araujo, A C; Mendes, S L; Chiarello, A G

2015-08-01

We report the roadkill of a jaguar in one of the longest highways in Brazil (BR-101), in the stretch where this road crosses one of the most important Atlantic Forest remnants in the country: the Linhares-Sooretama block. The jaguar population present in this area represents the very last in entire Espírito Santo state. There is an approved project to the lines duplication of the entire BR-101 Highway and the company responsible by the work has already started the first activities in the state. However, there is no environmental impact assessment already done neither planning for the implementation of measures to avoid or reduce the roadkill risk in the region. Thus, to minimize the impacts associated with the BR-101, we do not recommend its lines duplication along the 15 km stretch traversing the Linhares-Sooretama block. In addition, alternatively, we suggest the deviation of the current route of the BR-101 Highway or the construction of overpasses to fauna in the most critical points, interspersing these overpasses with electronic speed monitoring devices and warning and educational plates.

Robust Duplication with Comparison Methods in Microcontrollers

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

Quinn, Heather Marie; Baker, Zachary Kent; Fairbanks, Thomas D.

Commercial microprocessors could be useful computational platforms in space systems, as long as the risk is bound. Many spacecraft are computationally constrained because all of the computation is done on a single radiation-hardened microprocessor. It is possible that a commercial microprocessor could be used for configuration, monitoring and background tasks that are not mission critical. Most commercial microprocessors are affected by radiation, including single-event effects (SEEs) that could be destructive to the component or corrupt the data. Part screening can help designers avoid components with destructive failure modes, and mitigation can suppress data corruption. We have been experimenting with amore » method for masking radiation-induced faults through the software executing on the microprocessor. While triple-modular redundancy (TMR) techniques are very effective at masking faults in software, the increased amount of execution time to complete the computation is not desirable. Here in this article we present a technique for combining duplication with compare (DWC) with TMR that decreases observable errors by as much as 145 times with only a 2.35 time decrease in performance.« less

Robust Duplication with Comparison Methods in Microcontrollers

DOE PAGES

Quinn, Heather Marie; Baker, Zachary Kent; Fairbanks, Thomas D.; ...

2016-01-01

Commercial microprocessors could be useful computational platforms in space systems, as long as the risk is bound. Many spacecraft are computationally constrained because all of the computation is done on a single radiation-hardened microprocessor. It is possible that a commercial microprocessor could be used for configuration, monitoring and background tasks that are not mission critical. Most commercial microprocessors are affected by radiation, including single-event effects (SEEs) that could be destructive to the component or corrupt the data. Part screening can help designers avoid components with destructive failure modes, and mitigation can suppress data corruption. We have been experimenting with amore » method for masking radiation-induced faults through the software executing on the microprocessor. While triple-modular redundancy (TMR) techniques are very effective at masking faults in software, the increased amount of execution time to complete the computation is not desirable. Here in this article we present a technique for combining duplication with compare (DWC) with TMR that decreases observable errors by as much as 145 times with only a 2.35 time decrease in performance.« less

Can a Healthcare "Lean Sweep" Deliver on What Matters to Patients? Comment on "Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping".

PubMed

Verma, Jennifer Y; Amar, Claudia

2015-07-28

Disconnects and defects in care - such as duplication, poor integration between services or avoidable adverse events - are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects) and containing costs (eg, improving integration of services) as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim); and involve patients and families in co-designing new models of care that better address complex, longer-term health needs. © 2015 by Kerman University of Medical Sciences.

Allergic contact dermatitis to acrylates in disposable blue diathermy pads.

PubMed Central

Sidhu, S. K.; Shaw, S.

1999-01-01

We report 2 cases of elicitation of allergic contact dermatitis to acrylates from disposable blue diathermy pads used on patients who underwent routine surgery. Their reactions were severe, and took approximately 5 weeks to resolve. Both patients gave a prior history of finger tip dermatitis following the use of artificial sculptured acrylic nails, which is a common, but poorly reported, cause of acrylate allergy. Patch testing subsequently confirmed allergies to multiple acrylates present in both the conducting gel of disposable blue diathermy pads, and artificial sculptured acrylic nails. We advocate careful history taking prior to surgery to avoid unnecessary exposure to acrylates in patients already sensitized. Images Figure 1 Figure 2 PMID:10364952

Recurrence of primary extramedullary plasmacytoma in breast both simulating primary breast carcinoma

PubMed Central

Kaviani, Ahmad; Djamali-zavareie, Mansoor; Noparast, Maryam; Keyhani-Rofagha, Sedigheh

2004-01-01

Background Extramedullary myelomas (plasmacytoma) are malignant proliferations of plasma cells in the absence of bone involvement. When they occur in the soft tissue they usually involve the upper respiratory tract and oral cavity. Extramedullary plasmacytomas of breast are uncommon. Case presentation A 70 year-old woman with bilateral breast masses underwent excisional biopsy for suspected primary carcinoma that subsequently proved to be a recurrence from extramedullary plasmacytoma of the mediastinum. This was diagnosed and treated 5-years prior to appearance of breast lumps. Conclusion Though uncommon, considering the possibility of metastatic carcinoma and primary, secondary or recurrent lymphoproliferative disease presenting as a breast mass may avoid unnecessary surgeries. PMID:15339332

Pinworm infection masquerading as colorectal liver metastasis.

PubMed

Roberts, K J; Hubscher, S; Mangat, K; Sutcliffe, R; Marudanayagam, R

2012-09-01

Enterobius vermicularis is responsible for a variety of diseases but rarely affects the liver. Accurate characterisation of suspected liver metastases is essential to avoid unnecessary surgery. In the presented case, following a diagnosis of rectal cancer, a solitary liver nodule was diagnosed as a liver metastasis due to typical radiological features and subsequently resected. At pathological assessment, however, a necrotic nodule containing E. vermicularis was identified. Solitary necrotic nodules of the liver are usually benign but misdiagnosed frequently as malignant due to radiological features. It is standard practice to diagnose colorectal liver metastases solely on radiological evidence. Without obtaining tissue prior to liver resection, misdiagnosis of solitary necrotic nodules of the liver will continue to occur.

Pinworm infection masquerading as colorectal liver metastasis

PubMed Central

Roberts, KJ; Hubscher, S; Mangat, K; Sutcliffe, R; Marudanayagam, R

2012-01-01

Enterobius vermicularis is responsible for a variety of diseases but rarely affects the liver. Accurate characterisation of suspected liver metastases is essential to avoid unnecessary surgery. In the presented case, following a diagnosis of rectal cancer, a solitary liver nodule was diagnosed as a liver metastasis due to typical radiological features and subsequently resected. At pathological assessment, however, a necrotic nodule containing E vermicularis was identified. Solitary necrotic nodules of the liver are usually benign but misdiagnosed frequently as malignant due to radiological features. It is standard practice to diagnose colorectal liver metastases solely on radiological evidence. Without obtaining tissue prior to liver resection, misdiagnosis of solitary necrotic nodules of the liver will continue to occur. PMID:22943320

Enterobius Vermicularis-Associated Pelvic Inflammatory Disease in a Child.

PubMed

Mentessidou, Anastasia; Theocharides, Constantine; Patoulias, Ioannis; Panteli, Christina

2016-04-01

Enterobius vermicularis is the most highly prevalent intestinal worm in childhood and is generally considered of low pathogenicity. Little is known about the inflammatory complications of the female genital tract induced by E. vermicularis in childhood. A case of E. vermicularis-associated pelvic inflammatory disease with right salpingitis mimicking acute abdomen due to appendicitis in an 11-year-old girl is presented. E. vermicularis-related pelvic inflammatory disease should be included in the differential diagnosis of abdominal pain in children. Increased awareness is necessary to avoid an unnecessary surgery and to choose the correct antibiotic treatment. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Beyond the Golden Hours: Caring for Septic Patients After the Initial Resuscitation.

PubMed

Gelinas, Jean P; Walley, Keith R

2016-06-01

Recognition and management of agitation, delirium, and pain are key areas. Reduced use of sedatives is an important measure that must be coupled with increased patient engagement, mobilization, and exercise. Use of low tidal volumes and low mean airway pressures during mechanical ventilation is helpful. A key hemodynamic principle following early aggressive volume resuscitation is subsequent careful assessment to avoid unnecessary additional volume administration and adverse consequences of frank volume overload. Substantial evidence now supports a lower hemoglobin transfusion threshold of 7 g/dL. A rush to initiate enteral or parenteral feeds is not clearly supported by the current evidence. Copyright © 2016 Elsevier Inc. All rights reserved.

Practical pulse engineering: Gradient ascent without matrix exponentiation

NASA Astrophysics Data System (ADS)

Bhole, Gaurav; Jones, Jonathan A.

2018-06-01

Since 2005, there has been a huge growth in the use of engineered control pulses to perform desired quantum operations in systems such as nuclear magnetic resonance quantum information processors. These approaches, which build on the original gradient ascent pulse engineering algorithm, remain computationally intensive because of the need to calculate matrix exponentials for each time step in the control pulse. In this study, we discuss how the propagators for each time step can be approximated using the Trotter-Suzuki formula, and a further speedup achieved by avoiding unnecessary operations. The resulting procedure can provide substantial speed gain with negligible costs in the propagator error, providing a more practical approach to pulse engineering.

Recognition of Similar Shaped Handwritten Marathi Characters Using Artificial Neural Network

NASA Astrophysics Data System (ADS)

Jane, Archana P.; Pund, Mukesh A.

2012-03-01

The growing need have handwritten Marathi character recognition in Indian offices such as passport, railways etc has made it vital area of a research. Similar shape characters are more prone to misclassification. In this paper a novel method is provided to recognize handwritten Marathi characters based on their features extraction and adaptive smoothing technique. Feature selections methods avoid unnecessary patterns in an image whereas adaptive smoothing technique form smooth shape of charecters.Combination of both these approaches leads to the better results. Previous study shows that, no one technique achieves 100% accuracy in handwritten character recognition area. This approach of combining both adaptive smoothing & feature extraction gives better results (approximately 75-100) and expected outcomes.

Fluorescence-Guided Surgery

PubMed Central

Nagaya, Tadanobu; Nakamura, Yu A.; Choyke, Peter L.; Kobayashi, Hisataka

2017-01-01

Surgical resection of cancer remains an important treatment modality. Despite advances in preoperative imaging, surgery itself is primarily guided by the surgeon’s ability to locate pathology with conventional white light imaging. Fluorescence-guided surgery (FGS) can be used to define tumor location and margins during the procedure. Intraoperative visualization of tumors may not only allow more complete resections but also improve safety by avoiding unnecessary damage to normal tissue which can also reduce operative time and decrease the need for second-look surgeries. A number of new FGS imaging probes have recently been developed, complementing a small but useful number of existing probes. In this review, we describe current and new fluorescent probes that may assist FGS. PMID:29312886

Pseudo-hemothorax at computed tomography due to residual contrast media.

PubMed

Romero, Matías; Bächler, Pablo

2014-01-01

Pleural effusion is a clinical problem that has many causes, with hemothorax being one of them. Computed tomography readily characterizes pleural fluid with determination of the attenuation value, helping to distinguish hemothorax from other types of effusion. Herein, we report the case of a 67-year-old man with end-stage renal disease in which a high-density pleural effusion due to residual contrast media was misinterpreted as hemothorax. Radiologists should consider the possibility of contrast media retention when interpreting a high-density pleural effusion in patients with end-stage renal disease. Recognition of this entity is crucial to avoid misdiagnosis, which might lead to unnecessary testing or procedures. Copyright © 2014 Elsevier Inc. All rights reserved.

[Fever, atrial fibrillation, and angina pectoris in a 58-year-old man].

PubMed

Groebner, M; Südhoff, T; Doering, M; Kirmayer, M; Nitsch, T; Prügl, L; Römer, W; Wolf, H; Tacke, J; Massoudy, P; Nüsse, T; Elsner, D

2014-05-01

Primary cardiac lymphoma (PCL) respresents a very rare type of cardiac tumour. This report illustrates a case of PCL in an immunocompetent 58-year-old man presenting with atrial fibrillation and febrile syndrome. Comprehensive imaging [computer tomography (CT), cardiac magnetic resonance imaging (cMRI), 3-dimensional transesophageal echocardiography (3D-TEE)] identified a large right atrial tumour, leading to pericardial effusion. Isolated cardiac involvement was confirmed by positron emission tomography (PET)-CT. A diffuse large B-cell lymphoma (DLBCL) was diagnosed based on the results of a TEE-guided biopsy. A normalized PET scan (PETAL study) indicated complete remission following R-CHOP 14 immunochemotherapy. Thus, an interdisciplinary and multimodal approach avoided unnecessary cardiac surgery.

Diaphragmatic Myopotential Oversensing Caused by Change in Implantable Cardioverter Defibrillator Sensing Bandpass Filter.

PubMed

Ploux, Sylvain; Swerdlow, Charles D; Eschalier, Romain; Monteil, Benjamin; Ouali, Sana; Haïssaguerre, Michel; Bordachar, Pierre

2016-07-01

Diaphragmatic myopotential oversensing (DMO) causes inhibition of pacing and inappropriate detection of ventricular fibrillation in implantable cardioverter defibrillators (ICDs). It occurs almost exclusively with integrated bipolar leads and is extremely rare with dedicated bipolar leads. If DMO cannot be corrected by reducing programmed sensitivity, ventricular lead revision is often required. The new Low Frequency Attenuation (LFA) filter in St. Jude Medical ICDs (St. Jude Medical, Sylmar, CA, USA) alters the sensing bandpass to reduce T-wave oversensing. This paper aims to present the LFA filter as a reversible cause of DMO. Unnecessary lead revision can be avoided by the simple programming solution of deactivating this LFA filter. ©2016 Wiley Periodicals, Inc.

