Variable prospective financing in the Danish hospital sector and the development of a Danish case-mix system.

PubMed

Ankjaer-Jensen, Anni; Rosling, Pernille; Bilde, Lone

2006-08-01

This article aims to describe and assess the Danish case-mix system, the cost accounting applied in setting national tariffs and the introduction of variable, prospective payment in the Danish hospital sector. The tariffs are calculated as a national average from hospital data gathered in a national cost database. However, uncertainty, mainly resulting from the definition of cost centres at the individual hospital, implies that the cost weights may not fully reflect the hospital treatment cost. As variable prospective payment of hospitals currently only applies to 20% of a hospital's budget, the incentives and the effects on productivity, quality and equality are still limited.

Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

PubMed

Shankar-Hari, Manu; Phillips, Gary S; Levy, Mitchell L; Seymour, Christopher W; Liu, Vincent X; Deutschman, Clifford S; Angus, Derek C; Rubenfeld, Gordon D; Singer, Mervyn

2016-02-23

Septic shock currently refers to a state of acute circulatory failure associated with infection. Emerging biological insights and reported variation in epidemiology challenge the validity of this definition. To develop a new definition and clinical criteria for identifying septic shock in adults. The Society of Critical Care Medicine and the European Society of Intensive Care Medicine convened a task force (19 participants) to revise current sepsis/septic shock definitions. Three sets of studies were conducted: (1) a systematic review and meta-analysis of observational studies in adults published between January 1, 1992, and December 25, 2015, to determine clinical criteria currently reported to identify septic shock and inform the Delphi process; (2) a Delphi study among the task force comprising 3 surveys and discussions of results from the systematic review, surveys, and cohort studies to achieve consensus on a new septic shock definition and clinical criteria; and (3) cohort studies to test variables identified by the Delphi process using Surviving Sepsis Campaign (SSC) (2005-2010; n = 28,150), University of Pittsburgh Medical Center (UPMC) (2010-2012; n = 1,309,025), and Kaiser Permanente Northern California (KPNC) (2009-2013; n = 1,847,165) electronic health record (EHR) data sets. Evidence for and agreement on septic shock definitions and criteria. The systematic review identified 44 studies reporting septic shock outcomes (total of 166,479 patients) from a total of 92 sepsis epidemiology studies reporting different cutoffs and combinations for blood pressure (BP), fluid resuscitation, vasopressors, serum lactate level, and base deficit to identify septic shock. The septic shock-associated crude mortality was 46.5% (95% CI, 42.7%-50.3%), with significant between-study statistical heterogeneity (I2 = 99.5%; τ2 = 182.5; P < .001). The Delphi process identified hypotension, serum lactate level, and vasopressor therapy as variables to test using cohort studies. Based on these 3 variables alone or in combination, 6 patient groups were generated. Examination of the SSC database demonstrated that the patient group requiring vasopressors to maintain mean BP 65 mm Hg or greater and having a serum lactate level greater than 2 mmol/L (18 mg/dL) after fluid resuscitation had a significantly higher mortality (42.3% [95% CI, 41.2%-43.3%]) in risk-adjusted comparisons with the other 5 groups derived using either serum lactate level greater than 2 mmol/L alone or combinations of hypotension, vasopressors, and serum lactate level 2 mmol/L or lower. These findings were validated in the UPMC and KPNC data sets. Based on a consensus process using results from a systematic review, surveys, and cohort studies, septic shock is defined as a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone. Adult patients with septic shock can be identified using the clinical criteria of hypotension requiring vasopressor therapy to maintain mean BP 65 mm Hg or greater and having a serum lactate level greater than 2 mmol/L after adequate fluid resuscitation.

Preliminary definition of improvement in juvenile arthritis.

PubMed

Giannini, E H; Ruperto, N; Ravelli, A; Lovell, D J; Felson, D T; Martini, A

1997-07-01

To identify a core set of outcome variables for the assessment of children with juvenile arthritis (JA), to use the core set to develop a definition of improvement to determine whether individual patients demonstrate clinically important improvement, and to promote this definition as a single efficacy measure in JA clinical trials. A core set of outcome variables was established using a combination of statistical and consensus formation techniques. Variables in the core set consisted of 1) physician global assessment of disease activity; 2) parent/patient assessment of overall well-being; 3) functional ability; 4) number of joints with active arthritis; 5) number of joints with limited range of motion; and 6) erythrocyte sedimentation rate. To establish a definition of improvement using this core set, 21 pediatric rheumatologists from 14 countries met, and, using consensus formation techniques, scored each of 72 patient profiles as improved or not improved. Using the physicians' consensus as the gold standard, the chi-square, sensitivity, and specificity were calculated for each of 240 possible definitions of improvement. Definitions with sensitivity or specificity of <80% were eliminated. The ability of the remaining definitions to discriminate between the effects of active agent and those of placebo, using actual trial data, was then observed. Each definition was also ranked for face validity, and the sum of the ranks was then multiplied by the kappa statistic. The definition of improvement with the highest final score was as follows: at least 30% improvement from baseline in 3 of any 6 variables in the core set, with no more than 1 of the remaining variables worsening by >30%. The second highest scoring definition was closely related to the first; the third highest was similar to the Paulus criteria used in adult rheumatoid arthritis trials, except with different variables. This indicates convergent validity of the process used. We propose a definition of improvement for JA. Use of a uniform definition will help standardize the conduct and reporting of clinical trials, and should help practitioners decide if a child with JA has responded adequately to therapy. We are in the process of prospectively validating this definition and several others that scored highly.

International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics.

PubMed

Goldstein, Brahm; Giroir, Brett; Randolph, Adrienne

2005-01-01

Although general definitions of the sepsis continuum have been published for adults, no such work has been done for the pediatric population. Physiologic and laboratory variables used to define the systemic inflammatory response syndrome (SIRS) and organ dysfunction require modification for the developmental stages of children. An international panel of 20 experts in sepsis and clinical research from five countries (Canada, France, Netherlands, United Kingdom, and United States) was convened to modify the published adult consensus definitions of infection, sepsis, severe sepsis, septic shock, and organ dysfunction for children. Consensus conference. This document describes the issues surrounding consensus on four major questions addressed at the meeting: a) How should the pediatric age groups affected by sepsis be delineated? b) What are the specific definitions of pediatric SIRS, infection, sepsis, severe sepsis, and septic shock? c) What are the specific definitions of pediatric organ failure and the validity of pediatric organ failure scores? d) What are the appropriate study populations and study end points required to successfully conduct clinical trials in pediatric sepsis? Five subgroups first met separately and then together to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiological data, and coagulation variables. All conference participants approved the final draft of the proceedings of the meeting. Conference attendees modified the current criteria used to define SIRS and sepsis in adults to incorporate pediatric physiologic variables appropriate for the following subcategories of children: newborn, neonate, infant, child, and adolescent. In addition, the SIRS definition was modified so that either criteria for fever or white blood count had to be met. We also defined various organ dysfunction categories, severe sepsis, and septic shock specifically for children. Although no firm conclusion was made regarding a single appropriate study end point, a novel nonmortality end point, organ failure-free days, was considered optimal for pediatric clinical trials given the relatively low incidence of mortality in pediatric sepsis compared with adult populations. We modified the adult SIRS criteria for children. In addition, we revised definitions of severe sepsis and septic shock for the pediatric population. Our goal is for these first-generation pediatric definitions and criteria to facilitate the performance of successful clinical studies in children with sepsis.

Defining Flare in Osteoarthritis of the Hip and Knee: A Systematic Literature Review - OMERACT Virtual Special Interest Group.

PubMed

Cross, Marita; Dubouis, Ludovic; Mangin, Matthieu; Hunter, David J; March, Lyn; Hawker, Gillian; Guillemin, Francis

2017-12-01

Beyond the exacerbation of pain in describing a flare in osteoarthritis (OA), patients and health professionals add other elements that deserve to be fully elucidated, such as effusion, swelling, and mobility limitation. To define and conceptualize the construct flare in OA, the objective was to identify the key variables, or symptoms, that worsen, and to clarify how these variables are described in the literature by patients and clinicians. A systematic review of the literature was conducted in Medline and PsychINFO. In brief, the search terms used were "osteoarthritis," "knee," "hip," and "flare." Specific characteristics of included studies were identified, including the type of study design, type of flare assessed, how the flare developed, and what definition of flare was used, including whether the definition was based on qualitative or quantitative analysis. Pain was the major factor in the definition of flare within these studies. Four components of flare were identified: pain, other factors, composite criteria, and global assessment. While the majority of studies reported flare as an increase in pain using standardized outcome measures, only 1 study reported the antecedents and consequences of a pain flare using qualitative methods. The use of flare as an outcome or inclusion criterion in rheumatology trials is a common occurrence; however, this review highlights the wide variation in the definitions of OA flare currently in use and the emphasis on the measurement of pain. This variation in definition does not allow for direct comparison between trials and limits interpretation of evidence.

Night-to-night arousal variability and interscorer reliability of arousal measurements.

PubMed

Loredo, J S; Clausen, J L; Ancoli-Israel, S; Dimsdale, J E

1999-11-01

Measurement of arousals from sleep is clinically important, however, their definition is not well standardized, and little data exist on reliability. The purpose of this study is to determine factors that affect arousal scoring reliability and night-to-night arousal variability. The night-to-night arousal variability and interscorer reliability was assessed in 20 subjects with and without obstructive sleep apnea undergoing attended polysomnography during two consecutive nights. Five definitions of arousal were studied, assessing duration of electroencephalographic (EEG) frequency changes, increases in electromyographic (EMG) activity and leg movement, association with respiratory events, as well as the American Sleep Disorders Association (ASDA) definition of arousals. NA. NA. NA. Interscorer reliability varied with the definition of arousal and ranged from an Intraclass correlation (ICC) of 0.19 to 0.92. Arousals that included increases in EMG activity or leg movement had the greatest reliability, especially when associated with respiratory events (ICC 0.76 to 0.92). The ASDA arousal definition had high interscorer reliability (ICC 0.84). Reliability was lowest for arousals consisting of EEG changes lasting <3 seconds (ICC 0.19 to 0.37). The within subjects night-to-night arousal variability was low for all arousal definitions In a heterogeneous population, interscorer arousal reliability is enhanced by increases in EMG activity, leg movements, and respiratory events and decreased by short duration EEG arousals. The arousal index night-to-night variability was low for all definitions.

Intra-individual variability in tinnitus patients : current thoughts and perspectives.

PubMed

Dauman, N; Erlandsson, S; Lundlin, L; Dauman, R

2015-04-01

Most tinnitus studies have attempted to compare groups of individuals, thus revealing inter-individuals differences, i.e., variations between compared subjects. For methodological reasons, inter-individual studies cannot take into account the variability of tinnitus experience, which has been known for decades to be relevant in daily practice with tinnitus patients. The concept of intra-individual variability has been promoted in the research literature, in order to shed light on this aspect of individual perception. In previous studies, unrelated to hearing, the concept of intra-individual variability implied inclusion of the environment (i.e., physical and social interactions) as a factor of individual performance. In tinnitus research, we believe that the concept of variability (within a person) could find a place beside the concept of variation (between groups of subjects). In this paper, four perspectives of tinnitus experiences from the clinical and research fields are described: (1) ENT consultation; (2) short-term group psychotherapy; (3) psychodynamic psychotherapy; and (4) clinical psychological research. Intra-individual variability stresses the importance of defining tinnitus in a dynamic way, contrary to the current definition of tinnitus as the perception of sound(s). In clinical practice, it is useful to embrace the perspective of the perceiver of tinnitus, and to include social and cultural circumstances as well as audiological/physical changes.

Developing a New Definition and Assessing New Clinical Criteria for Septic Shock

PubMed Central

Shankar-Hari, Manu; Phillips, Gary S.; Levy, Mitchell L.; Seymour, Christopher W.; Liu, Vincent X.; Deutschman, Clifford S.; Angus, Derek C.; Rubenfeld, Gordon D.; Singer, Mervyn

2016-01-01

IMPORTANCE Septic shock currently refers to a state of acute circulatory failure associated with infection. Emerging biological insights and reported variation in epidemiology challenge the validity of this definition. OBJECTIVE To develop a new definition and clinical criteria for identifying septic shock in adults. DESIGN, SETTING, AND PARTICIPANTS The Society of Critical Care Medicine and the European Society of Intensive Care Medicine convened a task force (19 participants) to revise current sepsis/septic shock definitions. Three sets of studies were conducted: (1) a systematic review and meta-analysis of observational studies in adults published between January 1, 1992, and December 25, 2015, to determine clinical criteria currently reported to identify septic shock and inform the Delphi process; (2) a Delphi study among the task force comprising 3 surveys and discussions of results from the systematic review, surveys, and cohort studies to achieve consensus on a new septic shock definition and clinical criteria; and (3) cohort studies to test variables identified by the Delphi process using Surviving Sepsis Campaign (SSC) (2005–2010; n = 28 150), University of Pittsburgh Medical Center (UPMC) (2010–2012; n = 1 309 025), and Kaiser Permanente Northern California (KPNC) (2009–2013; n = 1 847 165) electronic health record (EHR) data sets. MAIN OUTCOMES AND MEASURES Evidence for and agreement on septic shock definitions and criteria. RESULTS The systematic review identified 44 studies reporting septic shock outcomes (total of 166 479 patients) from a total of 92 sepsis epidemiology studies reporting different cutoffs and combinations for blood pressure (BP), fluid resuscitation, vasopressors, serum lactate level, and base deficit to identify septic shock. The septic shock–associated crude mortality was 46.5% (95%CI, 42.7%–50.3%), with significant between-study statistical heterogeneity (I2 = 99.5%; τ2 = 182.5; P < .001). The Delphi process identified hypotension, serum lactate level, and vasopressor therapy as variables to test using cohort studies. Based on these 3 variables alone or in combination, 6 patient groups were generated. Examination of the SSC database demonstrated that the patient group requiring vasopressors to maintain mean BP 65 mmHg or greater and having a serum lactate level greater than 2 mmol/L (18 mg/dL) after fluid resuscitation had a significantly higher mortality (42.3%[95%CI, 41.2%–43.3%]) in risk-adjusted comparisons with the other 5 groups derived using either serum lactate level greater than 2 mmol/L alone or combinations of hypotension, vasopressors, and serum lactate level 2 mmol/L or lower. These findings were validated in the UPMC and KPNC data sets. CONCLUSIONS AND RELEVANCE Based on a consensus process using results from a systematic review, surveys, and cohort studies, septic shock is defined as a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone. Adult patients with septic shock can be identified using the clinical criteria of hypotension requiring vasopressor therapy to maintain mean BP 65 mmHg or greater and having a serum lactate level greater than 2 mmol/L after adequate fluid resuscitation. PMID:26903336

Diagnosis of murine mycoplasmal infections by enzyme-linked immunosorbent assay (ELISA).

PubMed

Davis, J; Cassell, G H; Gambill, G; Cox, N; Watson, H; Davidson, M

1987-06-01

ELISA is the currently accepted method for screening rodent colonies for Mycoplasma pulmonis infection. While this assay has greatly improved mycoplasmal detection, it suffers from major defects. Cross-reactions with M. arthritidis are the major technical problem, and prevent definitive diagnosis. Current methods for obtaining a definitive diagnosis are accurate in about 80% of cases, and include ELISA testing for both organisms, immunoblot analysis, and blocking of the murine reaction with heterologous serum. Another technical difficulty is the inherent variability in the assay, which can be overcome by rigid quality control measures and careful attention to detail. The difficulties that arise from the natural history of mycoplasmal infection in barrier-maintained colonies, i.e., low incidence of infected animals and delayed antibody response in animals infected with low numbers of organisms, seriously limit the usefulness of the ELISA. While the assay can be extremely useful in screening breeding colonies and in eliminating mycoplasmas from such colonies, it cannot easily be used to screen potential sources of weanling animals for experimental use.

Variable Order and Distributed Order Fractional Operators

NASA Technical Reports Server (NTRS)

Lorenzo, Carl F.; Hartley, Tom T.

2002-01-01

Many physical processes appear to exhibit fractional order behavior that may vary with time or space. The continuum of order in the fractional calculus allows the order of the fractional operator to be considered as a variable. This paper develops the concept of variable and distributed order fractional operators. Definitions based on the Riemann-Liouville definitions are introduced and behavior of the operators is studied. Several time domain definitions that assign different arguments to the order q in the Riemann-Liouville definition are introduced. For each of these definitions various characteristics are determined. These include: time invariance of the operator, operator initialization, physical realization, linearity, operational transforms. and memory characteristics of the defining kernels. A measure (m2) for memory retentiveness of the order history is introduced. A generalized linear argument for the order q allows the concept of "tailored" variable order fractional operators whose a, memory may be chosen for a particular application. Memory retentiveness (m2) and order dynamic behavior are investigated and applications are shown. The concept of distributed order operators where the order of the time based operator depends on an additional independent (spatial) variable is also forwarded. Several definitions and their Laplace transforms are developed, analysis methods with these operators are demonstrated, and examples shown. Finally operators of multivariable and distributed order are defined in their various applications are outlined.

THE PEDIATRIC RHEUMATOLOGY INTERNATIONAL TRIALS ORGANIZATION PROVISIONAL CRITERIA FOR THE EVALUATION OF RESPONSE TO THERAPY IN JUVENILE DERMATOMYOSITIS

PubMed Central

Ruperto, Nicolino; Pistorio, Angela; Ravelli, Angelo; Rider, Lisa G.; Pilkington, Clarissa; Oliveira, Sheila; Wulffraat, Nico; Espada, Graciela; Garay, Stella; Cuttica, Ruben; Hofer, Michael; Quartier, Pierre; Melo-Gomes, Jose; Reed, Ann M.; Wierzbowska, Malgorzata; Feldman, Brian M.; Harjacek, Miroslav; Huppertz, Hans-Iko; Nielsen, Susan; Flato, Berit; Lahdenne, Pekka; Michels, Harmut; Murray, Kevin J.; Punaro, Lynn; Rennebohm, Robert; Russo, Ricardo; Balogh, Zsolt; Rooney, Madeleine; Pachman, Lauren M.; Wallace, Carol; Hashkes, Philip; Lovell, Daniel J.; Giannini, Edward H.; Martini, Alberto

2010-01-01

Objective To develop a provisional definition for the evaluation of response to therapy in juvenile dermatomyositis (JDM) based on the PRINTO JDM core set of variables. Methods Thirty-seven experienced pediatric rheumatologists from 27 countries, achieved consensus on 128 difficult patient profiles as clinically improved or not improved using a stepwise approach (patients rating, statistical analysis, definition selection). Using the physicians’ consensus ratings as the “gold-standard measure”, chi-square, sensitivity, specificity, false positive and negative rate, area under the ROC, and kappa agreement for candidate definitions of improvement were calculated. Definitions with kappa >0.8 were multiplied with the face validity score to select the top definitions. Results The top definition of improvement was: at least 20% improvement from baseline in 3/6 core set variables with no more than 1 of the remaining worsening by more than 30%, which cannot be muscle strength. The second highest scoring definition was at least 20% improvement from baseline in 3/6 core set variables with no more than 2 of the remaining worsening by more than 25%, which cannot be muscle strength which is definition P1 selected by the IMACS group. The third is similar to the second with the maximum amount of worsening set to 30%. This indicates convergent validity of the process. Conclusion we proposes a provisional data driven definition of improvement that reflects well the consensus rating of experienced clinicians, which incorporates clinically meaningful change in core set variables in a composite endpoint for the evaluation of global response to therapy in JDM. PMID:20583105

'Trifecta' after radical prostatectomy: is there a standard definition?

PubMed

Borregales, Leonardo D; Berg, William T; Tal, Oded; Wambi, Chris; Kaufman, Sarah; Gaya, Jose M; Urzúa, Cristian; Badani, Ketan K

2013-07-01

To determine the extent of variability in the definitions of the 'trifecta' after radical prostatectomy (undetectable PSA, urinary continence and potency) to be found in the literature. To establish a consensus definition of the trifecta in an effort to standardize criteria and reporting. A systematic review of published articles found in the PubMed database for the period from January 2003 to March 2012 was performed. The search queries included the keywords 'radical prostatectomy,' 'prostatectomy outcome,' and 'trifecta'. A total of 86 publications were identified of which 14 were used for analysis. Eight different definitions of biochemical recurrence were reported, the most common definition being PSA ≥0.2 ng/mL. The definition of potency was the most variable. Ten different definitions of potency were found, with the most common being 'having erections sufficient for intercourse with or without a phosphodiesterase-5 inhibitor'. Nine different definitions of continence were found. The most common definition of continence was 'wearing no pads'. Only six of the 14 articles used validated questionnaires in their outcome measures. The definitions of trifecta reported in the literature are highly variable. We propose the following consensus definition based on our analysis: (1) PSA >0.2 ng/mL with confirmatory value; (2) attainment of erections sufficient for intercourse with or without oral pharmacological agents; (3) wearing zero pads. This consensus definition should be considered when designing studies and reporting outcomes of radical prostatectomy. © 2013 BJU International.

Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology.

PubMed

Nag, Subir; Demanes, D Jeffrey; Hagan, Michael; Rivard, Mark J; Thomadsen, Bruce R; Welsh, James S; Williamson, Jeffrey F

2011-10-01

The Nuclear Regulatory Commission deems it to be a medical event (ME) if the total dose delivered differs from the prescribed dose by 20% or more. A dose-based definition of ME is not appropriate for permanent prostate brachytherapy as it generates too many spurious MEs and thereby creates unnecessary apprehension in patients, and ties up regulatory bodies and the licensees in unnecessary and burdensome investigations. A more suitable definition of ME is required for permanent prostate brachytherapy. The American Society for Radiation Oncology (ASTRO) formed a working group of experienced clinicians to review the literature, assess the validity of current regulations, and make specific recommendations about the definition of an ME in permanent prostate brachytherapy. The working group found that the current definition of ME in §35.3045 as "the total dose delivered differs from the prescribed dose by 20 percent or more" was not suitable for permanent prostate brachytherapy since the prostate volume (and hence the resultant calculated prostate dose) is dependent on the timing of the imaging, the imaging modality used, the observer variability in prostate contouring, the planning margins used, inadequacies of brachytherapy treatment planning systems to calculate tissue doses, and seed migration within and outside the prostate. If a dose-based definition for permanent implants is applied strictly, many properly executed implants would be improperly classified as an ME leading to a detrimental effect on brachytherapy. The working group found that a source strength-based criterion, of >20% of source strength prescribed in the post-procedure written directive being implanted outside the planning target volume is more appropriate for defining ME in permanent prostate brachytherapy. ASTRO recommends that the definition of ME for permanent prostate brachytherapy should not be dose based but should be based upon the source strength (air-kerma strength) administered.

Ecological Momentary Assessment is a Neglected Methodology in Suicidology.

PubMed

Davidson, Collin L; Anestis, Michael D; Gutierrez, Peter M

2017-01-02

Ecological momentary assessment (EMA) is a group of research methods that collect data frequently, in many contexts, and in real-world settings. EMA has been fairly neglected in suicidology. The current article provides an overview of EMA for suicidologists including definitions, data collection considerations, and different sampling strategies. Next, the benefits of EMA in suicidology (i.e., reduced recall bias, accurate tracking of fluctuating variables, testing assumptions of theories, use in interventions), participant safety considerations, and examples of published research that investigate self-directed violence variables using EMA are discussed. The article concludes with a summary and suggested directions for EMA research in suicidology with the particular aim to spur the increased use of this methodology among suicidologists.

Influenza Vaccination in Patients with Common Variable Immunodeficiency (CVID).

PubMed

Mieves, Jan F; Wittke, Kirsten; Freitag, Helma; Volk, Hans-Dieter; Scheibenbogen, Carmen; Hanitsch, Leif G

2017-10-05

Vaccination against influenza in patients with primary antibody deficiency is recommended. Common variable immunodeficiency (CVID) is the most frequent and clinically relevant antibody deficiency disease and is by definition characterized by an impaired vaccination response. The purpose of this review is to present the current knowledge of humoral and cellular vaccine response to influenza in CVID patients. Studies conducted in CVID patients demonstrated an impaired humoral response upon influenza vaccination. Data on cellular immune response are in part conflicting, with two out of three studies showing responses similar to healthy controls. Available data suggest a benefit from influenza vaccination in CVID patients. Therefore, annual influenza vaccination in patients and their close household contacts is recommended.

Use of Actigraphy for Assessment in Pediatric Sleep Research

PubMed Central

Meltzer, Lisa J.; Montgomery-Downs, Hawley E.; Insana, Salvatore P.; Walsh, Colleen M.

2011-01-01

The use of actigraphs, or ambulatory devices that estimate sleep-wake patterns from activity levels, has become common in pediatric research. Actigraphy provides a more objective measure than parent-report, and has gained popularity due to its ability to measure sleep-wake patterns for extended periods of time in the child’s natural environment. The purpose of this review is: (1) to provide comprehensive information on the historic and current uses of actigraphy in pediatric sleep research; (2) to review how actigraphy has been validated among pediatric populations; and (3) offer recommendations for methodological areas that should be included in all studies that utilize actigraphy, including the definition and scoring of variables commonly reported. The poor specificity to detect wake after sleep onset was consistently noted across devices and age groups, thus raising concerns about what is an “acceptable” level of specificity for actigraphy. Other notable findings from this review include the lack of standard scoring rules or variable definitions. Suggestions for the use and reporting of actigraphy in pediatric research are provided. PMID:22424706

Development and initial evaluation of an enhanced measure of boundary flexibility for the work and family domains.

PubMed

Matthews, Russell A; Barnes-Farrell, Janet L

2010-07-01

This manuscript reports the development of a measure of work and family domain boundary flexibility. Building on previous research, we propose an expanded definition of boundary flexibility that includes two components-flexibility-ability and flexibility-willingness-and we develop a measure designed to capture this more comprehensive definition of boundary flexibility. Flexibility-ability is conceptualized as an individual's perception of personal and situational constraints that affect boundary management, and flexibility-willingness is conceptualized as an individual difference variable that captures the motivation to engage in boundary flexing. An additional feature of domain boundaries, permeability, is also examined. Data are presented from two studies. Study 1 (N = 244) describes the development of a multiscale measure that extends current conceptual definitions of boundary flexibility. Study 2 (N = 225) describes the refinement and evaluation of this measure. Confirmatory factor analysis, reliability evidence, interscale correlations, and correlations with important work-family constructs (e.g., domain centrality, work-family conflict) provide initial construct validity evidence for the measure.

The Paediatric Rheumatology International Trials Organisation provisional criteria for the evaluation of response to therapy in juvenile dermatomyositis.

PubMed

Ruperto, Nicolino; Pistorio, Angela; Ravelli, Angelo; Rider, Lisa G; Pilkington, Clarissa; Oliveira, Sheila; Wulffraat, Nico; Espada, Graciela; Garay, Stella; Cuttica, Ruben; Hofer, Michael; Quartier, Pierre; Melo-Gomes, Jose; Reed, Ann M; Wierzbowska, Malgorzata; Feldman, Brian M; Harjacek, Miroslav; Huppertz, Hans-Iko; Nielsen, Susan; Flato, Berit; Lahdenne, Pekka; Michels, Harmut; Murray, Kevin J; Punaro, Lynn; Rennebohm, Robert; Russo, Ricardo; Balogh, Zsolt; Rooney, Madeleine; Pachman, Lauren M; Wallace, Carol; Hashkes, Philip; Lovell, Daniel J; Giannini, Edward H; Gare, Boel Andersson; Martini, Alberto

2010-11-01

To develop a provisional definition for the evaluation of response to therapy in juvenile dermatomyositis (DM) based on the Paediatric Rheumatology International Trials Organisation juvenile DM core set of variables. Thirty-seven experienced pediatric rheumatologists from 27 countries achieved consensus on 128 difficult patient profiles as clinically improved or not improved using a stepwise approach (patient's rating, statistical analysis, definition selection). Using the physicians' consensus ratings as the "gold standard measure," chi-square, sensitivity, specificity, false-positive and-negative rates, area under the receiver operating characteristic curve, and kappa agreement for candidate definitions of improvement were calculated. Definitions with kappa values >0.8 were multiplied by the face validity score to select the top definitions. The top definition of improvement was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 1 of the remaining worsening by more than 30%, which cannot be muscle strength. The second-highest scoring definition was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 2 of the remaining worsening by more than 25%, which cannot be muscle strength (definition P1 selected by the International Myositis Assessment and Clinical Studies group). The third is similar to the second with the maximum amount of worsening set to 30%. This indicates convergent validity of the process. We propose a provisional data-driven definition of improvement that reflects well the consensus rating of experienced clinicians, which incorporates clinically meaningful change in core set variables in a composite end point for the evaluation of global response to therapy in juvenile DM. Copyright © 2010 by the American College of Rheumatology.

Current Literature Review of Registered Nurses' Competency in the Global Community.

PubMed

Liu, Ying; Aungsuroch, Yupin

2018-03-01

In order to enhance international standards of nursing service, this article aims to analyze the English full-text peer-reviewed published articles from the past 10 years that describe contemporary registered nurses' (RNs') competency in the global community. An integrative review of literature was conducted between June 2016 and January 2017. A systematic search was completed using four databases (Science Direct, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature) that covered the years between 2007 and 2017, and used the key words nurs * OR (staff nurs * ) OR (register nurs * ) AND competenc * AND international OR global. Ultimately, 32 studies meeting inclusion and exclusion criteria were selected for analysis. Nursing competency trended towards definitions using a holistic lens and behavior statements reflecting the skills, knowledge, attitudes, and judgment required for effective performance in the nursing profession. By using inductive content analysis, 11 components emerged. Additionally, six instruments were found to measure generalist RNs' competencies across countries. The variables related to generalist nursing competency included sociodemographic variables, professional-related variables, and work environment variables. This review provides the research evidence for updating definitions, components, measurements, and variables related to RNs' competency in the global community. Further research should consider cross-cultural validation of instruments and influencing factors related to nursing competency. The components and measurements identified in this review can be used by nursing administrators to select or evaluate qualified nurses. The multivariables related to nursing competency can assistant hospital administrators to recognize and find effective ways to improve nursing competency. © 2018 Sigma Theta Tau International.

Dynamic Task Assignment and Path Planning of Multi-AUV System Based on an Improved Self-Organizing Map and Velocity Synthesis Method in Three-Dimensional Underwater Workspace.

PubMed

Zhu, Daqi; Huang, Huan; Yang, S X

2013-04-01

For a 3-D underwater workspace with a variable ocean current, an integrated multiple autonomous underwater vehicle (AUV) dynamic task assignment and path planning algorithm is proposed by combing the improved self-organizing map (SOM) neural network and a novel velocity synthesis approach. The goal is to control a team of AUVs to reach all appointed target locations for only one time on the premise of workload balance and energy sufficiency while guaranteeing the least total and individual consumption in the presence of the variable ocean current. First, the SOM neuron network is developed to assign a team of AUVs to achieve multiple target locations in 3-D ocean environment. The working process involves special definition of the initial neural weights of the SOM network, the rule to select the winner, the computation of the neighborhood function, and the method to update weights. Then, the velocity synthesis approach is applied to plan the shortest path for each AUV to visit the corresponding target in a dynamic environment subject to the ocean current being variable and targets being movable. Lastly, to demonstrate the effectiveness of the proposed approach, simulation results are given in this paper.

Outlook for Improved Numerical Weather Prediction Using Satellite Data with a Special Emphasis on the Hydrological Variables,

DTIC Science & Technology

1983-11-18

Prediction, June 6-9, 1983, Omaha, Nebr., AMS, pp. 269-274. (5) Bellon, A., S. Lovejoy , and G. L. Austin, 1980: Combining satellite and radar data...1979: Global sea-ice limits. In Inventory of Snow Cover and Sea Ice Data. Rep. GD-7, Institute of Arctic and Alpine Research, edited by R. G. Crane... parent organization in parentheses and location or current name in square brackets follow the acronym definition. AFCRL Air Force Cambridge Research

Testing Alternative Definitions of Chronic Homelessness.

PubMed

Byrne, Thomas; Culhane, Dennis P

2015-09-01

This study examined the potential impact of a proposed change to the official federal definition of chronic homelessness. Using administrative data from the emergency shelters in a large U.S. city, this study estimated the number of persons identified as chronically homeless under the current definition of chronic homelessness, a proposed new federal definition, and two alternative definitions and examined shelter utilization for each group. Fewer than half as many people were considered chronically homeless under the proposed new federal definition compared with the current definition. Persons considered chronically homeless by the proposed new definition and, to a lesser extent, by the two alternative definitions, made heavier use of shelter compared with persons who met the current definition. A proposed new and two alternative definitions of chronic homelessness are better suited than the existing federal definition for identifying persons with the most protracted experiences of homelessness.

Physical activity self-definition among adolescents.