Circumventing photodamage in live-cell microscopy

PubMed Central

Magidson, Valentin; Khodjakov, Alexey

2013-01-01

Fluorescence microscopy has become an essential tool in cell biology. This technique allows researchers to visualize the dynamics of tissue, cells, individual organelles and macromolecular assemblies inside the cell. Unfortunately, fluorescence microscopy is not completely ‘non-invasive’ as the high-intensity excitation light required for excitation of fluorophores is inherently toxic for live cells. Physiological changes induced by excessive illumination can lead to artifacts and abnormal responses. In this chapter we review major factors that contribute to phototoxicity and discuss practical solutions for circumventing photodamage. These solutions include the proper choice of image acquisition parameters, optimization of filter sets, hardware synchronization, and the use of intelligent illumination to avoid unnecessary light exposure. PMID:23931522

Two models for identification and predicting behaviour of an induction motor system

NASA Astrophysics Data System (ADS)

Kuo, Chien-Hsun

2018-01-01

System identification or modelling is the process of building mathematical models of dynamical systems based on the available input and output data from the systems. This paper introduces system identification by using ARX (Auto Regressive with eXogeneous input) and ARMAX (Auto Regressive Moving Average with eXogeneous input) models. Through the identified system model, the predicted output could be compared with the measured one to help prevent the motor faults from developing into a catastrophic machine failure and avoid unnecessary costs and delays caused by the need to carry out unscheduled repairs. The induction motor system is illustrated as an example. Numerical and experimental results are shown for the identified induction motor system.

When should computed tomography angiography of pulmonary vessels be done in patients with low clinical probability of acute pulmonary embolism?

PubMed

Ródenas Quiñonero, I; Plasencia Martínez, J M; García Santos, J M

2018-02-24

When the probability of pulmonary embolism is low, the decision to do a computed tomography angiography (CTA) of the pulmonary vessels is based on the D-dimer concentration. However, excessive dependence on this parameter can result in unnecessary imaging studies, inappropriate treatment, or an inappropriate increase in the estimated probability of venous thromboembolism developing. The main objective of this study was to determine when CTA of pulmonary vessels could be avoided in patients with low clinical probability of pulmonary embolism through an efficient literature search of studies published about this question. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Summary of lightning activities by NASA for the Apollo Soyuz test project: Supplement no. 1 to Apollo Soyuz mission evaluation report

NASA Technical Reports Server (NTRS)

1976-01-01

To avoid the possibility of an unnecessary launch delay, a special program was initiated to provide aircraft measurement of electric fields at various altitudes over the Apollo vehicle launch pad. Eight aircraft, each equipped with electric field meters, were used in the program. This program and some of the more important findings are discussed. Also included is a summary of the history of manned space vehicle involvement with lightning, a brief description of the lightning instrumentation in use at KSC (Kennedy Space Center) at the time of the Apollo Soyuz mission and a discussion of the airborne instrumentation and related data.

A Fast MAC-Layer Handover for an IEEE 802.16e-Based WMAN

NASA Astrophysics Data System (ADS)

Ray, Sayan K.; Pawlikowski, Krzysztof; Sirisena, Harsha

We propose a modification of the IEEE 802.16e hard handover (HHO) procedure, which significantly reduces the handover latency constraint of the original HHO procedure in IEEE 802.16e networks. It allows a better handling of the delay-sensitive traffic by avoiding unnecessary time-consuming scanning and synchronization activity as well as simplifies the network re-entry procedure. With the help of the backhaul network, it reduces the number of control messages in the original handover policy, making the handover latency acceptable also for real-time streaming traffic. Preliminary performance evaluation studies show that the modified handover procedure is able to reduce the total handover latency by about 50%.

Bilateral Optic Disc Drusen Mimicking Papilledema

PubMed Central

Cingü, Abdullah Kürşat; Ari, Şeyhmus; Çinar, Yasin; Çaça, İhsan

2012-01-01

Background Optic disc drusen, which are calcified deposits that form anterior to the lamina cribrosa in the optic nerve, may mimic papilledema. Case Report We report herein three cases referred to us with suspicion of disc swelling and papilledema. Following ophthalmologic evaluation with B-scan ultrasound, red-free fundus photography, and computed tomography, the diagnosis of papilledema was excluded in all cases and optic disc drusen was diagnosed. Conclusions Clinical suspicion of optic disc drusen in cases presenting with swelling of the optic nerve head is important in order to avoid unnecessary interventions and anxiety. The reported cases highlight the commonly encountered clinical presentations and the practical aspects of diagnosis and management of optic disc drusen. PMID:22787500

IgG4-related disease presenting with destructive sinonasal lesion mimicking malignancy.

PubMed

Chen, Bo-Nien

2016-11-01

IgG4-related disease is a newly recognized systemic fibroinflammatory disorder. We report a 36-year-old man who presented with intractable right nasal pain and frontal headache for 1 month. Computed tomography revealed an ill-defined lesion with bony erosion over the right anterior ethmoid sinus and middle turbinate. The lesion was resected through endoscopic anterior ethmoidectomy and middle turbinectomy. IgG4-related disease was definitively diagnosed according to histopathological features. Prednisolone was administered postoperatively. IgG4-related disease presenting with destructive sinonasal lesion mimicking malignancy is rare. Awareness is essential to avoid delayed diagnosis or unnecessary invasive intervention, because the disorder responds to glucocorticoid and immunosuppressant therapy.

[Up-to-date research for clinical application in breast cancer].

PubMed

Koyama, Hiroki

2006-03-01

Breast cancer is still increasing in number of patients affected annually, with a peak incidence between 40-50 years of age. Various researches to control the disease have been attracting much attention scientifically and socially. Clinical application of trastuzumab (Herceptin), sentinel node biopsy to avoid unnecessary axillary dissection and individualized use of chemo-endocrine therapy as indicated by large scale clinical trials are among the recent successful results by pre-clinical and early clinical studies. In this context, the present special edition deals with articles on recent progress in breast cancer researches by leading scientists in this field. Hoping readers to understand, digest, and also to be stimulated by the updates for daily clinical practice.

Generalized likelihood ratios for quantitative diagnostic test scores.

PubMed

Tandberg, D; Deely, J J; O'Malley, A J

1997-11-01

The reduction of quantitative diagnostic test scores to the dichotomous case is a wasteful and unnecessary simplification in the era of high-speed computing. Physicians could make better use of the information embedded in quantitative test results if modern generalized curve estimation techniques were applied to the likelihood functions of Bayes' theorem. Hand calculations could be completely avoided and computed graphical summaries provided instead. Graphs showing posttest probability of disease as a function of pretest probability with confidence intervals (POD plots) would enhance acceptance of these techniques if they were immediately available at the computer terminal when test results were retrieved. Such constructs would also provide immediate feedback to physicians when a valueless test had been ordered.

Flux splitting algorithms for two-dimensional viscous flows with finite-rate chemistry

NASA Technical Reports Server (NTRS)

Shuen, Jian-Shun; Liou, Meng-Sing

1989-01-01

The Roe flux difference splitting method was extended to treat 2-D viscous flows with nonequilibrium chemistry. The derivations have avoided unnecessary assumptions or approximations. For spatial discretization, the second-order Roe upwind differencing is used for the convective terms and central differencing for the viscous terms. An upwind-based TVD scheme is applied to eliminate oscillations and obtain a sharp representation of discontinuities. A two-state Runge-Kutta method is used to time integrate the discretized Navier-Stokes and species transport equations for the asymptotic steady solutions. The present method is then applied to two types of flows: the shock wave/boundary layer interaction problems and the jet in cross flows.

Flux splitting algorithms for two-dimensional viscous flows with finite-rate chemistry

NASA Technical Reports Server (NTRS)

Shuen, Jian-Shun; Liou, Meng-Sing

1989-01-01

The Roe flux-difference splitting method has been extended to treat two-dimensional viscous flows with nonequilibrium chemistry. The derivations have avoided unnecessary assumptions or approximations. For spatial discretization, the second-order Roe upwind differencing is used for the convective terms and central differencing for the viscous terms. An upwind-based TVD scheme is applied to eliminate oscillations and obtain a sharp representation of discontinuities. A two-stage Runge-Kutta method is used to time integrate the discretized Navier-Stokes and species transport equations for the asymptotic steady solutions. The present method is then applied to two types of flows: the shock wave/boundary layer interaction problems and the jet in cross flows.

Using quantum theory to simplify input-output processes

NASA Astrophysics Data System (ADS)

Thompson, Jayne; Garner, Andrew J. P.; Vedral, Vlatko; Gu, Mile

2017-02-01

All natural things process and transform information. They receive environmental information as input, and transform it into appropriate output responses. Much of science is dedicated to building models of such systems-algorithmic abstractions of their input-output behavior that allow us to simulate how such systems can behave in the future, conditioned on what has transpired in the past. Here, we show that classical models cannot avoid inefficiency-storing past information that is unnecessary for correct future simulation. We construct quantum models that mitigate this waste, whenever it is physically possible to do so. This suggests that the complexity of general input-output processes depends fundamentally on what sort of information theory we use to describe them.

[Minilaparoscopy in penetrating abdominal trauma emergency room procedure with local anesthesia].

PubMed

Ariel, Peralta; Sebastián, Vélez; Sergio, Locicero; Nicolini, Francisco Florez

2007-01-01

There are a number of unnecessary laparotomies in penetrating trauma, with a non worthless percentage of complications. When the peritoneal injury is identified, surgical exploration of the abdomen should be evaluated. Evaluate the penetration of the peritoneum, using a diagnose method with direct vision. Hospital de Urgencias de Córdoba. Trauma Hospital. To evidence peritoneum trespassing, laparoscopy was performed with local anaesthesia in patients with penetrating abdominal trauma without signs of abdominal injury in the imaging methods and doubts in the physical examination, in a prospective setting. Patient with penetrating abdominal trauma, treated between May 2004 to January 2005, with doubtful diagnose of peritoneal violation. Under sedation and local anaesthesia, a 5 millimetres laparoscope with 90 degrees vision was placed at umbilicus. The anterior abdominal wall, flanks and diaphragm were exanimate, looking for the peritoneal wound or free fluid. Laparotomy could be avoided in four patients. In the four remaining, laparoscopy or conventional surgery was performed. Two presented hollow viscera injury, one hemoperitoneo and the other, minimum liver damage. There were not complications in both groups. The average hospital stay of the first group was 13 hours. In selected patients, the minilaparoscopy is useful in decreased the percentage of unnecessary laparotomies and general anaesthesia, and its complications.

Splenic syndrome in patients at high altitude with unrecognized sickle cell trait: splenectomy is often unnecessary.

PubMed

Sheikha, Anwar

2005-10-01

The health risks associated with sickle cell trait are minimal in this sizable sector of the world's population, and many of these patients have no information about their sickle cell status. Splenic syndrome at high altitude is well known to be associated with sickle cell trait, and unless this complication is kept in mind these patients may be subjected to unnecessary surgery when they present with altitude-induced acute abdomen. Four patients were admitted to the surgical ward with a similar complaint of acute severe left upper abdominal pain after arrival to the mountainous resort city of Abha, Saudi Arabia. All were subjected to splenectomy because of lack of suspicion regarding sickle cell status. Histologic examination of the spleen showed all patients had sickle cells in the red pulp. On further assessment all were found to have sickle cell trait with splenic infarction. In a similar study of 6 patients with known sickle cell disease who had comparable problems when they travelled to the Colorado mountains, all made an uncomplicated recovery with conservative management. In ethnically vulnerable patients with splenic syndrome, sickle cell trait should be ruled out before considering splenectomy. These patients could respond well to supportive management, and splenectomy would be avoided.

The self-adjusting file (SAF) system: An evidence-based update.

PubMed

Metzger, Zvi

2014-09-01

Current rotary file systems are effective tools. Nevertheless, they have two main shortcomings: They are unable to effectively clean and shape oval canals and depend too much on the irrigant to do the cleaning, which is an unrealistic illusionThey may jeopardize the long-term survival of the tooth via unnecessary, excessive removal of sound dentin and creation of micro-cracks in the remaining root dentin. The new Self-adjusting File (SAF) technology uses a hollow, compressible NiTi file, with no central metal core, through which a continuous flow of irrigant is provided throughout the procedure. The SAF technology allows for effective cleaning of all root canals including oval canals, thus allowing for the effective disinfection and obturation of all canal morphologies. This technology uses a new concept of cleaning and shaping in which a uniform layer of dentin is removed from around the entire perimeter of the root canal, thus avoiding unnecessary excessive removal of sound dentin. Furthermore, the mode of action used by this file system does not apply the machining of all root canals to a circular bore, as do all other rotary file systems, and does not cause micro-cracks in the remaining root dentin. The new SAF technology allows for a new concept in cleaning and shaping root canals: Minimally Invasive 3D Endodontics.

Looking for trouble? Diagnostics expanding disease and producing patients.