PubMed

Robbins, Lorraine B; Pis, Monika B; Pender, Nola J; Kazanis, Anamaria S

2004-01-01

Since research involving adults indicates that physical activity (PA) self-definition influences PA participation, understanding PA self-definition and related factors, such as PA frequency and enjoyment, in youth is essential for designing interventions to reverse the decline in PA that occurs from childhood through adolescence. The objective of this study was to explore correlates of PA self-definition and assess differences in PA self-definition among African American and European American boys and girls in early, middle, and late puberty. A 3 (developmental stage) x 2 (gender) design was used. African American and European American boys and girls, ages 9 to 17, participated. A total of 168 adolescents completed demographic data, developmental stage, and current and future PA self-definition questionnaires. Peak VO2 was obtained as a measure of physical fitness. Current PA self-definition was positively correlated with peak VO2 (p < .01) and future PA self-definition (p <.01). Males had higher current (p = .032) and future (p = .021) PA self-definition than females. The finding that boys have stronger current and future PA self-definitions than girls highlights the challenge for health professionals to enact immediate and effective measures to alter girls' perceptions of themselves in terms of PA participation. Since current PA self-definition is also significantly correlated with future PA participation, strategies to assist girls in developing a strong PA self-definition may contribute to increased PA in their adult years.

Clinical requirements for closed-loop control systems.

PubMed

Clarke, William L; Renard, Eric

2012-03-01

Closed-loop (CL) therapy systems should be safe, efficacious, and easily manageable for type 1 diabetes mellitus patient use. For the first two clinical requirements, noninferiority and superiority criteria must be determined based on current conventional and intensive therapy outcomes. Current frequencies of hypoglycemia and diabetic ketoacidosis are reviewed and safety expectations for CL therapy systems are proposed. Glycosylated hemoglobin levels lower than current American Diabetes Association recommendations for different age groups are proposed as superiority criteria. Measures of glycemic variability are described and the recording of blood glucose levels as percentages within, above, and below a target range are suggested as reasonable alternatives to sophisticated statistical analyses. It is also suggested that Diabetes Quality of Life and Fear of Hypoglycemia surveys should be used to track psychobehavioral outcomes. Manageability requirements for safe and effective clinical management of CL systems are worth being underscored. The weakest part of the infusion system remains the catheter, which is exposed to variable and under-delivery incidents. Detection methods are needed to warn both the system and the patient about altered insulin delivery, including internal pressure and flow alarms. Glucose monitor sensor accuracy is another requirement; it includes the definition of conditions that lead to capillary glucose measurement, eventually followed by sensor recalibration or replacement. The crucial clinical requirement will be a thorough definition of the situations when the patient needs to move from CL to manual management of insulin delivery, or inversely can switch back to CL after a requested interruption. Instructions about these actions will constitute a major part of the education process of the patients before using CL systems and contribute to the manageability of these systems. © 2012 Diabetes Technology Society.

Acute viral bronchiolitis: Physician perspectives on definition and clinically important outcomes.

PubMed

Fernandes, Ricardo M; Andrade, Maria Gabriela; Constant, Carolina; Malveiro, Duarte; Magalhães, Manuel; Abreu, Daisy; Azevedo, Inês; Sousa, Eduarda; Salgado, Rizério; Bandeira, Teresa

2016-07-01

Two key limitations hamper intervention research in bronchiolitis: the absence of a clear definition of disease, and the heterogeneous choice of outcome measures in current clinical trials. We assessed how paediatricians and general practitioners (GPs) perceived definition and clinically important outcomes in bronchiolitis. A nationwide online survey (ABBA study) was conducted through the Portuguese Society of Paediatrics and GPs' mailing lists. We assessed agreement with statements on bronchiolitis definition, and participants were asked to score the relative importance of several outcomes. Principal component analysis (PCA) explored dimensions underlying disease definition. Outcomes were ranked by mean score and proportion given highest score. We included 514 paediatricians and 165 GPs (overall 59% were board-certified). Most paediatricians (76.5%) agreed with a definition based on coryza, wheezing and/or crackles/rales, compared to 38.1% GPs (P < 0.001). Less than 5% physicians agreed with a definition commonly used in clinical trials (<12 months, first episode of wheeze). We retained three dimensions on PCA: one based on coryza, rales/crepitations and no sudden onset; another on number of episodes and age; and a third on wheeze. Dimensions varied by physician specialization and training (P < 0.01). Hospital admission and respiratory distress were top rated outcomes by both groups of physicians. Physician definitions of bronchiolitis have considerable variability and often mismatch those of clinical trials. Rating of important outcomes was consistent. Our results highlight the need for a robust standardized definition of acute bronchiolitis in infants and support the development of a core outcome set for future clinical trials. Pediatr Pulmonol. 2016;51:724-732. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Revised definitions of women's sexual dysfunction.

PubMed

Basson, Rosemary; Leiblum, Sandra; Brotto, Lori; Derogatis, Leonard; Fourcroy, Jean; Fugl-Meyer, Kerstin; Graziottin, Alessandra; Heiman, Julia R; Laan, Ellen; Meston, Cindy; Schover, Leslie; van Lankveld, Jacques; Schultz, Willibrord Weijmar

2004-07-01

Existing definitions of women's sexual disorders are based mainly on genitally focused events in a linear sequence model (desire, arousal and orgasm). To revise definitions based on an alternative model reflecting women's reasons/incentives for sexual activity beyond any initial awareness of sexual desire. An International Definitions Committee of 13 experts from seven countries repeatedly communicated, proposed new definitions and presented at the 2nd International Consultation on Sexual Medicine in Paris July 2003. Expert opinions/recommendations are based on a process that involved review of evidence-based medical literature, extensive internal committee discussion, informal testing and re-testing of drafted definitions in various clinical settings, public presentation and deliberation. Women have many reasons/incentives for sexual activity. Desire may be experienced once sexual stimuli have triggered arousal. Arousal and desire co-occur and reinforce each other. Women's subjective arousal may be minimally influenced by genital congestion. An absence of desire any time during the sexual experience designates disorder. Arousal disorder subtypes are proposed that separate an absence of subjective arousal from all types of sexual stimulation, from an absence of subjective arousal when the only stimulus is genital. A new arousal disorder has provisionally been suggested, namely that of persistent genital arousal. Orgasm disorder is limited to absence of orgasm despite high subjective arousal. Dyspareunia includes partial painful vaginal entry attempts as well as pain with intercourse. Variable reflex muscle tightening around the vagina and an absence of abnormal physical findings are noted in the definition of vaginismus. Women's sexuality is highly contextual and descriptors are recommended re past psychosexual development, current context, as well as medical status. Diagnosing sexual disorders need not imply intrinsic dysfunction of the woman's own sex response system. The International Definitions Committee has recommended a number of fundamental changes to the existing definitions of women's sexual disorders.

An evaluation of the usefulness of consensus definitions of sarcopenia in older men: results from the observational Osteoporotic Fractures in Men (MrOS) cohort study

PubMed Central

Cawthon, Peggy M; Blackwell, Terri L; Cauley, Jane; Kado, Deborah M; Barrett-Connor, Elizabeth; Lee, Christine G; Hoffman, Andrew R; Nevitt, Michael M; Stefanick, Marcia L; Lane, Nancy E; Ensrud, Kristine E; Cummings, Steven R; Orwoll, Eric S

2016-01-01

Background Recently, several consensus definitions for sarcopenia have been developed. Objective To evaluate the associations and discriminative ability of definitions of sarcopenia against clinical outcomes. Design Osteoporotic Fractures in Men study Setting Six clinical centers Participants 5,934 community-dwelling men aged ≥65 yrs Measurements Sarcopenia definitions evaluated were: International Working Group (IWG), European Working Group for Sarcopenia in Older Persons (EWGSOP), Foundation for the NIH (FNIH) Sarcopenia, Baumgartner, and Newman. Recurrent falls were defined as ≥2 self-reported falls in the year after baseline (N=694, 11.9%). Incident hip fractures (N=207, 3.5 %) and deaths (N=2003, 34.1%) were confirmed by central review of medical records over 9.8 years. Self-reported functional limitations were assessed at baseline and again 4.6 years later. Logistic regression or proportional hazards models estimated associations between sarcopenia and falls, hip fractures or death. The discriminative ability of the sarcopenia definitions (compared to referent models) for these outcomes was evaluated with areas under the receiver operator curve (AUCs) or C-statistics. Referent models included age alone for falls, function limitations and mortality, and age and BMD for hip fractures. Results The association between sarcopenia by the various definitions and risk of falls, functional limitations, and hip fractures was variable; all definitions were associated with increased mortality risk. However, none of the definitions materially changed discrimination based on AUC and C-statistic when compared to referent models (change ≤1% in all models). Conclusions Sarcopenia definitions as currently constructed did not consistently improve prediction of clinical outcomes in relatively healthy older men. PMID:26502831

The Exploring Nature of Definitions and Classifications of Language Learning Strategies (LLSs) in the Current Studies of Second/Foreign Language Learning

ERIC Educational Resources Information Center

Fazeli, Seyed Hossein

2011-01-01

This study aims to explore the nature of definitions and classifications of Language Learning Strategies (LLSs) in the current studies of second/foreign language learning in order to show the current problems regarding such definitions and classifications. The present study shows that there is not a universal agreeable definition and…

State of the Science of Spirituality and Palliative Care Research Part I: Definitions, Measurement, and Outcomes.

PubMed

Steinhauser, Karen E; Fitchett, George; Handzo, George F; Johnson, Kimberly S; Koenig, Harold G; Pargament, Kenneth I; Puchalski, Christina M; Sinclair, Shane; Taylor, Elizabeth J; Balboni, Tracy A

2017-09-01

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part I of the SOS-SPC two-part series focuses on questions of 1) What is spirituality? 2) What methodological and measurement issues are most salient for research in palliative care? And 3) What is the evidence relating spirituality and health outcomes? After describing current evidence we make recommendations for future research in each of the three areas of focus. Results show wide variance in the ways spirituality is operationalized and the need for definition and conceptual clarity in research in spirituality. Furthermore, the field would benefit from hypothesis-driven outcomes research based on a priori specification of the spiritual dimensions under investigation and their longitudinal relationship with key palliative outcomes, the use of validated measures of predictors and outcomes, and rigorous assessment of potential confounding variables. Finally, results highlight the need for research in more diverse populations. Published by Elsevier Inc.

Periodontal disease and oral health-related behavior as factors associated with preterm birth: a case-control study in south-eastern Brazil.

PubMed

Macedo, J F; Ribeiro, R A; Machado, F C; Assis, N M S P; Alves, R T; Oliveira, A S; Ribeiro, L C

2014-08-01

Several studies have suggested a link between periodontal disease and preterm birth, but the mechanism of how this occurs remains controversial. Therefore, this study aimed to investigate whether periodontal disease, defined according to two commonly used clinical definitions, is associated with preterm birth and to examine the association regarding oral health-related behaviors during pregnancy. This case-control study included women 18-40 years of age. Demographic and socio-economic data, information on current and previous pregnancies, and data on dental health-related behaviors and periodontal clinical parameters were collected within 48 h postpartum. Periodontal disease was assessed according to two definitions: four or more teeth with at least one site showing a probing depth of ≥ 4 mm and clinical attachment level of ≥ 3 mm (Definition 1); or at least one site with probing depth and clinical attachment level of ≥ 4 mm (Definition 2). The chi-square test was used to examine differences in the proportion of categorical variables. Bivariate analysis was performed to analyze the proportion of preterm births with respect to independent variables. Multiple logistic regression analyses were used to assess the association between periodontal disease and preterm birth. Odds ratios (ORs) were calculated with a 95% confidence interval (95% CI). A total of 296 postpartum women met the inclusion criteria. The case group included 74 women who delivered a preterm neonate (< 37 wk of gestation) and the control group included 222 women with deliveries at term (≥ 37 wk). Periodontal disease according to Definition 1 was not associated with fewer weeks of gestation (adjusted OR (OR adjusted ) = 1.62; 95% CI = 0.80-3.29; p = 0.178). However, a significant association was found between periodontal disease, according to Definition 2, and preterm birth (OR adjusted = 1.98; 95% CI = 1.14-3.43; p = 0.015). Increased appetite and a low number of daily toothbrushings were associated with preterm birth, regardless of the definition of periodontal disease used. Periodontal disease defined according to Definition 2 and unfavorable oral health-related behavior were factors associated with preterm birth. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Frequent attenders in general practice care: a literature review with special reference to methodological considerations.

PubMed

Vedsted, P; Christensen, M B

2005-02-01

To describe the basis on which our knowledge of frequent attendance in general practice rests and to propose recommendations for further research on frequent attenders (FAs). The literature review (finished February 2004) encompassed peer-reviewed articles in English describing contacts with general practice in terms of frequency. Searches were performed in the Medline, CINAHL, EMBASE, PsycINFO, Social Sciences Expanded Index and ISI Citation databases with additional searches in reference lists and the 'related articles' function in the ISI Citation database and Medline. General practice. Sixty-one articles (54 studies). The articles were assessed according to the following design variables: setting; definition of FAs; sampling; sample size; control groups; study aim; study design; data sources; effect measure; and main results. There was no generally accepted definition of frequent attendance. Research designs differed substantially. Eight articles gave sufficient information on all design variables. The top 10% of attenders accounted for 30-50% of all contacts, and up to 40% of FAs were still FAs the following year. More than 50% of FAs had a physical disease, more than 50% of FAs suffered from psychological distress, social factors (low social support, unemployment, divorce) were associated with frequent attendance in more than 50% of FAs, multiproblems (physical, psychological and social) were found in one-third of FAs, and frequent attendance was associated with increasing age and female gender. The diversity of designs, definitions and methods in the current literature on FAs in general practice hampers comparison of their precision, validity and generalizability, and calls for cautious interpretation and adoption of a common, generally acceptable definition in future studies.

Definition of current density in the presence of a non-local potential.

PubMed

Li, Changsheng; Wan, Langhui; Wei, Yadong; Wang, Jian

2008-04-16

In the presence of a non-local potential arising from electron-electron interaction, the conventional definition of current density J(c) = (e/2m)([(p-eA)ψ](*)ψ-ψ(*)[(p-eA)ψ]) cannot satisfy the condition of current conservation, i.e., [Formula: see text] in the steady state. In order to solve this problem, we give a new definition of current density including the contribution due to the non-local potential. We show that the current calculated based on the new definition of current density conserves the current and is the same as that obtained from the Landauer-Büttiker formula. Examples are given to demonstrate our results.

The underlying structure of diagnostic systems of schizophrenia: a comprehensive polydiagnostic approach.

PubMed

Peralta, Victor; Cuesta, Manuel J

2005-11-15

The objective was to ascertain the underlying factor structure of alternative definitions of schizophrenia, and to examine the distribution of schizophrenia-related variables against the resulting factor solution. Twenty-three diagnostic schemes of schizophrenia were applied to 660 patients presenting with psychotic symptoms regardless of the specific diagnosis of psychotic disorder. Factor analysis of the 23 diagnostic schemes yielded three interpretable factors explaining 58% of the variance, the first factor (general schizophrenia factor) accounting for most of the variance (36%). On the basis of the general schizophrenia factor score, the sample was divided in quintile groups representing 5 levels of schizophrenia definition (absent, doubtful, very broad, broad and narrow) and the distribution of a number of schizophrenia-related variables was examined across the groups. This grouping procedure was used for examining the comparative validity of alternative levels of categorically defined schizophrenia and an ordinal (i.e. dimensional) definition. Overall, schizophrenia-related variables displayed a dose-response relationship with level of schizophrenia definition. Logistic regression analyses revealed that the dimensional definition explained more variance in the schizophrenia-related variables than the alternative levels for defining schizophrenia categorically. These results are consistent with a unitary and dimensional construct of schizophrenia with no clear "points of rarity" at its boundaries, thus supporting the continuum hypothesis of the psychotic illness.

Bullying by Definition: An Examination of Definitional Components of Bullying

ERIC Educational Resources Information Center

Goldsmid, Susan; Howie, Pauline

2014-01-01

Lack of definitional consensus remains an important unresolved issue within bullying research. This study examined the ability of definitional variables to predict overall level of victimisation (distress, power inequity, and provocation as predictors) and bullying (intention to harm, power inequity, and provocation as predictors) in 246…

Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice?

PubMed Central

Maisto, Stephen A.; Witkiewitz, Katie; Moskal, Dezarie; Wilson, Adam D.

2016-01-01

Objective: Alcohol use disorder (AUD) relapse is a construct that has been of major clinical and research interest but has been inconsistently defined. The purpose of this study was to review the definitions of AUD relapse that have been used in clinical research as a basis for drawing conclusions about its heuristic value. Method: A systematic review of the literature was conducted on empirical studies that (a) were published in peer-reviewed journals, (b) were published between 2010 and 2015, (c) were written in English, and (d) provided a definition of alcohol relapse (or lapse) that was used in the study. Results: The review yielded 139 individual studies that met inclusion criteria. The studies showed wide variability in how relapse was defined and interpreted in the literature, and there was little direct empirical or theoretical rationale provided for the definitions of relapse that were chosen. Furthermore, the concept of AUD relapse as a discrete state is not consistent with the empirical literature on the clinical course of alcohol consumption. Conclusions: We conclude that the heuristic value of AUD relapse as currently studied is low. An alternative approach that embeds the construct in theory and data on the clinical course of alcohol consumption and aligns with current trends in healthcare would seem to have a better chance of improving AUD clinical decision-making and knowledge about AUD in general. PMID:27797685

Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice?

PubMed

Maisto, Stephen A; Witkiewitz, Katie; Moskal, Dezarie; Wilson, Adam D

2016-11-01

Alcohol use disorder (AUD) relapse is a construct that has been of major clinical and research interest but has been inconsistently defined. The purpose of this study was to review the definitions of AUD relapse that have been used in clinical research as a basis for drawing conclusions about its heuristic value. A systematic review of the literature was conducted on empirical studies that (a) were published in peer-reviewed journals, (b) were published between 2010 and 2015, (c) were written in English, and (d) provided a definition of alcohol relapse (or lapse) that was used in the study. The review yielded 139 individual studies that met inclusion criteria. The studies showed wide variability in how relapse was defined and interpreted in the literature, and there was little direct empirical or theoretical rationale provided for the definitions of relapse that were chosen. Furthermore, the concept of AUD relapse as a discrete state is not consistent with the empirical literature on the clinical course of alcohol consumption. We conclude that the heuristic value of AUD relapse as currently studied is low. An alternative approach that embeds the construct in theory and data on the clinical course of alcohol consumption and aligns with current trends in healthcare would seem to have a better chance of improving AUD clinical decision-making and knowledge about AUD in general.

Patient-Specific Induced Pluripotent Stem Cell Models: Generation and Characterization of Cardiac Cells.

PubMed

Zanella, Fabian; Sheikh, Farah

2016-01-01

The generation of human induced pluripotent stem cell (hiPSC)-derived cardiomyocytes has been of utmost interest for the study of cardiac development, cardiac disease modeling, and evaluation of cardiotoxic effects of novel candidate drugs. Several protocols have been developed to guide human stem cells toward the cardiogenic path. Pioneering work used serum to promote cardiogenesis; however, low cardiogenic throughputs, lack of chemical definition, and batch-to-batch variability of serum lots constituted a considerable impediment to the implementation of those protocols to large-scale cell biology. Further work focused on the manipulation of pathways that mouse genetics indicated to be fundamental in cardiac development to promote cardiac differentiation in stem cells. Although extremely elegant, those serum-free protocols involved the use of human recombinant cytokines that tend to be quite costly and which can also be variable between lots. The latest generation of cardiogenic protocols aimed for a more cost-effective and reproducible definition of the conditions driving cardiac differentiation, using small molecules to manipulate cardiogenic pathways overriding the need for cytokines. This chapter details methods based on currently available cardiac differentiation protocols for the generation and characterization of robust numbers of hiPSC-derived cardiomyocytes under chemically defined conditions.

Self-reported concussion history: impact of providing a definition of concussion.

PubMed

Robbins, Clifford A; Daneshvar, Daniel H; Picano, John D; Gavett, Brandon E; Baugh, Christine M; Riley, David O; Nowinski, Christopher J; McKee, Ann C; Cantu, Robert C; Stern, Robert A

2014-01-01

In recent years, the understanding of concussion has evolved in the research and medical communities to include more subtle and transient symptoms. The accepted definition of concussion in these communities has reflected this change. However, it is unclear whether this shift is also reflected in the understanding of the athletic community. Self-reported concussion history is an inaccurate assessment of someone's lifetime exposure to concussive brain trauma. However, unfortunately, in many cases it is the only available tool. We hypothesize that athletes' self-reported concussion histories will be significantly greater after reading them the current definition of concussion, relative to the reporting when no definition was provided. An increase from baseline to post-definition response will suggest that athletes are unaware of the currently accepted medical definition. Cross-sectional study of 472 current and former athletes. Investigators conducted structured telephone interviews with current and former athletes between January 2010 and January 2013, asking participants to report how many concussions they had received in their lives. Interviewers then read participants a current definition of concussion, and asked them to re-estimate based on that definition. THE TWO ESTIMATES WERE SIGNIFICANTLY DIFFERENT (WILCOXON SIGNED RANK TEST: z=15.636, P<0.001). Comparison of the baseline and post-definition medians (7 and 15, respectively) indicated that the post-definition estimate was approximately twice the baseline. Follow-up analyses indicated that this effect was consistent across all levels of competition examined and across type of sport (contact versus non-contact). Our results indicate that athletes' current understandings of concussions are not consistent with a currently accepted medical definition. We strongly recommend that clinicians and researchers preface requests for self-reported concussion history with a definition. In addition, it is extremely important that researchers report the definition they used in published manuscripts of their work. Our study shows that unprompted reporting of concussion history produces results that are significantly different from those provided after a definition has been given, suggesting one possible mechanism to improve the reliability of self-reported concussion history across multiple individuals.

Time for a neonatal–specific consensus definition for sepsis

PubMed Central

Wynn, James L.; Wong, Hector R.; Shanley, Thomas P.; Bizzarro, Matthew J.; Saiman, Lisa; Polin, Richard A.

2014-01-01

Objective To review the accuracy of the pediatric consensus definition of sepsis in term neonates and to determine the definition of neonatal sepsis used. Study selection The review focused primarily on pediatric literature relevant to the topic of interest. Conclusions Neonatal sepsis is variably defined based on a number of clinical and laboratory criteria that make the study of this common and devastating condition very difficult. Diagnostic challenges and uncertain disease epidemiology necessarily result from a variable definition of disease. In 2005, intensivists caring for children recognized that as new drugs became available, children would be increasingly studied and thus, pediatric-specific consensus definitions were needed. Pediatric sepsis criteria are not accurate for term neonates and have not been examined in preterm neonates for whom the developmental stage influences aberrations associated with host immune response. Thus, specific consensus definitions for both term and preterm neonates are needed. Such definitions are critical for the interpretation of observational studies, future training of scientists and practitioners, and implementation of clinical trials in neonates. PMID:24751791

Military health system efficiency: a review of history and recommendations for the future.

PubMed

Coppola, Nicholas; Satterwhite, Robin; Fulton, Lawrence V; Shanderson, Laurie L; Pasupathy, Rubini

2012-06-01

This article reviews the history of measuring military medical health care efficiency. No single approved definition or uniform framework has ever been offered or suggested defining military medical treatment facility efficiency over the last 225 years within the Department of Defense. The purpose of this article is to consolidate much of the existing research on the latent variable of military medical efficiency over the last two centuries, and to provide health care leaders a framework for understanding past and current practices in measuring efficiency in the military health care setting.

Workshop on Satellite and In situ Observations for Climate Prediction

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

Acker, J.G.; Busalacchi, A.

1995-02-01

Participants in this workshop, which convened in Venice, Italy, 6-8 May 1993, met to consider the current state of climate monitoring programs and instrumentation for the purpose of climatological prediction on short-term (seasonal to interannual) timescales. Data quality and coverage requirements for definition of oceanographic heat and momentum fluxes, scales of inter- and intra-annual variability, and land-ocean-atmosphere exchange processes were examined. Advantages and disadvantages of earth-based and spaceborne monitoring systems were considered, as were the structures for future monitoring networks, research programs, and modeling studies.

Workshop on Satellite and In situ Observations for Climate Prediction

NASA Technical Reports Server (NTRS)

Acker, James G.; Busalacchi, Antonio

1995-01-01

Participants in this workshop, which convened in Venice, Italy, 6-8 May 1993, met to consider the current state of climate monitoring programs and instrumentation for the purpose of climatological prediction on short-term (seasonal to interannual) timescales. Data quality and coverage requirements for definition of oceanographic heat and momentum fluxes, scales of inter- and intra-annual variability, and land-ocean-atmosphere exchange processes were examined. Advantages and disadvantages of earth-based and spaceborne monitoring systems were considered, as were the structures for future monitoring networks, research programs, and modeling studies.

Human Papilloma virus in Juvenile Nasopharyngeal Angiofibroma: possible recent trend.

PubMed

Mishra, Anupam; Sachadeva, Monica; Jain, Ankita; Shukla, Nimisha Mishra; Pandey, Amita

2016-01-01

Juvenile nasopharyngeal angiofibroma (JNA) has witnessed a four-fold increase in the incidence at our facility in the current decade as compared to the 1980s. With high global incidence of human pappilloma virus (HPV) related oropharyngeal cancer in India, we hypothesize its implication in JNA as it has not yet been reported. Clinico-Surgical variables of 6 patients of JNA were included for correlation and their tissue samples were subjected to western blotting (WB), polymerase chain reaction and immunoflorescence to demonstrate a definite association with HPV. In addition 6 control samples (adenoids) underwent WB analysis. A universal presence of HPV with JNA is novel 'discovery' and has suggested a possibility of a definite association. Only a single case suggested weak infection. None of the controls suggested infection, thus ruling out the presence of HPV in nasopharynx of normal population. With the dawn of this definite association, no specific conclusions can yet be drawn but a whole plethora of questions have emerged with our novel 'discovery'. Copyright © 2016 Elsevier Inc. All rights reserved.

Factors related to attrition from trauma-focused cognitive behavioral therapy.

PubMed

Wamser-Nanney, Rachel; Steinzor, Cazzie E

2017-04-01

Attrition from child trauma-focused treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is common; yet, the factors of children who prematurely terminate are unknown. The aim of the current study was to identify risk factors for attrition from TF-CBT. One hundred and twenty-two children (ages 3-18; M=9.97, SD=3.56; 67.2% females; 50.8% Caucasian) who received TF-CBT were included in the study. Demographic and family variables, characteristics of the trauma, and caregiver- and child-reported pretreatment symptoms levels were assessed in relation to two operational definitions of attrition: 1) clinician-rated dropout, and 2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Several demographic factors, number of traumatic events, and children's caregiver-rated pretreatment symptoms were related to clinician-rated dropout. Fewer factors were associated with the adequate dose definition. Child Protective Services involvement, complex trauma exposure, and child-reported pretreatment trauma symptoms were unrelated to either attrition definition. Demographics, trauma characteristics, and level of caregiver-reported symptoms may help to identify clients at risk for premature termination from TF-CBT. Clinical and research implications for different operational definitions and suggestions for future work will be presented. Published by Elsevier Ltd.

Neonatal polycythaemia: critical review and a consensus statement of the Israeli Neonatology Association.

PubMed

Mimouni, Francis B; Merlob, Paul; Dollberg, Shaul; Mandel, Dror

2011-10-01

The aim of this paper is to critically review neonatal polycythaemia (NP) literature, in terms of definition, diagnosis and management. We reviewed all Medline articles on NP up to December 2009. (i) The textbook definition of NP [venous haematocrit (HCT) > 65%] is empirical and not based on statistical definition, symptoms or complications. (ii) Measurement of viscosity is not better than HCT in predicting complications. (iii) Normovolaemic NP because of increased erythropoiesis may be different from hypervolaemic polycythaemia because of excessive foetal transfusion. (iv) Coexisting hypoglycaemia may worsen long-term outcome. (v) Four clinical trials (CTs) studied partial exchange transfusion (PET) on outcomes. In all trials, PET was performed after 6 h of life. There is no evidence that PET improves neurodevelopmental outcome of asymptomatic NP, and it might increase the risk of necrotizing enterocolitis. These CTs have inherent design flaws: (a) CNS 'damage' may occur before PET. (b) Confounding variables that may affect outcome have not been studied. (vi) If PET is performed, normal saline is the best alternative. (vii) The long-term effect of PET on symptomatic infants has not been studied. Current definition and management of NP are little evidence based, thus the need for a consensus based on expert opinion. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

Diagnosis of cystocele--the correlation between clinical and radiological evaluation.

PubMed

Altman, Daniel; Mellgren, Anders; Kierkegaard, Jonas; Zetterström, Jan; Falconer, Christian; López, Annika

2004-01-01

In patients with genital prolapse involving several compartments simultaneously, radiologic investigation can be used to complement the clinical assessment. Contrast medium in the urinary bladder enables visualization of the bladder base at cystodefecoperitoneography (CDP). The aim of the present study was to evaluate the correlation between clinical examination using the Pelvic Organ Prolapse Quantification system (POP-Q) and CDP. Thirty-three women underwent clinical assessment and CDP. Statistical analysis using Pearson's correlation coefficient ( r) demonstrated a wide variability between the current definition of cystocele at CDP and POP-Q ( r=0.67). An attempt to provide an alternative definition of cystocele at CDP had a similar outcome ( r=0.63). The present study demonstrates a moderate correlation between clinical and radiologic findings in patients with anterior vaginal wall prolapse. It does not support the use of bladder contrast at radiologic investigation in the routine preoperative assessment of patients with genital prolapse.

Impact of Definitions of FIA Variables and Compilation Procedures on Inventory Compilation Results in Georgia

Treesearch

Brock Stewart; Chris J. Cieszewski; Michal Zasada

2005-01-01

This paper presents a sensitivity analysis of the impact of various definitions and inclusions of different variables in the Forest Inventory and Analysis (FIA) inventory on data compilation results. FIA manuals have been changing recently to make the inventory consistent between all the States. Our analysis demonstrates the importance (or insignificance) of different...

Coastal vulnerability assessment using Fuzzy Logic and Bayesian Belief Network approaches

NASA Astrophysics Data System (ADS)

Valentini, Emiliana; Nguyen Xuan, Alessandra; Filipponi, Federico; Taramelli, Andrea

2017-04-01

Natural hazards such as sea surge are threatening low-lying coastal plains. In order to deal with disturbances a deeper understanding of benefits deriving from ecosystem services assessment, management and planning can contribute to enhance the resilience of coastal systems. In this frame assessing current and future vulnerability is a key concern of many Systems Of Systems SOS (social, ecological, institutional) that deals with several challenges like the definition of Essential Variables (EVs) able to synthesize the required information, the assignment of different weight to be attributed to each considered variable, the selection of method for combining the relevant variables. It is widely recognized that ecosystems contribute to human wellbeing and then their conservation increases the resilience capacities and could play a key role in reducing climate related risk and thus physical and economic losses. A way to fully exploit ecosystems potential, i.e. their so called ecopotential (see H2020 EU funded project "ECOPOTENTIAL"), is the Ecosystem based Adaptation (EbA): the use of ecosystem services as part of an adaptation strategy. In order to provide insight in understanding regulating ecosystem services to surge and which variables influence them and to make the best use of available data and information (EO products, in situ data and modelling), we propose a multi-component surge vulnerability assessment, focusing on coastal sandy dunes as natural barriers. The aim is to combine together eco-geomorphological and socio-economic variables with the hazard component on the base of different approaches: 1) Fuzzy Logic; 2) Bayesian Belief Networks (BBN). The Fuzzy Logic approach is very useful to get a spatialized information and it can easily combine variables coming from different sources. It provides information on vulnerability moving along-shore and across-shore (beach-dune transect), highlighting the variability of vulnerability conditions in the spatial dimension. According to the results using fuzzy operators, the analysis greatest weakness is the limited capacity to represent the relation among the different considered variables. The BBN approach, based on the definition of conditional probabilities, has allowed determining the trend of distributions of vulnerability along-shore, highlighting which parts of the coast are most likely to have higher or lower vulnerability than others. In BBN analysis, the greatest weakness emerge in the case of arbitrary definition of conditional probabilities (i.e. when there is a lack of information on the past hazardous events) because it is not possible to derive the individual contribution of each variable. As conclusion, the two approaches could be used together in the perspective of enhancing the multiple components in vulnerability assessment: the BBN as a preliminary assessment to provide a coarse description of the vulnerability distribution, and the Fuzzy Logic as an extended assessment to provide more space based information.