PubMed

Hofmann, Bjørn

2018-05-23

Novel tests give great opportunities for earlier and more precise diagnostics. At the same time, new tests expand disease, produce patients, and cause unnecessary harm in overdiagnosis and overtreatment. How can we evaluate diagnostics to obtain the benefits and avoid harm? One way is to pay close attention to the diagnostic process and its core concepts. Doing so reveals 3 errors that expand disease and increase overdiagnosis. The first error is to decouple diagnostics from harm, eg, by diagnosing insignificant conditions. The second error is to bypass proper validation of the relationship between test indicator and disease, eg, by introducing biomarkers for Alzheimer's disease before the tests are properly validated. The third error is to couple the name of disease to insignificant or indecisive indicators, eg, by lending the cancer name to preconditions, such as ductal carcinoma in situ. We need to avoid these errors to promote beneficial testing, bar harmful diagnostics, and evade unwarranted expansion of disease. Accordingly, we must stop identifying and testing for conditions that are only remotely associated with harm. We need more stringent verification of tests, and we must avoid naming indicators and indicative conditions after diseases. If not, we will end like ancient tragic heroes, succumbing because of our very best abilities. © 2018 John Wiley & Sons, Ltd.

An evaluation of the benefits and challenges of video consulting between general practitioners and residential aged care facilities.

PubMed

Wade, Victoria; Whittaker, Frank; Hamlyn, Jeremy

2015-12-01

This research evaluated a project that provided video consultations between general practitioners (GPs) and residential aged care facilities (RACFs), with the aim of enabling faster access to medical care and avoidance of unnecessary hospital transfers. GPs were paid for video consultations at a rate equivalent to existing insurance reimbursement for supporting telehealth services. Evaluation data were gathered by direct observation at the project sites, semi-structured interviews and video call data from the technical network. Three pairs of general practices and RACFs were recruited to the project. 40 video consultations eligible for payment occurred over a 6 month period, three of which were judged to have avoided hospital attendance. The process development and change management aspects of the project required substantially more effort than was anticipated. This was due to problems with RACF technical infrastructure, the need for repeated training and awareness raising in RACFs, the challenge of establishing new clinical procedures, the short length of the project and broader difficulties in the relationships between GPs and RACFs. Video consulting between GPs and RACFs was clinically useful and avoided hospital attendance on a small scale, but further focus on process development is needed to embed this as a routine method of service delivery. © The Author(s) 2015.

Numerical determination of partial spectrum of Hermitian matrices using a Lánczos method with selective reorthogonalization

NASA Astrophysics Data System (ADS)

Johnson, Chris; Kennedy, A. D.

2013-03-01

We introduce a new algorithm for finding the eigenvalues and eigenvectors of Hermitian matrices within a specified region, based upon the LANSO algorithm of Parlett and Scott. It uses selective reorthogonalization to avoid the duplication of eigenpairs in finite-precision arithmetic, but uses a new bound to decide when such reorthogonalization is required, and only reorthogonalizes with respect to eigenpairs within the region of interest. We investigate its performance for the Hermitian Wilson-Dirac operator γ5D in lattice quantum chromodynamics, and compare it with previous methods.

Minimalism through intraoperative functional mapping.

PubMed

Berger, M S

1996-01-01

Intraoperative stimulation mapping may be used to avoid unnecessary risk to functional regions subserving language and sensori-motor pathways. Based on the data presented here, language localization is variable in the entire population, with only certainty existing for the inferior frontal region responsible for motor speech. Anatomical landmarks such as the anterior temporal tip for temporal lobe language sites and the posterior aspect of the lateral sphenoid wing for the frontal lobe language zones are unreliable in avoiding postoperative aphasias. Thus, individual mapping to identify essential language sites has the greatest likelihood of avoiding permanent deficits in naming, reading, and motor speech. In a similar approach, motor and sensory pathways from the cortex and underlying white matter may be reliably stimulated and mapped in both awake and asleep patients. Although these techniques require an additional operative time and equipment nominally priced, the result is often gratifying, as postoperative morbidity has been greatly reduced in the process of incorporating these surgical strategies. The patients quality of life is improved in terms of seizure control, with or without antiepileptic drugs. This avoids having to perform a second costly operative procedure, which is routinely done when extraoperative stimulation and recording is done via subdural grids. In addition, an aggressive tumor resection at the initial operation lengthens the time to tumor recurrence and often obviates the need for a subsequent reoperation. Thus, intraoperative functional mapping may be best alluded to as a surgical technique that results in "minimalism in the long term".

Re-evaluating the relationships among filtering activity, unnecessary storage, and visual working memory capacity.

PubMed

Emrich, Stephen M; Busseri, Michael A

2015-09-01

The amount of task-irrelevant information encoded in visual working memory (VWM), referred to as unnecessary storage, has been proposed as a potential mechanism underlying individual differences in VWM capacity. In addition, a number of studies have provided evidence for additional activity that initiates the filtering process originating in the frontal cortex and basal ganglia, and is therefore a crucial step in the link between unnecessary storage and VWM capacity. Here, we re-examine data from two prominent studies that identified unnecessary storage activity as a predictor of VWM capacity by directly testing the implied path model linking filtering-related activity, unnecessary storage, and VWM capacity. Across both studies, we found that unnecessary storage was not a significant predictor of individual differences in VWM capacity once activity associated with filtering was accounted for; instead, activity associated with filtering better explained variation in VWM capacity. These findings suggest that unnecessary storage is not a limiting factor in VWM performance, whereas neural activity associated with filtering may play a more central role in determining VWM performance that goes beyond preventing unnecessary storage.

Model-based high-throughput design of ion exchange protein chromatography.

PubMed

Khalaf, Rushd; Heymann, Julia; LeSaout, Xavier; Monard, Florence; Costioli, Matteo; Morbidelli, Massimo

2016-08-12

This work describes the development of a model-based high-throughput design (MHD) tool for the operating space determination of a chromatographic cation-exchange protein purification process. Based on a previously developed thermodynamic mechanistic model, the MHD tool generates a large amount of system knowledge and thereby permits minimizing the required experimental workload. In particular, each new experiment is designed to generate information needed to help refine and improve the model. Unnecessary experiments that do not increase system knowledge are avoided. Instead of aspiring to a perfectly parameterized model, the goal of this design tool is to use early model parameter estimates to find interesting experimental spaces, and to refine the model parameter estimates with each new experiment until a satisfactory set of process parameters is found. The MHD tool is split into four sections: (1) prediction, high throughput experimentation using experiments in (2) diluted conditions and (3) robotic automated liquid handling workstations (robotic workstation), and (4) operating space determination and validation. (1) Protein and resin information, in conjunction with the thermodynamic model, is used to predict protein resin capacity. (2) The predicted model parameters are refined based on gradient experiments in diluted conditions. (3) Experiments on the robotic workstation are used to further refine the model parameters. (4) The refined model is used to determine operating parameter space that allows for satisfactory purification of the protein of interest on the HPLC scale. Each section of the MHD tool is used to define the adequate experimental procedures for the next section, thus avoiding any unnecessary experimental work. We used the MHD tool to design a polishing step for two proteins, a monoclonal antibody and a fusion protein, on two chromatographic resins, in order to demonstrate it has the ability to strongly accelerate the early phases of process development. Copyright © 2016 Elsevier B.V. All rights reserved.

Humanised care and a change in practice in a hospital in Benin.

PubMed

Fujita, Noriko; Perrin, Xavier R; Vodounon, Joséf A; Gozo, Michel K; Matsumoto, Yasuyo; Uchida, Sanae; Sugiura, Yasuo

2012-08-01

to describe the process of introduction and implementation of humanised care (humanised childbirth); to determine how the practice of humanised care affects midwives, obstetricians, and other service providers in the hospital; and to determine the factors influencing the change in practice. a qualitative study with grounded theory approach. A semi-structured, in-depth individual interview was conducted for data collection with open coding and a constant comparative analysis until the saturation of concepts. mothers' and children's hospital functioning as a top referral centre in Benin. 16 hospital staff, including 6 midwives. humanised care was initiated by midwives with hesitation and difficulties. Midwives and obstetricians learned that a supportive environment for women could produce a positive birth outcome without medication. Communication between the midwives and women and their families improved with a higher level of appreciation of the care provided by the midwives among the women and their families. Humanised care appears to affect the professional value of midwives, their levels of job satisfaction, and their personal motivation for work towards improving their performance. A positive influence on obstetricians and other staff was observed. These individuals were inspired to make changes in hospital culture to improve care, to avoid unnecessary interventions, and to improve communication. Important factors in achieving favourable results were the leadership and commitment of the hospital management team and the recognition and support they extended towards the hospital staff, especially the midwives. a system of humanised care that stresses improved communication between the women giving birth, their families, and care providers, based on respect for women's dignity and liberty, and avoidance of unnecessary intervention can be promoted with proper managerial support. This system can promote favourable changes in hospital practice, which are helpful in motivating midwives in resource-limited settings. Copyright © 2011 Elsevier Ltd. All rights reserved.

Comparison of Various Methods in the Diagnosis of Entamoeba histolytica in Stool and Serum Specimens

PubMed Central

Uslu, Hakan; Aktas, Osman; Uyanik, Muhammet Hamidullah

2016-01-01

Objective: Entamoeba histolytica is indistinguishable from Entamoeba dispar in direct microscopic examination. A definitive diagnosis of E. histolytica is important in terms of the treatment of the patient and to avoid unnecessary costs. This study’s aim is to determine the prevalence of E. histolytica and to make a comparison of the different diagnostic tests in the patients specimens defined as E. histolytica/E. dispar infection. Materials and Methods: Faecal and serum specimens of 90 patients defined as E. histolytica/E. dispar with microscopy (wet mount examination with 0.85% saline and Lugol’s iodine) were examined. Stool samples were examined by trichrome staining for trophozoites and cysts and by immunoassay methods for specific adhesin antigens (Wampole ® E. histolytica II antigen testing) and for specific serine-rich 30 kD membrane protein (Serazym® E. histolytica antigen testing). Anti-E. histolytica antibodies were investigated using a latex slide test and indirect hemagglutination methods in serum specimens. Results: Presence of E. histolytica was not confirmed in 31.1% cases with trichrome staining, 62.2% of the Wampole antigen test, 64.4%, of the Serazym antigen test, 73.3% of the indirect hemagglutination test and 75.6%. of the latex agglutination. Considering the common results from Wampole and Serazym antigen testing as a reference standard, the specificity/sensitivity is 100/53.85% for trichrome staining, 75.00/98.11% for the latex agglutination test and 78.57/96.77% for the indirect hemagglutination test. Conclusion: It has been shown that investigation of E. histolytica in stools by direct wet-smear microscopy alone can cause significant false positive results. To obtain a reliable diagnosis for E. histolytica and to avoid unnecessary treatment for this parasite, at least one more specific assay, particularly an antigen testing and microscopy, is required. PMID:27551176

Unusual food allergy: Alioidea allergic reactions overview.

PubMed

Cantisani, Carmen; Visconti, Bianca; Paolino, Giovanni; Frascani, Federica; Tofani, Sonia; Fazia, Gilda; Calvieri, Stefano

2014-01-01

Allergic reactions can cause by several aliments and foods. Symptoms usually appear after ingestion, several hours after consumption or even almost immediately. Various food allergies can lead to serious diseases and in some cases to death, so the priority for people suffering from them should be prevention and completely avoiding foods that cause this kind of reactions. Allergy to Alioidea is one of the probable causes of contact dermatitis, gingival and oculonasal diseases and asthma. In this review, we will focus on the increasing incidence of allergy to foods of common use like onions and garlic. In the last ten years, the world production of onions and garlic has increased of at least 25%. People make large use of them, not only in cookery but also from a therapeutic point of view. Their growing use is producing more and more specific, insidious and sometimes serious medical conditions, which highly influence the quality of life of patients. Medical practitioners should be able to recognize immediately these disorders in order to diagnose them quickly and accurately, avoiding unnecessary tests and treatments. We will also describe new patents for detecting food allergens.

Identifying opportunities to improve management of autoimmune hepatitis: evaluation of drug adherence and psychosocial factors.

PubMed

Sockalingam, Sanjeev; Blank, Diana; Abdelhamid, Nour; Abbey, Susan E; Hirschfield, Gideon M

2012-12-01

Recognizing the importance of adherence to therapy in autoimmune hepatitis (AIH) is critical for patient care and avoidance of unnecessary intervention. The influence of psychosocial factors on treatment adherence needs better understanding and prominence. We sought to determine the association between anxiety, depressive symptoms, and avoidant relationship style on self-reported immunosuppressant medication adherence and treatment response in patients with AIH. Fifty two patients with AIH were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Experiences in Close Relationship Scale (ECR) and a visual analogue scale to measure self-reported adherence. Laboratory markers of adherence and immunosuppressant treatment response were recorded. Chi-square Fisher's exact or Wilcox rank sum tests were used for comparison between groups. Treatment responders compared to non-responders were older (p=0.035), had normal or mild score ranges for anxiety and depression (p=0.025) and were significantly more likely to report >80% treatment adherence (p=0.007). Non-responders had higher anxiety symptoms (p=0.025), and significantly higher ECR-avoidance scores (p=0.023), suggestive of a tendency towards a more avoidant relationship style. We formally document that patients with AIH who have higher depressive and anxiety symptoms and avoidant relationship styles are more likely to be non-adherent to AIH therapy. We reiterate the need for early recognition and treatment of anxiety and depression in patients with AIH, stress the need for treatment adherence and highlight the need for formal evaluation of these factors in trials of therapy targeting apparent treatment non-responders. Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Unnecessary surgery.