Self-reported concussion history: impact of providing a definition of concussion

PubMed Central

Robbins, Clifford A; Daneshvar, Daniel H; Picano, John D; Gavett, Brandon E; Baugh, Christine M; Riley, David O; Nowinski, Christopher J; McKee, Ann C; Cantu, Robert C; Stern, Robert A

2014-01-01

Background In recent years, the understanding of concussion has evolved in the research and medical communities to include more subtle and transient symptoms. The accepted definition of concussion in these communities has reflected this change. However, it is unclear whether this shift is also reflected in the understanding of the athletic community. What is known about the subject Self-reported concussion history is an inaccurate assessment of someone’s lifetime exposure to concussive brain trauma. However, unfortunately, in many cases it is the only available tool. Hypothesis/purpose We hypothesize that athletes’ self-reported concussion histories will be significantly greater after reading them the current definition of concussion, relative to the reporting when no definition was provided. An increase from baseline to post-definition response will suggest that athletes are unaware of the currently accepted medical definition. Study design Cross-sectional study of 472 current and former athletes. Methods Investigators conducted structured telephone interviews with current and former athletes between January 2010 and January 2013, asking participants to report how many concussions they had received in their lives. Interviewers then read participants a current definition of concussion, and asked them to re-estimate based on that definition. Results The two estimates were significantly different (Wilcoxon signed rank test: z=15.636, P<0.001). Comparison of the baseline and post-definition medians (7 and 15, respectively) indicated that the post-definition estimate was approximately twice the baseline. Follow-up analyses indicated that this effect was consistent across all levels of competition examined and across type of sport (contact versus non-contact). Conclusion Our results indicate that athletes’ current understandings of concussions are not consistent with a currently accepted medical definition. We strongly recommend that clinicians and researchers preface requests for self-reported concussion history with a definition. In addition, it is extremely important that researchers report the definition they used in published manuscripts of their work. What this study adds to existing knowledge Our study shows that unprompted reporting of concussion history produces results that are significantly different from those provided after a definition has been given, suggesting one possible mechanism to improve the reliability of self-reported concussion history across multiple individuals. PMID:24891816

Emotional and Behavioral Disorders in South Korea: Current Status and Issues

ERIC Educational Resources Information Center

Kim, Joungmin; Kim, Kyeong-hwa

2016-01-01

In South Korea, there is no consensus on the definition of emotional and behavioral disorders (EBD). This column focuses on how the definition has affected the prevalence rates and services available for students with EBDs. Of the legal, clinical, and educational definitions, the legal definition of EBDs is currently in common use, which raises…

Defining Autism: Variability in State Education Agency Definitions of and Evaluations for Autism Spectrum Disorders

PubMed Central

Pennington, Malinda L.; Cullinan, Douglas; Southern, Louise B.

2014-01-01

In light of the steady rise in the prevalence of students with autism, this study examined the definition of autism published by state education agencies (SEAs), as well as SEA-indicated evaluation procedures for determining student qualification for autism. We compared components of each SEA definition to aspects of autism from two authoritative sources: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and Individuals with Disabilities Education Improvement Act (IDEA-2004). We also compared SEA-indicated evaluation procedures across SEAs to evaluation procedures noted in IDEA-2004. Results indicated that many more SEA definitions incorporate IDEA-2004 features than DSM-IV-TR features. However, despite similar foundations, SEA definitions of autism displayed considerable variability. Evaluation procedures were found to vary even more across SEAs. Moreover, within any particular SEA there often was little concordance between the definition (what autism is) and evaluation procedures (how autism is recognized). Recommendations for state and federal policy changes are discussed. PMID:24987527

Prevalence of cognitive impairment in major depression and bipolar disorder.

PubMed

Douglas, Katie M; Gallagher, Peter; Robinson, Lucy J; Carter, Janet D; McIntosh, Virginia Vw; Frampton, Christopher Ma; Watson, Stuart; Young, Allan H; Ferrier, I Nicol; Porter, Richard J

2018-05-01

The current study examines prevalence of cognitive impairment in four mood disorder samples, using four definitions of impairment. The impact of premorbid IQ on prevalence was examined, and the influence of treatment response. Samples were: (i) 58 inpatients in a current severe depressive episode (unipolar or bipolar), (ii) 69 unmedicated outpatients in a mild to moderate depressive episode (unipolar or bipolar), (iii) 56 outpatients with bipolar disorder, in a depressive episode, and (iv) 63 outpatients with bipolar disorder, currently euthymic. Cognitive assessment was conducted after treatment in Studies 1 (6 weeks of antidepressant treatment commenced on admission) and 2 (16-week course of cognitive behaviour therapy or schema therapy), allowing the impact of treatment response to be assessed. All mood disorder samples were compared with healthy control groups. The prevalence of cognitive impairment was highest for the inpatient depression sample (Study 1), and lowest for the outpatient depression sample (Study 2). Substantial variability in rates was observed depending on the definition of impairment used. Correcting cognitive performance for premorbid IQ had a significant impact on the prevalence of cognitive impairment in the inpatient depression sample. There was minimal evidence that treatment response impacted on prevalence of cognitive impairment, except in the domain of psychomotor speed in inpatients. As interventions aiming to improve cognitive outcomes in mood disorders receive increasing research focus, the issue of setting a cut-off level of cognitive impairment for screening purposes becomes a priority. This analysis demonstrates important differences in samples likely to be recruited depending on the definition of cognitive impairment and begins to examine the importance of premorbid IQ in determining who is impaired. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Metabolic syndrome in Mexican children: Low effectiveness of diagnostic definitions.

PubMed

Peña-Espinoza, Barbara Itzel; Granados-Silvestre, María de Los Ángeles; Sánchez-Pozos, Katy; Ortiz-López, María Guadalupe; Menjivar, Marta

Early identification of children with metabolic syndrome (MS) is essential to decrease the risk of developing diabetes and cardiovascular disease in adulthood. Detection of MS is however challenging because of the different definitions for diagnosis; as a result, preventive actions are not taken in some children at risk. The study objective was therefore to compare prevalence of MS in children according to the IDF, NCEP-ATP-III, Cook, de Ferranti and Weiss definitions, considering insulin resistance (IR) markers such as HOMA-IR and/or metabolic index (MI). A total of 508 Mexican children (aged 9 to 13 years) from seven schools were enrolled in a cross-sectional study. Somatometric, biochemical, and hormonal measurements were evaluated. Frequency of MS was 2.4-45.9% depending on the definition used. Frequency of IR in children not diagnosed with MS was 12.4-25.2% using HOMA-IR and 4.0-16.3% using MI. When HOMA-IR or MI was included in each of the definitions, frequency of MS was 8.5-50.2% and 7.7-46.9% respectively. The kappa value including HOMA-IR and/or MI was greater than 0.8. This study demonstrated the poor effectiveness of the current criteria used to diagnose MS in Mexican children, as shown by the variability in the definitions and by the presence of IR in children who not diagnosed with MS. Inclusion of HOMA-IR and/or MI in definitions of MS (thus increasing agreement between them) decreases the chance of excluding children at risk and allows for MS prevalence between populations. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Graded Structure in Sexual Definitions: Categorizations of Having "Had Sex" and Virginity Loss Among Homosexual and Heterosexual Men and Women.

PubMed

Horowitz, Ava D; Bedford, Edward

2017-08-01

Definitions of sexual behavior display a robust hierarchy of agreement regarding whether or not acts should be classed as, for example, sex or virginity loss. The current research offers a theoretical explanation for this hierarchy, proposing that sexual definitions display graded categorical structure, arising from goodness of membership judgments. Moderation of this graded structure is also predicted, with the focus here on how sexual orientation identity affects sexual definitions. A total of 300 18- to 30-year-old participants completed an online survey, rating 18 behaviors for how far each constitutes having "had sex" and virginity loss. Participants fell into one of four groups: heterosexual male or female, gay male or lesbian. The predicted ratings hierarchy emerged, in which bidirectional genital acts were rated significantly higher than unidirectional or nonpenetrative contact, which was in turn rated significantly higher than acts involving no genital contact. Moderation of graded structure was also in line with predictions. Compared to the other groups, the lesbian group significantly upgraded ratings of genital contact that was either unidirectional or nonpenetrative. There was also evidence of upgrading by the gay male sample of anal intercourse ratings. These effects are theorized to reflect group-level variation in experience, contextual perspective, and identity-management. The implications of the findings in relation to previous research are discussed. It is suggested that a graded structure approach can greatly benefit future research into sexual definitions, by permitting variable definitions to be predicted and explained, rather than merely identified.

The landscape of fear conceptual framework: definition and review of current applications and misuses.

PubMed

Bleicher, Sonny S

2017-01-01

Landscapes of Fear (LOF), the spatially explicit distribution of perceived predation risk as seen by a population, is increasingly cited in ecological literature and has become a frequently used "buzz-word". With the increase in popularity, it became necessary to clarify the definition for the term, suggest boundaries and propose a common framework for its use. The LOF, as a progeny of the "ecology of fear" conceptual framework, defines fear as the strategic manifestation of the cost-benefit analysis of food and safety tradeoffs. In addition to direct predation risk, the LOF is affected by individuals' energetic-state, inter- and intra-specific competition and is constrained by the evolutionary history of each species. Herein, based on current applications of the LOF conceptual framework, I suggest the future research in this framework will be directed towards: (1) finding applied management uses as a trait defining a population's habitat-use and habitat-suitability; (2) studying multi-dimensional distribution of risk-assessment through time and space; (3) studying variability between individuals within a population; (4) measuring eco-neurological implications of risk as a feature of environmental heterogeneity and (5) expanding temporal and spatial scales of empirical studies.

The landscape of fear conceptual framework: definition and review of current applications and misuses

PubMed Central

2017-01-01

Landscapes of Fear (LOF), the spatially explicit distribution of perceived predation risk as seen by a population, is increasingly cited in ecological literature and has become a frequently used “buzz-word”. With the increase in popularity, it became necessary to clarify the definition for the term, suggest boundaries and propose a common framework for its use. The LOF, as a progeny of the “ecology of fear” conceptual framework, defines fear as the strategic manifestation of the cost-benefit analysis of food and safety tradeoffs. In addition to direct predation risk, the LOF is affected by individuals’ energetic-state, inter- and intra-specific competition and is constrained by the evolutionary history of each species. Herein, based on current applications of the LOF conceptual framework, I suggest the future research in this framework will be directed towards: (1) finding applied management uses as a trait defining a population’s habitat-use and habitat-suitability; (2) studying multi-dimensional distribution of risk-assessment through time and space; (3) studying variability between individuals within a population; (4) measuring eco-neurological implications of risk as a feature of environmental heterogeneity and (5) expanding temporal and spatial scales of empirical studies. PMID:28929015

The macro-structural variability of the human neocortex.

PubMed

Kruggel, Frithjof

2018-05-15

The human neocortex shows a considerable individual structural variability. While primary gyri and sulci are found in all normally developed brains and bear clear-cut gross structural descriptions, secondary structures are highly variable and not present in all brains. The blend of common and individual structures poses challenges when comparing structural and functional results from quantitative neuroimaging studies across individuals, and sets limits on the precision of location information much above the spatial resolution of current neuroimaging methods. This work aimed at quantifying structural variability on the neocortex, and at assessing the spatial relationship between regions common to all brains and their individual structural variants. Based on structural MRI data provided as the "900 Subjects Release" of the Human Connectome Project, a data-driven analytic approach was employed here from which the definition of seven cortical "communities" emerged. Apparently, these communities comprise common regions of structural features, while the individual variability is confined within a community. Similarities between the community structure and the state of the brain development at gestation week 32 lead suggest that communities are segregated early. Subdividing the neocortex into communities is suggested as anatomically more meaningful than the traditional lobar structure. Copyright © 2018 Elsevier Inc. All rights reserved.

The utility of Cox's Interaction Model to direct the assessment and prevention of adolescent aggression.

PubMed

DiNapoli, Pamela Pershing

2003-02-01

The current study of violence prevention is hampered by a lack of consensus on the definition of violence. There is, however, some agreement about the behavioral cues that may predict violent behavior such as aggression. Although it has been shown that individual-level variables (e.g., race, gender, and ethnicity) are correlated with aggressive behavior, it is clear that they alone are not explanatory of aggressive behavior. This article demonstrates how the Interaction Model of Client Health Behavior is an important health behavior framework for the assessment of aggression in adolescents, offering insight into the contextual nature of adolescent aggression. Victimization and witnessing of violence, frequently identified to be precursors of adolescent aggression in current epidemiologic studies, are examined within this framework. On the basis of the interactional nature of the phenomenon, necessary components for successful prevention programs are suggested. Finally, future research implications calling for a well-designed study that integrates individual and contextual variables with the use of this theory-driven explanatory framework are proposed. Copyright 2003, Elsevier Science (USA). All rights reserved.

Accurate Realization of GPS Vertical Global Reference Frame

NASA Technical Reports Server (NTRS)

Elosegui, Pedro

2005-01-01

The goal of this project is to improve our current understanding of GPS error sources associated with estimates of radial velocities at global scales. An improvement in the accuracy of radial global velocities would have a very positive impact on a large number of geophysical studies of current general interest such as global sea-level and climate change, coastal hazards, glacial isostatic adjustment, atmospheric and oceanic loading, glaciology and ice mass variability, tectonic deformation and volcanic inflation, and geoid variability. A set of GPS error sources relevant to this project are those related to the combination of the positions and velocities of a set of globally distributed stations as determined &om the analysis of GPS data, including possible methods of combining and defining terrestrial reference frames. This is were our research activities during this reporting period have concentrated. During this reporting period, we have researched two topics: (1) The effect of errors on the GPS satellite antenna models (or lack thereof) on global GPS vertical position and velocity estimates; (2) The effect of reference W e definition and practice on estimates of the geocenter variations.

Outcome definitions and clinical predictors influence pharmacogenetic associations between HTR3A gene polymorphisms and response to clozapine in patients with schizophrenia.

PubMed

Rajkumar, A P; Poonkuzhali, B; Kuruvilla, A; Srivastava, A; Jacob, M; Jacob, K S

2012-12-01

Pharmacogenetics of schizophrenia has not yet delivered anticipated clinical dividends. Clinical heterogeneity of schizophrenia contributes to the poor replication of the findings of pharmacogenetic association studies. Functionally important HTR3A gene single-nucleotide polymorphisms (SNPs) were reported to be associated with response to clozapine. The aim of this study was to investigate how the association between HTR3A gene SNP and response to clozapine is influenced by various clinical predictors and by differing outcome definitions in patients with treatment-resistant schizophrenia (TRS). We recruited 101 consecutive patients with TRS, on stable doses of clozapine, and evaluated their HTR3A gene SNP (rs1062613 and rs2276302), psychopathology, and serum clozapine levels. We assessed their socio-demographic and clinical profiles, premorbid adjustment, traumatic events, cognition, and disability using standard assessment schedules. We evaluated their response to clozapine, by employing six differing outcome definitions. We employed appropriate multivariate statistics to calculate allelic and genotypic association, accounting for the effects of various clinical variables. T allele of rs1062613 and G allele of rs2276302 were significantly associated with good clinical response to clozapine (p = 0.02). However, varying outcome definitions make these associations inconsistent. rs1062613 and rs2276302 could explain only 13.8 % variability in the responses to clozapine, while combined clinical predictors and HTR3A pharmacogenetic association model could explain 38 % variability. We demonstrated that the results of pharmacogenetic studies in schizophrenia depend heavily on their outcome definitions and that combined clinical and pharmacogenetic models have better predictive values. Future pharmacogenetic studies should employ multiple outcome definitions and should evaluate associated clinical variables.

Notalgia paresthetica: treatment using intradermal botulinum toxin A.

PubMed

Pérez-Pérez, L; García-Gavín, J; Allegue, F; Caeiro, J L; Fabeiro, J M; Zulaica, A

2014-01-01

Notalgia paresthetica is a sensory mononeuropathy that affects dorsal segments T2 to T6. It can have a significant effect on quality of life. Numerous treatments have been used with variable results. Five patients diagnosed with notalgia paresthetica were treated with intradermal botulinum toxin A. None had achieved relief of the pruritus with previous treatments. Variable results were observed after the administration of intradermal botulinum toxin. Complete resolution of the pruritus was not achieved in any of the patients. Botulinum toxin A appears to be a safe therapeutic option for patients with notalgia paresthetica. However, data currently available come from small patient series, making it difficult to draw definitive conclusions regarding the true efficacy and long-term effects of this treatment. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.

The Influence of Context on Quality Improvement Success in Health Care: A Systematic Review of the Literature

PubMed Central

Kaplan, Heather C; Brady, Patrick W; Dritz, Michele C; Hooper, David K; Linam, W Matthew; Froehle, Craig M; Margolis, Peter

2010-01-01

Context: The mixed results of success among QI initiatives may be due to differences in the context of these initiatives. Methods: The business and health care literature was systematically reviewed to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field. Findings: Forty-seven articles were included in the final review. Consistent with current theories of implementation and organization change, leadership from top management, organizational culture, data infrastructure and information systems, and years involved in QI were suggested as important to QI success. Other potentially important factors identified in this review included: physician involvement in QI, microsystem motivation to change, resources for QI, and QI team leadership. Key limitations in the existing literature were the lack of a practical conceptual model, the lack of clear definitions of contextual factors, and the lack of well-specified measures. Conclusions: Several contextual factors were shown to be important to QI success, although the current body of literature lacks adequate definitions and is characterized by considerable variability in how contextual factors are measured across studies. Future research should focus on identifying and developing measures of context tied to a conceptual model that examines context across all levels of the health care system and explores the relationships among various aspects of context. PMID:21166868

The influence of context on quality improvement success in health care: a systematic review of the literature.

PubMed

Kaplan, Heather C; Brady, Patrick W; Dritz, Michele C; Hooper, David K; Linam, W Matthew; Froehle, Craig M; Margolis, Peter

2010-12-01

The mixed results of success among QI initiatives may be due to differences in the context of these initiatives. The business and health care literature was systematically reviewed to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field. Forty-seven articles were included in the final review. Consistent with current theories of implementation and organization change, leadership from top management, organizational culture, data infrastructure and information systems, and years involved in QI were suggested as important to QI success. Other potentially important factors identified in this review included: physician involvement in QI, microsystem motivation to change, resources for QI, and QI team leadership. Key limitations in the existing literature were the lack of a practical conceptual model, the lack of clear definitions of contextual factors, and the lack of well-specified measures. Several contextual factors were shown to be important to QI success, although the current body of literature lacks adequate definitions and is characterized by considerable variability in how contextual factors are measured across studies. Future research should focus on identifying and developing measures of context tied to a conceptual model that examines context across all levels of the health care system and explores the relationships among various aspects of context. © 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

The MIXR sample or: how I learned to stop worrying and love multiwavelength catalogue cross-correlations

NASA Astrophysics Data System (ADS)

Mingo, Beatriz; Watson, Mike; Stewart, Gordon; Rosen, Simon; Blain, Andrew; Hardcastle, Martin; Mateos, Silvia; Carrera, Francisco; Ruiz, Angel; Pineau, Francois-Xavier

2016-08-01

We cross-match 3XMM, WISE and FIRST/NVSS to create the largest-to-date mid-IR, X-ray, and radio (MIXR) sample of galaxies and AGN. We use MIXR to triage sources and efficiently and accurately pre-classify them as star-forming galaxies or AGN, and to highlight bias and shortcomings in current AGN sample selection methods, paving the way for the next generation of instruments. Our results highlight key questions in AGN science, such as the need for a re-definition of the radio-loud/radio-quiet classification, and our observed lack of correlation between the kinetic (jet) and radiative (luminosity) output in AGN, which has dramatic potential consequences on our current understanding of AGN accretion, variability and feedback.

Antecedent Moisture and Biological Inertia as Predictors of Plant and Ecosystem Productivity in Arid and Semiarid Systems

NASA Astrophysics Data System (ADS)

Ogle, K.

2011-12-01

Many plant and ecosystem processes in arid and semiarid systems may be affected by antecedent environmental conditions (e.g., precipitation patterns, soil water availability, temperature) that integrate over past days, weeks, months, seasons, or years. However, the importance of such antecedent exogenous effects relative to conditions occurring at the time of the observed process is relatively unexplored. Even less is known about the potential importance of antecedent endogenous effects that describe the influence of past ecosystem states on the current ecosystem state; e.g., how is current ecosystem productivity related to past productivity patterns? We hypothesize that incorporation of antecedent exogenous and endogenous factors can improve our predictive understanding of many plant and ecosystem processes, especially in arid and semiarid ecosystems. Furthermore, the common approach to quantifying the effects of antecedent (exogenous) variables relies on arbitrary, deterministic definitions of antecedent variables that (1) may not accurately describe the role of antecedent conditions and (2) ignore uncertainty associated with applying deterministic definitions. In this study, we employ a stochastic framework for (1) computing the antecedent variables that estimates the relative importance of conditions experienced each time unit into the past, also providing insight into potential lag responses, and (2) estimating the effect of antecedent factors on the response variable of interest. We employ this approach to explore the potential roles of antecedent exogenous and endogenous influences in three settings that illustrate the: (1) importance of antecedent precipitation for net primary productivity in the shortgrass steppe in northern Colorado, (2) dependency of tree growth on antecedent precipitation and past growth states for pinyon growing in western Colorado, and (3) influence of antecedent soil water and prior root status on observed root growth in the Mojave Desert FACE experiment. All three examples suggest that antecedent conditions are critical to predicting different indices of productivity such that the incorporation of antecedent effects explained an additional 20-40% of the variation in the productivity responses. Antecedent endogenous factors were important for understanding tree and root growth, suggesting a potential biological inertia effect that is likely linked to labile carbon storage and allocation strategies. The role of antecedent exogenous (water) variables suggests a lag response whose duration and timing differs according to the time scale of the response variable. In summary, antecedent water availability and past endogenous states appear critical to understanding plant and ecosystem productivity in arid and semiarid systems, and this study describes a stochastic framework for quantifying the potential influence of such antecedent conditions.

Are PCI Service Volumes Associated with 30-Day Mortality? A Population-Based Study from Taiwan.

PubMed

Yu, Tsung-Hsien; Chou, Ying-Yi; Wei, Chung-Jen; Tung, Yu-Chi

2017-11-09

The volume-outcome relationship has been discussed for over 30 years; however, the findings are inconsistent. This might be due to the heterogeneity of service volume definitions and categorization methods. This study takes percutaneous coronary intervention (PCI) as an example to examine whether the service volume was associated with PCI 30-day mortality, given different service volume definitions and categorization methods. A population-based, cross-sectional multilevel study was conducted. Two definitions of physician and hospital volume were used: (1) the cumulative PCI volume in a previous year before each PCI; (2) the cumulative PCI volume within the study period. The volume was further treated in three ways: (1) a categorical variable based on the American Heart Association's recommendation; (2) a semi-data-driven categorical variable based on k-means clustering algorithm; and (3) a data-driven categorical variable based on the Generalized Additive Model. The results showed that, after adjusting the patient-, physician-, and hospital-level covariates, physician volume was associated inversely with PCI 30-day mortality, but hospital volume was not, no matter which definitions and categorization methods of service volume were applied. Physician volume is negatively associated with PCI 30-day mortality, but the results might vary because of definition and categorization method.

Conceptualizing minimalist footwear: an objective definition.

PubMed

Coetzee, Devon R; Albertus, Yumna; Tam, Nicholas; Tucker, Ross

2018-04-01

Running has been plagued with an alarmingly high incidence of injury, which has resulted in the exploration of interventions aimed at reducing the risk of running-related injury. One such intervention is the introduction of footwear that mimics barefoot running. These have been termed minimalist shoes. Minimalist footwear aims to reduce the risk of injury by promoting adaptations in running biomechanics that have been linked to a reduction in both impact and joint forces. However, some studies have found that minimalist footwear may be beneficial to the runner as they promote favourable biomechanical adaptations, whilst other studies have found the opposite to be true. Reasons for these conflicting results could be attributed to the lack of a definition for minimalist footwear. The aim of this review article is to provide a structural definition for minimalist footwear based on studies that have examined the influence of footwear on biomechanical variables during running. Based on current literature, we define minimalist footwear as a shoe with a highly flexible sole and upper that weighs 200g or less, has a heel stack height of 20mm or less and a heel-toe differential of 7mm or less.

Integral definition of the logarithmic function and the derivative of the exponential function in calculus

NASA Astrophysics Data System (ADS)

Vaninsky, Alexander

2015-04-01

Defining the logarithmic function as a definite integral with a variable upper limit, an approach used by some popular calculus textbooks, is problematic. We discuss the disadvantages of such a definition and provide a way to fix the problem. We also consider a definition-based, rigorous derivation of the derivative of the exponential function that is easier, more intuitive, and complies with the standard definitions of the number e, the logarithmic, and the exponential functions.

Toward More Precise Definition and Evaluation of Televised Educational Programming

ERIC Educational Resources Information Center

Aversa Fran; Morrison, Gary R.

1978-01-01

An operational definition of public television programming and its implications for development and production agencies is sorely needed. This article explores some of the components of such a definition and examines the differences in several types of educational programming in terms of specific design and evaluation variables of the program.…

78 FR 56132 - Human Reliability Program: Technical Amendments

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-12

....'' In addition, the definition of ``Manager'' in the current rule does not reflect recent changes within...'' authorities, but are not listed in the definition of ``Manager.'' DOE has decided to substitute the following definition of ``Manager'' for the current listing in Sec. 712.3: ``Manager means the senior Federal line...

Developing syndrome definitions based on consensus and current use

PubMed Central

Dowling, John N; Baer, Atar; Buckeridge, David L; Cochrane, Dennis; Conway, Michael A; Elkin, Peter; Espino, Jeremy; Gunn, Julia E; Hales, Craig M; Hutwagner, Lori; Keller, Mikaela; Larson, Catherine; Noe, Rebecca; Okhmatovskaia, Anya; Olson, Karen; Paladini, Marc; Scholer, Matthew; Sniegoski, Carol; Thompson, David; Lober, Bill

2010-01-01

Objective Standardized surveillance syndromes do not exist but would facilitate sharing data among surveillance systems and comparing the accuracy of existing systems. The objective of this study was to create reference syndrome definitions from a consensus of investigators who currently have or are building syndromic surveillance systems. Design Clinical condition–syndrome pairs were catalogued for 10 surveillance systems across the United States and the representatives of these systems were brought together for a workshop to discuss consensus syndrome definitions. Results Consensus syndrome definitions were generated for the four syndromes monitored by the majority of the 10 participating surveillance systems: Respiratory, gastrointestinal, constitutional, and influenza-like illness (ILI). An important element in coming to consensus quickly was the development of a sensitive and specific definition for respiratory and gastrointestinal syndromes. After the workshop, the definitions were refined and supplemented with keywords and regular expressions, the keywords were mapped to standard vocabularies, and a web ontology language (OWL) ontology was created. Limitations The consensus definitions have not yet been validated through implementation. Conclusion The consensus definitions provide an explicit description of the current state-of-the-art syndromes used in automated surveillance, which can subsequently be systematically evaluated against real data to improve the definitions. The method for creating consensus definitions could be applied to other domains that have diverse existing definitions. PMID:20819870

Developing syndrome definitions based on consensus and current use.

PubMed

Chapman, Wendy W; Dowling, John N; Baer, Atar; Buckeridge, David L; Cochrane, Dennis; Conway, Michael A; Elkin, Peter; Espino, Jeremy; Gunn, Julia E; Hales, Craig M; Hutwagner, Lori; Keller, Mikaela; Larson, Catherine; Noe, Rebecca; Okhmatovskaia, Anya; Olson, Karen; Paladini, Marc; Scholer, Matthew; Sniegoski, Carol; Thompson, David; Lober, Bill

2010-01-01

Standardized surveillance syndromes do not exist but would facilitate sharing data among surveillance systems and comparing the accuracy of existing systems. The objective of this study was to create reference syndrome definitions from a consensus of investigators who currently have or are building syndromic surveillance systems. Clinical condition-syndrome pairs were catalogued for 10 surveillance systems across the United States and the representatives of these systems were brought together for a workshop to discuss consensus syndrome definitions. Consensus syndrome definitions were generated for the four syndromes monitored by the majority of the 10 participating surveillance systems: Respiratory, gastrointestinal, constitutional, and influenza-like illness (ILI). An important element in coming to consensus quickly was the development of a sensitive and specific definition for respiratory and gastrointestinal syndromes. After the workshop, the definitions were refined and supplemented with keywords and regular expressions, the keywords were mapped to standard vocabularies, and a web ontology language (OWL) ontology was created. The consensus definitions have not yet been validated through implementation. The consensus definitions provide an explicit description of the current state-of-the-art syndromes used in automated surveillance, which can subsequently be systematically evaluated against real data to improve the definitions. The method for creating consensus definitions could be applied to other domains that have diverse existing definitions.

An Automated Method for High-Definition Transcranial Direct Current Stimulation Modeling*

PubMed Central

Huang, Yu; Su, Yuzhuo; Rorden, Christopher; Dmochowski, Jacek; Datta, Abhishek; Parra, Lucas C.

2014-01-01

Targeted transcranial stimulation with electric currents requires accurate models of the current flow from scalp electrodes to the human brain. Idiosyncratic anatomy of individual brains and heads leads to significant variability in such current flows across subjects, thus, necessitating accurate individualized head models. Here we report on an automated processing chain that computes current distributions in the head starting from a structural magnetic resonance image (MRI). The main purpose of automating this process is to reduce the substantial effort currently required for manual segmentation, electrode placement, and solving of finite element models. In doing so, several weeks of manual labor were reduced to no more than 4 hours of computation time and minimal user interaction, while current-flow results for the automated method deviated by less than 27.9% from the manual method. Key facilitating factors are the addition of three tissue types (skull, scalp and air) to a state-of-the-art automated segmentation process, morphological processing to correct small but important segmentation errors, and automated placement of small electrodes based on easily reproducible standard electrode configurations. We anticipate that such an automated processing will become an indispensable tool to individualize transcranial direct current stimulation (tDCS) therapy. PMID:23367144

A risk-adjusted definition of biochemical recurrence after radical prostatectomy.

PubMed

Morgan, T M; Meng, M V; Cooperberg, M R; Cowan, J E; Weinberg, V; Carroll, P R; Lin, D W

2014-06-01

To determine whether a variable definition of biochemical recurrence (BCR) based on clincopathologic features facilitates early identification of patients likely to suffer from disease progression. The definition of BCR after radical prostatectomy (RP) bears important implications for patient counseling and management; however, there remains a significant debate regarding the appropriate definition. The study cohort consisted of 3619 men who underwent RP for localized prostate cancer from 1989 to 2007, with data abstracted from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry. Patients were stratified into three risk groups according to Cancer of the Prostate Risk Assessment post-Surgical (CAPRA-S) score. Three single threshold PSA cut-points for BCR were evaluated (PSA > or =0.05, > or =0.2 and > or =0.4 ng ml(-1)) as well as a variable cut-point defined by risk group. After reaching the cut-points, patients were followed for further PSA progression. The proportion of patients with BCR differed by cut-point and risk group, ranging from 7 to 37% (low risk), 22 to 58% (intermediate risk) and 60 to 86% (high risk). The positive-predictive value (PPV) for predicting further PSA progression was 49% for the PSA > or =0.05 ng ml(-1), 62% for the PSA > or =0.2 ng ml(-1), 65% for the PSA > or =0.4 ng ml(-1) and 68% for the risk-adjusted definition. Five-year progression-free survival was 39% for the risk-adjusted definition compared with 45-52% for the other definitions of BCR. These data suggest that a variable definition of BCR determined by clinicopathologic risk may improve the identification of early recurrence after RP without increasing the overdiagnosis of BCR. By using a risk-adjusted BCR definition, clinicians can better predict future PSA progression and more appropriately counsel patients regarding salvage therapies.

An evaluation of FIA's stand age variable

Treesearch

John D. Shaw

2015-01-01

The Forest Inventory and Analysis Database (FIADB) includes a large number of measured and computed variables. The definitions of measured variables are usually well-documented in FIA field and database manuals. Some computed variables, such as live basal area of the condition, are equally straightforward. Other computed variables, such as individual tree volume,...

Estimation of residence time in a shallow lacustrine embayment

NASA Astrophysics Data System (ADS)

Razmi, A. M.; Barry, D. A.; Lemmin, U.; Bakhtyar, R.

2012-12-01

Near-shore water quality in lacustrine bays subjected to effluent or stream discharges is affected by, amongst other things, the residence time within a given bay. Vidy Bay, located on the northern shore of Lake Geneva, Switzerland, receives discharge from a wastewater treatment plant, the Chamberonne River and a storm-water drain. The residence time of water in the bay largely depends on water exchanges with the main basin (Grand Lac) of Lake Geneva. Field investigations and modeling of the hydrodynamics of Vidy Bay have shown that currents are variable, due mainly to wind variability over the lake. However, in broad terms there are two main current patterns in the bay, (i) currents are linked to large gyres in the Grand Lac, or (ii) currents are partially independent of the Grand Lac and are controlled by small-scale gyres within the bay. Residence times in Vidy Bay were computed using the hydrodynamic model Delft3D. Since the Vidy Bay shoreline follows a shallow arc, the definition of the off-shore extent of the bay is ambiguous. Here, the largest within-bay gyre is used. Particle tracking was conducted for each of the three discharges into the bay. Model results were computed using meteorological data for 2010, and thus include the natural variability in wind patterns and seasonal stratification. An analysis of the results shows that a water parcel from the waste water outfall has a residence time ranging from hours to days. The water residence time is minimum near to the surface and maximum at the near bottom layer. The results confirmed that wind force, thermal stratification, and water depth are the main factors influencing residence time.

Novel methods to optimize the effects of transcranial direct current stimulation: a systematic review of transcranial direct current stimulation patents.