PubMed Central

Leape, L L

1989-01-01

The extent of unnecessary surgery has been the object of considerable speculation and occasional wild accusation in recent years. Most evidence of the existence of unnecessary surgery, such as information from studies of geographic variations and the results of second surgical opinion programs, is circumstantial. However, results from the few studies that have measured unnecessary surgery directly indicate that for some highly controversial operations the fraction that are unwarranted could be as high as 30 percent. Most unnecessary surgery results from physician uncertainty about the effectiveness of an operation. Elimination of this uncertainty requires more efficient production and dissemination of scientific information about clinical effectiveness. In the absence of adequate data from scientific studies, the use of a consensus of expert opinion, disseminated by means of comprehensive practice guidelines, offers the best opportunity to identify and eliminate unnecessary surgery. PMID:2668237

Autopolyploidy genome duplication preserves other ancient genome duplications in Atlantic salmon (Salmo salar).

PubMed

Christensen, Kris A; Davidson, William S

2017-01-01

Salmonids (e.g. Atlantic salmon, Pacific salmon, and trouts) have a long legacy of genome duplication. In addition to three ancient genome duplications that all teleosts are thought to share, salmonids have had one additional genome duplication. We explored a methodology for untangling these duplications from each other to better understand them in Atlantic salmon. In this methodology, homeologous regions (paralogous/duplicated genomic regions originating from a whole genome duplication) from the most recent genome duplication were assumed to have duplicated genes at greater density and have greater sequence similarity. This assumption was used to differentiate duplicated gene pairs in Atlantic salmon that are either from the most recent genome duplication or from earlier duplications. From a comparison with multiple vertebrate species, it is clear that Atlantic salmon have retained more duplicated genes from ancient genome duplications than other vertebrates--often at higher density in the genome and containing fewer synonymous mutations. It may be that polysomic inheritance is the mechanism responsible for maintaining ancient gene duplicates in salmonids. Polysomic inheritance (when multiple chromosomes pair during meiosis) is thought to be relatively common in salmonids compared to other vertebrate species. These findings illuminate how genome duplications may not only increase the number of duplicated genes, but may also be involved in the maintenance of them from previous genome duplications as well.

Primary epiploic appendagitis and successful outpatient management

PubMed Central

Schnedl, Wolfgang J.; Krause, Robert; Wallner-Liebmann, Sandra J.; Tafeit, Erwin; Mangge, Harald; Tillich, Manfred

2012-01-01

Summary Background Primary epiploic appendagitis (PEA) is a rare cause of abdominal acute or subacute complaints. Diagnosis of PEA is made with ultrasonography (US) or when computed tomography (CT) reveals a characteristic lesion. Case Report We report on two patients with PEA. In one patient PEA was first seen with US and confirmed with contrast enhanced CT, and in the second patient CT without contrast enhancement demonstrated PEA. In both patients an outpatient recovery with conservative non-surgical treatment is described. Conclusions Medical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions. A correct diagnosis of PEA with imaging procedures enables conservative and successful outpatient management avoiding unnecessary surgical intervention and additional costs. PMID:22648258

Global case management: Scotland. Real-time monitoring of patient flow as an instrument to optimize quality of care in acute receiving units.

PubMed

Thuemmler, Christoph; Morris, Carole

2005-01-01

Recent audits within our hospital suggest that especially during peak phases the patient flow from our acute admission units downstream into hospital beds is not directed in the most efficient way and patients may be placed inappropriately. This inevitably causes time delays and potentially increases the risk of malpractice as patients have to spend an extended period of time in admission areas with a high workload and very busy staff. Using latest information technology, such as wireless local area networks and handheld devices, can improve the efficiency of patient management and can increase the quality of care by helping to avoid unnecessary treatment delays in overcrowded admission areas.

What Instills Trust? A Qualitative Study of Phishing

NASA Astrophysics Data System (ADS)

Jakobsson, Markus; Tsow, Alex; Shah, Ankur; Blevis, Eli; Lim, Youn-Kyung

This paper reports the highlights of a user study which gauges reactions to a variety of common "trust indicators" - such as logos, third party endorsements, and padlock icons - over a selection of authentic and phishing stimuli. In the course of the think-aloud protocol, participants revealed different sensitivities to email messages and web pages. Our principal result is the analysis of what makes phishing emails and web pages appear authentic. This is not only of interest from a pure scientific point of view, but can also guide the design of legitimate material to avoid unnecessary risks. A second result of ours are observations of what makes legitimate content appear dubious to consumers. This is a result with obvious applications to online advertising.

Spasm of the near reflex: A case report.

PubMed

Rhatigan, Maedbh; Byrne, Caroline; Logan, Patricia

2017-06-01

Spasm of the near reflex (SNR) is a triad of miosis, excess accommodation and excess convergence. Primary SNR is most often functional in origin We aim to highlight the clinical features which distinguish primary convergence from other conditions with a similar presentation but more sinister underlying aetiology, for example bilateral abducens nerve palsy. There is a paucity of published data on SNR, in particular diagnostic criteria and treatment. We report a case of SNR of functional origin in an otherwise healthy young female and discuss the clinical features that differentiate this condition from similar conditions with underlying neurological origin. SNR is predominantly a clinical diagnosis, and often leads to patients undergoing unnecessary investigations and sometimes treatment. Recognising the salient features that differentiate it could potentially avoid this.

Primary Pancreatic Head Tuberculosis: Great Masquerader of Pancreatic Adenocarcinoma

PubMed Central

Gupta, Dhaval; Patel, Jatin; Rathi, Chetan; Ingle, Meghraj; Sawant, Prabha

2015-01-01

Isolated pancreatic tuberculosis (TB) is considered an extremely rare condition, even in the developing countries. Most reported cases of pancreatic TB are diagnosed after exploratory laparotomy or autopsy. Pancreatic TB is a potential mimic of invasive pancreatic malignancy and the presence of vascular invasion does not distinguish one condition from the other. Every effort should be made for the earliest diagnosis of this condition as TB is a treatable condition and it avoids unnecessary management of pancreatic carcinoma. Here we report a rare case of primary pancreatic head TB in a 58-year-old male who presented with hypodense lesion in head of pancreas with double duct sign and portal vein invasion mimicking non-resectable pancreatic carcinoma. PMID:27785295

Postpolypectomy Electrocoagulation Syndrome: A Mimicker of Colonic Perforation

PubMed Central

Benson, Brian C.; Myers, Jonathan J.; Laczek, Jeffrey T.

2013-01-01

Postpolypectomy electrocoagulation syndrome is a rare complication of polypectomy with electrocautery and is characterized by a transmural burn of the colon wall. Patients typically present within 12 hours after the procedure with symptoms mimicking colonic perforation. Presented is the case of a 56-year-old man who developed abdominal pain six hours after colonoscopy during which polypectomy was performed using snare cautery. CT imaging of the abdomen revealed circumferential thickening of the wall of the transverse colon without evidence of free air. The patient was treated conservatively as an outpatient and had resolution of his pain over the following four days. Recognition of the diagnosis and understanding of the treatment are important to avoid unnecessary exploratory laparotomy or hospitalization. PMID:23956889

Cerebral Fat Embolism: Recognition, Complications, and Prognosis.

PubMed

Godoy, Daniel Agustín; Di Napoli, Mario; Rabinstein, Alejandro A

2017-09-20

Fat embolism syndrome (FES) is a rare syndrome caused by embolization of fat particles into multiple organs including the brain. It typically manifests with petechial rash, deteriorating mental status, and progressive respiratory insufficiency, usually occurring within 24-48 h of trauma with long-bone fractures or an orthopedic surgery. The diagnosis of FES is based on clinical and imaging findings, but requires exclusion of alternative diagnoses. Although there is no specific treatment for FES, prompt recognition is important because it can avoid unnecessary interventions and clarify prognosis. Patients with severe FES can become critically ill, but even comatose patients with respiratory failure may recover favorably. Prophylactic measures, such as early stabilization of fractures and certain intraoperative techniques, may help decrease the incidence and severity of FES.

Unreliable numbers: error and harm induced by bad design can be reduced by better design

PubMed Central

Thimbleby, Harold; Oladimeji, Patrick; Cairns, Paul

2015-01-01

Number entry is a ubiquitous activity and is often performed in safety- and mission-critical procedures, such as healthcare, science, finance, aviation and in many other areas. We show that Monte Carlo methods can quickly and easily compare the reliability of different number entry systems. A surprising finding is that many common, widely used systems are defective, and induce unnecessary human error. We show that Monte Carlo methods enable designers to explore the implications of normal and unexpected operator behaviour, and to design systems to be more resilient to use error. We demonstrate novel designs with improved resilience, implying that the common problems identified and the errors they induce are avoidable. PMID:26354830

Pregnancy Luteoma in Ectopic Pregnancy: A Case Report.

PubMed

Brar, Rupinder Kaur; Bharti, Jyotsna Naresh; Nigam, Jitendra Singh; Sehgal, Sahil; Singh, Hena Paul; Ojha, Pushpanjali

2017-01-01

Pregnancy luteoma is a rare non neoplastic condition of the ovary. It is usually asymptomatic and found incidentally during imaging in pregnancy or during cesarean section. Pregnancy luteoma can also occur after ectopic pregnancy. A 30 year old female presented to G.B. Pant Hospital, Andaman and Nicobar Islands institute of Medical Sciences, Port Blair in October 2015 with abdominal pain. After initial investigations, exploratory laporotomy was done for ruptured ectopic pregnancy. Enlarged ovary was removed along with the ruptured portion of fallopian tube. Histopathological examination revealed solid aggregates of large cells with abundant eosinophilic cytoplasm; diagnosis of pregnancy luteoma was given. It must be considered in the differential diagnosis of ovarian masses in pregnant females that early diagnosis of this entity may avoid unnecessary radical surgery.

Practical Unitary Simulator for Non-Markovian Complex Processes

NASA Astrophysics Data System (ADS)

Binder, Felix C.; Thompson, Jayne; Gu, Mile

2018-06-01

Stochastic processes are as ubiquitous throughout the quantitative sciences as they are notorious for being difficult to simulate and predict. In this Letter, we propose a unitary quantum simulator for discrete-time stochastic processes which requires less internal memory than any classical analogue throughout the simulation. The simulator's internal memory requirements equal those of the best previous quantum models. However, in contrast to previous models, it only requires a (small) finite-dimensional Hilbert space. Moreover, since the simulator operates unitarily throughout, it avoids any unnecessary information loss. We provide a stepwise construction for simulators for a large class of stochastic processes hence directly opening the possibility for experimental implementations with current platforms for quantum computation. The results are illustrated for an example process.

Challenges for allergy diagnosis in regions with complex pollen exposures.

PubMed

Barber, Domingo; Díaz-Perales, Araceli; Villalba, Mayte; Chivato, Tomas

2015-02-01

Over the past few decades, significant scientific progress has influenced clinical allergy practice. The biological standardization of extracts was followed by the massive identification and characterization of new allergens and their progressive use as diagnostic tools including allergen micro arrays that facilitate the simultaneous testing of more than 100 allergen components. Specific diagnosis is the basis of allergy practice and is always aiming to select the best therapeutic or avoidance intervention. As a consequence, redundant or irrelevant information might be adding unnecessary cost and complexity to daily clinical practice. A rational use of the different diagnostic alternatives would allow a significant improvement in the diagnosis and treatment of allergic patients, especially for those residing in complex pollen exposure areas.

Integrated billing and accounts receivable management system needed to maximize payments and cope with managed care.

PubMed

Sanders, J; Wold, D; Sullivan, T

1999-01-01

The billing and accounts receivable management process in medical practices today has evolved into a multidisciplinary function. This function requires efficient, coordinated performance by physicians and all staff members, from the point of initial patient contact through aggressive follow-up on delinquent payments for services rendered. Offices with deficient or nonexistent billing and accounts receivable management systems typically experience collection ratios that are less than industry norms. They also experience poor cash flow and unnecessary overhead costs. To avoid costly inefficiencies and ensure that it maximizes payments from third-party payors and patients, a medical practice must have an integrated billing and accounts receivable management system that includes components outlined in this article.

Anti-claudin 18.2 antibody as new targeted therapy for advanced gastric cancer.

PubMed

Singh, Prabhsimranjot; Toom, Sudhamshi; Huang, Yiwu

2017-05-12

Targeted therapy and immunotherapy have revolutionized treatment of various cancers in the past decade. Despite targeted therapy with trastuzumab in Her2-positive gastric cancer patients, survival has been dismal, mostly due to disease progression and toxicity related to the treatments. One area of active development is looking for ideal monoclonal antibodies (IMAB) specific to the proteins only on the tumor and hence avoiding unnecessary side effects. Claudin proteins with isoform 2 are one such protein, specific for several cancers, particularly gastric cancer and its metastases, leading to the development of anti-claudin 18.2 specific antibody, claudiximab. This review will highlight the latest development of claudiximab as first in class IMAB for the treatment of gastric cancer.

Apparent mineralcorticoid excess syndrome, an often forgotten or unrecognized cause of hypokalemia and hypertension: case report and appraisal of the pathophysiology.

PubMed

Bisogni, Valeria; Rossi, Gian Paolo; Calò, Lorenzo A

2014-06-01

The glicyrrhizic acid, contained in licorice, has a mineralcorticoid-like effect. Chronic excess intake of licorice induces the rare syndrome of "apparent mineralcorticoid excess", due to the inhibitory effect of glicyrrhizic acid on 11 β-hydroxysteroid dehydrogenase type 2 determining clinical/biochemical manifestations as resistant hypertension, metabolic alkalosis and severe hypokalemia. We report a typical clinical case of licorice abuse to emphasize the importance of a detailed anamnesis, which is essential for the diagnosis, avoid unnecessary and expensive investigations, and reduce the duration of hospitalization. We also provide an appraisal of the pathophysiology of "apparent mineralcorticoid excess" syndrome, still an often forgotten or unrecognized cause of hypokalemia and hypertension.