PubMed

Malavera, Alejandra; Vasquez, Alejandra; Fregni, Felipe

2015-01-01

Transcranial direct current stimulation (tDCS) is a neuromodulatory technique that has been extensively studied. While there have been initial positive results in some clinical trials, there is still variability in tDCS results. The aim of this article is to review and discuss patents assessing novel methods to optimize the use of tDCS. A systematic review was performed using Google patents database with tDCS as the main technique, with patents filling date between 2010 and 2015. Twenty-two patents met our inclusion criteria. These patents attempt to address current tDCS limitations. Only a few of them have been investigated in clinical trials (i.e., high-definition tDCS), and indeed most of them have not been tested before in human trials. Further clinical testing is required to assess which patents are more likely to optimize the effects of tDCS. We discuss the potential optimization of tDCS based on these patents and the current experience with standard tDCS.

Temporal evolution of acute respiratory distress syndrome definitions.

PubMed

Fioretto, José R; Carvalho, Werther B

2013-01-01

to review the evolution of acute respiratory distress syndrome (ARDS) definitions and present the current definition for the syndrome. a literature review and selection of the most relevant articles on ARDS definitions was performed using the MEDLINE®/PubMed® Resource Guide database (last ten years), in addition to including the most important articles (classic articles) that described the disease evolution. the review included the following subjects: introduction; importance of definition; description of the first diagnostic criterion and subsequently used definitions, such as acute lung injury score; definition by the American-European Consensus Conference, and its limitations; description of the definition by Delphi, and its problems; accuracy of the aforementioned definitions; description of most recent definition (the Berlin definition), and its limitations; and practical importance of the new definition. ARDS is a serious disease that remains an ongoing diagnostic and therapeutic challenge. The evolution of definitions used to describe the disease shows that studies are needed to validate the current definition, especially in pediatrics, where the data are very scarce. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

A Geometrical Framework for Covariance Matrices of Continuous and Categorical Variables

ERIC Educational Resources Information Center

Vernizzi, Graziano; Nakai, Miki

2015-01-01

It is well known that a categorical random variable can be represented geometrically by a simplex. Accordingly, several measures of association between categorical variables have been proposed and discussed in the literature. Moreover, the standard definitions of covariance and correlation coefficient for continuous random variables have been…

A catalog of rules, variables, and definitions applied to accelerometer data in the National Health and Nutrition Examination Survey, 2003-2006.

PubMed

Tudor-Locke, Catrine; Camhi, Sarah M; Troiano, Richard P

2012-01-01

The National Health and Nutrition Examination Survey (NHANES) included accelerometry in the 2003-2006 data collection cycles. Researchers have used these data since their release in 2007, but the data have not been consistently treated, examined, or reported. The objective of this study was to aggregate data from studies using NHANES accelerometry data and to catalogue study decision rules, derived variables, and cut point definitions to facilitate a more uniform approach to these data. We conducted a PubMed search of English-language articles published (or indicated as forthcoming) from January 2007 through December 2011. Our initial search yielded 74 articles, plus 1 article that was not indexed in PubMed. After excluding 21 articles, we extracted and tabulated details on 54 studies to permit comparison among studies. The 54 articles represented various descriptive, methodological, and inferential analyses. Although some decision rules for treating data (eg, criteria for minimal wear-time) were consistently applied, cut point definitions used for accelerometer-derived variables (eg, time spent in various intensities of physical activity) were especially diverse. Unique research questions may require equally unique analytical approaches; some inconsistency in approaches must be tolerated if scientific discovery is to be encouraged. This catalog provides a starting point for researchers to consider relevant and/or comparable accelerometer decision rules, derived variables, and cut point definitions for their own research questions.

On the definition of absorbed dose

NASA Astrophysics Data System (ADS)

Grusell, Erik

2015-02-01

Purpose: The quantity absorbed dose is used extensively in all areas concerning the interaction of ionizing radiation with biological organisms, as well as with matter in general. The most recent and authoritative definition of absorbed dose is given by the International Commission on Radiation Units and Measurements (ICRU) in ICRU Report 85. However, that definition is incomplete. The purpose of the present work is to give a rigorous definition of absorbed dose. Methods: Absorbed dose is defined in terms of the random variable specific energy imparted. A random variable is a mathematical function, and it cannot be defined without specifying its domain of definition which is a probability space. This is not done in report 85 by the ICRU, mentioned above. Results: In the present work a definition of a suitable probability space is given, so that a rigorous definition of absorbed dose is possible. This necessarily includes the specification of the experiment which the probability space describes. In this case this is an irradiation, which is specified by the initial particles released and by the material objects which can interact with the radiation. Some consequences are discussed. Specific energy imparted is defined for a volume, and the definition of absorbed dose as a point function involves the specific energy imparted for a small mass contained in a volume surrounding the point. A possible more precise definition of this volume is suggested and discussed. Conclusions: The importance of absorbed dose motivates a proper definition, and one is given in the present work. No rigorous definition has been presented before.

KOALA RETROVIRUS: A REVIEW.

PubMed

Kinney, Matthew E; Pye, Geoffrey W

2016-06-01

Koala retrovirus (KoRV) is a gammaretrovirus that has been identified in both captive and free-ranging koalas ( Phascolarctos cinereus ) with variable geographic distribution in Australia. KoRV is capable of both exogenous and endogenous transmission, which provides an interesting research platform for scientists to study active retrovirus endogenization into a host genome and offers veterinary scientists an opportunity to examine the clinical consequences of KoRV infection in koalas. Causation between KoRV and frequently recognized clinical conditions associated with immune suppression and neoplasia in koalas has not been definitively established, however research continues to evaluate a potential association. Three KoRV variants, KoRV-A, KoRV-B, and KoRV-J, have been the most thoroughly described and preliminary evidence suggests KoRV variability may be fundamental in host pathogenicity. In addition to reviewing what is currently known about KoRV, this article discusses treatment, management, and future research directions.

New insights on premature ejaculation: a review of definition, classification, prevalence and treatment.

PubMed

Serefoglu, Ege C; Saitz, Theodore R

2012-11-01

There are ongoing debates about the definition, classification and prevalence of premature ejaculation (PE). The first evidence-based definition of PE was limited to heterosexual men with lifelong PE who engage in vaginal intercourse. Unfortunately, many patients with the complaint of PE do not meet these criteria. However, these men can be diagnosed as one of the PE subtypes, namely acquired PE, natural variable PE or premature-like ejaculatory dysfunction. Nevertheless, the validity of these subtypes has not yet been supported by evidence. The absence of a universally accepted PE definition and lack of standards for data acquisition have resulted in prevalence studies that have reported conflicting rates. The very high prevalence of 20%-30% is probably due to the vague terminology used in the definitions at the time when such surveys were conducted. Although many men may complain of PE when questioned for a population-based prevalence study, only a few of them will actively seek treatment for their complaint, even though most of these patients would define symptoms congruent with PE. The complaints of acquired PE patients may be more severe, whereas complaints of patients experiencing premature-like ejaculatory dysfunction seem to be least severe among men with various forms of PE. Although numerous treatment modalities have been proposed for management of PE, only antidepressants and topical anaesthetic creams have currently been proven to be effective. However, as none of the treatment modalities have been approved by the regulatory agencies, further studies must be carried to develop a beneficial treatment strategy for PE.

Emergency cesarean section and the 30-minute rule: definitions.

PubMed

Schauberger, Charles W; Chauhan, Suneet P

2009-03-01

We explored the role that lack of a standard definition and heterogeneity in patient selection criteria in the literature might have on the apparent inability to routinely begin an emergency cesarean section in less than 30 minutes. A review of the literature on emergency cesarean delivery was performed. Although there are some similarities in definitions and the criteria used for patient selection in multiple studies, the variability in the definitions could be responsible for some of the apparent timeliness performance deficiency in the literature. A standard definition and directions for future research are suggested.

The Flipped Classroom: Fertile Ground for Nursing Education Research.

PubMed

Bernard, Jean S

2015-07-16

In the flipped classroom (FC) students view pre-recorded lectures or complete pre-class assignments to learn foundational concepts. Class time involves problem-solving and application activities that cultivate higher-level cognitive skills. A systematic, analytical literature review was conducted to explore the FC's current state of the science within higher education. Examination of this model's definition and measures of student performance, student and faculty perceptions revealed an ill-defined educational approach. Few studies confirmed FC effectiveness; many lacked rigorous design, randomized samples, or control of extraneous variables. Few researchers conducted longitudinal studies to determine sufficiently trends related to FC practice. This study proves relevant to nurse educators transitioning from traditional teaching paradigms to learner-centered models, and provides insight from faculty teaching across disciplines around the world. It reveals pertinent findings and identifies current knowledge gaps that call for further inquiry.

Acute respiratory infection case definitions for young children: a systematic review of community-based epidemiologic studies in South Asia.

PubMed

Roth, Daniel E; Gaffey, Michelle F; Smith-Romero, Evelyn; Fitzpatrick, Tiffany; Morris, Shaun K

2015-12-01

To explore the variability in childhood acute respiratory infection case definitions for research in low-income settings where there is limited access to laboratory or radiologic investigations. We conducted a systematic review of community-based, longitudinal studies in South Asia published from January 1990 to August 2013, in which childhood acute respiratory infection outcomes were reported. Case definitions were classified by their label (e.g. pneumonia, acute lower respiratory infection) and clinical content 'signatures' (array of clinical features that would be always present, conditionally present or always absent among cases). Case definition heterogeneity was primarily assessed by the number of unique case definitions overall and by label. We also compared case definition-specific acute respiratory infection incidence rates for studies reporting incidence rates for multiple case definitions. In 56 eligible studies, we found 124 acute respiratory infection case definitions. Of 90 case definitions for which clinical content was explicitly defined, 66 (73%) were unique. There was a high degree of content heterogeneity among case definitions with the same label, and some content signatures were assigned multiple labels. Within studies for which incidence rates were reported for multiple case definitions, variation in content was always associated with a change in incidence rate, even when the content differed by a single clinical feature. There has been a wide variability in case definition label and content combinations to define acute upper and lower respiratory infections in children in community-based studies in South Asia over the past two decades. These inconsistencies have important implications for the synthesis and translation of knowledge regarding the prevention and treatment of childhood acute respiratory infection. © 2015 John Wiley & Sons Ltd.

Standardization of collection requirements for fasting samples: for the Working Group on Preanalytical Phase (WG-PA) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM).

PubMed

Simundic, A M; Cornes, M; Grankvist, K; Lippi, G; Nybo, M

2014-05-15

Standardized protocols for patient preparation for laboratory testing are currently lacking. Moreover, a great heterogeneity exists in the definitions of "fasting" currently being used among healthcare workers and in the literature. Marked metabolic and hormonal changes occur after food ingestion, mainly due to the absorption of fluids, lipids, proteins, carbohydrates and other food constituents. This postprandial response varies markedly in response to numerous factors, such as eating behavior, food composition, fasting duration, time of the day, chronic and acute smoking, coffee and alcohol consumption. It is therefore crucial to minimize the total variability by controlling as many of these modifying factors as possible. Control of the abovementioned effects on postprandial response can only be achieved by standardizing the way patients are prepared for laboratory testing, i.e. by defining the fasting duration, as well as what is and what is not allowed (e.g., coffee, tea, smoking, water) during the period of fasting prior to sample collection. The aim of this article is to describe the range of effects of different approaches to fasting on laboratory tests, and to provide a framework for the harmonization of definitions for fasting requirements for laboratory tests. Copyright © 2013 Elsevier B.V. All rights reserved.

Epidemiology and Natural History of Non-alcoholic Fatty Liver Disease

PubMed Central

Mishra, Alita; Younossi, Zobair M

2012-01-01

Non-alcoholic fatty liver disease (NAFLD) is an important cause of liver disease burden across the world. By definition, although the histopathologic features of NAFLD are identical to that of alcoholic liver disease, its diagnosis requires absence of significant alcohol use and absence of other causes of chronic liver disease. We now know that NAFLD is not simply a disease of the Western world. It is manifested across the world, in varying rates, across gender, across varying ethnicities, and in its association with other host factors. In this review article, the definition of NAFLD, its spectrum, ranging from mild steatosis to hepatocellular injury and inflammation defined as non-alcoholic steatohepatitis (NASH) is discussed. Mild steatosis is generally a stable disease whereas NASH can be progressive. Based on current published literature, current incidence and prevalence of NAFLD and NASH are discussed. It is also accepted that these processes will continue to increase in prevalence with the rise of obesity, type II diabetes, and associated metabolic syndrome. Some of the risk factors have been well-established and are discussed. In addition, this review also presents emerging associations with other risk factors for NAFLD. Natural history of NAFLD is variable depending upon the histologic subtypes and other underlying comorbidities and is discussed in this review as well. PMID:25755422

Definition of variables required for comprehensive description of drug dosage and clinical pharmacokinetics.

PubMed

Medem, Anna V; Seidling, Hanna M; Eichler, Hans-Georg; Kaltschmidt, Jens; Metzner, Michael; Hubert, Carina M; Czock, David; Haefeli, Walter E

2017-05-01

Electronic clinical decision support systems (CDSS) require drug information that can be processed by computers. The goal of this project was to determine and evaluate a compilation of variables that comprehensively capture the information contained in the summary of product characteristic (SmPC) and unequivocally describe the drug, its dosage options, and clinical pharmacokinetics. An expert panel defined and structured a set of variables and drafted a guideline to extract and enter information on dosage and clinical pharmacokinetics from textual SmPCs as published by the European Medicines Agency (EMA). The set of variables was iteratively revised and evaluated by data extraction and variable allocation of roughly 7% of all centrally approved drugs. The information contained in the SmPC was allocated to three information clusters consisting of 260 variables. The cluster "drug characterization" specifies the nature of the drug. The cluster "dosage" provides information on approved drug dosages and defines corresponding specific conditions. The cluster "clinical pharmacokinetics" includes pharmacokinetic parameters of relevance for dosing in clinical practice. A first evaluation demonstrated that, despite the complexity of the current free text SmPCs, dosage and pharmacokinetic information can be reliably extracted from the SmPCs and comprehensively described by a limited set of variables. By proposing a compilation of variables well describing drug dosage and clinical pharmacokinetics, the project represents a step forward towards the development of a comprehensive database system serving as information source for sophisticated CDSS.

On the mid-infrared variability of candidate eruptive variables (exors): A comparison between Spitzer and WISE data

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

Antoniucci, S.; Giannini, T.; Li Causi, G.

2014-02-10

Aiming to statistically study the variability in the mid-IR of young stellar objects, we have compared the 3.6, 4.5, and 24 μm Spitzer fluxes of 1478 sources belonging to the C2D (Cores to Disks) legacy program with the WISE fluxes at 3.4, 4.6, and 22 μm. From this comparison, we have selected a robust sample of 34 variable sources. Their variations were classified per spectral Class (according to the widely accepted scheme of Class I/flat/II/III protostars), and per star forming region. On average, the number of variable sources decreases with increasing Class and is definitely higher in Perseus and Ophiuchusmore » than in Chamaeleon and Lupus. According to the paradigm Class ≡ Evolution, the photometric variability can be considered to be a feature more pronounced in less evolved protostars, and, as such, related to accretion processes. Moreover, our statistical findings agree with the current knowledge of star formation activity in different regions. The 34 selected variables were further investigated for similarities with known young eruptive variables, namely the EXors. In particular, we analyzed (1) the shape of the spectral energy distribution, (2) the IR excess over the stellar photosphere, (3) magnitude versus color variations, and (4) output parameters of model fitting. This first systematic search for EXors ends up with 11 bona fide candidates that can be considered as suitable targets for monitoring or future investigations.« less

Tracing Actual Causes

DTIC Science & Technology

2016-08-08

actual values for variables in the SEM ), and an event e with M ,~u |= e, our definition answers the question : Which paths of the causal network G( M ...for each variable and a directed edge from vari- able X to Y if the equation for computing X uses Y . Given an SEM M , a context ~u (that supplies the...caused the event e1? Our definition answers this question as a set of causal slices, where each causal slice is a subgraph of G( M ). All paths in each

Low-frequency high-definition power Doppler in visualizing and defining fetal pulmonary venous connections.

PubMed

Liu, Lin; He, Yihua; Li, Zhian; Gu, Xiaoyan; Zhang, Ye; Zhang, Lianzhong

2014-07-01

The use of low-frequency high-definition power Doppler in assessing and defining pulmonary venous connections was investigated. Study A included 260 fetuses at gestational ages ranging from 18 to 36 weeks. Pulmonary veins were assessed by performing two-dimensional B-mode imaging, color Doppler flow imaging (CDFI), and low-frequency high-definition power Doppler. A score of 1 was assigned if one pulmonary vein was visualized, 2 if two pulmonary veins were visualized, 3 if three pulmonary veins were visualized, and 4 if four pulmonary veins were visualized. The detection rate between Exam-1 and Exam-2 (intra-observer variability) and between Exam-1 and Exam-3 (inter-observer variability) was compared. In study B, five cases with abnormal pulmonary venous connection were diagnosed and compared to their anatomical examination. In study A, there was a significant difference between CDFI and low-frequency high-definition power Doppler for the four pulmonary veins observed (P < 0.05). The detection rate of each pulmonary vein when employing low-frequency high-definition power Doppler was higher than that when employing two-dimensional B-mode imaging or CDFI. There was no significant difference between the intra- and inter-observer variabilities using low-frequency high-definition power Doppler display of pulmonary veins (P > 0.05). The coefficient correlation between Exam-1 and Exam-2 was 0.844, and the coefficient correlation between Exam-1 and Exam-3 was 0.821. In study B, one case of total anomalous pulmonary venous return and four cases of partial anomalous pulmonary venous return were diagnosed by low-frequency high-definition power Doppler and confirmed by autopsy. The assessment of pulmonary venous connections by low-frequency high-definition power Doppler is advantageous. Pulmonary venous anatomy can and should be monitored during fetal heart examination.

Preliminary Multi-Variable Parametric Cost Model for Space Telescopes

NASA Technical Reports Server (NTRS)

Stahl, H. Philip; Hendrichs, Todd

2010-01-01

This slide presentation reviews creating a preliminary multi-variable cost model for the contract costs of making a space telescope. There is discussion of the methodology for collecting the data, definition of the statistical analysis methodology, single variable model results, testing of historical models and an introduction of the multi variable models.

Pacemaker Dependency after Cardiac Surgery: A Systematic Review of Current Evidence.

PubMed

Steyers, Curtis M; Khera, Rohan; Bhave, Prashant

2015-01-01

Severe postoperative conduction disturbances requiring permanent pacemaker implantation frequently occur following cardiac surgery. Little is known about the long-term pacing requirements and risk factors for pacemaker dependency in this population. We performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery. Using a comprehensive search of the Medline, Web of Science and EMBASE databases, studies were selected for review based on predetermined inclusion and exclusion criteria. A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint. There were 10 unique studies with a total of 780 patients. Mean follow-up ranged from 6-72 months. Pacemaker dependency rates ranged from 32%-91% and recovery of AV conduction ranged from 16%-42%. There was significant heterogeneity with respect to the definition of pacemaker dependency. Several patient and procedure-specific variables were found to be independently associated with pacemaker dependency, but these were not consistent between studies. Pacemaker dependency following cardiac surgery occurs with variable frequency. While individual studies have identified various perioperative risk factors for pacemaker dependency and non-resolution of AV conduction disease, results have been inconsistent. Well-conducted studies using a uniform definition of pacemaker dependency might identify patients who will benefit most from early permanent pacemaker implantation after cardiac surgery.

Diagnosis, follow-up and treatment of cystic fibrosis-related liver disease.

PubMed

van de Peppel, Ivo P; Bertolini, Anna; Jonker, Johan W; Bodewes, Frank A J A; Verkade, Henkjan J

2017-11-01

To provide an insight and overview of the challenges in the diagnosis, follow-up and treatment of cystic fibrosis-related liver disease (CFLD). The variable pathophysiology of CFLD complicates its diagnosis and treatment. A 'gold standard' for CFLD diagnosis is lacking. Over the past years, new techniques to diagnose features of CFLD, such as transient elastography, have been investigated. Although most of these tests confirm cystic fibrosis-related liver involvement (CFLI), they are, however, not suitable to distinguish various phenotypical presentations or predict progression to clinically relevant cirrhosis or portal hypertension. A combined initiative from the European and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has been started, aimed to obtain consensus on CFLD criteria and definitions. Currently, only ursodeoxycholic acid is used in CFLD treatment, although it has not been convincingly demonstrated to change the natural course of the disease. Drugs that directly target cystic fibrosis transmembrane conductance regulator protein dysfunction show promising results; however, more long-term follow-up and validation studies are needed. CFLD is an umbrella term referring to a wide variety of liver manifestations with variable clinical needs and consequences. CFLD with portal hypertension is the most severe form of CFLD due to its significant implications on morbidity and mortality. The clinical relevance of other CFLI is uncertain. Consensus on CFLD definitions is essential to validate new diagnostic tools and therapeutic outcome measures.

Does the Reliability of Reporting in Injury Surveillance Studies Depend on Injury Definition?

PubMed

Cross, Matthew; Williams, Sean; Kemp, Simon P T; Fuller, Colin; Taylor, Aileen; Brooks, John; Trewartha, Grant; Stokes, Keith

2018-03-01

Choosing an appropriate definition for injury in injury surveillance studies is essential to ensure a balance among reporting reliability, providing an accurate representation of injury risk, and describing the nature of the clinical demand. To provide guidance on the choice of injury definition for injury surveillance studies by comparing within- and between-team variability in injury incidence with >24-hour and >7-day time-loss injury definitions in a large multiteam injury surveillance study. Cohort study (diagnosis); Level of evidence, 2. Injury data were reported for 2248 professional rugby union players from 15 Premiership Rugby clubs over 12 seasons. Within-team percentage coefficient of variation and mean between-team standard deviation (expressed as a percentage coefficient of variation) in injury incidence rates (injuries per 1000 player match hours) were calculated. For both variables, a comparison was made between >24-hour and >7-day injury incidence rates in terms of the magnitude of the observed effects. The overall mean incidence across the population with a >24-hour time-loss injury definition was approximately double the reported incidence with the >7-day definition. There was a 10% higher between-team variation in match injury incidence rates with the >24-hour time-loss definition versus the >7-day definition. There was a likely higher degree of between-team variation in match injury incidence rates with a >24-hour time-loss definition than with a >7-day definition of injury. However, in professional sports settings, it is likely that the benefits of using a more inclusive definition of injury (improved understanding of clinical demand and the appropriate and accurate reporting of injury risk) outweigh the small increase in variation in reporting consistency.

Does the Reliability of Reporting in Injury Surveillance Studies Depend on Injury Definition?

PubMed Central

Cross, Matthew; Williams, Sean; Kemp, Simon P.T.; Fuller, Colin; Taylor, Aileen; Brooks, John; Trewartha, Grant; Stokes, Keith

2018-01-01

Background: Choosing an appropriate definition for injury in injury surveillance studies is essential to ensure a balance among reporting reliability, providing an accurate representation of injury risk, and describing the nature of the clinical demand. Purpose: To provide guidance on the choice of injury definition for injury surveillance studies by comparing within- and between-team variability in injury incidence with >24-hour and >7-day time-loss injury definitions in a large multiteam injury surveillance study. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Injury data were reported for 2248 professional rugby union players from 15 Premiership Rugby clubs over 12 seasons. Within-team percentage coefficient of variation and mean between-team standard deviation (expressed as a percentage coefficient of variation) in injury incidence rates (injuries per 1000 player match hours) were calculated. For both variables, a comparison was made between >24-hour and >7-day injury incidence rates in terms of the magnitude of the observed effects. Results: The overall mean incidence across the population with a >24-hour time-loss injury definition was approximately double the reported incidence with the >7-day definition. There was a 10% higher between-team variation in match injury incidence rates with the >24-hour time-loss definition versus the >7-day definition. Conclusion: There was a likely higher degree of between-team variation in match injury incidence rates with a >24-hour time-loss definition than with a >7-day definition of injury. However, in professional sports settings, it is likely that the benefits of using a more inclusive definition of injury (improved understanding of clinical demand and the appropriate and accurate reporting of injury risk) outweigh the small increase in variation in reporting consistency. PMID:29581994

Variable Importance in Multivariate Group Comparisons.

ERIC Educational Resources Information Center

Huberty, Carl J.; Wisenbaker, Joseph M.

1992-01-01

Interpretations of relative variable importance in multivariate analysis of variance are discussed, with attention to (1) latent construct definition; (2) linear discriminant function scores; and (3) grouping variable effects. Two numerical ranking methods are proposed and compared by the bootstrap approach using two real data sets. (SLD)

7 CFR 1738.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... financial analysis prepared by the Agency, based on the financial projections supplied by the applicant and... definition includes Variable Interest Entities as described in Financial Accounting Standards Board... required at the time the application was received by the Agency. Build-out means the construction...

7 CFR 1738.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... financial analysis prepared by the Agency, based on the financial projections supplied by the applicant and... definition includes Variable Interest Entities as described in Financial Accounting Standards Board... required at the time the application was received by the Agency. Build-out means the construction...

7 CFR 1738.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... financial analysis prepared by the Agency, based on the financial projections supplied by the applicant and... definition includes Variable Interest Entities as described in Financial Accounting Standards Board... required at the time the application was received by the Agency. Build-out means the construction...

VSCE technology definition study

NASA Technical Reports Server (NTRS)

Howlett, R. A.; Hunt, R. B.

1979-01-01

Refined design definition of the variable stream control engine (VSCE) concept for advanced supersonic transports is presented. Operating and performance features of the VSCE are discussed, including the engine components, thrust specific fuel consumption, weight, noise, and emission system. A preliminary engine design is presented.

Unraveling human complexity and disease with systems biology and personalized medicine

PubMed Central

Naylor, Stephen; Chen, Jake Y

2010-01-01

We are all perplexed that current medical practice often appears maladroit in curing our individual illnesses or disease. However, as is often the case, a lack of understanding, tools and technologies are the root cause of such situations. Human individuality is an often-quoted term but, in the context of human biology, it is poorly understood. This is compounded when there is a need to consider the variability of human populations. In the case of the former, it is possible to quantify human complexity as determined by the 35,000 genes of the human genome, the 1–10 million proteins (including antibodies) and the 2000–3000 metabolites of the human metabolome. Human variability is much more difficult to assess, since many of the variables, such as the definition of race, are not even clearly agreed on. In order to accommodate human complexity, variability and its influence on health and disease, it is necessary to undertake a systematic approach. In the past decade, the emergence of analytical platforms and bioinformatics tools has led to the development of systems biology. Such an approach offers enormous potential in defining key pathways and networks involved in optimal human health, as well as disease onset, progression and treatment. The tools and technologies now available in systems biology analyses offer exciting opportunities to exploit the emerging areas of personalized medicine. In this article, we discuss the current status of human complexity, and how systems biology and personalized medicine can impact at the individual and population level. PMID:20577569

The HEALTHGRAIN definition of ‘whole grain’

PubMed Central

van der Kamp, Jan Willem; Poutanen, Kaisa; Seal, Chris J.; Richardson, David P.

2014-01-01

Most cereal products, like white bread, pasta, and biscuits, are based on flour after removal of bran and germ, the two parts of grain kernels containing most of the dietary fibre and other bioactive components. In the past decade, consumers have been rediscovering whole grain-based products and the number of wholegrain products has increased rapidly. In most countries in Europe and worldwide, however, no legally endorsed definition of wholegrain flour and products exists. Current definitions are often incomplete, lacking descriptions of the included grains and the permitted flour manufacturing processes. The consortium of the HEALTHGRAIN EU project (FP6-514008, 2005–2010) identified the need for developing a definition of whole grain with the following scope: 1) more comprehensive than current definitions in most EU countries; 2) one definition for Europe – when possible equal to definitions outside Europe; 3) reflecting current industrial practices for production of flours and consumer products; 4) useful in the context of nutritional guidelines and for labelling purposes. The definition was developed in a range of discussion meetings and consultations and was launched in 2010 at the end of the HEALTHGRAIN project. The grains included are specified: a wide range of cereal grains from the Poaceae family, and the pseudo-cereals amaranth, buckwheat, quinoa, and wild rice. The definition also describes manufacturing processes allowed for producing wholegrain flours. This paper compares the HEALTHGRAIN definition with previous definitions, provides more comprehensive explanations than in the definition itself regarding the inclusion of specific grains, and sets out the permitted flour manufacturing processes. PMID:24505218

Exploration Supply Chain Simulation

NASA Technical Reports Server (NTRS)

2008-01-01

The Exploration Supply Chain Simulation project was chartered by the NASA Exploration Systems Mission Directorate to develop a software tool, with proper data, to quantitatively analyze supply chains for future program planning. This tool is a discrete-event simulation that uses the basic supply chain concepts of planning, sourcing, making, delivering, and returning. This supply chain perspective is combined with other discrete or continuous simulation factors. Discrete resource events (such as launch or delivery reviews) are represented as organizational functional units. Continuous resources (such as civil service or contractor program functions) are defined as enabling functional units. Concepts of fixed and variable costs are included in the model to allow the discrete events to interact with cost calculations. The definition file is intrinsic to the model, but a blank start can be initiated at any time. The current definition file is an Orion Ares I crew launch vehicle. Parameters stretch from Kennedy Space Center across and into other program entities (Michaud Assembly Facility, Aliant Techsystems, Stennis Space Center, Johnson Space Center, etc.) though these will only gain detail as the file continues to evolve. The Orion Ares I file definition in the tool continues to evolve, and analysis from this tool is expected in 2008. This is the first application of such business-driven modeling to a NASA/government-- aerospace contractor endeavor.

Acute respiratory distress syndrome.

PubMed

Confalonieri, Marco; Salton, Francesco; Fabiano, Francesco

2017-06-30

Since its first description, the acute respiratory distress syndrome (ARDS) has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foster geographic variability and contrasting outcome data. A large international multicentre prospective cohort study including 50 countries across five continents reported that ARDS is underdiagnosed, and there is potential for improvement in its management. Furthermore, epidemiological data from low-income countries suggest that a revision of the current definition of ARDS is needed in order to improve its recognition and global clinical outcome. In addition to the well-known risk-factors for ARDS, exposure to high ozone levels and low vitamin D plasma concentrations were found to be predisposing circumstances. Drug-based preventive strategies remain a major challenge, since two recent trials on aspirin and statins failed to reduce the incidence in at-risk patients. A new disease-modifying therapy is awaited: some recent studies promised to improve the prognosis of ARDS, but mortality and disabling complications are still high in survivors in intensive care. Copyright ©ERS 2017.

Identifying Context Variables in Research.

ERIC Educational Resources Information Center

Piazza, Carolyn L.

1987-01-01

Identifies context variables in written composition from theoretical perspectives in cognitive psychology, sociology, and anthropology. Considers how multiple views of context from across the disciplines can build toward a broader definition of writing. (JD)

Framework for Computer Assisted Instruction Courseware: A Case Study.

ERIC Educational Resources Information Center

Betlach, Judith A.

1987-01-01

Systematically investigates, defines, and organizes variables related to production of internally designed and implemented computer assisted instruction (CAI) courseware: special needs of users; costs; identification and definition of realistic training needs; CAI definition and design methodology; hardware and software requirements; and general…

High prevalence of the metabolic syndrome in HIV-infected patients: impact of different definitions of the metabolic syndrome.

PubMed

Worm, Signe W; Friis-Møller, Nina; Bruyand, Mathias; D'Arminio Monforte, Antonella; Rickenbach, Martin; Reiss, Peter; El-Sadr, Wafaa; Phillips, Andrew; Lundgren, Jens; Sabin, Caroline

2010-01-28

This study describes the characteristics of the metabolic syndrome in HIV-positive patients in the Data Collection on Adverse Events of Anti-HIV Drugs study and discusses the impact of different methodological approaches on estimates of the prevalence of metabolic syndrome over time. We described the prevalence of the metabolic syndrome in patients under follow-up at the end of six calendar periods from 2000 to 2007. The definition that was used for the metabolic syndrome was modified to take account of the use of lipid-lowering and antihypertensive medication, measurement variability and missing values, and assessed the impact of these modifications on the estimated prevalence. For all definitions considered, there was an increasing prevalence of the metabolic syndrome over time, although the prevalence estimates themselves varied widely. Using our primary definition, we found an increase in prevalence from 19.4% in 2000/2001 to 41.6% in 2006/2007. Modification of the definition to incorporate antihypertensive and lipid-lowering medication had relatively little impact on the prevalence estimates, as did modification to allow for missing data. In contrast, modification to allow the metabolic syndrome to be reversible and to allow for measurement variability lowered prevalence estimates substantially. The prevalence of the metabolic syndrome in cohort studies is largely based on the use of nonstandardized measurements as they are captured in daily clinical care. As a result, bias is easily introduced, particularly when measurements are both highly variable and may be missing. We suggest that the prevalence of the metabolic syndrome in cohort studies should be based on two consecutive measurements of the laboratory components in the syndrome definition.

Scenario Development for the Southwestern United States

NASA Astrophysics Data System (ADS)

Mahmoud, M.; Gupta, H.; Stewart, S.; Liu, Y.; Hartmann, H.; Wagener, T.