Do event horizons exist?

NASA Astrophysics Data System (ADS)

Baccetti, Valentina; Mann, Robert B.; Terno, Daniel R.

Event horizons are the defining feature of classical black holes. They are the key ingredient of the information loss paradox which, as paradoxes in quantum foundations, is built on a combination of predictions of quantum theory and counterfactual classical features: neither horizon formation nor its crossing by a test body can be detected by a distant observer. Furthermore, horizons are unnecessary for the production of Hawking-like radiation. We demonstrate that when this radiation is taken into account, it can prevent horizon crossing/formation in a large class of models. We conjecture that horizon avoidance is a general feature of collapse. The nonexistence of event horizons dispels the paradox, but opens up important questions about thermodynamic properties of the resulting objects and correlations between different degrees of freedom.

Traumatic bone cyst suggestive of a chronic periapical abscess: a case report.

PubMed

Kahler, Bill

2011-08-01

Traumatic bone cysts can mimic the signs and symptoms of an endodontic lesion. This case reports on a 19-year-old male patient who was referred for endodontic assessment of a symptomatic tooth with a gingival swelling and a draining sinus at the furcation of a mandibular second molar. Radiographically, a periradicular radiolucency is evident. A prior history of trauma as well as removal of the wisdom teeth was determined. After careful diagnosis unnecessary endodontic intervention was avoided. Surgical exploration, curettage and the generation of a blood clot resulted in healing at the 6 month review appointment. The tooth remained responsive to pulp sensibility testing at that time. © 2010 The Author. Australian Endodontic Journal © 2010 Australian Society of Endodontology.

Zoster-associated segmental paresis in a patient with cervical spinal stenosis.

PubMed

Kang, Sung-Hee; Song, Ho-Kyung; Jang, Yeon

2013-06-01

Segmental zoster paresis is a rare complication of herpes zoster, characterized by focal motor weakness that does not always present simultaneously with skin lesions. Zoster paresis can be easily confused with other neuromuscular or spinal diseases. This case report describes the case of a 72-year-old woman with herpes zoster and cervical spinal stenosis at the same spinal level, where it was difficult to distinguish segmental zoster paresis from cervical radiculopathy combined with motor neuropathy. Although segmental zoster paresis in the upper extremity is rare, it should be included in the differential diagnosis of segmental pain and weakness in the extremities, especially in older or immunocompromised patients. Correct diagnosis is required, to avoid unnecessary surgery and allow timely antiviral treatment.

The Prophylactic Extraction of Third Molars: A Public Health Hazard

PubMed Central

Friedman, Jay W.

2007-01-01

Ten million third molars (wisdom teeth) are extracted from approximately 5 million people in the United States each year at an annual cost of over $3 billion. In addition, more than 11 million patient days of “standard discomfort or disability”—pain, swelling, bruising, and malaise—result postoperatively, and more than 11000 people suffer permanent paresthesia—numbness of the lip, tongue, and cheek—as a consequence of nerve injury during the surgery. At least two thirds of these extractions, associated costs, and injuries are unnecessary, constituting a silent epidemic of iatrogenic injury that afflicts tens of thousands of people with lifelong discomfort and disability. Avoidance of prophylactic extraction of third molars can prevent this public health hazard. PMID:17666691

Malakoplakia mimics urinary bladder cancer: a case report.

PubMed

Ristić-Petrović, Ana; Stojnev, Slavica; Janković-Velicković, Ljubinka; Marjanović, Goran

2013-06-01

Malakoplakia is an unusual and very rare chronic inflammatory disease. In bladder especially it can mimic malignancy and lead to serious misdiagnosis. We presented a case of a middle-aged woman with persistent macrohematuria and cystoscopically polypoid bladder mass that resembled a neoplastic process. The final diagnosis was based on cystoscopic biopsy and microscopic findings of acidophilic, foamy histiocytes with the presence of Michaelis-Gutmann inclusions which are characteristic for diagnosis of malakoplakia. Immunohistochemistry confirmed diagnosis by demonstrating CD68-positive macrophages. Urinary bladder malakoplakia should be considered in patients with persistent urinary tract infections and tumor mass at cystoscopy. Early identification with prompt antibiotic treatment can be helpful in avoiding unnecessary surgical interventions and in preventing development of possible complications.

"Turn laterally to the left!". The need for uniform C-arm communication terminology during orthopaedic trauma surgery.

PubMed

De Muinck Keizer, R-J; Klei, D S; Van Koperen, P J; Van Dijk, C N; Goslings, J C

2017-03-01

To avoid disturbed teamwork, unnecessary radiation exposure, and procedural delays, we designed and tested a uniform communication language for use in fluoroscopy-assisted surgical procedures. Input of surgeons and radiographers was used to create a set of commands. The potential benefit of this terminology was explored in an experimental setting. There was a tremendous diversity in the currently used terminology. Use of the newly designed terminology showed a reduction of procedural time and amount of images needed. Our first standardized Dutch language terminology can reduce total fluoroscopy time, number of images acquired, and potentially radiation exposure. For Dutch speaking colleagues, the developed terminology is freely available for use in their OR.

Strategies for maximizing your chances for weaning success. Limitations--and advantages--of common predictive indices.

PubMed

Patel, R G; Petrini, M F; Norman, J R

1995-06-01

Using indices to predict weaning outcome can avoid premature extubation and unnecessary prolongation of ventilatory support. Unfortunately, none of the indices is consistently able to predict outcome. The key to successful weaning is to assess respiratory function repeatedly with several indices, not just one. The patient should be able to sustain spontaneous breathing for at least 24 hours on minimal partial ventilatory support (a pressure support or a continuous positive airway pressure of 5 cm H2O or a T piece, for example). Indices of maximal inspiratory pressure; work of breathing; and rapid, shallow breathing are useful in evaluating a patient's respiratory muscle performance; airway occlusion pressure is helpful as well when increased neuromuscular drive is a problem.

Aspiration cytology of extramammary tumours metastatic to the breast.

PubMed

Handa, Uma; Chhabra, Seema; Mohan, Harsh

2007-10-01

This study was undertaken to highlight the use of fine needle aspiration cytology (FNAC) to distinguish tumours metastatic to the breast from primary breast malignancies. A total of 1866 fine needle aspirates of the breast were performed during a period of 7 years. Three hundred and fourteen cases of breast malignancies were diagnosed and 5 (1.5%) out of these cases were metastatic in origin. The metastatic tumors included, 2 cases of malignant melanoma (chest wall and left arm), 1 case each of haematolymphoid malignancy, adenocarcinoma of the ovary, and squamous cell carcinoma (left leg). FNA diagnosis of metastasis to the breast is essential in order to avoid unnecessary mastectomy and to ensure appropriate chemotherapy and/or irradiation treatment.

Basal cell carcinoma of the nipple-areola complex: a case report.

PubMed

Huang, Ching-Wen; Pan, Ching-Kuen; Shih, Teng-Fu; Tsai, Cheng-Chien; Juan, Chung-Chou; Ker, Chen-Guo

2005-10-01

Basal cell carcinoma (BCC) of the nipple-areola complex is very rare. Only 24 cases were reported in the literature and 17 (70.8%) of these cases arose in men. Most of the cases were treated with simple excision. We report on a case of BCC of the nipple-areola complex in a 46-year-old woman, treated with partial mastectomy. Metastasis to the axillary lymph nodes had been noted in 3 (12.5%) of the 24 reported cases of BCC of the nipple-areola complex. Thus, we applied the concept of the sentinel lymph node to detect possible metastases of axillary lymph nodes, letting us avoid the unnecessary axillary lymph node dissection and possible future morbidity.

Profiling of gene duplication patterns of sequenced teleost genomes: evidence for rapid lineage-specific genome expansion mediated by recent tandem duplications.

PubMed

Lu, Jianguo; Peatman, Eric; Tang, Haibao; Lewis, Joshua; Liu, Zhanjiang

2012-06-15

Gene duplication has had a major impact on genome evolution. Localized (or tandem) duplication resulting from unequal crossing over and whole genome duplication are believed to be the two dominant mechanisms contributing to vertebrate genome evolution. While much scrutiny has been directed toward discerning patterns indicative of whole-genome duplication events in teleost species, less attention has been paid to the continuous nature of gene duplications and their impact on the size, gene content, functional diversity, and overall architecture of teleost genomes. Here, using a Markov clustering algorithm directed approach we catalogue and analyze patterns of gene duplication in the four model teleost species with chromosomal coordinates: zebrafish, medaka, stickleback, and Tetraodon. Our analyses based on set size, duplication type, synonymous substitution rate (Ks), and gene ontology emphasize shared and lineage-specific patterns of genome evolution via gene duplication. Most strikingly, our analyses highlight the extraordinary duplication and retention rate of recent duplicates in zebrafish and their likely role in the structural and functional expansion of the zebrafish genome. We find that the zebrafish genome is remarkable in its large number of duplicated genes, small duplicate set size, biased Ks distribution toward minimal mutational divergence, and proportion of tandem and intra-chromosomal duplicates when compared with the other teleost model genomes. The observed gene duplication patterns have played significant roles in shaping the architecture of teleost genomes and appear to have contributed to the recent functional diversification and divergence of important physiological processes in zebrafish. We have analyzed gene duplication patterns and duplication types among the available teleost genomes and found that a large number of genes were tandemly and intrachromosomally duplicated, suggesting their origin of independent and continuous duplication. This is particularly true for the zebrafish genome. Further analysis of the duplicated gene sets indicated that a significant portion of duplicated genes in the zebrafish genome were of recent, lineage-specific duplication events. Most strikingly, a subset of duplicated genes is enriched among the recently duplicated genes involved in immune or sensory response pathways. Such findings demonstrated the significance of continuous gene duplication as well as that of whole genome duplication in the course of genome evolution.

Genomics education for medical professionals - the current UK landscape.

PubMed

Slade, Ingrid; Subramanian, Deepak N; Burton, Hilary

2016-08-01

Genomics education in the UK is at an early stage of development, and its pace of evolution has lagged behind that of the genomics research upon which it is based. As a result, knowledge of genomics and its applications remains limited among non-specialist clinicians. In this review article, we describe the complex landscape for genomics education within the UK, and highlight the large number and variety of organisations that can influence, direct and provide genomics training to medical professionals. Postgraduate genomics education is being shaped by the work of the Health Education England (HEE) Genomics Education Programme, working in conjunction with the Joint Committee on Genomics in Medicine. The success of their work will be greatly enhanced by the full cooperation and engagement of the many groups, societies and organisations involved with medical education and training (such as the royal colleges). Without this cooperation, there is a risk of poor coordination and unnecessary duplication of work. Leadership from an organisation such as the HEE Genomics Education Programme will have a key role in guiding the formulation and delivery of genomics education policy by various stakeholders among the different disciplines in medicine. © 2016 Royal College of Physicians.

Time to consider sharing data extracted from trials included in systematic reviews.

PubMed

Wolfenden, Luke; Grimshaw, Jeremy; Williams, Christopher M; Yoong, Sze Lin

2016-11-03

While the debate regarding shared clinical trial data has shifted from whether such data should be shared to how this is best achieved, the sharing of data collected as part of systematic reviews has received little attention. In this commentary, we discuss the potential benefits of coordinated efforts to share data collected as part of systematic reviews. There are a number of potential benefits of systematic review data sharing. Shared information and data obtained as part of the systematic review process may reduce unnecessary duplication, reduce demand on trialist to service repeated requests from reviewers for data, and improve the quality and efficiency of future reviews. Sharing also facilitates research to improve clinical trial and systematic review methods and supports additional analyses to address secondary research questions. While concerns regarding appropriate use of data, costs, or the academic return for original review authors may impede more open access to information extracted as part of systematic reviews, many of these issues are being addressed, and infrastructure to enable greater access to such information is being developed. Embracing systems to enable more open access to systematic review data has considerable potential to maximise the benefits of research investment in undertaking systematic reviews.

Meta-analyses of animal studies: an introduction of a valuable instrument to further improve healthcare.

PubMed

Hooijmans, Carlijn R; IntHout, Joanna; Ritskes-Hoitinga, Merel; Rovers, Maroeska M

2014-01-01

In research aimed at improving human health care, animal studies still play a crucial role, despite political and scientific efforts to reduce preclinical experimentation in laboratory animals. In animal studies, the results and their interpretation are not always straightforward, as no single study is executed perfectly in all steps. There are several possible sources of bias, and many animal studies are replicates of studies conducted previously. Use of meta-analysis to combine the results of studies may lead to more reliable conclusions and a reduction of unnecessary duplication of animal studies. In addition, due to the more exploratory nature of animal studies as compared to clinical trials, meta-analyses of animal studies have greater potential in exploring possible sources of heterogeneity. There is an abundance of literature on how to perform meta-analyses on clinical data. Animal studies, however, differ from clinical studies in some aspects, such as the diversity of animal species studied, experimental design, and study characteristics. In this paper, we will discuss the main principles and practices for meta-analyses of experimental animal studies. © The Author 2014. Published by Oxford University Press.

Demonstration of Sensor Data Integration Across Naval Aviation Maintenance

DTIC Science & Technology

2018-02-01

With expedited fault detection, fewer unnecessary parts would need to be ordered, saving time and money . Recommendations Based on our findings...level maintainer. These notes were included in every MAF in the “corrective action” block and were unformatted free -text. Out of the 70 repairs, only...translates to fewer unnecessary parts ordered, a reduction in the money spent on unnecessary parts, and a reduction of unnecessary logistic delays

[Antenatal diagnosis: the revolution of new technologies].