2006-12-01

The primary goal of employing a scenario development approach for the U.S. southwest is to inform regional policy by examining future possibilities related to regional vegetation change, water-leasing, and riparian restoration. This approach is necessary due to a lack of existing explicit water resources application of scenarios to the entire southwest region. A formal approach for scenario development is adopted and applied towards water resources issues within the arid and semi-arid regions of the U.S. southwest following five progressive and reiterative phases: scenario definition, scenario construction, scenario analysis, scenario assessment, and risk management. In the scenario definition phase, the inputs of scientists, modelers, and stakeholders were collected in order to define and construct relevant scenarios to the southwest and its water sustainability needs. From stakeholder-driven scenario workshops and breakout sessions, the three main axes of principal change were identified to be climate change, population development patterns, and quality of information monitoring technology. Based on the extreme and varying conditions of these three main axes, eight scenario narratives were drafted to describe the state of each scenario's respective future and the events which led to it. Events and situations are described within each scenario narrative with respect to key variables; variables that are both important to regional water resources (as distinguished by scientists and modelers), and are good tracking and monitoring indicators of change. The current phase consists of scenario construction, where the drafted scenarios are re-presented to regional scientists and modelers to verify that proper key variables are included (or excluded) from the eight narratives. The next step is to construct the data sets necessary to implement the eight scenarios on the respective computational models of modelers investigating vegetation change, water-leasing, and riparian restoration in the southwest

Influence of ROI definition on the heart-to-mediastinum ratio in planar 123I-MIBG imaging.

PubMed

Klene, Christiane; Jungen, Christiane; Okuda, Koichi; Kobayashi, Yuske; Helberg, Annabelle; Mester, Janos; Meyer, Christian; Nakajima, Kenichi

2018-02-01

Iodine-123-metaiodobenzylguanidine ( 123 I-MIBG) imaging with estimation of the heart-to-mediastinum ratio (HMR) has been established for risk assessment in patients with chronic heart failure. Our aim was to evaluate the effect of different methods of ROI definition on the renderability of HMR to normal or decreased sympathetic innervation. The results of three different methods of ROI definition (clinical routine (CLI), simple standardization (STA), and semi-automated (AUT) were compared. Ranges of 95% limits of agreement (LoA) of inter-observer variabilities were 0.28 and 0.13 for STA and AUT, respectively. Considering a HMR of 1.60 as the lower limit of normal, 13 of 32 (41%) for method STA and 5 of 32 (16%) for method AUT of all HMR measurements could not be classified to normal or pathologic. Ranges of 95% LoA of inter-method variabilities were 0.72 for CLI vs AUT, 0.65 for CLI vs STA, and 0.31 for STA vs AUT. Different methods of ROI definition result in different ranges of the LoA of the measured HMR with relevance for rendering the results to normal or pathological innervation. We could demonstrate that standardized protocols can help keep methodological variabilities limited, narrowing the gray zone of renderability.

12 CFR 619.9340 - Variable interest rate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Variable interest rate. 619.9340 Section 619.9340 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM DEFINITIONS § 619.9340 Variable interest rate. An interest rate on the outstanding loan balances, which may be changed from time to time...

Functional groups of ecosystem engineers: a proposed classification with comments on current issues.

PubMed

Berke, Sarah K

2010-08-01

Ecologists have long known that certain organisms fundamentally modify, create, or define habitats by altering the habitat's physical properties. In the past 15 years, these processes have been formally defined as "ecosystem engineering", reflecting a growing consensus that environmental structuring by organisms represents a fundamental class of ecological interactions occurring in most, if not all, ecosystems. Yet, the precise definition and scope of ecosystem engineering remains debated, as one should expect given the complexity, enormity, and variability of ecological systems. Here I briefly comment on a few specific current points of contention in the ecosystem engineering concept. I then suggest that ecosystem engineering can be profitably subdivided into four narrower functional categories reflecting four broad mechanisms by which ecosystem engineering occurs: structural engineers, bioturbators, chemical engineers, and light engineers. Finally, I suggest some conceptual model frameworks that could apply broadly within these functional groups.

An integrated operational definition and conceptual model of asthma self-management in teens.

PubMed

Mammen, Jennifer; Rhee, Hyekyun; Norton, Sally A; Butz, Arlene M; Halterman, Jill S; Arcoleo, Kimberly

2018-01-19

A previous definition of adolescent asthma self-management was derived from interviews with clinicians/researchers and published literature; however, it did not incorporate perspectives of teens or parents. Therefore, we conducted in-depth interviews with teens and parents and synthesized present findings with the prior analysis to develop a more encompassing definition and model. Focal concepts were qualitatively extracted from 14-day self-management voice-diaries (n = 14) and 1-hour interviews (n = 42) with teens and parents (28 individuals) along with concepts found in the previous clinical/research oriented analysis. Conceptual structure and relationships were identified and key findings synthesized to develop a revised definition and model of adolescent asthma self-management. There were two primary self-management constructs: processes of self-management and tasks of self-management. Self-management was defined as the iterative process of assessing, deciding, and responding to specific situations in order to achieve personally important outcomes. Clinically relevant asthma self-management tasks included monitoring asthma, managing active issues through pharmacologic and non-pharmacologic strategies, preventing future issues, and communicating with others as needed. Self-management processes were reciprocally influenced by intrapersonal factors (both cognitive and physical), interpersonal factors (family, social and physical environments), and personally relevant asthma and non-asthma outcomes. This is the first definition of asthma self-management incorporating teen, parent, clinician, and researcher perspectives, which suggests that self-management processes and behaviors are influenced by individually variable personal and interpersonal factors, and are driven by personally important outcomes. Clinicians and researchers should investigate teens' symptom perceptions, medication beliefs, current approaches to symptom management, relevant outcomes, and personal priorities.

Definition of mission requirements for the follow-on EUMETSAT polar system

NASA Astrophysics Data System (ADS)

Phillips, P. L.; Schlüssel, P.; Accadia, C. J.; Munro, R.; Wilson, J. J. W.; Perez-Albinana, A.; Banfi, S.

2007-10-01

EUMETSAT has initiated preparatory activities for the definition of the follow-on EUMETSAT Polar System (post- EPS) needed for the timeframe 2020 onwards as a replacement for the current EUMETSAT Polar System. Based on the first outputs of the EUMETSAT post-EPS user consultation process initiated in 2005, mission requirements for potential post-EPS missions have been drafted. Expertise from a variety of communities was drawn upon in order to ascertain user needs expressed in terms of geophysical variables, for operational meteorology, climate monitoring, atmospheric chemistry, oceanography, and hydrology. Current trends in the evolution of these applications were considered in order to derive the necessary satellite products that will be required in the post-EPS era. The increasing complexity of models with regard to parameterisation and data assimilation, along with the trend towards coupled atmosphere, ocean and land models, generates new requirements, particularly in the domains of clouds and precipitation, trace gases and ocean/land surface products. Following the requirements definition, concept studies at instrument and system levels will shortly commence with the support of the European Space Agency (ESA), together with industry and representatives of the user and science communities. Such studies, planned for completion by end of 2008, aim at defining and trading off possible mission and system concepts and will establish preliminary functional requirements for full or partial implementation of post-EPS mission requirements. Cost drivers and needs for critical research and development will also be identified. The generation of both the user and mission requirements have been supported substantially by the post-EPS Mission Experts Team and the Application Expert Groups. Their support is gratefully acknowledged.

Tackling extremes: challenges for ecological and evolutionary research on extreme climatic events.

PubMed

Bailey, Liam D; van de Pol, Martijn

2016-01-01

Extreme climatic events (ECEs) are predicted to become more frequent as the climate changes. A rapidly increasing number of studies - though few on animals - suggest that the biological consequences of ECEs can be severe. However, ecological research on the impacts of ECEs has been limited by a lack of cohesiveness and structure. ECEs are often poorly defined and have often been confusingly equated with climatic variability, making comparison between studies difficult. In addition, a focus on short-term studies has provided us with little information on the long-term implications of ECEs, and the descriptive and anecdotal nature of many studies has meant it is still unclear what the key research questions are. Synthesizing the current state of work is essential to identify ways to make progress. We conduct a synthesis of the literature and discuss conceptual and practical challenges faced by research on ECEs. We consider three steps to advance research. First, we discuss the importance of choosing an ECE definition and identify the pros and cons of 'climatological' and 'biological' definitions of ECEs. Secondly, we advocate research beyond short-term descriptive studies to address questions concerning the long-term implications of ECEs, focussing on selective pressures and phenotypically plastic responses and how they might differ from responses to a changing climatic mean. Finally, we encourage a greater focus on multi-event studies that help us understand the implications of changing patterns of ECEs, through the combined use of modelling, experimental and observational field studies. This study aims to open a discussion on the definitions, questions and methods currently used to study ECEs, which will lead to a more cohesive approach to future ECE research. © 2015 The Authors. Journal of Animal Ecology © 2015 British Ecological Society.

30 CFR 74.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Definitions. 74.2 Section 74.2 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH COAL MINE... consensus standards used worldwide. (f) Precision: the relative variability of measurements from a...

Wind driven general circulation of the Mediterranean Sea simulated with a Spectral Element Ocean Model

NASA Astrophysics Data System (ADS)

Molcard, A.; Pinardi, N.; Iskandarani, M.; Haidvogel, D. B.

2002-05-01

This work is an attempt to simulate the Mediterranean Sea general circulation with a Spectral Finite Element Model. This numerical technique associates the geometrical flexibility of the finite elements for the proper coastline definition with the precision offered by spectral methods. The model is reduced gravity and we study the wind-driven ocean response in order to explain the large scale sub-basin gyres and their variability. The study period goes from January 1987 to December 1993 and two forcing data sets are used. The effect of wind variability in space and time is analyzed and the relationship between wind stress curl and ocean response is stressed. Some of the main permanent structures of the general circulation (Gulf of Lions cyclonic gyre, Rhodes gyre, Gulf of Syrte anticylone) are shown to be induced by permanent wind stress curl structures. The magnitude and spatial variability of the wind is important in determining the appearance or disappearance of some gyres (Tyrrhenian anticyclonic gyre, Balearic anticyclonic gyre, Ionian cyclonic gyre). An EOF analysis of the seasonal variability indicates that the weakening and strengthening of the Levantine basin boundary currents is a major component of the seasonal cycle in the basin. The important discovery is that seasonal and interannual variability peak at the same spatial scales in the ocean response and that the interannual variability includes the change in amplitude and phase of the seasonal cycle in the sub-basin scale gyres and boundary currents. The Coriolis term in the vorticity balance seems to be responsible for the weakening of anticyclonic structures and their total disappearance when they are close to a boundary. The process of adjustment to winds produces a train of coastally trapped gravity waves which travel around the eastern and western basins, respectively in approximately 6 months. This corresponds to a phase velocity for the wave of about 1 m/s, comparable to an average velocity of an internal Kelvin wave in the area.

Creating order from chaos: part II: tactical planning for mass casualty and disaster response at definitive care facilities.

PubMed

Baker, Michael S

2007-03-01

Current events highlight the need for disaster preparedness. We have seen tsunamis, hurricanes, terrorism, and combat in the news every night. There are many variables in a disaster, such as damage to facilities, loss of critical staff members, and overwhelming numbers of casualties. Each medical treatment facility should have a plan for everything from caring for staff members to getting the laundry done and providing enhanced security or mortuary services. Communication and agreements with local, regional, and federal agencies are vital. Then we must train and drill to shape the tools to impose order on chaos and to provide the most care to the greatest number.

Personality and Situation in the Prediction of Women's Life Patterns.

ERIC Educational Resources Information Center

Stewart, Abigail J.

1980-01-01

Marriage, achievement need, children and self-definition predicted negative career persistence and career activity patterns in some family situations. Self-definition was associated with professional career activity among unconstrained women, but with freelance activity among married mothers. Personality variables may predict behavior within broad…

Multivariate localization methods for ensemble Kalman filtering

NASA Astrophysics Data System (ADS)

Roh, S.; Jun, M.; Szunyogh, I.; Genton, M. G.

2015-05-01

In ensemble Kalman filtering (EnKF), the small number of ensemble members that is feasible to use in a practical data assimilation application leads to sampling variability of the estimates of the background error covariances. The standard approach to reducing the effects of this sampling variability, which has also been found to be highly efficient in improving the performance of EnKF, is the localization of the estimates of the covariances. One family of localization techniques is based on taking the Schur (entry-wise) product of the ensemble-based sample covariance matrix and a correlation matrix whose entries are obtained by the discretization of a distance-dependent correlation function. While the proper definition of the localization function for a single state variable has been extensively investigated, a rigorous definition of the localization function for multiple state variables has been seldom considered. This paper introduces two strategies for the construction of localization functions for multiple state variables. The proposed localization functions are tested by assimilating simulated observations experiments into the bivariate Lorenz 95 model with their help.

Definition of a 5-MW Reference Wind Turbine for Offshore System Development

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

Jonkman, J.; Butterfield, S.; Musial, W.

2009-02-01

This report describes a three-bladed, upwind, variable-speed, variable blade-pitch-to-feather-controlled multimegawatt wind turbine model developed by NREL to support concept studies aimed at assessing offshore wind technology.

29 CFR 1910.34 - Coverage and definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 5 2014-07-01 2014-07-01 false Coverage and definitions. 1910.34 Section 1910.34 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Exit Routes and Emergency Planning § 1910.34 Coverage and definitions... plans. (c) Definitions. Electroluminescent means a light-emitting capacitor. Alternating current excites...

29 CFR 1910.34 - Coverage and definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 5 2013-07-01 2013-07-01 false Coverage and definitions. 1910.34 Section 1910.34 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Exit Routes and Emergency Planning § 1910.34 Coverage and definitions... plans. (c) Definitions. Electroluminescent means a light-emitting capacitor. Alternating current excites...

29 CFR 1910.34 - Coverage and definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 5 2012-07-01 2012-07-01 false Coverage and definitions. 1910.34 Section 1910.34 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Exit Routes and Emergency Planning § 1910.34 Coverage and definitions... plans. (c) Definitions. Electroluminescent means a light-emitting capacitor. Alternating current excites...

p-adic stochastic hidden variable model

NASA Astrophysics Data System (ADS)

Khrennikov, Andrew

1998-03-01

We propose stochastic hidden variables model in which hidden variables have a p-adic probability distribution ρ(λ) and at the same time conditional probabilistic distributions P(U,λ), U=A,A',B,B', are ordinary probabilities defined on the basis of the Kolmogorov measure-theoretical axiomatics. A frequency definition of p-adic probability is quite similar to the ordinary frequency definition of probability. p-adic frequency probability is defined as the limit of relative frequencies νn but in the p-adic metric. We study a model with p-adic stochastics on the level of the hidden variables description. But, of course, responses of macroapparatuses have to be described by ordinary stochastics. Thus our model describes a mixture of p-adic stochastics of the microworld and ordinary stochastics of macroapparatuses. In this model probabilities for physical observables are the ordinary probabilities. At the same time Bell's inequality is violated.

Early variability in the conceptualisation of "sustainable development and human factors".

PubMed

Thatcher, Andrew

2012-01-01

The sub-discipline of "sustainable development and human factors" is relatively new, first being used in 2006 with a Technical Committee of the IEA being established only in 2009 and a similar special interest group on "green ergonomics" at the Institute of Ergonomics and Human Factors being established in 2010. In general though, the definitions and practice of "sustainable development" is highly contentious and ambiguous across a range of disciplines. This paper examines the diversity of definitions and approaches to sustainable development and human factors in the early papers in this sub-discipline. An examination of 45 chapters and papers (from 2008 to 2011) reveals a surprising consistency in the definitions used for sustainable development but also a large proportion of the papers where no definitions are given at all. The majority of papers were, however, biased towards an economic capital and social capital emphasis, which is to be expected of work traditionally in the ergonomics paradigm. Further, most papers were theoretical in nature demonstrating a great opportunity for empirical work. The variability in definitions is discussed in relation to the future challenges facing the growth of this emergent sub-discipline and opportunities for further theoretical and empirical work.

Principal stratification in causal inference.

PubMed

Frangakis, Constantine E; Rubin, Donald B

2002-03-01

Many scientific problems require that treatment comparisons be adjusted for posttreatment variables, but the estimands underlying standard methods are not causal effects. To address this deficiency, we propose a general framework for comparing treatments adjusting for posttreatment variables that yields principal effects based on principal stratification. Principal stratification with respect to a posttreatment variable is a cross-classification of subjects defined by the joint potential values of that posttreatment variable tinder each of the treatments being compared. Principal effects are causal effects within a principal stratum. The key property of principal strata is that they are not affected by treatment assignment and therefore can be used just as any pretreatment covariate. such as age category. As a result, the central property of our principal effects is that they are always causal effects and do not suffer from the complications of standard posttreatment-adjusted estimands. We discuss briefly that such principal causal effects are the link between three recent applications with adjustment for posttreatment variables: (i) treatment noncompliance, (ii) missing outcomes (dropout) following treatment noncompliance. and (iii) censoring by death. We then attack the problem of surrogate or biomarker endpoints, where we show, using principal causal effects, that all current definitions of surrogacy, even when perfectly true, do not generally have the desired interpretation as causal effects of treatment on outcome. We go on to forrmulate estimands based on principal stratification and principal causal effects and show their superiority.

The Use of Race-Related Variables in Counseling Research

ERIC Educational Resources Information Center

Strom, Thad Q.; Lee, D. John; Trahan, Emily; Kaufman, Aimee; Pritchett, Tiffany

2009-01-01

This study provides a detailed analysis of all race-related articles published in prominent counseling journals between 1995 and 2004. Findings indicate that 75% of articles did not define race variables and in the absence of an operational definition, authors tended to conceptualize race as an inherent biological variable. (Contains 3 tables.)

Inter-annual Variability of Temperature and Extreme Heat Events during the Nairobi Warm Season

NASA Astrophysics Data System (ADS)

Scott, A.; Misiani, H. O.; Zaitchik, B. F.; Ouma, G. O.; Anyah, R. O.; Jordan, A.

2016-12-01

Extreme heat events significantly stress all organisms in the ecosystem, and are likely to be amplified in peri-urban and urban areas. Understanding the variability and drivers behind these events is key to generating early warnings, yet in Equatorial East Africa, this information is currently unavailable. This study uses daily maximum and minimum temperature records from weather stations within Nairobi and its surroundings to characterize variability in daily minimum temperatures and the number of extreme heat events. ERA-Interim reanalysis is applied to assess the drivers of these events at event and seasonal time scales. At seasonal time scales, high temperatures in Nairobi are a function of large scale climate variability associated with the Atlantic Multi-decadal Oscillation (AMO) and Global Mean Sea Surface Temperature (GMSST). Extreme heat events, however, are more strongly associated with the El Nino Southern Oscillation (ENSO). For instance, the persistence of AMO and ENSO, in particular, provide a basis for seasonal prediction of extreme heat events/days in Nairobi. It is also apparent that the temporal signal from extreme heat events in tropics differs from classic heat wave definitions developed in the mid-latitudes, which suggests that a new approach for defining these events is necessary for tropical regions.

[Insight, neurocognition and psychopathology in schizophrenia].

PubMed

Gil, D; Bengochea, R; Arrieta, M; Alvarez, A; Sánchez, R; Diego, M

2006-01-01

In recent years, research has been aimed at finding variables mediating between neurocognition and psychosocial functioning in schizophrenia, proposing insight as one of these variables. Some authors have found associations between insight and functional outcome, and between insight and symptomatology, although these associations remain unclear. These different findings could be explained by the insight definition used. The current study evaluates insight unidimensionally and multidimensionally and studies its relationship with cognitive and psychopathological variables. The sample consisted of 94 subjects admitted to an outpatient Psychosocial Rehabilitation Program, all diagnosed of schizophrenia according to ICD-10 diagnostic criteria. A brief version of the Neuropsychology Battery Test Barcelona and the Wisconsin Card Sorting Test were used to evaluate cognitive variables. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate psychopathology. Insight was assessed with the PANSS item ((lack of judgment and insight)), and with a semi-structured interview. Two insight factors were found, one including more specific knowledge about the disease and its consequences (cognitive factor), that is related to executive functions, and another referring to unspecific knowledge about suffering from an illness and the need for treatment (psychotic factor). Each factor was statistically related to positive symptoms and superior cognitive functions. These findings support a relationship between insight and low cognitive performance.

Temporal Variability in the Deglutition Literature

PubMed Central

Molfenter, Sonja M.; Steele, Catriona M.

2013-01-01

A literature review was conducted on temporal measures of swallowing in healthy individuals with the purpose of determining the degree of variability present in such measures within the literature. A total of 46 studies that met inclusion criteria were reviewed. The definitions and descriptive statistics for all reported temporal parameters were compiled for meta-analysis. In total, 119 different temporal parameters were found in the literature. The three most-frequently occurring durational measures were: UES opening, laryngeal closure and hyoid movement. The three most-frequently occurring interval measures were: stage transition duration, pharyngeal transit time and duration from laryngeal closure to UES opening. Subtle variations in operational definitions across studies were noted, making the comparison of data challenging. Analysis of forest plots compiling descriptive statistical data (means and 95% confidence intervals) across studies revealed differing degrees of variability across durations and intervals. Two parameters (UES opening duration and the laryngeal-closure-to-UES-opening interval) demonstrated the least variability, reflected by small ranges for mean values and tight confidence intervals. Trends emerged for factors of bolus size and participant age for some variables. Other potential sources of variability are discussed. PMID:22366761

17 CFR 270.2a-4 - Definition of “current net asset value” for use in computing periodically the current price of...

Code of Federal Regulations, 2010 CFR

2010-04-01

... AND REGULATIONS, INVESTMENT COMPANY ACT OF 1940 § 270.2a-4 Definition of “current net asset value” for... value of any redeemable security issued by a registered investment company used in computing... which reflects calculations, whether or not recorded in the books of account, made substantially in...

The definition of polytrauma revisited: An international consensus process and proposal of the new 'Berlin definition'

PubMed

Pape, Hans-Christoph; Lefering, Rolf; Butcher, Nerida; Peitzman, Andrew; Leenen, Luke; Marzi, Ingo; Lichte, Philip; Josten, Christoph; Bouillon, Bertil; Schmucker, Uli; Stahel, Philip; Giannoudis, Peter; Balogh, Zsolt

2014-11-01

The nomenclature for patients with multiple injuries with high mortality rates is highly variable, and there is a lack of a uniform definition of the term polytrauma. A consensus process was therefore initiated by a panel of international experts with the goal of assessing an improved, database-supported definition for the polytraumatized patient. The consensus process involved the following: RESULTS: A total of 28,211 patients in the trauma registry met the inclusion criteria. The mean (SD) age of the study cohort was 42.9 (20.2) years (72% males, 28% females). The mean (SD) ISS was 30.5 (12.2), with an overall mortality rate of 18.7% (n = 5,277) and an incidence of 3% of penetrating injuries (n = 886). Five independent physiologic variables were identified, and their individual cutoff values were calculated based on a set mortality rate of 30%: hypotension (systolic blood pressure ≤ 90 mm Hg), level of consciousness (Glasgow Coma Scale [GCS] score ≤ 8), acidosis (base excess ≤ -6.0), coagulopathy (international normalized ratio ≥ 1.4/partial thromboplastin time ≥ 40 seconds), and age (≥70 years). Based on several consensus meetings and a database analysis, the expert panel proposes the following parameters for a definition of "polytrauma": significant injuries of three or more points in two or more different anatomic AIS regions in conjunction with one or more additional variables from the five physiologic parameters. Further validation of this proposal should occur, favorably by mutivariate analyses of these parameters in a separate data set.

23 CFR 1340.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... OBSERVATIONAL SURVEYS OF SEAT BELT USE General § 1340.3 Definitions. As used in this part— Access ramp means the... general public are not allowed to drive motor vehicles. Nonresponse rate means, for any survey variable... location where survey data are collected. Passenger motor vehicle means a motor vehicle with a gross...

23 CFR 1340.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... OBSERVATIONAL SURVEYS OF SEAT BELT USE General § 1340.3 Definitions. As used in this part— Access ramp means the... general public are not allowed to drive motor vehicles. Nonresponse rate means, for any survey variable... location where survey data are collected. Passenger motor vehicle means a motor vehicle with a gross...

23 CFR 1340.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... OBSERVATIONAL SURVEYS OF SEAT BELT USE General § 1340.3 Definitions. As used in this part— Access ramp means the... general public are not allowed to drive motor vehicles. Nonresponse rate means, for any survey variable... location where survey data are collected. Passenger motor vehicle means a motor vehicle with a gross...

40 CFR 799.9620 - TSCA neurotoxicity screening battery.

Code of Federal Regulations, 2011 CFR

2011-07-01

... address in paragraph (g) of this section. (c) Definitions. The following definitions apply to this section... facilitate interpretation of the data. (C) Additional measures. Other measures may also be included and the.... Among the variables which can affect motor activity are sound level, size and shape of the test cage...

40 CFR 799.9620 - TSCA neurotoxicity screening battery.

Code of Federal Regulations, 2010 CFR

2010-07-01

... address in paragraph (g) of this section. (c) Definitions. The following definitions apply to this section... facilitate interpretation of the data. (C) Additional measures. Other measures may also be included and the.... Among the variables which can affect motor activity are sound level, size and shape of the test cage...

Univariate Analysis of Multivariate Outcomes in Educational Psychology.

ERIC Educational Resources Information Center

Hubble, L. M.

1984-01-01

The author examined the prevalence of multiple operational definitions of outcome constructs and an estimate of the incidence of Type I error rates when univariate procedures were applied to multiple variables in educational psychology. Multiple operational definitions of constructs were advocated and wider use of multivariate analysis was…

Definitions of Idioms in Preadolescents, Adolescents, and Adults

ERIC Educational Resources Information Center

Chan, Yen-Ling; Marinellie, Sally A.

2008-01-01

The purpose of this study was to expand the current literature on word definitions by focusing on definitions of idioms provided by several age groups. Preadolescents, young adolescents, older adolescents, and adults wrote definitions for 10 frequently used idioms and also rated their familiarity with the idiomatic expressions. Participants'…

Improved prediction of disturbed flow via hemodynamically-inspired geometric variables.

PubMed

Bijari, Payam B; Antiga, Luca; Gallo, Diego; Wasserman, Bruce A; Steinman, David A

2012-06-01

Arterial geometry has long been considered as a pragmatic alternative for inferring arterial flow disturbances, and their impact on the natural history and treatment of vascular diseases. Traditionally, definition of geometric variables is based on convenient shape descriptors, with only superficial consideration of their influence on flow and wall shear stress patterns. In the present study we demonstrate that a more studied consideration of the actual (cf. nominal) local hemodynamics can lead to substantial improvements in the prediction of disturbed flow by geometry. Starting from a well-characterized computational fluid dynamics (CFD) dataset of 50 normal carotid bifurcations, we observed that disturbed flow tended to be confined proximal to the flow divider, whereas geometric variables previously shown to be significant predictors of disturbed flow included features distal to the flow divider in their definitions. Flaring of the bifurcation leading to flow separation was redefined as the maximum relative expansion of the common carotid artery (CCA), proximal to the flow divider. The beneficial effect of primary curvature on flow inertia, via suppression of flow separation, was characterized by the in-plane tortuosity of CCA as it enters the flare region. Multiple linear regressions of these redefined geometric variables against various metrics of disturbed flow revealed R(2) values approaching 0.6, better than the roughly 0.3 achieved using the conventional shape-based variables, while maintaining their demonstrated real-world reproducibility. Such a hemodynamically-inspired approach to the definition of geometric variables may reap benefits for other applications where geometry is used as a surrogate marker of local hemodynamics. Copyright © 2012 Elsevier Ltd. All rights reserved.

Reference materials for molecular diagnostics: Current achievements and future strategies.

PubMed

Jing, Rongrong; Wang, Huimin; Ju, Shaoqing; Cui, Ming

2018-06-01

Molecular diagnoses have become more widespread in many areas of laboratory medicine where qualitative or quantitative approaches are used to detect nucleic acids. The increasing number of assay methods and the targets for molecular diagnostics contribute to variability in the test results among clinical laboratories. Thus, reference materials (RMs) are required to enhance the comparability of results. This review focuses on the definition of RMs as well as the production and characteristics of higher order RMs from different organizations and their future strategies. We describe the recent progress in RMs, including the definition of RMs by the Joint Committee for Guides in Metrology, as well as the production and characteristics of higher order RMs by international official bodies. There is an urgent need for RMs in nucleic acid testing, especially higher order RMs. To advance the harmonization and standardization of clinical nucleic acid detection, cooperation between the above organizations is proposed and different approaches to higher order RMs development are also needed. Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Pacemaker Dependency after Cardiac Surgery: A Systematic Review of Current Evidence

PubMed Central

2015-01-01

Background Severe postoperative conduction disturbances requiring permanent pacemaker implantation frequently occur following cardiac surgery. Little is known about the long-term pacing requirements and risk factors for pacemaker dependency in this population. Methods We performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery. Using a comprehensive search of the Medline, Web of Science and EMBASE databases, studies were selected for review based on predetermined inclusion and exclusion criteria. Results A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint. There were 10 unique studies with a total of 780 patients. Mean follow-up ranged from 6–72 months. Pacemaker dependency rates ranged from 32%-91% and recovery of AV conduction ranged from 16%-42%. There was significant heterogeneity with respect to the definition of pacemaker dependency. Several patient and procedure-specific variables were found to be independently associated with pacemaker dependency, but these were not consistent between studies. Conclusions Pacemaker dependency following cardiac surgery occurs with variable frequency. While individual studies have identified various perioperative risk factors for pacemaker dependency and non-resolution of AV conduction disease, results have been inconsistent. Well-conducted studies using a uniform definition of pacemaker dependency might identify patients who will benefit most from early permanent pacemaker implantation after cardiac surgery. PMID:26470027

The first definitive Middle Jurassic atoposaurid (Crocodylomorpha, Neosuchia), and a discussion on the genus Theriosuchus.

PubMed

Young, Mark T; Tennant, Jonathan P; Brusatte, Stephen L; Challands, Thomas J; Fraser, Nicholas C; Clark, Neil D L; Ross, Dugald A

2016-02-01

Atoposaurids were a clade of semiaquatic crocodyliforms known from the Late Jurassic to the latest Cretaceous. Tentative remains from Europe, Morocco, and Madagascar may extend their range into the Middle Jurassic. Here we report the first unambiguous Middle Jurassic (late Bajocian-Bathonian) atoposaurid: an anterior dentary from the Isle of Skye, Scotland, UK. A comprehensive review of atoposaurid specimens demonstrates that this dentary can be referred to T heriosuchus based on several derived characters, and differs from the five previously recognized species within this genus. Despite several diagnostic features, we conservatively refer it to T heriosuchus sp., pending the discovery of more complete material. As the oldest known definitively diagnostic atoposaurid, this discovery indicates that the oldest members of this group were small-bodied, had heterodont dentition, and were most likely widespread components of European faunas. Our review of mandibular and dental features in atoposaurids not only allows us to present a revised diagnosis of T heriosuchus , but also reveals a great amount of variability within this genus, and indicates that there are currently five valid species that can be differentiated by unique combinations of dental characteristics. This variability can be included in future broad-scale cladistics analyses of atoposaurids and closely related crocodyliforms, which promise to help untangle the complicated taxonomy and evolutionary history of Atoposauridae.  © 2015 The Authors. Zoological Journal of the Linnean Society published by John Wiley & Sons Ltd on behalf of The Linnean Society of London.

Clinical Geneticists’ Views of VACTERL/VATER Association

PubMed Central

Solomon, Benjamin D.; Bear, Kelly A.; Kimonis, Virginia; de Klein, Annelies; Scott, Daryl A.; Shaw-Smith, Charles; Tibboel, Dick; Reutter, Heiko; Giampietro, Philip F.

2012-01-01

VACTERL association (sometimes termed “VATER association” depending on which component features are included) is typically defined by the presence of at least three of the following congenital malformations, which tend to statistically co-occur in affected individuals: Vertebral anomalies, Anal atresia, Cardiac malformations, Tracheo-Esophageal fistula, Renal anomalies, and Limb abnormalities. Although the clinical criteria for VACTERL association may appear to be straightforward, there is wide variability in the way clinical geneticists define the disorder and the genetic testing strategy they use when confronted with an affected patient. In order to describe this variability and determine the most commonly used definitions and testing modalities, we present the results of survey responses by 121 clinical geneticists. We discuss the results of the survey responses, provide a literature review and commentary from a group of physicians who are currently involved in clinical and laboratory-based research on VACTERL association, and offer an algorithm for genetic testing in patients with this association. PMID:23165726

Structural Tailoring of Advanced Turboprops (STAT). Theoretical manual

NASA Technical Reports Server (NTRS)

Brown, K. W.

1992-01-01

This manual describes the theories in the Structural Tailoring of Advanced Turboprops (STAT) computer program, which was developed to perform numerical optimizations on highly swept propfan blades. The optimization procedure seeks to minimize an objective function, defined as either direct operating cost or aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. The STAT analyses include an aerodynamic efficiency evaluation, a finite element stress and vibration analysis, an acoustic analysis, a flutter analysis, and a once-per-revolution (1-p) forced response life prediction capability. The STAT constraints include blade stresses, blade resonances, flutter, tip displacements, and a 1-P forced response life fraction. The STAT variables include all blade internal and external geometry parameters needed to define a composite material blade. The STAT objective function is dependent upon a blade baseline definition which the user supplies to describe a current blade design for cost optimization or for the tailoring of an aeroelastic scale model.