PubMed

Fokstuen, Siv; Sloan-Béna, Frédérique; lrion, Olivier

2014-01-15

Since ten years, the number of amniocenteses or chorionic villous sampling for maternal anxiety has decreased thanks to the first trimester screening of trisomy 21 by ultrasound and maternal serum analysis. Two new tools have recently revolutionized antenatal screening and diagnosis: Analysing fetal DNA in maternal blood for chromosomes 21, 18 and 13 in order to avoid invasive fetal sampling and genomic comparative hybridization in order to diagnose deletions or duplications not detected by conventional caryotyping. These new technologies are dedicated to high-risk pregnancies, and have limitations. They do not replace ultrasound or first trimester screening. Information and ethics are central in antenatal screening and diagnosis.

An Elliptic Curve Based Schnorr Cloud Security Model in Distributed Environment

PubMed Central

Muthurajan, Vinothkumar; Narayanasamy, Balaji

2016-01-01

Cloud computing requires the security upgrade in data transmission approaches. In general, key-based encryption/decryption (symmetric and asymmetric) mechanisms ensure the secure data transfer between the devices. The symmetric key mechanisms (pseudorandom function) provide minimum protection level compared to asymmetric key (RSA, AES, and ECC) schemes. The presence of expired content and the irrelevant resources cause unauthorized data access adversely. This paper investigates how the integrity and secure data transfer are improved based on the Elliptic Curve based Schnorr scheme. This paper proposes a virtual machine based cloud model with Hybrid Cloud Security Algorithm (HCSA) to remove the expired content. The HCSA-based auditing improves the malicious activity prediction during the data transfer. The duplication in the cloud server degrades the performance of EC-Schnorr based encryption schemes. This paper utilizes the blooming filter concept to avoid the cloud server duplication. The combination of EC-Schnorr and blooming filter efficiently improves the security performance. The comparative analysis between proposed HCSA and the existing Distributed Hash Table (DHT) regarding execution time, computational overhead, and auditing time with auditing requests and servers confirms the effectiveness of HCSA in the cloud security model creation. PMID:26981584

An Elliptic Curve Based Schnorr Cloud Security Model in Distributed Environment.

PubMed

Muthurajan, Vinothkumar; Narayanasamy, Balaji

2016-01-01

Cloud computing requires the security upgrade in data transmission approaches. In general, key-based encryption/decryption (symmetric and asymmetric) mechanisms ensure the secure data transfer between the devices. The symmetric key mechanisms (pseudorandom function) provide minimum protection level compared to asymmetric key (RSA, AES, and ECC) schemes. The presence of expired content and the irrelevant resources cause unauthorized data access adversely. This paper investigates how the integrity and secure data transfer are improved based on the Elliptic Curve based Schnorr scheme. This paper proposes a virtual machine based cloud model with Hybrid Cloud Security Algorithm (HCSA) to remove the expired content. The HCSA-based auditing improves the malicious activity prediction during the data transfer. The duplication in the cloud server degrades the performance of EC-Schnorr based encryption schemes. This paper utilizes the blooming filter concept to avoid the cloud server duplication. The combination of EC-Schnorr and blooming filter efficiently improves the security performance. The comparative analysis between proposed HCSA and the existing Distributed Hash Table (DHT) regarding execution time, computational overhead, and auditing time with auditing requests and servers confirms the effectiveness of HCSA in the cloud security model creation.

Authors, editors, and the signs, symptoms and causes of plagiarism.

PubMed

Shashok, Karen

2011-07-01

Plagiarism and inadequate citing appear to have reached epidemic proportions in research publication. This article discusses how plagiarism is defined and suggests some possible causes for the increase in the plagiarism disease. Most editors do not have much tolerance for text re-use with inadequate citation regardless of reasons why words are copied from other sources without correct attribution. However, there is now some awareness that re-use of words in research articles to improve the writing or "the English" (which has become a common practice) should be distinguished from intentional deceit for the purpose of stealing other authors' ideas (which appears to remain a very rare practice). Although it has become almost as easy for editors to detect duplicate text as it is for authors to re-use text from other sources, editors often fail to consider the reasons why researchers resort to this strategy, and tend to consider any text duplication as a symptom of serious misconduct. As a result, some authors may be stigmatized unfairly by being labeled as plagiarists. The article concludes with practical advice for researchers on how to improve their writing and citing skills and thus avoid accusations of plagiarism.

We read spam a lot: prospective cohort study of unsolicited and unwanted academic invitations

PubMed Central

Bolland, Mark J; Dalbeth, Nicola; Gamble, Greg; Sadler, Lynn

2016-01-01

Objectives To assess the amount, relevance, content, and suppressibility of academic electronic spam invitations to attend conferences or submit manuscripts. Design Prospective cohort study. Setting Email accounts of participating academics. Participants Five intrepid academics and a great many publishers, editors, and conference organisers. Intervention Unsubscribing from sender’s distribution lists. Main outcome measures Number of spam invitations received before, immediately after, and one year after unsubscribing from senders’ distribution lists. The proportion of duplicate invitations was also assessed and the relevance of each invitation graded to the recipient’s research interests. A qualitative assessment of the content of spam invitations was conducted. Results At baseline, recipients received an average of 312 spam invitations each month. Unsubscribing reduced the frequency of the invitations by 39% after one month but by only 19% after one year. Overall, 16% of spam invitations were duplicates and 83% had little or no relevance to the recipients’ research interests. Spam invitations were characterised by inventive language, flattery, and exuberance, and they were sometimes baffling and amusing. Conclusions Academic spam is common, repetitive, often irrelevant, and difficult to avoid or prevent. PMID:27974354

Authors, editors, and the signs, symptoms and causes of plagiarism

PubMed Central

Shashok, Karen

2011-01-01

Plagiarism and inadequate citing appear to have reached epidemic proportions in research publication. This article discusses how plagiarism is defined and suggests some possible causes for the increase in the plagiarism disease. Most editors do not have much tolerance for text re-use with inadequate citation regardless of reasons why words are copied from other sources without correct attribution. However, there is now some awareness that re-use of words in research articles to improve the writing or “the English” (which has become a common practice) should be distinguished from intentional deceit for the purpose of stealing other authors’ ideas (which appears to remain a very rare practice). Although it has become almost as easy for editors to detect duplicate text as it is for authors to re-use text from other sources, editors often fail to consider the reasons why researchers resort to this strategy, and tend to consider any text duplication as a symptom of serious misconduct. As a result, some authors may be stigmatized unfairly by being labeled as plagiarists. The article concludes with practical advice for researchers on how to improve their writing and citing skills and thus avoid accusations of plagiarism. PMID:21957412

System design of the Pioneer Venus spacecraft. Volume 12: International cooperation

NASA Technical Reports Server (NTRS)

Kelly, R. S.

1973-01-01

A spectrum of plans has been prepared to illustrate the range of practical sharing possibilities available so as to assist Ames Research Center (ARC) and European Space Research Organization (ESRO) in selection of a program meeting mutual goals. Five plans are described showing increased participation by ESRO WITH ascending plan number. Each of these has sharing properties fulfilling particular requirements such as available ESRO budget level, extent of ESRO program responsibility, matching particular ESRO capability, and cost saving to ARC through sharing. All plans apply to orbiter sharing only. A sharing plan based on the model Plan 4 may offer the most attractive division of Pioneer Venus between ARC and ESRO. This plan allows ESRO to bear primary responsibility for the orbiter and to avoid an extensive financial burden. Savings to ARC are commensurate with ARC loss of program control. Duplication of effort is avoided by using orbiter subsystems that are common to the probe bus and orbiter.

T cell lymphomatoid contact dermatitis: a challenging case and review of the literature.

PubMed

Knackstedt, Thomas J; Zug, Kathryn A

2015-02-01

Lymphomatoid contact dermatitis is a pseudolymphoma with clinical and histological features of allergic contact dermatitis and cutaneous T cell lymphoma. Incorrect diagnosis may lead to unnecessary testing, unnecessary treatment, or patient harm. The objective of this study is to present a case to demonstrate the diagnostic challenge and overlap between allergic contact dermatitis and cutaneous T cell lymphoma in a patient with lymphomatoid contact dermatitis caused by methylchoroisothiazolinone/methylisothiazolinone and paraben mix, and to review the existing literature in order to summarize the demographics, clinical features, allergens and treatments reported for lymphomatoid contact dermatitis. A search of major scientific databases was conducted for English-language articles reporting cases of lymphomatoid contact dermatitis or additional synonymous search headings. Nineteen articles with a total of 23 patients were analysed. Lymphomatoid contact dermatitis was more common in men, with an average age of 58.5 years. Fourteen unique allergens were identified and confirmed by patch testing. However, no single test or study was diagnostic of lymphomatoid contact dermatitis. Allergen avoidance was the most useful management tool, but selected patients required topical or systemic immunosuppression. In conclusion, without specific diagnostic features, evaluation for lymphomatoid contact dermatitis should include a thorough history and examination, patch testing, and biopsy with immunohistochemistry and clonality studies. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Logistic regression model can reduce unnecessary artificial liver support in hepatitis B virus-associated acute-on-chronic liver failure: decision curve analysis.

PubMed

Qin, Gang; Bian, Zhao-Lian; Shen, Yi; Zhang, Lei; Zhu, Xiao-Hong; Liu, Yan-Mei; Shao, Jian-Guo

2016-06-04

Several models have been proposed to predict the short-term outcome of acute-on-chronic liver failure (ACLF) after treatment. We aimed to determine whether better decisions for artificial liver support system (ALSS) treatment could be made with a model than without, through decision curve analysis (DCA). The medical profiles of a cohort of 232 patients with hepatitis B virus (HBV)-associated ACLF were retrospectively analyzed to explore the role of plasma prothrombin activity (PTA), model for end-stage liver disease (MELD) and logistic regression model (LRM) in identifying patients who could benefit from ALSS. The accuracy and reliability of PTA, MELD and LRM were evaluated with previously reported cutoffs. DCA was performed to evaluate the clinical role of these models in predicting the treatment outcome. With the cut-off value of 0.2, LRM had sensitivity of 92.6 %, specificity of 42.3 % and an area under the receiving operating characteristic curve (AUC) of 0.68, which showed superior discrimination over PTA and MELD. DCA revealed that the LRM-guided ALSS treatment was superior over other strategies including "treating all" and MELD-guided therapy, for the midrange threshold probabilities of 16 to 64 %. The use of LRM-guided ALSS treatment could increase both the accuracy and efficiency of this procedure, allowing the avoidance of unnecessary ALSS.

The self-adjusting file (SAF) system: An evidence-based update

PubMed Central

Metzger, Zvi

2014-01-01

Current rotary file systems are effective tools. Nevertheless, they have two main shortcomings: They are unable to effectively clean and shape oval canals and depend too much on the irrigant to do the cleaning, which is an unrealistic illusionThey may jeopardize the long-term survival of the tooth via unnecessary, excessive removal of sound dentin and creation of micro-cracks in the remaining root dentin. The new Self-adjusting File (SAF) technology uses a hollow, compressible NiTi file, with no central metal core, through which a continuous flow of irrigant is provided throughout the procedure. The SAF technology allows for effective cleaning of all root canals including oval canals, thus allowing for the effective disinfection and obturation of all canal morphologies. This technology uses a new concept of cleaning and shaping in which a uniform layer of dentin is removed from around the entire perimeter of the root canal, thus avoiding unnecessary excessive removal of sound dentin. Furthermore, the mode of action used by this file system does not apply the machining of all root canals to a circular bore, as do all other rotary file systems, and does not cause micro-cracks in the remaining root dentin. The new SAF technology allows for a new concept in cleaning and shaping root canals: Minimally Invasive 3D Endodontics. PMID:25298639

The Value of Ultrasound Monitoring of Adnexal Masses for Early Detection of Ovarian Cancer

PubMed Central

Suh-Burgmann, Elizabeth; Kinney, Walter

2016-01-01

Although ultrasound has so far been found to be ineffective as a screening tool for ovarian cancer, it is commonly used as a means of evaluating or following ovarian or adnexal masses once they are detected. We review the use of serial ultrasound for the management of adnexal masses and propose an approach to monitoring based on an understanding of the overall risk of cancer among the population in question and an assessment of how the potential benefit of monitoring compares with potential risk. In our approach, masses that are symptomatic, large (>10 cm), associated with an elevated CA 125 level or overt signs of malignancy, or that are determined to have a worrisome appearance by stringent ultrasound criteria should be evaluated surgically. Women with masses that have none of these characteristics should be offered monitoring. Short-term initial ultrasound monitoring carries significant potential benefit in terms of aiding detection of early malignancy and avoidance of unnecessary surgery. However, if a mass remains stable but persistent, the potential benefit of ongoing monitoring wanes with time, whereas the potential harms, in terms of patient anxiety, cost, and the risk of incidental findings and unnecessary surgery increase. Therefore, monitoring of stable lesions should be limited in duration in order to limit potential harms from overtreatment and overdiagnosis. PMID:26904503

Complex regional pain syndrome type i. An analysis of 7 cases in children.

PubMed

Pedemonte Stalla, V; Medici Olaso, C; Kanopa Almada, V; Gonzalez Rabelino, G

2015-01-01

Complex regional pain syndrome (CRPS) is characterised by the presence of pain accompanied by sensory, autonomic and motor symptoms, usually preceded by a lesion or immobilisation. The clinical course is disproportionate to the initial injury in intensity and in duration. Its distribution is regional, predominantly in limbs. It is classified as type I and type II according to the absence or presence of nerve injury. We present the cases of seven children, 6 girls and 1 boy, aged 7 to 15 years. Three had a history of previous trauma. In 5 cases, the symptoms were located in the lower limbs. Time to diagnosis was between 4 and 90 days. Three patients had clinical features of anxiety and depression. Imaging and immunological studies were performed to rule out differential diagnoses in all the children. Interdisciplinary treatment was performed with physiotherapy, psychotherapy, and gabapentin or pregabalin. All patients had a good clinical outcome, with no relapses in the follow-up period (between 4 and 30 months). CRPS is frequently unrecognised in children, leading to family anxiety and unnecessary para-clinical costs. Paediatricians and paediatric neurologists should be aware of this syndrome in order to avoid delay in diagnosis, unnecessary studies, and multiple visits to specialists, with a view to providing effective treatment. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Special diets are common among preschool children aged one to five years in south-east Sweden according to a population-based cross-sectional survey.

PubMed

Servin, Caroline; Hellerfelt, Sofia; Botvid, Christina; Ekström, Magnus

2017-04-01

Information about the prevalence of special diets in preschool children is limited. The aim of this study was to measure the prevalence of all special diets among preschool children in a Swedish municipality. This was a population-based cross-sectional survey of all 3276 preschool children aged one to five years in the municipality of Karlskrona, Sweden. The questionnaire assessed the number of children at each preschool, how many were on special diets, their dietary requirements, age, sex, whether they had a medical certificate and whether the special diet had a perceived medical cause. We obtained data for 3221 (98%) of the children, and 19% had special diets, including 12% on nonmedical diets and 6.3% on medical diets. The five most common diets were avoiding pork (7.8%), a vegetarian diet (4.8%), and avoiding cows' milk (3.5%), hens' eggs (1.2%) and lactose (1.1%). Gluten avoidance was more common in girls than boys (0.8% versus 0.2%, p = 0.032). Half (47%) of the children on special medical diets lacked a medical certificate. Special diets were common in preschool children in south-east Sweden, and the causes were mainly nonmedical. Mandatory medical certificates for medically based special diets might reduce unnecessary dietary restrictions. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Evolution of Gene Duplication in Plants1[OPEN

PubMed Central

2016-01-01

Ancient duplication events and a high rate of retention of extant pairs of duplicate genes have contributed to an abundance of duplicate genes in plant genomes. These duplicates have contributed to the evolution of novel functions, such as the production of floral structures, induction of disease resistance, and adaptation to stress. Additionally, recent whole-genome duplications that have occurred in the lineages of several domesticated crop species, including wheat (Triticum aestivum), cotton (Gossypium hirsutum), and soybean (Glycine max), have contributed to important agronomic traits, such as grain quality, fruit shape, and flowering time. Therefore, understanding the mechanisms and impacts of gene duplication will be important to future studies of plants in general and of agronomically important crops in particular. In this review, we survey the current knowledge about gene duplication, including gene duplication mechanisms, the potential fates of duplicate genes, models explaining duplicate gene retention, the properties that distinguish duplicate from singleton genes, and the evolutionary impact of gene duplication. PMID:27288366

Evolution of Gene Duplication in Plants.

PubMed

Panchy, Nicholas; Lehti-Shiu, Melissa; Shiu, Shin-Han

2016-08-01

Ancient duplication events and a high rate of retention of extant pairs of duplicate genes have contributed to an abundance of duplicate genes in plant genomes. These duplicates have contributed to the evolution of novel functions, such as the production of floral structures, induction of disease resistance, and adaptation to stress. Additionally, recent whole-genome duplications that have occurred in the lineages of several domesticated crop species, including wheat (Triticum aestivum), cotton (Gossypium hirsutum), and soybean (Glycine max), have contributed to important agronomic traits, such as grain quality, fruit shape, and flowering time. Therefore, understanding the mechanisms and impacts of gene duplication will be important to future studies of plants in general and of agronomically important crops in particular. In this review, we survey the current knowledge about gene duplication, including gene duplication mechanisms, the potential fates of duplicate genes, models explaining duplicate gene retention, the properties that distinguish duplicate from singleton genes, and the evolutionary impact of gene duplication. © 2016 American Society of Plant Biologists. All Rights Reserved.

The QUiPP App: a safe alternative to a treat-all strategy for threatened preterm labor.

PubMed

Watson, H A; Carter, J; Seed, P T; Tribe, R M; Shennan, A H

2017-09-01

To evaluate the impact of triaging women at risk of spontaneous preterm birth (sPTB) using the QUiPP App, which incorporates a predictive model combining history of sPTB, gestational age and quantitative measurements of fetal fibronectin, compared with a treat-all policy (advocated by the UK National Institute for Health and Care Excellence) among women with threatened preterm labor before 30 weeks' gestation. Prospectively collected data of pregnant women presenting with symptoms of preterm labor (abdominal pain or tightening) at 24-34 weeks' gestation were retrieved from the research databases of the EQUIPP and PETRA studies for subanalysis. Each episode of threatened preterm labor was retrospectively assigned a risk for sPTB within 7 days using the QUiPP App. A primary outcome of delivery within 7 days was used to model the performance accuracy of the QUiPP App compared with a treat-all policy. Using a 5% risk of delivery within 7 days according to the QUiPP App as the threshold for intervention, 9/9 women who presented with threatened preterm labor < 34 weeks would have been treated correctly, giving a sensitivity of 100% (one-sided 97.5% CI, 66.4%) and a negative predictive value of 100% (97.5% CI, 98.9-100%). The positive predictive value for delivery within 7 days was 30.0% (95% CI, 11.9-54.3%) for women presenting before 30 weeks and 20.0% (95% CI, 12.7-30.1%) for women presenting between 30 + 0 and 34 + 0 weeks. If this 5% threshold had been used to triage women presenting between 24 + 0 and 29 + 6 weeks, 89.4% (n = 168) of admissions could have been safely avoided, compared with 0% for a treat-all strategy. No true case of preterm labor would have been missed, as no woman who was assigned a risk of < 10% delivered within 7 days. For women with threatened preterm labor, the QUiPP App can accurately guide management at risk thresholds for sPTB of 1%, 5% and 10%, allowing outpatient management in the vast majority of cases. A treat-all approach would not have avoided admission for any woman, and would have exposed 188 mothers and their babies to unnecessary hospitalization and steroid administration and increased the burden on network and transport services owing to unnecessary in-utero transfers. Prediction of sPTB should be performed before 30 weeks to determine management until there is evidence that such a high level of unnecessary intervention, as suggested by the treat-all strategy, does less harm than the occurrence of rare false negatives. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Large-Scale Gene Relocations following an Ancient Genome Triplication Associated with the Diversification of Core Eudicots.

PubMed

Wang, Yupeng; Ficklin, Stephen P; Wang, Xiyin; Feltus, F Alex; Paterson, Andrew H

2016-01-01

Different modes of gene duplication including whole-genome duplication (WGD), and tandem, proximal and dispersed duplications are widespread in angiosperm genomes. Small-scale, stochastic gene relocations and transposed gene duplications are widely accepted to be the primary mechanisms for the creation of dispersed duplicates. However, here we show that most surviving ancient dispersed duplicates in core eudicots originated from large-scale gene relocations within a narrow window of time following a genome triplication (γ) event that occurred in the stem lineage of core eudicots. We name these surviving ancient dispersed duplicates as relocated γ duplicates. In Arabidopsis thaliana, relocated γ, WGD and single-gene duplicates have distinct features with regard to gene functions, essentiality, and protein interactions. Relative to γ duplicates, relocated γ duplicates have higher non-synonymous substitution rates, but comparable levels of expression and regulation divergence. Thus, relocated γ duplicates should be distinguished from WGD and single-gene duplicates for evolutionary investigations. Our results suggest large-scale gene relocations following the γ event were associated with the diversification of core eudicots.

Large-Scale Gene Relocations following an Ancient Genome Triplication Associated with the Diversification of Core Eudicots

PubMed Central

Wang, Yupeng; Ficklin, Stephen P.; Wang, Xiyin; Feltus, F. Alex; Paterson, Andrew H.

2016-01-01

Different modes of gene duplication including whole-genome duplication (WGD), and tandem, proximal and dispersed duplications are widespread in angiosperm genomes. Small-scale, stochastic gene relocations and transposed gene duplications are widely accepted to be the primary mechanisms for the creation of dispersed duplicates. However, here we show that most surviving ancient dispersed duplicates in core eudicots originated from large-scale gene relocations within a narrow window of time following a genome triplication (γ) event that occurred in the stem lineage of core eudicots. We name these surviving ancient dispersed duplicates as relocated γ duplicates. In Arabidopsis thaliana, relocated γ, WGD and single-gene duplicates have distinct features with regard to gene functions, essentiality, and protein interactions. Relative to γ duplicates, relocated γ duplicates have higher non-synonymous substitution rates, but comparable levels of expression and regulation divergence. Thus, relocated γ duplicates should be distinguished from WGD and single-gene duplicates for evolutionary investigations. Our results suggest large-scale gene relocations following the γ event were associated with the diversification of core eudicots. PMID:27195960

Genome Mutational and Transcriptional Hotspots Are Traps for Duplicated Genes and Sources of Adaptations.

PubMed

Fares, Mario A; Sabater-Muñoz, Beatriz; Toft, Christina

2017-05-01

Gene duplication generates new genetic material, which has been shown to lead to major innovations in unicellular and multicellular organisms. A whole-genome duplication occurred in the ancestor of Saccharomyces yeast species but 92% of duplicates returned to single-copy genes shortly after duplication. The persisting duplicated genes in Saccharomyces led to the origin of major metabolic innovations, which have been the source of the unique biotechnological capabilities in the Baker's yeast Saccharomyces cerevisiae. What factors have determined the fate of duplicated genes remains unknown. Here, we report the first demonstration that the local genome mutation and transcription rates determine the fate of duplicates. We show, for the first time, a preferential location of duplicated genes in the mutational and transcriptional hotspots of S. cerevisiae genome. The mechanism of duplication matters, with whole-genome duplicates exhibiting different preservation trends compared to small-scale duplicates. Genome mutational and transcriptional hotspots are rich in duplicates with large repetitive promoter elements. Saccharomyces cerevisiae shows more tolerance to deleterious mutations in duplicates with repetitive promoter elements, which in turn exhibit higher transcriptional plasticity against environmental perturbations. Our data demonstrate that the genome traps duplicates through the accelerated regulatory and functional divergence of their gene copies providing a source of novel adaptations in yeast. © The Author 2017. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.

Evaluation of prenatal hydronephrosis: novel criteria for predicting vesicoureteral reflux on ultrasonography.

PubMed

Lee, Nora G; Rushton, H Gil; Peters, Craig A; Groves, Danja S; Pohl, Hans G

2014-09-01

Radiographic evaluation for prenatal hydronephrosis often includes voiding cystourethrography to ascertain whether vesicoureteral reflux is present. We sought to determine whether use of voiding cystourethrography could be limited to those patients at greatest risk for vesicoureteral reflux. We hypothesized that vesicoureteral reflux could be predicted by findings on renal/bladder ultrasonography of hydroureter, renal dysmorphia and/or duplication. We reviewed the records of patients with prenatal hydronephrosis who underwent initial postnatal ultrasonography and voiding cystourethrography during a 3-year period. The presence of vesicoureteral reflux on voiding cystourethrogram was correlated to ultrasound findings, including hydronephrosis grade, presence of hydroureter, renal dysmorphia or duplication, with ultrasound considered positive for any of the latter 3 findings. Of 262 patients 47 (18%) had vesicoureteral reflux. Ultrasound was positive in 24 of 29 patients (83%) with high grade reflux and 12 of 18 (67%) with low grade reflux. If ultrasonography showed any of the 3 positive findings, the odds ratio of detecting vesicoureteral reflux was 8.07 (95% CI 3.86, 16.87). Using these criteria, among all cases of prenatal hydronephrosis 5 (2%) with high grade vesicoureteral reflux and 6 (2%) with low grade reflux would have been missed. Among the 47 cases of reflux overall 5 of 29 high grade (17%) and 6 of 18 low grade cases (33%) would have been missed. By using ultrasonography criteria of hydroureter, duplication and renal dysmorphia for patients with prenatal hydronephrosis, vesicoureteral reflux can be detected more specifically. Using our criteria, 165 of 262 voiding cystourethrograms (63%) could have been avoided in patients with prenatal hydronephrosis during a 3-year period. Reducing these evaluations may decrease risks regarding radiation exposure, family anxiety and health care costs. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Prenatal diagnosis for a Chinese family with a de novo DMD gene mutation

PubMed Central

Li, Tao; Zhang, Zhao-jing; Ma, Xin; Lv, Xue; Xiao, Hai; Guo, Qian-nan; Liu, Hong-yan; Wang, Hong-dan; Wu, Dong; Lou, Gui-yu; Wang, Xin; Zhang, Chao-yang; Liao, Shi-xiu

2017-01-01

Abstract Background: Patients with Duchenne muscular dystrophy (DMD) usually have severe and fatal symptoms. At present, there is no effective treatment for DMD, thus it is very important to avoid the birth of children with DMD by effective prenatal diagnosis. We identified a de novo DMD gene mutation in a Chinese family, and make a prenatal diagnosis. Methods: First, multiplex ligation-dependent probe amplification (MLPA) was applied to analyze DMD gene exon deletion/duplication in all family members. The coding sequences of 79 exons in DMD gene were analyzed by Sanger sequencing in the patient; and then according to DMD gene exon mutation in the patient, DMD gene sequencing was performed in the family members. On the basis of results above, the pathogenic mutation in DMD gene was identified. Results: MLPA showed no DMD gene exon deletion/duplication in all family members. Sanger sequencing revealed c.2767_2767delT [p.Ser923LeufsX26] mutation in DMD gene of the patient. Heterozygous deletion mutation (T/-) at this locus was observed in the pregnant woman and her mother and younger sister. The analyses of amniotic fluid samples indicated negative Y chromosome sex-determining gene, no DMD gene exon deletion/duplication, no mutations at c.2767 locus, and the inherited maternal X chromosome different from that of the patient. Conclusion: The pathogenic mutation in DMD gene, c.2767_2767delT [p.Ser923LeufsX26], identified in this family is a de novo mutation. On the basis of specific conditions, it is necessary to select suitable methods to make prenatal diagnosis more effective, accurate, and economic. PMID:29390271

Comprehensive annotated STR physical map of the human Y chromosome: Forensic implications.