Structural Tailoring of Advanced Turboprops (STAT). Theoretical manual

NASA Astrophysics Data System (ADS)

Brown, K. W.

1992-10-01

This manual describes the theories in the Structural Tailoring of Advanced Turboprops (STAT) computer program, which was developed to perform numerical optimizations on highly swept propfan blades. The optimization procedure seeks to minimize an objective function, defined as either direct operating cost or aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. The STAT analyses include an aerodynamic efficiency evaluation, a finite element stress and vibration analysis, an acoustic analysis, a flutter analysis, and a once-per-revolution (1-p) forced response life prediction capability. The STAT constraints include blade stresses, blade resonances, flutter, tip displacements, and a 1-P forced response life fraction. The STAT variables include all blade internal and external geometry parameters needed to define a composite material blade. The STAT objective function is dependent upon a blade baseline definition which the user supplies to describe a current blade design for cost optimization or for the tailoring of an aeroelastic scale model.

Biomechanics as a window into the neural control of movement

PubMed Central

2016-01-01

Abstract Biomechanics and motor control are discussed as parts of a more general science, physics of living systems. Major problems of biomechanics deal with exact definition of variables and their experimental measurement. In motor control, major problems are associated with formulating currently unknown laws of nature specific for movements by biological objects. Mechanics-based hypotheses in motor control, such as those originating from notions of a generalized motor program and internal models, are non-physical. The famous problem of motor redundancy is wrongly formulated; it has to be replaced by the principle of abundance, which does not pose computational problems for the central nervous system. Biomechanical methods play a central role in motor control studies. This is illustrated with studies with the reconstruction of hypothetical control variables and those exploring motor synergies within the framework of the uncontrolled manifold hypothesis. Biomechanics and motor control have to merge into physics of living systems, and the earlier this process starts the better. PMID:28149390

Responsiveness of measures of heartburn improvement in non-erosive reflux disease

PubMed Central

Junghard, Ola; Halling, Katarina

2007-01-01

Background When measuring treatment effect on symptoms, the treatment success variable should be as responsive as possible. The aim of the study was to investigate the responsiveness of various treatment success variables in patients with symptoms of heartburn. Methods A total of 1640 patients with non-erosive reflux disease (NERD) were treated with proton pump inhibitors for 4 weeks. Treatment success variables were based on a symptom questionnaire (Gastrointestinal Symptom Rating Scale) and on investigator-assessed heartburn, measured at baseline and after 4 weeks of treatment. The rates of treatment success were compared with patients' perceived change in symptoms, assessed by the Overall Treatment Effect questionnaire. Results Generally, more stringent treatment success criteria (i.e., those demanding the better response) translated into more responsive treatment success variables. For example, the treatment success variable 'no heartburn' at 4 weeks was more responsive than the variable 'at most mild heartburn' at 4 weeks. Treatment success variables based on change from baseline to 4 weeks were, in general, less responsive than those based on the week 4 assessments only. Conclusion In patients with NERD, responsiveness varied among different treatment success definitions, with more demanding definitions (based on the 4-week assessment) giving better responsiveness. PMID:17562006

Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries.

PubMed

Kalinowski, Agnieszka; Humphreys, Keith

2016-07-01

One of the challenges of international alcohol research and policy is the variability in and lack of knowledge of how governments in different nations define a standard drink and low-risk drinking. This study gathered such information from governmental agencies in 37 countries. A pool of 75 countries that might have definitions was created using World Health Organization (WHO) information and the authors' own judgement. Structured internet searches of relevant terms for each country were supplemented by efforts to contact government agencies directly and to consult with alcohol experts in the country. Most of the 75 national governments examined were not identified as having adopted a standard drink definition. Among the 37 that were so identified, the modal standard drink size was 10 g pure ethanol, but variation was wide (8-20 g). Significant variability was also evident for low-risk drinking guidelines, ranging from 10-42 g per day for women and 10-56 g per day for men to 98-140 g per week for women and 150-280 g per week for men. Researchers working and communicating across national boundaries should be sensitive to the substantial variability in 'standard' drink definitions and low-risk drinking guidelines. The potential impact of guidelines, both in general and in specific national cases, remains an important question for public health research. © 2016 Society for the Study of Addiction.

Variability in target delineation of cervical carcinoma: A Korean radiation oncology group study (KROG 15-06)

PubMed Central

Joo, Ji Hyeon; Cho, Byung Chul; Jeong, Chi Young; Park, Won; Kim, Hak Jae; Yoon, Won Sup; Yoon, Mee Sun; Kim, Ji-Yoon; Choi, Jin Hwa; Choi, Youngmin; Kim, Joo-Young

2017-01-01

Purpose To determine inter-observer variability in target volume definition of cervical cancer in radical and adjuvant radiotherapy (RT) settings. Methods Eight physicians contoured CTVs of 2 patients underwent definitive and postoperative RT. Each volume was analyzed using the individual/median volume ratio and generalized conformity index (CIgen). And center of mass (COM) of each contour was calculated. Expert agreement was quantified using an expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE). Results For definitive RT, the individual/median volume ratio ranged from 0.51 to 1.41, and CIgen was 0.531. Mean 3-dimensional distances of average to each COM were 7.8 mm. For postoperative RT setting, corresponding values were 0.65–1.38, 0.563, and 5.3 mm. Kappa value of expert agreement was 0.65 and 0.67, respectively. STAPLE estimates of the sensitivity, specificity, and kappa measures of inter-physician agreement were 0.73, 0.98, and 0.65 for the definitive and 0.75, 0.98, and 0.67 for the adjuvant radiotherapy setting. The largest difference was observed in the superior-inferior direction, particularly in the upper vagina and the common iliac area. Conclusion As there was still some variability in target delineation, more detailed guidelines for target volume delineation and continuing education would help to reduce this uncertainty. PMID:28301492

49 CFR 630.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.3 Definitions. (a) Except as otherwise provided, terms defined in... current editions of the National Transit Database Reporting Manuals and the NTD Uniform System of Accounts... benefits from assistance under 49 U.S.C. 5307 or 5311. Current edition of the National Transit Database...

49 CFR 630.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.3 Definitions. (a) Except as otherwise provided, terms defined in... current editions of the National Transit Database Reporting Manuals and the NTD Uniform System of Accounts... benefits from assistance under 49 U.S.C. 5307 or 5311. Current edition of the National Transit Database...

49 CFR 630.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.3 Definitions. (a) Except as otherwise provided, terms defined in... current editions of the National Transit Database Reporting Manuals and the NTD Uniform System of Accounts... benefits from assistance under 49 U.S.C. 5307 or 5311. Current edition of the National Transit Database...

49 CFR 630.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.3 Definitions. (a) Except as otherwise provided, terms defined in... current editions of the National Transit Database Reporting Manuals and the NTD Uniform System of Accounts... benefits from assistance under 49 U.S.C. 5307 or 5311. Current edition of the National Transit Database...

49 CFR 630.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.3 Definitions. (a) Except as otherwise provided, terms defined in... current editions of the National Transit Database Reporting Manuals and the NTD Uniform System of Accounts... benefits from assistance under 49 U.S.C. 5307 or 5311. Current edition of the National Transit Database...

Impact of Pharmacogenetics on Efficacy and Safety of Statin Therapy for Dyslipidemia.

PubMed

Maxwell, Whitney D; Ramsey, Laura B; Johnson, Samuel G; Moore, Kate G; Shtutman, Michael; Schoonover, John H; Kawaguchi-Suzuki, Marina

2017-09-01

Interindividual variability in response to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, with regard to both efficacy and safety is an obvious target for pharmacogenetic research. Many genes have been identified as possible contributors to variability in statin response and safety. Genetic polymorphisms may alter the structure or expression of coded proteins, with potential impacts on lipid and statin absorption, distribution, metabolism, and elimination as well as response pathways related to the pharmacologic effect. Many studies have explored the variation in statins' pharmacokinetic and pharmacodynamic parameters; however, to our knowledge, few have established definitive relationships between the genetic polymorphisms and patient outcomes, such as cardiovascular events. In this review article, we provide a statin-based summary of available evidence describing pharmacogenetic associations that may be of clinical relevance in the future. Although currently available studies are often small or retrospective, and may have conflicting results, they may be useful in providing direction for future confirmatory studies and may point to associations that could be confirmed in the future when more patient outcomes-based studies are available. We also summarize the clinically relevant evidence currently available to assist clinicians with providing personalized pharmacotherapy for patients requiring statin therapy. © 2017 Pharmacotherapy Publications, Inc.

The quest for population-level cancer recurrence data; current deficiencies and targets for improvement.

PubMed

In, Haejin; Simon, Cassie A; Phillips, Jerri Linn; Posner, Mitchell C; Ko, Clifford Y; Winchester, David P

2015-05-01

Cancer recurrence is a critical outcome in cancer care. However, population-level recurrence information is currently unavailable. Tumor registries provide an opportunity to generate this information, but require major reform. Our objectives were to (1) determine causes for variability in collection of recurrence, and (2) identify targets for intervention. On-site interviews and observations of tumor registry follow-up procedures were conducted at Commission on Cancer (CoC) accredited hospitals. Information regarding registry resources (caseload, staffing, chart availability), follow-up methods and perceived causes for difficulty in obtaining recurrence information was obtained. Seven NCI/academic, 5 comprehensive community and 2 community centers agreed to participate. Hospitals were inconsistent in their investigation of cancer recurrence, resulting in underreporting of rates of recurrence. Hospital characteristics, registry staffing, staff qualifications and medical chart access influenced follow-up practices. Coding standards and definitions for recurrence were suboptimal, resulting in hospital variability of recurrence reporting. Finally, inability to identify cases lost to follow-up in collected data prevents accurate analysis of recurrence rates. Tumor registries collect varying degrees of recurrence information and provide the underpinnings to capture population-level cancer recurrence data. Targets for intervention are listed, and provide a roadmap to obtain this critical information in cancer care. © 2015 Wiley Periodicals, Inc.

The mycotoxin definition reconsidered towards fungal cyclic depsipeptides.

PubMed

Taevernier, Lien; Wynendaele, Evelien; De Vreese, Leen; Burvenich, Christian; De Spiegeleer, Bart

2016-04-02

Currently, next to the major classes, cyclic depsipeptides beauvericin and enniatins are also positioned as mycotoxins. However, as there are hundreds more fungal cyclic depsipeptides already identified, should these not be considered as mycotoxins as well? The current status of the mycotoxin definition revealed a lack of consistency, leading to confusion about what compounds should be called mycotoxins. Because this is of pivotal importance in risk assessment prioritization, a clear and quantitatively expressed mycotoxin definition is proposed, based on data of widely accepted mycotoxins. Finally, this definition is applied to a set of fungal cyclic depsipeptides, revealing that some of these should indeed be considered as mycotoxins.

Measuring performance in virtual reality phacoemulsification surgery

NASA Astrophysics Data System (ADS)

Söderberg, Per; Laurell, Carl-Gustaf; Simawi, Wamidh; Skarman, Eva; Nordh, Leif; Nordqvist, Per

2008-02-01

We have developed a virtual reality (VR) simulator for phacoemulsification surgery. The current work aimed at developing a relative performance index that characterizes the performance of an individual trainee. We recorded measurements of 28 response variables during three iterated surgical sessions in 9 experienced cataract surgeons, separately for the sculpting phase and the evacuation phase of phacoemulsification surgery and compared their outcome to that of a reference group of naive trainees. We defined an individual overall performance index, an individual class specific performance index and an individual variable specific performance index. We found that on an average the experienced surgeons performed at a lower level than a reference group of naive trainees but that this was particularly attributed to a few surgeons. When their overall performance index was further analyzed as class specific performance index and variable specific performance index it was found that the low level performance was attributed to a behavior that is acceptable for an experienced surgeon but not for a naive trainee. It was concluded that relative performance indices should use a reference group that corresponds to the measured individual since the definition of optimal surgery may vary among trainee groups depending on their level of experience.

Verifying and Validating Simulation Models

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

Hemez, Francois M.

2015-02-23

This presentation is a high-level discussion of the Verification and Validation (V&V) of computational models. Definitions of V&V are given to emphasize that “validation” is never performed in a vacuum; it accounts, instead, for the current state-of-knowledge in the discipline considered. In particular comparisons between physical measurements and numerical predictions should account for their respective sources of uncertainty. The differences between error (bias), aleatoric uncertainty (randomness) and epistemic uncertainty (ignorance, lack-of- knowledge) are briefly discussed. Four types of uncertainty in physics and engineering are discussed: 1) experimental variability, 2) variability and randomness, 3) numerical uncertainty and 4) model-form uncertainty. Statisticalmore » sampling methods are available to propagate, and analyze, variability and randomness. Numerical uncertainty originates from the truncation error introduced by the discretization of partial differential equations in time and space. Model-form uncertainty is introduced by assumptions often formulated to render a complex problem more tractable and amenable to modeling and simulation. The discussion concludes with high-level guidance to assess the “credibility” of numerical simulations, which stems from the level of rigor with which these various sources of uncertainty are assessed and quantified.« less

Current orbital debris environment

NASA Technical Reports Server (NTRS)

Kessler, Donald J.

1989-01-01

NASA has instituted a plan for the definition of activities and resources required over the coming decade for the deepening of current understanding of anthropogenic orbital debris, and its effects on future mission operations. This understanding will be the basis of policy definition and policy implementation efforts. The most immediate requirement is the definition of the debris environment, with emphasis on data for debris sizes smaller than 4 cm. Systems-damage criteria and hypervelocity-impact theory will then be used to define the hazard to specific spacecraft.

Resilience definitions, theory, and challenges: interdisciplinary perspectives.

PubMed

Southwick, Steven M; Bonanno, George A; Masten, Ann S; Panter-Brick, Catherine; Yehuda, Rachel

2014-01-01

In this paper, inspired by the plenary panel at the 2013 meeting of the International Society for Traumatic Stress Studies, Dr. Steven Southwick (chair) and multidisciplinary panelists Drs. George Bonanno, Ann Masten, Catherine Panter-Brick, and Rachel Yehuda tackle some of the most pressing current questions in the field of resilience research including: (1) how do we define resilience, (2) what are the most important determinants of resilience, (3) how are new technologies informing the science of resilience, and (4) what are the most effective ways to enhance resilience? These multidisciplinary experts provide insight into these difficult questions, and although each of the panelists had a slightly different definition of resilience, most of the proposed definitions included a concept of healthy, adaptive, or integrated positive functioning over the passage of time in the aftermath of adversity. The panelists agreed that resilience is a complex construct and it may be defined differently in the context of individuals, families, organizations, societies, and cultures. With regard to the determinants of resilience, there was a consensus that the empirical study of this construct needs to be approached from a multiple level of analysis perspective that includes genetic, epigenetic, developmental, demographic, cultural, economic, and social variables. The empirical study of determinates of resilience will inform efforts made at fostering resilience, with the recognition that resilience may be enhanced on numerous levels (e.g., individual, family, community, culture).

Resilience definitions, theory, and challenges: interdisciplinary perspectives

PubMed Central

Southwick, Steven M.; Bonanno, George A.; Masten, Ann S.; Panter-Brick, Catherine; Yehuda, Rachel

2014-01-01

In this paper, inspired by the plenary panel at the 2013 meeting of the International Society for Traumatic Stress Studies, Dr. Steven Southwick (chair) and multidisciplinary panelists Drs. George Bonanno, Ann Masten, Catherine Panter-Brick, and Rachel Yehuda tackle some of the most pressing current questions in the field of resilience research including: (1) how do we define resilience, (2) what are the most important determinants of resilience, (3) how are new technologies informing the science of resilience, and (4) what are the most effective ways to enhance resilience? These multidisciplinary experts provide insight into these difficult questions, and although each of the panelists had a slightly different definition of resilience, most of the proposed definitions included a concept of healthy, adaptive, or integrated positive functioning over the passage of time in the aftermath of adversity. The panelists agreed that resilience is a complex construct and it may be defined differently in the context of individuals, families, organizations, societies, and cultures. With regard to the determinants of resilience, there was a consensus that the empirical study of this construct needs to be approached from a multiple level of analysis perspective that includes genetic, epigenetic, developmental, demographic, cultural, economic, and social variables. The empirical study of determinates of resilience will inform efforts made at fostering resilience, with the recognition that resilience may be enhanced on numerous levels (e.g., individual, family, community, culture). PMID:25317257

Feedback: Implications for Further Research and Study.

ERIC Educational Resources Information Center

Nishikawa, Sue S.

This report reviews current literature on feedback and suggests practical implications of feedback research for educators. A definition of feedback is offered, and past definitions in prior research are noted. An analysis of the current state of knowledge of feedback discusses the historical development of feedback theory and suggests that…

What Is Comprehensive Sexuality Education? Going WAAAAAY beyond Abstinence and Condoms

ERIC Educational Resources Information Center

Helmich, Joan

2009-01-01

In this article, the author expands our definition of "comprehensive sexuality education," broadening the discourse to something more ideal than what current rhetoric seems to suggest, and in the process presents the rationale for real comprehensive sexuality education. Current definitions of comprehensive sexuality education focus on prevention…

A DEFINITION OF CURIOSITY, A FACTOR ANALYSIS STUDY.

ERIC Educational Resources Information Center

MAW, WALLACE H.

AN INVESTIGATION WAS CONDUCTED TO DETERMINE A DEFINITION OF CURIOSITY THAT WOULD HELP IDENTIFY PERSONALITY PATTERNS OF CHILDREN WHO ARE MOST LIKELY TO BE EITHER HIGH OR LOW IN CURIOSITY. DATA COLLECTED IN EARLIER STUDIES WERE FACTOR ANALYZED TO IDENTIFY THE PERSONAL AND SOCIAL VARIABLES THAT DIFFERENTIATE CHILDREN HIGH IN CURIOSITY FROM THOSE LOW…

78 FR 803 - Revisions to Electric Reliability Organization Definition of Bulk Electric System and Rules of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-04

...In this Final Rule, pursuant to section 215 of the Federal Power Act, the Federal Energy Regulatory Commission (Commission) approves modifications to the currently-effective definition of ``bulk electric system'' developed by the North American Electric Reliability Corporation (NERC), the Commission-certified Electric Reliability Organization. The Commission finds that the modified definition of ``bulk electric system'' removes language allowing for regional discretion in the currently-effective bulk electric system definition and establishes a bright-line threshold that includes all facilities operated at or above 100 kV. The modified definition also identifies specific categories of facilities and configurations as inclusions and exclusions to provide clarity in the definition of ``bulk electric system.'' In this Final Rule, the Commission also approves: NERC's revisions to its Rules of Procedure, which create an exception process to add elements to, or remove elements from, the definition of ``bulk electric system'' on a case-by-case basis; NERC's form entitled ``Detailed Information To Support an Exception Request'' that entities will use to support requests for exception from the ``bulk electric system'' definition; and NERC's implementation plan for the revised ``bulk electric system'' definition.

Usual interstitial pneumonia: typical, possible, and “inconsistent” patterns

PubMed Central

Torres, Pedro Paulo Teixeira e Silva; Rabahi, Marcelo Fouad; Moreira, Maria Auxiliadora Carmo; Meirelles, Gustavo de Souza Portes; Marchiori, Edson

2017-01-01

ABSTRACT Idiopathic pulmonary fibrosis is a severe and progressive chronic fibrosing interstitial lung disease, a definitive diagnosis being established by specific combinations of clinical, radiological, and pathological findings. According to current international guidelines, HRCT plays a key role in establishing a diagnosis of usual interstitial pneumonia (UIP). Current guidelines describe three UIP patterns based on HRCT findings: a typical UIP pattern; a pattern designated “possible UIP”; and a pattern designated “inconsistent with UIP”, each pattern having important diagnostic implications. A typical UIP pattern on HRCT is highly accurate for the presence of histopathological UIP, being currently considered to be diagnostic of UIP. The remaining patterns require further diagnostic investigation. Other known causes of a UIP pattern include drug-induced interstitial lung disease, chronic hypersensitivity pneumonitis, occupational diseases (e.g., asbestosis), and connective tissue diseases, all of which should be included in the clinical differential diagnosis. Given the importance of CT studies in establishing a diagnosis and the possibility of interobserver variability, the objective of this pictorial essay was to illustrate all three UIP patterns on HRCT. PMID:29160385

Review article: Paediatric status epilepticus in the pre-hospital setting: An update.

PubMed

Furyk, Jeremy; Watt, Kerriane; Emeto, Theophilus I; Dalziel, Stuart; Bodnar, Daniel; Riney, Kate; Babl, Franz E

2017-08-01

Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Discoveries and controversies in cutaneous mosaicism.

PubMed

Castori, Marco; Tadini, Gianluca

2016-06-01

Genetic mosaicism is thought to be a common phenomenon in inherited skin disorders. It is the leading molecular mechanism explaining cutaneous hamartomas and nevoid disorders, skin manifestations of most X-linked genodermatoses and specific forms of clinical variability and topographic distribution in autosomal skin disorders. The developmental (in utero) origin and timing dependence are two major attributes for the current definition of cutaneous mosaicism. Chromosomal mosaicism, lyonization in X-linked genodermatoses, and various types of mosaicism (i.e. type 1, type 2 and revertant mosaicism) in autosomal skin disorders are mechanisms well defined at the molecular level. All these concepts have been fully included in the current medical terminology in dermatology and genetics. Mitotic crossing-over, paradominant inheritance, monoallelic expression of autosomal traits and mosaicism in acquired skin disorders remain without a formal molecular proof and still represent sources of debate in the scientific community. This review summarizes current concepts, discoveries and controversies in the field of cutaneous mosaicism for practitioners and clinical researchers to enhance their understanding of such a underestimated clinical phenomenon and its biological basis.

Biomarkers for Cystic Fibrosis Drug Development

PubMed Central

Muhlebach, Marianne S.; Clancy, JP; Heltshe, Sonya L.; Ziady, Assem; Kelley, Tom; Accurso, Frank; Pilewski, Joseph; Mayer-Hamblett, Nicole; Joseloff, Elizabeth; Sagel, Scott D.

2016-01-01

Purpose To provide a review of the status of biomarkers in cystic fibrosis drug development, including regulatory definitions and considerations, a summary of biomarkers in current use with supportive data, current gaps, and future needs. Methods Biomarkers are considered across several areas of CF drug development, including cystic fibrosis transmembrane conductance regulator modulation, infection, and inflammation. Results Sweat chloride, nasal potential difference, and intestinal current measurements have been standardized and examined in the context of multicenter trials to quantify CFTR function. Detection and quantification of pathogenic bacteria in CF respiratory cultures (e.g.: Pseudomonas aeruginosa) is commonly used in early phase antimicrobial clinical trials, and to monitor safety of therapeutic interventions. Sputum (e.g.: neutrophil elastase, myeloperoxidase, calprotectin) and blood biomarkers (e.g.: C reactive protein, calprotectin, serum amyloid A) have had variable success in detecting response to inflammatory treatments. Conclusions Biomarkers are used throughout the drug development process in CF, and many have been used in early phase clinical trials to provide proof of concept, detect drug bioactivity, and inform dosing for later-phase studies. Advances in the precision of current biomarkers, and the identification of new biomarkers with ‘omics-based technologies, are needed to accelerate CF drug development. PMID:28215711

Remote Monitoring to Reduce Heart Failure Readmissions.

PubMed

Emani, Sitaramesh

2017-02-01

Rehospitalization for heart failure remains a challenge in the treatment of affected patients. The ability to remotely monitor patients for worsening heart failure may provide an avenue through which therapeutic interventions can be made to prevent a rehospitalization. Available data on remote monitoring to reduce heart failure rehospitalizations are reviewed within. Strategies to reduce readmissions include clinical telemonitoring, bioimpedance changes, biomarkers, and remote hemodynamic monitoring. Telemonitoring is readily available, but has low sensitivity and adherence. No data exist to demonstrate the efficacy of this strategy in reducing admissions. Bioimpedance offers improved sensitivity compared to telemonitoring, but has not demonstrated an ability to reduce hospitalizations and is currently limited to those patients who have separate indications for an implantable device. Biomarker levels have shown variable results in the ability to reduce hospitalizations and remain without definitive proof supporting their utilization. Remote hemodynamic monitoring has shown the strongest ability to reduce heart failure readmissions and is currently approved for this purpose. However, remote hemodynamic monitoring requires an invasive procedure and may not be cost-effective. All currently available strategies to reduce hospitalizations with remote monitoring have drawbacks and challenges. Remote hemodynamic monitoring is currently the most efficacious based on data, but is not without its own imperfections.

Exclusion of Patients with a Severe T-Cell Defect Improves the Definition of Common Variable Immunodeficiency.

PubMed

Bertinchamp, Rémi; Gérard, Laurence; Boutboul, David; Malphettes, Marion; Fieschi, Claire; Oksenhendler, Eric

In 2014, the European Society for Immune Deficiencies (ESID) revised the common variable immunodeficiency (CVID) diagnosis criteria by incorporating new clinical and biological markers. The new definition appeared more restrictive but had not yet been evaluated in a large cohort of patients. The objective of this study was to evaluate the impact of this new definition in a large cohort of patients with primary hypogammaglobulinemia. Evaluation of 3 different CVID definitions (ESID/Pan-American Group for Immunodeficiency [PAGID] 1999, ESID 2014, DEFI 2015) in 521 patients included in the French DEFI study with a diagnosis of primary hypogammaglobulinemia. Using the ESID/PAGID 1999 definition, 351 patients were classified as CVID. The new ESID 2014 definition excluded 62 (18%) patients. Most of them (n = 56; 90%) had a less severe disease, whereas 6 (10%) presented with a severe disease with major T-cell defect. We propose different criteria (occurrence of opportunistic infection or very low naive CD4+ T-cell count) to define this population with severe T-cell defect. Sixty-two patients fulfilled these criteria, represented 20% of the initial CVID population but accounted for 77% of the deaths, with a 5-year overall survival of 67.6% (95% confidence interval, 51.0-79.6), and were considered as late onset combined immunodeficiency (LOCID). The new ESID definition for CVID still fails to exclude a large number of patients with severe T-cell defect. We propose a new definition (DEFI 2015) that excluded more patients with a T-cell defect and consider these patients as LOCID. This population has a poor outcome and should be considered as a distinct group requiring specific care. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Reliability and validity of four alternative definitions of rapid-cycling bipolar disorder.

PubMed

Maj, M; Pirozzi, R; Formicola, A M; Tortorella, A

1999-09-01

This study tested the reliability and validity of four definitions of rapid cycling. Two trained psychiatrists, using the Schedule for Affective Disorders and Schizophrenia, independently assessed 210 patients with bipolar disorder. They checked whether each patient met four definitions of rapid cycling: one consistent with DSM-IV criteria, one waiving criteria for duration of affective episodes, one waiving such criteria and requiring at least one switch from mania to depression or vice versa during the reference year, and one waiving duration criteria and requiring at least 8 weeks of fully symptomatic affective illness during the reference year. The interrater reliability was calculated by Cohen's kappa statistic. Patients who met each definition according to both psychiatrists were compared to those who did not meet any definition (nonrapid-cycling group) on demographic and clinical variables. All patients were followed up for 1 year. Kappa values were 0.93, 0.73, 0.75, and 0.80, respectively, for the four definitions of rapid cycling. The groups meeting the second and third definitions included significantly more female and bipolar II patients than did the nonrapid-cycling group. Those two groups also had the lowest proportion of patients with a favorable lithium prophylaxis outcome and the highest stability of the rapid-cycling pattern on follow-up. The four groups of rapid-cycling patients did not differ significantly among themselves on any of the assessed variables. The expression "rapid cycling" encompasses a spectrum of conditions. The DSM-IV definition, although quite reliable, covers only part of this spectrum, and the conditions that are excluded are very typical in terms of key validators and are relatively stable over time.

76 FR 70368 - Disaster Designation Process

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-14

... two steps for natural disasters, including special provisions for certain drought situations. FSA.... Proposed Change in Natural Disaster Definition Under the current regulations, producers with eligible... in 7 CFR 759.3 a definition of ``natural disaster'' that is consistent with the definition of...

Structuring the formal definition of Ada

NASA Technical Reports Server (NTRS)

Hansen, Kurt W.

1986-01-01

The structure of the formal definition of Ada are described. At present, a difficult subset of Ada has been defined and the experience gained so far by this work is reported. Currently, the work continues towards the formal definition of the Ada language.

47 CFR 13.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 1 2012-10-01 2012-10-01 false Definitions. 13.3 Section 13.3 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL RADIO OPERATORS General § 13.3 Definitions... Telecommunication Union. (g) PPC. Proof-of-Passing Certificate. (h) Question pool. All current examination questions...

Clinical periodontal variables in patients with and without dementia-a systematic review and meta-analysis.

PubMed

Maldonado, Alejandra; Laugisch, Oliver; Bürgin, Walter; Sculean, Anton; Eick, Sigrun

2018-06-22

Considering the increasing number of elderly people, dementia has gained an important role in today's society. Although the contributing factors for dementia have not been fully understood, chronic periodontitis (CP) seems to have a possible link to dementia. To conduct a systematic review including meta-analysis in order to assess potential differences in clinical periodontal variables between patients with dementia and non-demented individuals. The following focused question was evaluated: is periodontitis associated with dementia? Electronic searches in two databases, MEDLINE and EMBASE, were conducted. Meta-analysis was performed with the collected data in order to find a statistically significant difference in clinical periodontal variables between the group of dementia and the cognitive normal controls. Forty-two articles remained for full text reading. Finally, seven articles met the inclusion criteria and only five studies provided data suitable for meta-analysis. Periodontal probing depth (PPD), bleeding on probing (BOP), gingival bleeding index (GBI), clinical attachment level (CAL), and plaque index (PI) were included as periodontal variables in the meta-analysis. Each variable revealed a statistically significant difference between the groups. In an attempt to reveal an overall difference between the periodontal variables in dementia patients and non-demented individuals, the chosen variables were transformed into units that resulted in a statistically significant overall difference (p < 0.00001). The current findings indicate that compared to systemically healthy individuals, demented patients show significantly worse clinical periodontal variables. However, further epidemiological studies including a high numbers of participants, the use of exact definitions both for dementia and chronic periodontitis and adjusted for cofounders is warranted. These findings appear to support the putative link between CP and dementia. Consequently, the need for periodontal screening and treatment of elderly demented people should be emphasized.

On the Usefulness of "Value" in the Definition of Creativity

ERIC Educational Resources Information Center

Weisberg, Robert W.

2015-01-01

Current definitions of creativity almost universally include "value" or a close cognate as one of the criteria. This article discusses two problems that arise as the result of the inclusion of value in those definitions. First, there is a conflict between the researchers' definition of the relevant phenomena and that used in the ordinary…

Does decompression of odontogenic cysts and cystlike lesions change the histologic diagnosis?

PubMed

Schlieve, Thomas; Miloro, Michael; Kolokythas, Antonia

2014-06-01

The purpose of this study was to report the histopathologic findings after postdecompression definitive treatment of odontogenic cystlike lesions and determine whether the diagnosis was consistent with the pretreatment diagnosis, thereby answering the clinical question: does decompression change the histologic diagnosis? The authors implemented a retrospective cohort study from a sample of patients diagnosed with a benign odontogenic cystlike lesion and who underwent decompression followed by definitive surgery as part of their treatment. The predictor variable was treatment by decompression and the dependent variable was change in histologic diagnosis. Age, gender, and lesion location were included as variables. The χ(2) test was used for statistical analysis of the categorical data and P values less than .05 were considered statistically significant. Twenty-five cysts and cystlike lesions in 25 patients were treated with decompression followed by enucleation and curettage. The mean age was 34 years (range, 13 to 80 yr) and 56% (14) were male patients. Lesions were located in the mandible in 76% (19 of 25) of patients. Postdecompression histologic examination at the time of definitive surgical treatment was consistent with the preoperative biopsy diagnosis in 91% (10 of 11) of keratocystic odontogenic tumors, 67% (2 of 3) of glandular odontogenic cysts, 75% (3 of 4) of dentigerous cysts, and 100% (7 of 7) of cystic ameloblastomas. The histologic diagnosis at time of definitive treatment by enucleation and curettage is consistent with the predecompression diagnosis. Therefore, all lesions should be definitively treated after decompression based on the initial lesion diagnosis, with all patients placed on appropriate follow-up protocols. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. All rights reserved.

Multivariate localization methods for ensemble Kalman filtering

NASA Astrophysics Data System (ADS)

Roh, S.; Jun, M.; Szunyogh, I.; Genton, M. G.

2015-12-01

In ensemble Kalman filtering (EnKF), the small number of ensemble members that is feasible to use in a practical data assimilation application leads to sampling variability of the estimates of the background error covariances. The standard approach to reducing the effects of this sampling variability, which has also been found to be highly efficient in improving the performance of EnKF, is the localization of the estimates of the covariances. One family of localization techniques is based on taking the Schur (element-wise) product of the ensemble-based sample covariance matrix and a correlation matrix whose entries are obtained by the discretization of a distance-dependent correlation function. While the proper definition of the localization function for a single state variable has been extensively investigated, a rigorous definition of the localization function for multiple state variables that exist at the same locations has been seldom considered. This paper introduces two strategies for the construction of localization functions for multiple state variables. The proposed localization functions are tested by assimilating simulated observations experiments into the bivariate Lorenz 95 model with their help.