PubMed

Hanson, Erin K; Ballantyne, Jack

2006-03-01

A plethora of Y-STR markers from diverse sources have been deposited in public databases and represent potential candidates for incorporation into the next generation of Y-STR multiplexes for forensic use. Here, based upon all of the Y-STR loci that have been deposited in the human genome database (>400), we have sequentially positioned each one along the Y chromosome using the most current human genome sequencing data (NCBI Build 35). The information derived from this work defines the number and relative position of all potentially forensically relevant Y-STR loci, their location within the physical linkage map of the Y chromosome and their relationship to structural genes. We conclude that there exists at present at least 417 separate Y-STR markers available for potential forensic use, although many of these will be found to be unsuitable for other reasons. However, from this data, we were able to identify 28 pairs of duplicated loci that were given separate DYS designations and four pairs of loci with overlapping flanking regions. Removing one locus from each set of duplicates reduced the number of potentially useful loci from 417 to 389. The derived information should be useful for workers who are designing novel Y-STR multiplexes to ensure the presence of non-synonymous loci and, if so desired, to avoid loci that lie within structural genes. It may also be useful for forensic casework practitioners (or molecular anthropologists) to aid in distinguishing between chromosomal rearrangements (such as duplications and deletions) and bona fide DNA admixtures or null alleles caused by primer binding site mutations. We illustrate the practical usefulness of the chromosomal positioning data in the design of eight multiplex systems using 94 Y-STR loci.

A computational method for estimating the PCR duplication rate in DNA and RNA-seq experiments.

PubMed

Bansal, Vikas

2017-03-14

PCR amplification is an important step in the preparation of DNA sequencing libraries prior to high-throughput sequencing. PCR amplification introduces redundant reads in the sequence data and estimating the PCR duplication rate is important to assess the frequency of such reads. Existing computational methods do not distinguish PCR duplicates from "natural" read duplicates that represent independent DNA fragments and therefore, over-estimate the PCR duplication rate for DNA-seq and RNA-seq experiments. In this paper, we present a computational method to estimate the average PCR duplication rate of high-throughput sequence datasets that accounts for natural read duplicates by leveraging heterozygous variants in an individual genome. Analysis of simulated data and exome sequence data from the 1000 Genomes project demonstrated that our method can accurately estimate the PCR duplication rate on paired-end as well as single-end read datasets which contain a high proportion of natural read duplicates. Further, analysis of exome datasets prepared using the Nextera library preparation method indicated that 45-50% of read duplicates correspond to natural read duplicates likely due to fragmentation bias. Finally, analysis of RNA-seq datasets from individuals in the 1000 Genomes project demonstrated that 70-95% of read duplicates observed in such datasets correspond to natural duplicates sampled from genes with high expression and identified outlier samples with a 2-fold greater PCR duplication rate than other samples. The method described here is a useful tool for estimating the PCR duplication rate of high-throughput sequence datasets and for assessing the fraction of read duplicates that correspond to natural read duplicates. An implementation of the method is available at https://github.com/vibansal/PCRduplicates .

The early stages of duplicate gene evolution

PubMed Central

Moore, Richard C.; Purugganan, Michael D.

2003-01-01

Gene duplications are one of the primary driving forces in the evolution of genomes and genetic systems. Gene duplicates account for 8–20% of the genes in eukaryotic genomes, and the rates of gene duplication are estimated at between 0.2% and 2% per gene per million years. Duplicate genes are believed to be a major mechanism for the establishment of new gene functions and the generation of evolutionary novelty, yet very little is known about the early stages of the evolution of duplicated gene pairs. It is unclear, for example, to what extent selection, rather than neutral genetic drift, drives the fixation and early evolution of duplicate loci. Analysis of recently duplicated genes in the Arabidopsis thaliana genome reveals significantly reduced species-wide levels of nucleotide polymorphisms in the progenitor and/or duplicate gene copies, suggesting that selective sweeps accompany the initial stages of the evolution of these duplicated gene pairs. Our results support recent theoretical work that indicates that fates of duplicate gene pairs may be determined in the initial phases of duplicate gene evolution and that positive selection plays a prominent role in the evolutionary dynamics of the very early histories of duplicate nuclear genes. PMID:14671323

From clinical integration to accountable care.

PubMed

Shields, Mark

2011-01-01

Four key challenges to reforming health care organizations can be addressed by a clinical integration model patterned after Advocate Physician Partners (APP). These challenges are: predominance of small group practices, dominant fee-for-service reimbursement methods, weaknesses of the traditional hospital medical staff structure and a need to partner with commercial insurance companies. APP has demonstrated teamwork between 3800 physicians and hospitals to improve quality, patient safety and cost-effectiveness. Building on this model, an innovative contract with Blue Cross Blue Shield of Illinois serves as a prototype for a commercial Accountable Care Organization. For this contract to succeed, APP must outperform the market competition. To accomplish this, APP has implemented strategies to reduce readmissions, avoid unnecessary admissions and emergency room visits, expand primary care access, and enhance quality and patient safety.

Molecular Signature of Indeterminate Thyroid Lesions: Current Methods to Improve Fine Needle Aspiration Cytology (FNAC) Diagnosis

PubMed Central

Cantara, Silvia; Marzocchi, Carlotta; Pilli, Tania; Cardinale, Sandro; Forleo, Raffaella; Castagna, Maria Grazia; Pacini, Furio

2017-01-01

Fine needle aspiration cytology (FNAC) represents the gold standard for determining the nature of thyroid nodules. It is a reliable method with good sensitivity and specificity. However, indeterminate lesions remain a diagnostic challenge and researchers have contributed molecular markers to search for in cytological material to refine FNAC diagnosis and avoid unnecessary surgeries. Nowadays, several “home-made” methods as well as commercial tests are available to investigate the molecular signature of an aspirate. Moreover, other markers (i.e., microRNA, and circulating tumor cells) have been proposed to discriminate benign from malignant thyroid lesions. Here, we review the literature and provide data from our laboratory on mutational analysis of FNAC material and circulating microRNA expression obtained in the last 6 years. PMID:28383480

Clinical trials--a brave new partnership?

PubMed Central

Thornton, H

1994-01-01

The need for informed consent is considered from the patient's viewpoint by an examination of the shortcomings of the UK Ductal Carcinoma In Situ (DCIS) trial and its failure satisfactorily to accrue both profession and patient. The impersonal, negative aspects of the informed consent process in the research situation are contrasted with the positive benefits of confidence fostered by the traditional doctor/patient relationship. The need for new research with a partnership between patient and profession, the necessity for rigorous re-assessment of treatments and care both within and outside of trials to avoid waste by the perpetration of unnecessary treatments together with the need for evaluation of the efficacy of treatments employed outside of trials, especially in 'new' conditions, to foster progress and maintain public confidence in the profession, is advocated. PMID:8035434

Activating the critical lure during study is unnecessary for false recognition.

PubMed

Zeelenberg, René; Boot, Inge; Pecher, Diane

2005-06-01

Participants studied lists of nonwords (e.g., froost, floost, stoost, etc.) that were orthographic-phonologically similar to a nonpresented critical lure, which was also a nonword (e.g., ploost). Experiment 1 showed a high level of false recognition for the critical lure. Experiment 2 showed that the false recognition effect was also present for forewarned participants who were informed about the nature of the false recognition effect and told to avoid making false recognition judgments. The present results show that false recognition effects can be obtained even when the critical lure itself is not stored during study. This finding is problematic for accounts that attribute false memories to implicit associative responses or spreading activation but is easily explained by global familiarity models of recognition memory.

Issues of medical necessity: a medical director's guide to good faith adjudication.

PubMed

Quinn, C

1997-06-01

The term medical necessity is difficult to define, a problem for insurers who need to clearly describe what is and is not covered in their contracts with subscribers. An unclear, vague definition of medical necessity leaves insurers vulnerable to litigation by subscribers denied care deemed medically unnecessary. To avoid lawsuits, insurers must make every effort to educate their subscribers about their medical coverage, going beyond merely providing a lengthy subscriber handbook. In decisions on medical necessity, medical directors at insurance companies play a key role. They can bolster the insurer's position in denial-of-care cases in numerous ways, including keeping meticulous records, eliminating unreasonable financial incentives, maintaining a claims denial database, and consulting with other insurers to achieve a consensus on medical necessity.

Protecting worker and public health during responses to catastrophic disasters-learning from the World Trade Center experience.

PubMed

Newman, David M

2014-11-01

Despite incremental lessons learned since 9/11, responder and community health remain at unnecessary risk during responses to catastrophic disasters, as evidenced during the BP Deepwater Horizon spill and Hurricanes Katrina, Rita, and Sandy. Much of the health harm that occurs during disaster response, as distinct from during the disaster event itself, is avoidable. Protection of public health should be an integral component of disaster response, which should "do no additional harm." This commentary examines how challenges and gaps the World Trade Center response resulted in preventable occupational and environmental health harm. It proposes changes in disaster response policies to better protect the health of rescue and recovery workers, volunteers, and impacted worker and residential communities. © 2014 Wiley Periodicals, Inc.

Lateralized hyperkinetic motor behavior.

PubMed

Krishnaiah, Balaji; Acharya, Jayant; Ahmed, Aiesha

2018-01-01

Seizures are followed by a post-ictal period, which is characterized by usual slowing of brain activity. This case report describes a 68-year old woman who presented with right-sided rhythmic, non-voluntary, semi-purposeful motor behavior that started 2 days after an episode of generalized seizure. Her initial electroencephalogram (EEG) showed beta activity with no evidence of epileptiform discharges. Computed tomography scan showed hypodensity in the left parieto-occipital region. Magnetic resonance imaging (MRI) showed restricted diffusion/fluid-attenuated inversion recovery hyperintensities in the left precentral and post-central gyrus. Unilateral compulsive motor behavior during the post-ictal state should be considered, and not confused with partial status epilepticus to avoid unnecessary treatment. Abnormal magnetic resonance imaging (MRI) findings, which are reversible, can help with the diagnostic and therapeutic approach.

[Mild head injury in children and adults: Diagnostic challenges in the emergency department].

PubMed

Leidel, B A; Lindner, T; Wolf, S; Bogner, V; Steinbeck, A; Börner, N; Peiser, C; Audebert, H J; Biberthaler, P; Kanz, K-G

2015-06-01

Mild head injuries are one of the most frequent reasons for attending emergency departments and are particularly challenging in different ways. While clinically important injuries are infrequent, delayed or missed injuries may lead to fatal consequences. The initial mostly inconspicuous appearance may not reflect the degree of intracranial injury and computed tomography (CT) is necessary to rule out covert injuries. Furthermore, infants and young children with a lack of or rudimentary cognitive and language development are challenging, especially for those examiners not familiar with pediatric care. Established check lists of clinical risk factors for children and adults regarding traumatic brain injuries allow specific and rational decision-making for cranial CT imaging. Clinically important intracranial injuries can be reliably detected and unnecessary radiation exposure avoided at the same time.

[Mild head injury in children and adults. Diagnostic challenges in the emergency department].

PubMed

Leidel, B A; Lindner, T; Wolf, S; Bogner, V; Steinbeck, A; Börner, N; Peiser, C; Audebert, H J; Biberthaler, P; Kanz, K-G

2015-01-01

Mild head injuries are one of the most frequent reasons for attending emergency departments and are particularly challenging in different ways. While clinically important injuries are infrequent, delayed or missed injuries may lead to fatal consequences. The initial mostly inconspicuous appearance may not reflect the degree of intracranial injury and computed tomography (CT) is necessary to rule out covert injuries. Furthermore, infants and young children with a lack of or rudimentary cognitive and language development are challenging, especially for those examiners not familiar with pediatric care. Established check lists of clinical risk factors for children and adults regarding traumatic brain injuries allow specific and rational decision-making for cranial CT imaging. Clinically important intracranial injuries can be reliably detected and unnecessary radiation exposure avoided at the same time.

Fail-over file transfer process

NASA Technical Reports Server (NTRS)

Semancik, Susan K. (Inventor); Conger, Annette M. (Inventor)

2005-01-01

The present invention provides a fail-over file transfer process to handle data file transfer when the transfer is unsuccessful in order to avoid unnecessary network congestion and enhance reliability in an automated data file transfer system. If a file cannot be delivered after attempting to send the file to a receiver up to a preset number of times, and the receiver has indicated the availability of other backup receiving locations, then the file delivery is automatically attempted to one of the backup receiving locations up to the preset number of times. Failure of the file transfer to one of the backup receiving locations results in a failure notification being sent to the receiver, and the receiver may retrieve the file from the location indicated in the failure notification when ready.