Critical discussion of evaluation parameters for inter-observer variability in target definition for radiation therapy.

PubMed

Fotina, I; Lütgendorf-Caucig, C; Stock, M; Pötter, R; Georg, D

2012-02-01

Inter-observer studies represent a valid method for the evaluation of target definition uncertainties and contouring guidelines. However, data from the literature do not yet give clear guidelines for reporting contouring variability. Thus, the purpose of this work was to compare and discuss various methods to determine variability on the basis of clinical cases and a literature review. In this study, 7 prostate and 8 lung cases were contoured on CT images by 8 experienced observers. Analysis of variability included descriptive statistics, calculation of overlap measures, and statistical measures of agreement. Cross tables with ratios and correlations were established for overlap parameters. It was shown that the minimal set of parameters to be reported should include at least one of three volume overlap measures (i.e., generalized conformity index, Jaccard coefficient, or conformation number). High correlation between these parameters and scatter of the results was observed. A combination of descriptive statistics, overlap measure, and statistical measure of agreement or reliability analysis is required to fully report the interrater variability in delineation.

"My child has a sleep problem": a cross-cultural comparison of parental definitions.

PubMed

Sadeh, Avi; Mindell, Jodi; Rivera, Luis

2011-05-01

Sleep problems are highly prevalent in early childhood. In many cases, parents seek professional help when they suspect their child suffers from a sleep problem. The aim of this study was to explore sleep, demographic and cultural factors associated with parental definition of child sleep problem in a large-scale, cross cultural study. Parents (or caregivers) of 29,287 infants and toddlers (aged 0-3 years) from 17 countries completed a questionnaire on their child's sleep patterns, sleep setting, and demographic variables. The results indicated that, in comparison to parents from predominantly Caucasian (PC) countries, parents from predominantly Asian (PA) countries were significantly more likely to identify a sleep problem in their children (26% vs 52% overall; 2% vs 17% "severe" sleep problem). Furthermore, whereas infant sleep variables were strong predictors of a sleep problem definition in PC countries, they were significantly less predictive in PA countries where demographic variables played a significant role. These results highlight the need to further explore the role of demographic and cultural variables in determining parental perception of a sleep problem, a perception that relates to help seeking professional treatment for infant sleep problems. Our findings also emphasize the need to educate parents about infant and toddler sleep and to provide parents information and screening tools to help them identify sleep problems in a more evidence-based approach. Copyright © 2011 Elsevier B.V. All rights reserved.

Teacher stress research: problems and progress.

PubMed

Pithers, R T

1995-12-01

There is a reasonably large body of published research evidence available which indicates that teaching is a 'highly' or 'extremely highly' stressful occupation for up to one-third of its professionals. Generalisations such as this one, however, are wrought with problems. These problems, for instance, range from confusion about the definition of stress through to how it is to be measured. They include methodological problems inherent in some of the research used to examine the area of teacher stress and as well include, for example, confusion about the effect of mediating variables in the production of stress and strain. This paper examines some of the more important pervasive research problems in current research on teacher stress and makes some suggestions for research progress.

75 FR 18228 - Notice of Change in Definitions and Modification to Neighborhood Stabilization Program (NSP)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-09

... tribal law. The new definition of foreclosed applies the term ``current delinquency status''. This... use the Mortgage Banker Association (MBA) Delinquency Calculation Method to determine the current delinquency status of a mortgage. Under the MBA method, a loan would be considered delinquent if the payment...

77 FR 75885 - Control of Communicable Diseases: Foreign; Scope and Definitions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

... primary authority supporting this rulemaking is section 361 of the Public Health Service Act (42 U.S.C... the scope and definitions to part 71 to reflect modern science and current practices. HHS/CDC has... products'' in subpart F. This revision more adequately reflects modern science and current practice which...

Factors influencing common diagnoses made during first-opinion small-animal consultations in the United Kingdom.

PubMed

Robinson, N J; Dean, R S; Cobb, M; Brennan, M L

2016-09-01

It is currently unclear how frequently a diagnosis is made during small-animal consultations or how much of a role making a diagnosis plays in veterinary decision-making. Understanding more about the diagnostic process will help direct future research towards areas relevant to practicing veterinary surgeons. The aim of this study was to determine the frequency with which a diagnosis was made, classify the types of diagnosis made (and the factors influencing these) and determine which specific diagnoses were made for health problems discussed during small-animal consultations. Data were gathered during real-time direct observation of small-animal consultations in eight practices in the United Kingdom. Data collected included characteristics of the consultation (e.g. consultation type), patient (e.g. breed), and each problem discussed (e.g. new or pre-existing problem). Each problem discussed was classified into one of the following diagnosis types: definitive; working; presumed; open; previous. A three-level multivariable logistic-regression model was developed, with problem (Level 1) nested within patient (Level 2) nested within consulting veterinary surgeon (Level 3). Problems without a previous diagnosis, in cats and dogs only, were included in the model, which had a binary outcome variable of definitive diagnosis versus no definitive diagnosis. Data were recorded for 1901 animals presented, and data on diagnosis were gathered for 3192 health problems. Previous diagnoses were the most common diagnosis type (n=1116/3192; 35.0%), followed by open (n=868/3192; 27.2%) then definitive (n=660/3192; 20.7%). The variables remaining in the final model were patient age, problem history, consultation type, who raised the problem, and body system affected. New problems, problems in younger animals, and problems raised by the veterinary surgeon were more likely to result in a definitive diagnosis than pre-existing problems, problems in older animals, and problems raised by the owner. The most common diagnoses made were overweight/obese and periodontal disease (both n=210; 6.6%). Definitive diagnoses are rarely made during small-animal consultations, with much of the veterinary caseload involving management of ongoing problems or making decisions around new problems prior to a diagnosis being made. This needs to be taken into account when considering future research priorities, and it may be necessary to conduct research focused on the approach to common clinical presentations, rather than purely on the common diagnoses made. Examining how making a diagnosis affects the actions taken during the consultation may shed further light on the role of diagnosis in the clinical decision-making process. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Understanding Learning Disabilities

ERIC Educational Resources Information Center

Walcot-Gayda, Elizabeth

2004-01-01

Knowledgeable persons within the field frequently criticize definitions of "learning disabilities" for the choice of vocabulary, phrasing and implied ideas. Although there may never be a universally accepted definition, a definition that reflects current research is used in this article to make evident some of the cognitive and…

Variable & Recode Definitions - SEER Documentation

Cancer.gov

Resources that define variables and provide documentation for reporting using SEER and related datasets. Choose from SEER coding and staging manuals plus instructions for recoding behavior, site, stage, cause of death, insurance, and several additional topics. Also guidance on months survived, calculating Hispanic mortality, and site-specific surgery.

Searching for a relevant definition of sarcopenia: results from the cross-sectional EPIDOS study

PubMed Central

Dupuy, Charlotte; Lauwers-Cances, Valérie; Guyonnet, Sophie; Gentil, Catherine; Abellan Van Kan, Gabor; Beauchet, Olivier; Schott, Anne-Marie; Vellas, Bruno; Rolland, Yves

2015-01-01

Background The diversity of definitions proposed for sarcopenia has been rarely tested in the same population, and so far, their clinical utilities for predicting physical difficulties could not be clearly understood. Our objective is to report the prevalence of sarcopenia and the characteristics of sarcopenic community-dwelling older women according to the different definitions of sarcopenia currently proposed. We also assessed these definitions for their incremental predictive value over currently standard predictors for some self-reported difficulties in physical function and knee extension strength. Methods Cross-sectional analysis included data from 3025 non-disabled women aged 75 years or older without previous history of hip fracture from the inclusion visit of the EPIDémiologie de l'OStéoporose study. A total body composition evaluation was available for 2725 women. Sarcopenia was defined using six different definitions of sarcopenia based on different muscle mass, gait speed, and grip strength cut-offs. Self-reported difficulties in physical function and knee extension strength were collected. Logistic regression and multiple linear regression models were built for each physical dysfunction, and the predictive capacity of sarcopenia (one model for each definition) was studied using the C-statistic, the net reclassification index, or adjusted R2. Results The estimated prevalence of sarcopenia ranged from 3.3–20.0%. Only 85 participants (3.1%) were identified having sarcopenia according to all definitions. All definitions were, to some degree, associated with self-reported difficulties in physical function and knee extension strength, but none improved the predictive ability of the self-reported difficulties in physical function. Conversely, all definitions accounted for a small but significant amount of explained variation for predicting knee extension strength. Conclusions Prevalence of sarcopenia varies widely depending on the definition adopted. Based on this research, the current definitions for sarcopenia does not substantially increment the predictive value of clinical characteristics of patients to predict self-reported physical difficulties and knee extension strength. PMID:26136190

Models, Definitions, and Outcome Variables of Action Learning: A Synthesis with Implications for HRD

ERIC Educational Resources Information Center

Chenhall, Everon C.; Chermack, Thomas J.

2010-01-01

Purpose: The purpose of this paper is to propose an integrated model of action learning based on an examination of four reviewed action learning models, definitions, and espoused outcomes. Design/methodology/approach: A clear articulation of the strengths and limitations of each model was essential to developing an integrated model, which could be…

A Systematic Literature Review of Engineering Identity: Definitions, Factors, and Interventions Affecting Development, and Means of Measurement

ERIC Educational Resources Information Center

Morelock, John R.

2017-01-01

Studies exploring what it means to be an engineer professionally have been conducted for decades, but have boomed in recent years. This systematic literature review aims to organise extant studies on engineering identity by coding around four key variables: (a) definitions of engineering identity, (b) factors affecting engineering identity…

Definitions and Anatomic Considerations in Chiari I Malformation and Associated Syringomyelia.

PubMed

Tubbs, R Shane

2015-10-01

Current understanding of the hindbrain hernias known as Chiari I malformations is based on more than 100 years of pathologic and clinical experience. Over time, the definition of this finding has been analyzed and altered. The term Chiari I malformation is currently used to describe tonsillar ectopia in a wide range of patients with varying embryonic derailments. This article discusses this malformation, its various definitions, and varied anatomic traits. In addition, the morphology of the commonly associated syringomyelia is reviewed. Copyright © 2015 Elsevier Inc. All rights reserved.

Current Topics on Salvage Thoracic Surgery in Patients with Primary Lung Cancer.

PubMed

Uramoto, Hidetaka

2016-01-01

Salvage primary tumor resection is sometimes considered for isolated local failures after definitive chemoradiation, urgent matters, such as hemoptysis (palliative intent), and in cases judged to be contraindicated for chemotherapy or definite radiation due to severe comorbidities, despite an initial clinical diagnosis of stage III or IV disease. However, salvage surgery is generally considered to be technically more difficult, with a potentially higher morbidity. This review discusses the current topics on salvage thoracic surgery such as the definition of salvage surgery and its outcome, and future perspectives.

Would a new definition and classification of nocturia and nocturnal polyuria improve our management of patients? ICI-RS 2014.

PubMed

Bosch, J L H Ruud; Everaert, Karel; Weiss, Jeffrey P; Hashim, Hashim; Rahnama'i, M Sajjad; Goessaert, An-Sofie; Aizen, Joshua

2016-02-01

The following is a report of the proceedings of the Nocturia Think Tank sessions of the annual International Consultation on Incontinence-Research Society, which took place September 22-24, 2014 in Bristol, UK. The report is organized into sections pertaining to the main topic of discussion focussing on the question as to whether a new definition and classification of nocturia and nocturnal polyuria would improve the outcome of management in our patients. First, discussions identified theoretical and practical shortcomings of current definitions. Secondly, the utility of several nocturnal polyuria definitions was tested in a real life population in relation to the symptom nocturia, in order to display weaknesses of these definitions. Thirdly, we explored in a clinical population the utility of bladder diary based parameters by asking the question: when nocturia improves, which of these parameters improve most? Based on the above explorations the Think Tank summarized elements of the current definitions that need reconsideration and suggests proposals for further research to reach more practical and more clinically meaningful definitions. © 2015 Wiley Periodicals, Inc.

Improving the consistency in cervical esophageal target volume definition by special training.

PubMed

Tai, Patricia; Van Dyk, Jake; Battista, Jerry; Yu, Edward; Stitt, Larry; Tonita, Jon; Agboola, Olusegun; Brierley, James; Dar, Rashid; Leighton, Christopher; Malone, Shawn; Strang, Barbara; Truong, Pauline; Videtic, Gregory; Wong, C Shun; Wong, Rebecca; Youssef, Youssef

2002-07-01

Three-dimensional conformal radiation therapy requires the precise definition of the target volume. Its potential benefits could be offset by the inconsistency in target definition by radiation oncologists. In a previous survey of radiation oncologists, a large degree of variation in target volume definition of cervical esophageal cancer was noted for the boost phase of radiotherapy. The present study evaluated whether special training could improve the consistency in target volume definitions. A pre-training survey was performed to establish baseline values. This was followed by a special one-on-one training session on treatment planning based on the RTOG 94-05 protocol to 12 radiation oncologists. Target volumes were redrawn immediately and at 1-2 months later. Post-training vs. pre-training target volumes were compared. There was less variability in the longitudinal positions of the target volumes post-training compared to pre-training (p < 0.05 in 5 of 6 comparisons). One case had more variability due to the lack of a visible gross tumor on CT scans. Transverse contours of target volumes did not show any significant difference pre- or post-training. For cervical esophageal cancer, this study suggests that special training on protocol guidelines may improve consistency in target volume definition. Explicit protocol directions are required for situations where the gross tumor is not easily visible on CT scans. This may be particularly important for multicenter clinical trials, to reduce the occurrences of protocol violations.

Establishing a Common Definition for Zero Energy Buildings: Time to Move the Market

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

Peterson, Kent; Torcellini, Paul; Taylor, Cody

To change the current paradigm from buildings being consumers of energy to producers of energy requires a common language to facilitate market transformation. Common definitions help create market movement by sharing concepts across market actors. While the term 'zero energy buildings' has been in the marketplace for over 20 years, no common definition had been established. US DOE, last year, embarked on a process to evaluate current definitions and solicit industry input to formulate a common definition and nomenclature for zero energy buildings. This definition uses commonly available site measurements and national conversion factors to define zero energy buildings onmore » a source energy basis for a variety of boundary conditions including building, portfolio, campus, and community. Issues addressed include multiple fuel types, cogeneration, and renewable energy certificates. This paper describes the process used to arrive at the definition, looks at methods of calculating site to source energy conversions, and how boundary decisions affect a robust and stable definition that can be used to direct programs and policies for many years to come. This stability is critical to move building investments towards buildings that produce as much energy as they consume.« less

High-definition transcranial direct current stimulation (HD-tDCS) of left dorsolateral prefrontal cortex affects performance in Balloon Analogue Risk Task (BART).

PubMed

Guo, Heng; Zhang, Zhuoran; Da, Shu; Sheng, Xiaotian; Zhang, Xichao

2018-02-01

Studies on risk preferences have long been of great concern and have examined the neural basis underlying risk-based decision making. However, studies using conventional transcranial direct current stimulation (tDCS) revealed that bilateral stimulation could change risk propensity with limited evidence of precisely focalized unilateral high-definition transcranial direct current stimulation (HD-tDCS). The aim of this experiment was to investigate the effect of HD-tDCS focalizing the left dorsal lateral prefrontal cortex (DLPFC) on risk-taking behavior during the Balloon Analogue Risk Task (BART). This study was designed as a between-subject, single-blind, sham-controlled experiment. University students were randomly assigned to three groups: the anodal group (F3 anode, AF3, F1, F5, FC3 returned), the cathodal group (F3 cathodal, AF3, F1, F5, FC3 returned) and the sham group. Subsequently, 1.5-mA 20-min HD-tDCS was applied during the BART, and the Positive Affect and Negative Affect Scale (PANAS), the Sensation Seeking Scale-5 (SSS-5), and the Behavioral Inhibition System and Behavioral Approach System scale (BIS/BAS) were measured as control variables. The cathodal group earned less total money than the sham group, and no significant difference was observed between the anodal group and the sham group. These results showed that, to some extent, focalized unilateral cathodal HD-tDCS on left DLPFC could change performance during risky tasks and diminish risky decision making. Further studies are needed to investigate the dose effect and electrode distribution of HD-tDCS during risky tasks and examine synchronous brain activity to show the neural basis.

21 CFR 211.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 4 2012-04-01 2012-04-01 false Definitions. 211.3 Section 211.3 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.3 Definitions...

21 CFR 211.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Definitions. 211.3 Section 211.3 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.3 Definitions...

21 CFR 211.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 4 2013-04-01 2013-04-01 false Definitions. 211.3 Section 211.3 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.3 Definitions...

21 CFR 211.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 4 2014-04-01 2014-04-01 false Definitions. 211.3 Section 211.3 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.3 Definitions...

21 CFR 211.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Definitions. 211.3 Section 211.3 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.3 Definitions...

Biocular image misalignment tolerance

NASA Astrophysics Data System (ADS)

Kalich, Melvyn E.; Rash, Clarence E.; van de Pol, Corina; Rowe, Terri L.; Lont, Lisa M.; Peterson, R. David

2003-09-01

Biocular helmet-mounted display (HMD) design flexibility and cost are directly related to image misalignment tolerance standards. Currently recommended tolerance levels are based on highly variable data from a number of studies. This paper presents progress of an ongoing study to evaluate optometric measures sensitive to misalignment in partial-overlap biocular optical systems like that proposed for the Comanche RAH-66 helicopter helmet integrated display sighting system (HIDSS). Horizontal divergent and relative vertical misalignments (offsets) of see-through biocular symbology viewed against a simulated daytime background were chosen for this study. Misalignments within and just beyond current tolerance recommendations were evaluated using pre, pre and post, and during measures of visual performance. Data were obtained from seven experimental and four control subjects. The diplopia responses from experimental and control subjects were essentially the same. However, accommodative facility showed a rate decrement following exposure to both types of misalignment. Horizontal heterophorias showed definite post-misalignment increases. Subject responses to questionnaires universally indicated increased adaptation to (ease with) visual tasks over the testing period.

Complementary and alternative medicine among veterans and military personnel: a synthesis of population surveys.

PubMed

Davis, Margot T; Mulvaney-Day, Norah; Larson, Mary Jo; Hoover, Ronald; Mauch, Danna

2014-12-01

Recent reports reinforce the widespread interest in complementary and alternative medicine (CAM), not only among military personnel with combat-related disorders, but also among providers who are pressed to respond to patient demand for these therapies. However, an understanding of utilization of CAM therapies in this population is lacking. The goals of this study are to synthesize the content of self-report population surveys with information on use of CAM in military and veteran populations, assess gaps in knowledge, and suggest ways to address current limitations. The research team conducted a literature review of population surveys to identify CAM definitions, whether military status was queried, the medical and psychological conditions queried, and each specific CAM question. Utilization estimates specific to military/veterans were summarized and limitations to knowledge was classified. Seven surveys of CAM utilization were conducted with military/veteran groups. In addition, 7 household surveys queried military status, although there was no military/veteran subgroup analysis. Definition of CAM varied widely limiting cross-survey analysis. Among active duty and Reserve military, CAM use ranged between 37% and 46%. Survey estimates do not specify CAM use that is associated with a medical or behavioral health condition. Comparisons between surveys are hampered due to variation in methodologies. Too little is known about reasons for using CAM and conditions for which it is used. Additional information could be drawn from current surveys with additional subgroup analysis, and future surveys of CAM should include military status variable.

Do Current Basal Series Use Clear Explanations and Correct Exemplars in Teaching Prefixes?

ERIC Educational Resources Information Center

Volpe, Myra Elaine

A study (replicating a similar 1977 study by S. Stotsky), examined whether current basal series teach prefixion clearly. Teacher's guides, student texts, and workbooks of nine popular basal reader series were examined to ascertain whether they offered a clear definition of the term "prefix" and whether that definition was reinforced by…

Value of the Definition of Severe Familial Hypercholesterolemia for Stratification of Heterozygous Patients.

PubMed

Pérez-Calahorra, Sofia; Sánchez-Hernández, Rosa María; Plana, Núria; Marco-Benedi, Victoria; Pedro-Botet, Juan; Almagro, Fátima; Brea, Angel; Ascaso, Juan Francisco; Lahoz, Carlos; Civeira, Fernando

2017-03-01

Familial hypercholesterolemia (FH) is characterized by high low-density lipoprotein (LDL) cholesterol with co-dominant transmission and high risk of cardiovascular disease (CVD), although with high variability among subjects. Currently, CVD stratification tools for heterozygous FH (HeFH) are not available. A definition of severe HeFH has been recently proposed by the International Atherosclerosis Society (IAS), but it has not been validated. Our study aims to see clinical characteristics and prevalence of CVD in subjects defined as severe HeFH by IAS criteria. Probable or definite HeFH introduced in the Dyslipidemia Registry of Spanish Arteriosclerosis Society were analyzed by the IAS criteria. Univariate and multivariate analysis was used to assess the association of CVD with the IAS criteria. About 1,732 HeFH cases were analyzed. Severe HeFH had higher prevalence of familial history of CVD, personal history of tendon xanthomas, LDL cholesterol, and CVD than nonsevere HeFH. A total of 656 (77.1%) and 441 (50.1%) of men and women, respectively, fulfilled the IAS criteria of severe HeFH. In the univariate analysis, subjects defined as severe HeFH showed odds ratio 3.016 (95% CI 3.136 to 4.257, p <0.001) for CVD. However, when traditional risk factors were included in the multivariate analysis, only the presence of cholesterol >400 mg/dl had a statistically significant association with CVD odds ratio 8.76 (95% CI 3.90 to 19.69, p <0.001). In conclusion, the IAS definition of severe HeFH is not significantly associated with CVD when adjusted for classic risk factors. Risk stratification in HeFH is an important issue, but the proposed criteria do not seem to solve this problem. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical definition of respiratory viral infections in young children and potential bronchiolitis misclassification.

PubMed

Megalaa, Rosemary; Perez, Geovanny F; Kilaikode-Cheruveettara, Sasikumar; Kotwal, Nidhi; Rodriguez-Martinez, Carlos E; Nino, Gustavo

2018-01-01

Viral respiratory infections are often grouped as a single respiratory syndrome named 'viral bronchiolitis', independently of the viral etiology or individual risk factors. Clinical trials and guidelines have used a more stringent definition of viral bronchiolitis, including only the first episode of wheezing in children less than 12 months of age without concomitant respiratory comorbidities. There is increasing evidence suggesting that this definition is not being followed by pediatric care providers, but it is unclear to what extent viral respiratory infections are currently misclassified as viral bronchiolitis using standard definitions. We conducted a retrospective analysis of hospitalized young children (≤3 years) due to viral respiratory infections. Bronchiolitis was defined as the first wheezing episode less than 12 months of age. Demographic variables and comorbidities were obtained by electronic medical record review. The study comprised a total of 513 hospitalizations (n=453). Viral bronchiolitis was diagnosed in 144 admissions (28.1%). Notably, we identified that the majority of children diagnosed with bronchiolitis (63%) were misclassified as they had prior episodes of wheezing. Many children with bronchiolitis misclassification had significant comorbidities, including prematurity (51%), neuromuscular conditions (9.8%), and congenital heart disease (9.8%). Misclassification of bronchiolitis is a common problem that may lead to inappropriate management of viral respiratory infections in young children. A comprehensive approach that takes into consideration viral etiology and individual risk factors may lead to a more accurate clinical assessment of this condition and would potentially prevent bronchiolitis misclassification. © American Federation for Medical Research (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

34 CFR 32.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... DEPARTMENT OF EDUCATION EMPLOYEES § 32.2 Definitions. The following definitions apply to this part: Department means the Department of Education. Disposable pay means the amount that remains from an employee's...; and such other deductions that are required by law to be withheld. Employee means a current or former...

Scan posture definition and hip girth measurement: the impact on clothing design and body scanning.

PubMed

Gill, Simeon; Parker, Christopher J

2017-08-01

Ergonomic measurement is central to product design and development; especially for body worn products and clothing. However, there is a large variation in measurement definitions, complicated by new body scanning technology that captures measurements in a posture different to traditional manual methods. Investigations of hip measurement definitions in current clothing measurement practices supports analysis of the effect of scan posture and hip measurement definition on the circumferences of the hip. Here, the hip girth is a key clothing measurement that is not defined in current body scanning measurement standards. Sixty-four participants were scanned in the standard scan posture of a [TC] 2 body scanner, and also in a natural posture similar to that of traditional manual measurement collection. Results indicate that scan posture affects hip girth circumferences, and that some current clothing measurement practices may not define the largest lower body circumference. Recommendations are made concerning how the hip is defined in measurement practice and within body scanning for clothing product development. Practitioner Summary: The hip girth is an important measurement in garment design, yet its measurement protocol is not currently defined. We demonstrate that body posture during body scanning affects hip circumferences, and that current clothing measurement practices may not define the largest lower body circumference. This paper also provides future measurement practice recommendations.

An overview of AmeriFlux data products and methods for data acquisition, processing, and publication

NASA Astrophysics Data System (ADS)

Pastorello, G.; Poindexter, C.; Agarwal, D.; Papale, D.; van Ingen, C.; Torn, M. S.

2014-12-01

The AmeriFlux network encompasses independently managed field sites measuring ecosystem carbon, water, and energy fluxes across the Americas. In close coordination with ICOS in Europe, a new set of fluxes data and metadata products is being produced and released at the FLUXNET level, including all AmeriFlux sites. This will enable continued releases of global standardized set of flux data products. In this release, new formats, structures, and ancillary information are being proposed and adopted. This presentation discusses these aspects, detailing current and future solutions. One of the major revisions was to the BADM (Biological, Ancillary, and Disturbance Metadata) protocols. The updates include structure and variable changes to address new developments in data collection related to flux towers and facilitate two-way data sharing. In particular, a new organization of templates is now in place, including changes in templates for biomass, disturbances, instrumentation, soils, and others. New variables and an extensive addition to the vocabularies used to describe BADM templates allow for a more flexible and comprehensible coverage of field sites and the data collection methods and results. Another extensive revision is in the data formats, levels, and versions for fluxes and micrometeorological data. A new selection and revision of data variables and an integrated new definition for data processing levels allow for a more intuitive and flexible notation for the variety of data products. For instance, all variables now include positional information that is tied to BADM instrumentation descriptions. This allows for a better characterization of spatial representativeness of data points, e.g., individual sensors or the tower footprint. Additionally, a new definition for data levels better characterizes the types of processing and transformations applied to the data across different dimensions (e.g., spatial representativeness of a data point, data quality checks applied, and differentiation between measured data and data from models that use process knowledge). We also present an expanded approach to versions of data and data processing software, with stable and immutable data releases, but also pre-release versions to allow evaluation and feedback prior to a stable release.

Development of a data dictionary for the Strategies for Post Arrest Resuscitation Care (SPARC) network for post cardiac arrest research.

PubMed

Lin, Steve; Morrison, Laurie J; Brooks, Steven C

2011-04-01

The widely accepted Utstein style has standardized data collection and analysis in resuscitation and post resuscitation research. However, collection of many of these variables poses significant practical challenges. In addition, several important variables in post resuscitation research are missing. Our aim was to develop a comprehensive data dictionary and web-based data collection tool as part of the Strategies for Post Arrest Resuscitation Care (SPARC) Network project, which implemented a knowledge translation program for post cardiac arrest therapeutic hypothermia in 37 Ontario hospitals. A list of data variables was generated based on the current Utstein style, previous studies and expert opinion within our group of investigators. We developed a data dictionary by creating clear definitions and establishing abstraction instructions for each variable. The data dictionary was integrated into a web-based collection form allowing for interactive data entry. Two blinded investigators piloted the data collection tool, by performing a retrospective chart review. A total of 454 variables were included of which 400 were Utstein, 2 were adapted from existing studies and 52 were added to address missing elements. Kappa statistics for two outcome variables, survival to discharge and induction of therapeutic hypothermia were 0.86 and 0.64, respectively. This is the first attempt in the literature to develop a data dictionary as part of a standardized, pragmatic data collection tool for post cardiac arrest research patients. In addition, our dataset defined important variables that were previously missing. This data collection tool can serve as a reference for future trials in post cardiac arrest care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Considering the influence of stimulation parameters on the effect of conventional and high-definition transcranial direct current stimulation.

PubMed

To, Wing Ting; Hart, John; De Ridder, Dirk; Vanneste, Sven

2016-01-01

Recently, techniques to non-invasively modulate specific brain areas gained popularity in the form of transcranial direct current stimulation (tDCS) and high-definition transcranial direct current stimulation. These non-invasive techniques have already shown promising outcomes in various studies with healthy subjects as well as patient populations. Despite widespread dissemination of tDCS, there remain significant unknowns about the influence of a diverse number of tDCS parameters (e.g. polarity, size, position of electrodes & duration of stimulation) in inducing neurophysiological and behavioral effects. This article explores both techniques starting with the history of tDCS, to the differences between conventional tDCS and high-definition transcranial direct current stimulation, the underlying physiological mechanism, the (in)direct effects, the applications of tDCS with varying parameters, the efficacy, the safety issues and the opportunities for future research.

Definition of blindness under National Programme for Control of Blindness: Do we need to revise it?

PubMed Central

Vashist, Praveen; Senjam, Suraj Singh; Gupta, Vivek; Gupta, Noopur; Kumar, Atul

2017-01-01

A review appropriateness of the current definition of blindness under National Programme for Control of Blindness (NPCB), Government of India. Online search of peer-reviewed scientific published literature and guidelines using PubMed, the World Health Organization (WHO) IRIS, and Google Scholar with keywords, namely blindness and visual impairment, along with offline examination of reports of national and international organizations, as well as their cross-references was done until December 2016, to identify relevant documents on the definition of blindness. The evidence for the historical and currently adopted definition of blindness under the NPCB, the WHO, and other countries was reviewed. Differences in the NPCB and WHO definitions were analyzed to assess the impact on the epidemiological status of blindness and visual impairment in India. The differences in the criteria for blindness under the NPCB and the WHO definitions cause an overestimation of the prevalence of blindness in India. These variations are also associated with an over-representation of refractive errors as a cause of blindness and an under-representation of other causes under the NPCB definition. The targets for achieving elimination of blindness also become much more difficult to achieve under the NPCB definition. Ignoring differences in definitions when comparing the global and Indian prevalence of blindness will cause erroneous interpretations. We recommend that the appropriate modifications should be made in the NPCB definition of blindness to make it consistent with the WHO definition. PMID:28345562

Definition of blindness under National Programme for Control of Blindness: Do we need to revise it?

PubMed

Vashist, Praveen; Senjam, Suraj Singh; Gupta, Vivek; Gupta, Noopur; Kumar, Atul

2017-02-01

A review appropriateness of the current definition of blindness under National Programme for Control of Blindness (NPCB), Government of India. Online search of peer-reviewed scientific published literature and guidelines using PubMed, the World Health Organization (WHO) IRIS, and Google Scholar with keywords, namely blindness and visual impairment, along with offline examination of reports of national and international organizations, as well as their cross-references was done until December 2016, to identify relevant documents on the definition of blindness. The evidence for the historical and currently adopted definition of blindness under the NPCB, the WHO, and other countries was reviewed. Differences in the NPCB and WHO definitions were analyzed to assess the impact on the epidemiological status of blindness and visual impairment in India. The differences in the criteria for blindness under the NPCB and the WHO definitions cause an overestimation of the prevalence of blindness in India. These variations are also associated with an over-representation of refractive errors as a cause of blindness and an under-representation of other causes under the NPCB definition. The targets for achieving elimination of blindness also become much more difficult to achieve under the NPCB definition. Ignoring differences in definitions when comparing the global and Indian prevalence of blindness will cause erroneous interpretations. We recommend that the appropriate modifications should be made in the NPCB definition of blindness to make it consistent with the WHO definition.

Variable thickness transient ground-water flow model. Volume 1. Formulation

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

Reisenauer, A.E.

1979-12-01

Mathematical formulation for the variable thickness transient (VTT) model of an aquifer system is presented. The basic assumptions are described. Specific data requirements for the physical parameters are discussed. The boundary definitions and solution techniques of the numerical formulation of the system of equations are presented.

Sex-Role Ideology and the Aspirations of High School Girls

ERIC Educational Resources Information Center

Gaskell, Jane

1977-01-01

Variables specifically related to sex-role definitions in our society must be considered in accounting for the generally lower aspirations of women since after controlling the variables of social class and academic achievement, sex continues to make a difference in the aspiration levels of high school girls. (MJB)

Associations of physical activity and sedentary behaviour with metabolic syndrome in rural Australian adults.

PubMed

Mitchell, Braden L; Smith, Ashleigh E; Rowlands, Alex V; Parfitt, Gaynor; Dollman, James

2018-05-22

Associations between objectively measured sedentary behaviour, physical activity (PA) and metabolic syndrome (MetS)-classified using three different definitions were investigated in an inactive sample of rural Australian adults. Quantitative, cross-sectional. 171 adults (50.7±12.4years) from two rural South Australian regions underwent seven-day accelerometer activity monitoring and MetS classification using the National Cholesterol Education Program, the International Diabetes Federation and the Harmonized definitions. Associations between sedentary and activity variables and MetS (adjusted for age, sex, diet and smoking status) were modelled using logistic regression. In secondary modelling, associations of sedentary and activity outcomes for each MetS definition were assessed, adjusting for other activity and sedentary variables. Prediction differences across the definitions of MetS were directly compared using Akaike's Information Criterion. Sedentary behaviour increased MetS risk, whereas light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) reduced MetS risk, irrespective of definition. In secondary models, LPA predicted MetS independently of MVPA and total sedentary time. Time spent in sedentary bouts (>30min) predicted MetS independently of MVPA and the number of sedentary bouts predicted MetS independently of LPA and MVPA. Prediction differences for MetS definitions failed to reach the critical threshold for difference (>10). This study highlights the importance of sedentary behaviour and LPA on the prevalence of MetS in an inactive sample of rural Australian adults. Studies assessing the efficacy of increasing LPA on MetS in this population are needed. Minimal predictive differences across the three MetS definitions suggest evidence from previous studies can be considered cumulative. Copyright © 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Use of Ancillary Carbapenemase Tests To Improve Specificity of Phenotypic Definitions for Carbapenemase-Producing Enterobacteriaceae.

PubMed

Miller, Shelley A; Hindler, Janet A; Chengcuenca, Angelo; Humphries, Romney M

2017-06-01

Carbapenemase-producing Enterobacteriaceae (CPE) are a significant threat to public health. In 2015, CDC revised the surveillance definition for CPE to include all Enterobacteriaceae resistant to any carbapenem tested. However, this definition is associated with poor specificity. We evaluated the performance of this definition, compared to carbapenemase PCR, for a collection of 125 Enterobacteriaceae We also investigated the impact of ancillary testing for carbapenemase of isolates that met the CDC CPE surveillance definition. The two ancillary tests evaluated were the Xpert Carba-R assay, a molecular test, and the carbapenem inactivation method (CIM). Two variables were evaluated for the CIM: suspension of organisms in double-distilled water (ddH 2 O) versus tryptic soy broth (TSB) to incubate disks, and incubation of plates for 6 h versus 18 to 20 h. The sensitivity and specificity of the Carba-R assay were 100% compared to the results of in-house PCR. The sensitivities of the CIM performed with TSB were 94.6% when read at 6 h and 97.7% when read at 18 to 20 h; the sensitivities with ddH 2 O were 88.0% when read at 6 h and 93.0% when incubated for 18 to 20 h. The specificity was 100% for all variables tested. Without ancillary testing, the sensitivity of the CDC definition was 98.9% for CPE, and the specificity was 6.1%. Testing isolates that screened positive by the CDC definition with the Xpert Carba-R did not change the sensitivity, and it improved the specificity to 100%. Similarly, the use of the CIM (TSB and 18 to 20 h of incubation) to confirm screen-positive isolates resulted in a sensitivity of 95.6% and specificity of 100%. Copyright © 2017 American Society for Microbiology.

Aircraft signal definition for flight safety system monitoring system

NASA Technical Reports Server (NTRS)

Gibbs, Michael (Inventor); Omen, Debi Van (Inventor)

2003-01-01

A system and method compares combinations of vehicle variable values against known combinations of potentially dangerous vehicle input signal values. Alarms and error messages are selectively generated based on such comparisons. An aircraft signal definition is provided to enable definition and monitoring of sets of aircraft input signals to customize such signals for different aircraft. The input signals are compared against known combinations of potentially dangerous values by operational software and hardware of a monitoring function. The aircraft signal definition is created using a text editor or custom application. A compiler receives the aircraft signal definition to generate a binary file that comprises the definition of all the input signals used by the monitoring function. The binary file also contains logic that specifies how the inputs are to be interpreted. The file is then loaded into the monitor function, where it is validated and used to continuously monitor the condition of the aircraft.

Sarcocystis cafferi, n. sp. (Protozoa: Apicomplexa) from the African buffalo (Syncerus caffer)

USDA-ARS?s Scientific Manuscript database

Four species of Sarcocystis are currently recognized in the Asian water buffalo (Bubalus bubalis): Sarcocystis fusiformis with macrocysts and cats as definitive hosts, S. buffalonis also with macrocysts and cats as definitive hosts, S. levinei with microcysts and dogs as definitive hosts, and S. dub...

33 CFR 328.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 3 2013-07-01 2013-07-01 false Definitions. 328.3 Section 328.3 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE DEFINITION... currently used, or were used in the past, or may be susceptible to use in interstate or foreign commerce...

33 CFR 328.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 3 2014-07-01 2014-07-01 false Definitions. 328.3 Section 328.3 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE DEFINITION... currently used, or were used in the past, or may be susceptible to use in interstate or foreign commerce...

33 CFR 328.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 3 2012-07-01 2012-07-01 false Definitions. 328.3 Section 328.3 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE DEFINITION... currently used, or were used in the past, or may be susceptible to use in interstate or foreign commerce...

77 FR 75880 - Control of Communicable Diseases: Interstate; Scope and Definitions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

... definitions related to the control of communicable diseases and add more current medical terminology where... definitions for interstate quarantine regulations to reflect modern terminology and plain language used by..., under section 70.1, to reflect modern terminology and plain language commonly used by private sector...

Improving fire season definition by optimized temporal modelling of daily human-caused ignitions.

PubMed

Costafreda-Aumedes, S; Vega-Garcia, C; Comas, C

2018-07-01

Wildfire suppression management is usually based on fast control of all ignitions, especially in highly populated countries with pervasive values-at-risk. To minimize values-at-risk loss by improving response time of suppression resources it is necessary to anticipate ignitions, which are mainly caused by people. Previous studies have found that human-ignition patterns change spatially and temporally depending on socio-economic activities, hence, the deployment of suppression resources along the year should consider these patterns. However, full suppression capacity is operational only within legally established fire seasons, driven by past events and budgets, which limits response capacity and increases damages out of them. The aim of this study was to assess the temporal definition of fire seasons from the perspective of human-ignition patterns for the case study of Spain, where people cause over 95% of fires. Humans engage in activities that use fire as a tool in certain periods within a year, and in locations linked to specific spatial factors. Geographic variables (population, infrastructures, physiography and land uses) were used as explanatory variables for human-ignition patterns. The changing influence of these geographic variables on occurrence along the year was analysed with day-by-day logistic regression models. Daily models were built for all the municipal units in the two climatic regions in Spain (Atlantic and Mediterranean Spain) from 2002 to 2014, and similar models were grouped within continuous periods, designated as ignition-based seasons. We found three ignition-based seasons in the Mediterranean region and five in the Atlantic zones, not coincidental with calendar seasons, but with a high degree of agreement with current legally designated operational fire seasons. Our results suggest that an additional late-winter-early-spring fire season in the Mediterranean area and the extension of this same season in the Atlantic zone should be re-considered for operational purposes in the future. Copyright © 2018 Elsevier Ltd. All rights reserved.

Highly variable population-based prevalence rates of unilateral hearing loss after the application of common case definitions.

PubMed

Ross, Danielle S; Visser, Susanna N; Holstrum, W June; Qin, Tielin; Kenneson, Aileen

2010-02-01

This study shows how population-based estimates of the prevalence of unilateral hearing loss (UHL) in children aged 6 to 19 yrs can differ considerably with various applications of commonly accepted case definitions. It also examines demographic variables and risk factors related to UHL. The Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994, is a national population-based, cross-sectional survey. This study examined results of audiometric testing at 0.5 to 8 kHz and demographic data from in-person examination interviews. Three definitions of UHL were used: (1) 0.5, 1, and 2 kHz > or = 15 dB pure-tone average (PTA); (2) 0.5, 1, 2, and 4 kHz > or = 15 dB PTA; and (3) 0.5, 1, and 2 kHz > or = 20 dB or PTA >25 dB at two or more frequencies above 2 kHz (3, 4, 6, and 8 kHz). Case definitions 2 and 3 are not merely subsets of case definition 1. Some overlap exists between the groups, but each case definition classifies a proportion of children who fall uniquely under that case definition. Inclusion of participants based on tympanometry results (test of middle ear function) was also examined as were demographic characteristics and risk factors associated with UHL. Overall, the weighted proportion of children with UHL using case definition 1 was 6.3% (approximately 3,213,000 children nationally); using case definition 2, it was 5.8% (approximately 2,958,000 nationally); using case definition 3, it was 3.0% (approximately 1,530,000 nationally). For all three case definitions, children who failed tympanometry were at higher risk for UHL than children who passed. For case definition 2, children from rural areas were at higher risk for UHL than were children from urban areas. This study demonstrates that different applications of well-accepted case definitions of UHL can influence population-based prevalence estimates, in this study by as much as a factor of 2. These findings highlight the importance of controlling for tympanometry status as a risk factor in such estimates. Which demographic characteristics and risk factors are significantly associated with hearing loss seem to vary depending on the case definition. These findings have implications for the interpretation of prevalence rates and risk factors in the literature on hearing loss in general. Prevalence rate estimates require careful consideration of the case definition of hearing loss, tympanometry status, and demographic characteristics.

Risk Factors as Major Determinants of Resilience: A Replication Study.

PubMed

Eshel, Yohanan; Kimhi, Shaul; Lahad, Mooli; Leykin, Dmitry; Goroshit, Marina

2018-03-16

The present study was conducted in the context of current concerns about replication in psychological research. It claims that risk factors should be regarded as an integral part of the definition of individual resilience, which should be defined in terms of the balance between individual strength or protective factors, and individual vulnerability or risk factors (IND-SVR). Five independent samples, including 3457 Israeli participants, were employed to determine the effects of resilience promoting and resilience suppressing variables on the IND-SVR index of resilience, and on its two components: recovery from adversity, and distress symptoms. Five path analyses were employed for determining the role of distress symptoms as a measure of psychological resilience, as compared to other indices of this resilience. Results indicated the major role of risk factors (distress symptoms) as an integral component of resilience. This role was generally replicated in the five investigated samples. Risk factors are legitimate, valid, and useful parts of the definition of psychological resilience. Resilience research has shifted away from studying individual risk factors to investigating the process through which individuals overcome the hardships they experience. The present data seem to suggest that this shift should be reexamined.

Some elements of a theory of multidimensional complex variables. I - General theory. II - Expansions of analytic functions and application to fluid flows

NASA Technical Reports Server (NTRS)

Martin, E. Dale

1989-01-01

The paper introduces a new theory of N-dimensional complex variables and analytic functions which, for N greater than 2, is both a direct generalization and a close analog of the theory of ordinary complex variables. The algebra in the present theory is a commutative ring, not a field. Functions of a three-dimensional variable were defined and the definition of the derivative then led to analytic functions.

The Narrowing of Knowing: What It Means to Be Literate and Learned in Today's Society

ERIC Educational Resources Information Center

Smith, Thomas

2008-01-01

Currently, the idea and definition of learning and literacy is being pushed and pulled in competing directions. Current governmental policies, most notably embodied in the No Child Left Behind law, are pushing the definitions to mechanical enterprises aimed at the lowest common denominator. At the same time, the technology race is working to open…

Climate Change and International Competition: the US Army in the Arctic Environment

DTIC Science & Technology

2015-05-21

capabilities are evaluated within the domains of the current US doctrinal definition of Doctrine , Organization, Training, Materiel, Leadership and Education...environment. 15. SUBJECT TERMS US Army Cold Weather Doctrine ; US Army Arctic Operational Capability; ULO; Mission Command; Arctic Council; UNCLOS...capabilities are evaluated within the domains of the current US doctrinal definition of Doctrine , Organization, Training, Materiel, Leadership and

Is surgical decontamination definitive treatment of "body-packers"?

PubMed

Olmedo, R; Nelson, L; Chu, J; Hoffman, R S

2001-11-01

The current recommendations for body-packers are based on packet content, the presence of drug toxicity, or of bowel obstruction. Asymptomatic patients are usually treated with activated charcoal and whole bowel irrigation (WBI). Surgical removal of packets is advocated in symptomatic cocaine body-packers and in those with bowel obstruction. Currently, surgery is regarded as definitive. However, we report 2 body-packers who show the limitations of this technique. These cases show the importance of confirming the absence of drug packets in the gastrointestinal (GI) tract as the definitive end-point in the treatment of body-packers.

Conceptual parameters of acculturation within the Asian and Pacific Islander American populations: applications for nursing practice and research.

PubMed

Baker, Dian

2011-01-01

Asian and Pacific Islander Americans (A&PIAs) are experiencing health inequities. For example, A&PIA is the only racial/ethnic group in America to experience cancer as their leading cause of death. Several studies within the A&PIA population have pointed to acculturation as a significant variable to explain their health and health-seeking behaviors. Acculturation is a key construct in understanding the health of the A&PIA population. The purpose of this concept analysis is to provide a current conceptual understanding of the relationship between acculturation and health, especially within the A&PIA populations, which will serve as a pragmatic guideline for nursing practice and research. Understanding the contemporary issues surrounding the conceptual application of acculturation will aid in the development of appropriate programs to reduce health inequities. Acculturation was explored using the Morse method of concept analysis. An iterative historical and contemporary literature review across the disciplines of anthropology, sociology, psychology, medicine, and nursing was completed. Analytical questions asked of the resultant data provided the theoretical definition, antecedents, key attributes, outcomes, and implications. The concept analysis resulted in a new theoretical definition that includes multidimensional concepts of acculturation. Dilemmas in the measurement of key attributes of acculturation include unidirectional and bidirectional analysis, psychometric issues, and the appropriateness of proxy measurements. Outcomes of acculturation on health can be positive or negative and depend on an individual's or group's ability to navigate freely with necessary supports. Results of the conceptual analysis resulted in recommendations for nursing practice and future acculturation research. While debate continues about the appropriate use and definition of acculturation, researchers agree that it is an important construct in understanding the health of migrating individuals and groups. Currently there is no testable framework that delineates the role of acculturation in health. Further research is indicated to clarify the relationship between acculturation and health. © 2011 Wiley Periodicals, Inc.

A simple transformation independent method for outlier definition.

PubMed

Johansen, Martin Berg; Christensen, Peter Astrup

2018-04-10

Definition and elimination of outliers is a key element for medical laboratories establishing or verifying reference intervals (RIs). Especially as inclusion of just a few outlying observations may seriously affect the determination of the reference limits. Many methods have been developed for definition of outliers. Several of these methods are developed for the normal distribution and often data require transformation before outlier elimination. We have developed a non-parametric transformation independent outlier definition. The new method relies on drawing reproducible histograms. This is done by using defined bin sizes above and below the median. The method is compared to the method recommended by CLSI/IFCC, which uses Box-Cox transformation (BCT) and Tukey's fences for outlier definition. The comparison is done on eight simulated distributions and an indirect clinical datasets. The comparison on simulated distributions shows that without outliers added the recommended method in general defines fewer outliers. However, when outliers are added on one side the proposed method often produces better results. With outliers on both sides the methods are equally good. Furthermore, it is found that the presence of outliers affects the BCT, and subsequently affects the determined limits of current recommended methods. This is especially seen in skewed distributions. The proposed outlier definition reproduced current RI limits on clinical data containing outliers. We find our simple transformation independent outlier detection method as good as or better than the currently recommended methods.

A survey to determine agreement regarding the definition of centric relation.

PubMed

Goldstein, Gary; Andrawis, Mark; Choi, Mijin; Wiens, Jonathan; Janal, Malvin N

2017-03-01

The definition of centric relation (CR) has been both controversial and divisive, with little consensus. The purpose of this study was to determine whether agreement can be reached on a definition for CR among the Fellows of the Academy of Prosthodontics, the organization that writes the Glossary of Prosthodontic Terms. A survey of the Fellows of the Academy of Prosthodontics was conducted at the organization's annual business meeting. Of the 83 eligible Fellows in attendance, 72 responded to the survey, a response rate of 86%. Of those, the 5 responders who did not indicate a preferred definition and the 2 that chose 2 definitions were censored, yielding an analyzable sample of 65 for the definitions. The most common definition received 19 votes, the next 16, and the third 13, with the other 6 definitions receiving from 2 to 5 votes. Some of the variability in definition depended on the era of training. Disagreement and confusion continues regarding the definition of centric relation. Some of this disagreement can be explained by training era. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Assessment of state measures of risk-appropriate care for very low birth weight infants and recommendations for enhancing regionalized state systems.

PubMed

Nowakowski, Lindsey; Barfield, Wanda D; Kroelinger, Charlan D; Lauver, Cassie B; Lawler, Michele H; White, Vanessa A; Ramos, Lauren Raskin

2012-01-01

The goal of this study was to examine state measurements and improvements in risk-appropriate care for very low birth weight (VLBW) infants. The authors reviewed state perinatal regionalization models and levels of care to compare varying definitions between states and assess mechanisms of measurement and areas for improvement. Seven states that presented at a 2009 Association of Maternal & Child Health Programs Perinatal Regionalization Meeting were included in the assessment. Information was gathered from meeting presentations, presenters, state representatives, and state websites. Comparison of state levels of care and forms of regulation were outlined. Review of state models revealed variability in the models themselves, as well as the various mechanisms for measuring and improving risk-appropriate care. Regulation of regionalization programs, data surveillance, review of adverse events, and consideration of geography and demographics were identified as mechanisms facilitating better measurement of risk-appropriate care. Antenatal or neonatal transfer arrangements, telemedicine networks, acquisition of funding, provision of financial incentives, and patient education comprised state actions for improving risk-appropriate care. The void of explicit and updated national standards led to the current variations in definitions and models among states. State regionalization models and measures of risk-appropriate care varied greatly. These variations arose from inconsistent definitions and models of perinatal regionalization. Guidelines should be collaboratively developed by healthcare providers and public health officials for consistent and suitable measures of perinatal risk-appropriate care.

Definition and classification of cancer cachexia: an international consensus.

PubMed

Fearon, Kenneth; Strasser, Florian; Anker, Stefan D; Bosaeus, Ingvar; Bruera, Eduardo; Fainsinger, Robin L; Jatoi, Aminah; Loprinzi, Charles; MacDonald, Neil; Mantovani, Giovanni; Davis, Mellar; Muscaritoli, Maurizio; Ottery, Faith; Radbruch, Lukas; Ravasco, Paula; Walsh, Declan; Wilcock, Andrew; Kaasa, Stein; Baracos, Vickie E

2011-05-01

To develop a framework for the definition and classification of cancer cachexia a panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. Cancer cachexia was defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. The agreed diagnostic criterion for cachexia was weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current bodyweight and height (body-mass index [BMI] <20 kg/m(2)) or skeletal muscle mass (sarcopenia). An agreement was made that the cachexia syndrome can develop progressively through various stages--precachexia to cachexia to refractory cachexia. Severity can be classified according to degree of depletion of energy stores and body protein (BMI) in combination with degree of ongoing weight loss. Assessment for classification and clinical management should include the following domains: anorexia or reduced food intake, catabolic drive, muscle mass and strength, functional and psychosocial impairment. Consensus exists on a framework for the definition and classification of cancer cachexia. After validation, this should aid clinical trial design, development of practice guidelines, and, eventually, routine clinical management. Copyright © 2011 Elsevier Ltd. All rights reserved.

Critical concepts in elder abuse research.

PubMed

Goergen, Thomas; Beaulieu, Marie

2013-08-01

This paper identifies core elements in principal definitions of elder abuse or mistreatment of older adults (EA/MOA) and discusses the relevance of four crucial concepts: age, vulnerability, trust, and power balance in relationships. A critical analysis of selected literature in EA/MOA with a focus on works from the last 10 years. Current definitions of EA/MOA share commonalities regarding an understanding of elder abuse as a status offence, the inclusion of both acts and omissions, and the consideration of multiple levels of behavior and its effects. Definitions differ with regard to aspects as crucial as the intentionality of an abusive action and its actual or potential harmful effects. EA/MOA can be considered as a complex subtype of victimization in later life limited to victim-perpetrator relationships, where the perpetrator has assumed responsibility for the victim, the victim puts trust in the offender, or the role assigned to the offending person creates the perception and expectation that the victim may trust the perpetrator. Vulnerability is identified as a key variable in EA/MOA theory and research. With regard to neglect, the mere possibility of being neglected presupposes a heightened level of vulnerability. Power imbalance often characterizes victim - perpetrator relationships but is not a necessary characteristic of abuse. Research on EA/MOA needs conceptual development. Confining phenomena of EA/MOA to specific relationships and tying them to notions of vulnerability has implications for research design and sampling and points to the limits of population-based victimization surveys.

Toward a definition of intolerance of uncertainty: a review of factor analytical studies of the Intolerance of Uncertainty Scale.

PubMed

Birrell, Jane; Meares, Kevin; Wilkinson, Andrew; Freeston, Mark

2011-11-01

Since its emergence in the early 1990s, a narrow but concentrated body of research has developed examining the role of intolerance of uncertainty (IU) in worry, and yet we still know little about its phenomenology. In an attempt to clarify our understanding of this construct, this paper traces the way in which our understanding and definition of IU have evolved throughout the literature. This paper also aims to further our understanding of IU by exploring the latent variables measures by the Intolerance of Uncertainty Scale (IUS; Freeston, Rheaume, Letarte, Dugas & Ladouceur, 1994). A review of the literature surrounding IU confirmed that the current definitions are categorical and lack specificity. A critical review of existing factor analytic studies was carried out in order to determine the underlying factors measured by the IUS. Systematic searches yielded 9 papers for review. Two factors with 12 consistent items emerged throughout the exploratory studies, and the stability of models containing these two factors was demonstrated in subsequent confirmatory studies. It is proposed that these factors represent (i) desire for predictability and an active engagement in seeking certainty, and (ii) paralysis of cognition and action in the face of uncertainty. It is suggested that these factors may represent approach and avoidance responses to uncertainty. Further research is required to confirm the construct validity of these factors and to determine the stability of this structure within clinical samples. Copyright © 2011 Elsevier Ltd. All rights reserved.

Definition of Hydrologic Response Units in Depression Plagued Digital Elevation Models

NASA Astrophysics Data System (ADS)

Lindsay, J. B.; Creed, I. F.

2002-12-01

Definition of hydrologic response units using digital elevation models (DEMs) is sensitive to the occurrence of topographic depressions. Real depressions can be important to the hydrology and biogeochemistry a catchment, often coinciding with areas of surface saturation. Artifact depressions, in contrast, result in digital "black holes", artificially truncating the hydrologic flow lengths and altering hydrologic flow directions, parameters that are often used in defining hydrologic response units. Artifact depressions must be removed from DEMs prior to definition of hydrologic response units. Depression filling or depression trenching techniques can be used to remove these artifacts. Depression trenching methods are often considered more appropriate because they preserve the topographic variability within a depression thus avoiding the creation of spurious flat areas. Current trenching algorithms are relatively slow and unable to process very large or noisy DEMs. A new trenching algorithm that overcomes these limitations is described. The algorithm does not require finding depression catchments or outlets, nor does it need special handling for nested depressions. Therefore, artifacts can be removed from large or noisy DEMs efficiently, while minimizing the number of grid elevations requiring modification. The resulting trench is a monotonically descending path starting from the lowest point in a depression, passing through the depression's outlet, and ending at a point of lower elevation outside the depression. The importance of removing artifact depressions is demonstrated by showing hydrologic response units both before and after the removal of artifact depressions from the DEM.

A current landscape of provincial perinatal data collection in Canada.

PubMed

Massey, Kiran A; Magee, Laura A; Dale, Sheryll; Claydon, Jennifer; Morris, Tara J; von Dadelszen, Peter; Liston, Robert M; Ansermino, J Mark

2009-03-01

The Canadian Perinatal Network (CPN) was launched in 2005 as a national perinatal database project designed to identify best practices in maternity care. The inaugural project of CPN is focused on interventions that optimize maternal and perinatal outcomes in women with threatened preterm birth at 22+0 to 28+6 weeks' gestation. To examine existing data collection by perinatal health programs (PHPs) to inform decisions about shared data collection and CPN database construction. We reviewed the database manuals and websites of all Canadian PHPs and compiled a list of data fields and their definitions. We compared these fields and definitions with those of CPN and the Canadian Minimal Dataset, proposed as a common dataset by the Canadian Perinatal Programs Coalition of Canadian PHPs. PHPs collect information on 2/3 of deliveries in Canada. PHPs consistently collect information on maternal demographics (including both maternal and neonatal personal identifiers), past obstetrical history, maternal lifestyle, aspects of labour and delivery, and basic neonatal outcomes. However, most PHPs collect insufficient data to enable identification of obstetric (and neonatal) practices associated with improved maternal and perinatal outcomes. In addition, there is between-PHP variability in defining many data fields. Construction of a separate CPN database was needed although harmonization of data field definitions with those of the proposed Canadian Minimal Dataset was done to plan for future shared data collection. This convergence should be the goal of researchers and clinicians alike as we construct a common language for electronic health records.

Definitions of idioms in preadolescents, adolescents, and adults.

PubMed

Chan, Yen-Ling; Marinellie, Sally A

2008-01-01

The purpose of this study was to expand the current literature on word definitions by focusing on definitions of idioms provided by several age groups. Preadolescents, young adolescents, older adolescents, and adults wrote definitions for 10 frequently used idioms and also rated their familiarity with the idiomatic expressions. Participants' definitions were scored based on the degree to which their definitions reflected use of critical elements (determined by a standard dictionary of idioms), use of examples or related/associated concepts, and errors. Significant age differences were found in both idiom familiarity and idiom definition tasks: both idiom familiarity and definitional skill improved with age. In addition, we found a positive correlation between idiom familiarity and idiom definition. Results are discussed with respect to age-related changes in definitional response types and understanding of figurative language.

Contemporary group estimates adjusted for climatic effects provide a finer definition of the unknown environmental challenges experienced by growing pigs.

PubMed

Guy, S Z Y; Li, L; Thomson, P C; Hermesch, S

2017-12-01

Environmental descriptors derived from mean performances of contemporary groups (CGs) are assumed to capture any known and unknown environmental challenges. The objective of this paper was to obtain a finer definition of the unknown challenges, by adjusting CG estimates for the known climatic effects of monthly maximum air temperature (MaxT), minimum air temperature (MinT) and monthly rainfall (Rain). As the unknown component could include infection challenges, these refined descriptors may help to better model varying responses of sire progeny to environmental infection challenges for the definition of disease resilience. Data were recorded from 1999 to 2013 at a piggery in south-east Queensland, Australia (n = 31,230). Firstly, CG estimates of average daily gain (ADG) and backfat (BF) were adjusted for MaxT, MinT and Rain, which were fitted as splines. In the models used to derive CG estimates for ADG, MaxT and MinT were significant variables. The models that contained these significant climatic variables had CG estimates with a lower variance compared to models without significant climatic variables. Variance component estimates were similar across all models, suggesting that these significant climatic variables accounted for some known environmental variation captured in CG estimates. No climatic variables were significant in the models used to derive the CG estimates for BF. These CG estimates were used to categorize environments. There was no observable sire by environment interaction (Sire×E) for ADG when using the environmental descriptors based on CG estimates on BF. For the environmental descriptors based on CG estimates of ADG, there was significant Sire×E only when MinT was included in the model (p = .01). Therefore, this new definition of the environment, preadjusted by MinT, increased the ability to detect Sire×E. While the unknown challenges captured in refined CG estimates need verification for infection challenges, this may provide a practical approach for the genetic improvement of disease resilience. © 2017 Blackwell Verlag GmbH.

Comparative studies of social buffering: A consideration of approaches, terminology, and pitfalls.

PubMed

Kiyokawa, Yasushi; Hennessy, Michael B

2018-03-01

KIYOKAWA, Y. and HENNESSY, M.B. Comparative studies of social buffering: A consideration of approaches, terminology, and pitfalls…NEUROSCI BIOBEHAV REV XXX-XXX, .- Over the past decades, there has been an increasing number of investigations of the impact of social variables on neural, endocrine, and immune outcomes. Among these are studies of "social buffering"-or the phenomenon by which affiliative social partners mitigate the response to stressors. Yet, as social buffering studies have become more commonplace, the variety of approaches taken, definitions employed, and divergent results obtained in different species can lead to confusion and miscommunication. The aim of the present paper, therefore, is to address terminology and approaches and to highlight potential pitfalls to the study of social buffering across nonhuman species. We review and categorize variables currently being employed in social buffering studies and provide an overview of responses measured, mediating sensory modalities and underlying mechanisms. It is our hope that the paper will be useful to those contemplating examination of social buffering in the context of their own research. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Gulf of Lions' hydrodynamics

NASA Astrophysics Data System (ADS)

Millot, Claude

1990-09-01

From an hydrodynamical point of view, the Gulf of Lions can be considered as a very complex region, because several intense and highly variable phenomena compete simultaneously. These processes include the powerful general circulation along the continental slope, the formation of dense water both on the shelf and offshore, a seasonal variation of stratification and the extreme energies associated with meteorological conditions. The cloudless atmospheric conditions encountered generally in the northwestern Mediterranean Sea have enabled us to make use of, over more than 10 years, large use of various satellite imageries. The large space and time variability of the hydrodynamical features, a complex topography and a noticeable fishing activity, represent certain difficulties to the collection of observations in situ. We have obtained, therefore, only a few current time series on the slope; those obtained on the shelf only cover the summer period. Models have been elaborated to help us understand the reasons for the general circulation. Observational programmes to be carried out in the forthcoming years will probably provide us with more definitive results on the Gulf of Lions' hydrodynamics.

Mean centering helps alleviate "micro" but not "macro" multicollinearity.

PubMed

Iacobucci, Dawn; Schneider, Matthew J; Popovich, Deidre L; Bakamitsos, Georgios A

2016-12-01

There seems to be confusion among researchers regarding whether it is good practice to center variables at their means prior to calculating a product term to estimate an interaction in a multiple regression model. Many researchers use mean centered variables because they believe it's the thing to do or because reviewers ask them to, without quite understanding why. Adding to the confusion is the fact that there is also a perspective in the literature that mean centering does not reduce multicollinearity. In this article, we clarify the issues and reconcile the discrepancy. We distinguish between "micro" and "macro" definitions of multicollinearity and show how both sides of such a debate can be correct. To do so, we use proofs, an illustrative dataset, and a Monte Carlo simulation to show the precise effects of mean centering on both individual correlation coefficients as well as overall model indices. We hope to contribute to the literature by clarifying the issues, reconciling the two perspectives, and quelling the current confusion regarding whether and how mean centering can be a useful practice.

Calculating the risk of a pancreatic fistula after a pancreaticoduodenectomy: a systematic review

PubMed Central

Vallance, Abigail E; Young, Alastair L; Macutkiewicz, Christian; Roberts, Keith J; Smith, Andrew M

2015-01-01

Background A post-operative pancreatic fistula (POPF) is a major cause of morbidity and mortality after a pancreaticoduodenectomy (PD). This systematic review aimed to identify all scoring systems to predict POPF after a PD, consider their clinical applicability and assess the study quality. Method An electronic search was performed of Medline (1946–2014) and EMBASE (1996–2014) databases. Results were screened according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and quality assessed according to the QUIPS (quality in prognostic studies) tool. Results Six eligible scoring systems were identified. Five studies used the International Study Group on Pancreatic Fistula (ISGPF) definition. The proposed scores feature between two and five variables and of the 16 total variables, the majority (12) featured in only one score. Three scores could be fully completed pre-operatively whereas 1 score included intra-operative and two studies post-operative variables. Four scores were internally validated and of these, two scores have been subject to subsequent multicentre review. The median QUIPS score was 38 out of 50 (range 16–50). Conclusion These scores show potential in calculating the individualized patient risk of POPF. There is, however, much variation in current scoring systems and further validation in large multicentre cohorts is now needed. PMID:26456948

In-vehicle signing functions of an in-vehicle information system

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

Tufano, D.R.; Knee, H.E.; Spelt, P.F.

The definition of In-Vehicle Signing (IVS) functions was guided by the principles of traffic engineering as they apply to the design and placement of roadway signs. Because of the dynamic and active nature of computing, communications, and display technology, IVS can fulfill the signing principles of traffic engineering in ways that have been impossible with conventional signage. Current signing technology represents a series of compromises of these principles, especially the data and equations contributing to the calculation of required sight distance. A number of conditions relevant to sight distance are quite variable, e.g.: vehicle speed, visibility, weather, and driver reactionmore » time. However, conventional signing requires that there are fixed values of each variable for the determination of (e.g.) legibility distance. IVS, on the other hand, will be able to tailor the timing of sign presentation to the dynamically diverse variable values of all of these conditions. A clear, in-vehicle sign display, adaptive to ambient and driver conditions, will in fact obviate the entire issue of sign legibility. These capabilities, together with information filtering functions, will truly enhance the presentation of sign information to drivers. The development of IVS is a critical step in the development of an integrated In-Vehicle Information System (IVIS).« less

Validating a pragmatic definition of shock in adult patients presenting to the ED.

PubMed

Li, Yan-ling; Chan, Cangel Pui-yee; Sin, King-keung; Chan, Stewart S W; Lin, Pei-yi; Chen, Xiao-hui; Smith, Brendan E; Joynt, Gavin M; Graham, Colin A; Rainer, Timothy H

2014-11-01

The importance of the early recognition of shock in patients presenting to emergency departments is well recognized, but at present, there is no agreed practical definition for undifferentiated shock. The main aim of this study was to validate an a priori clinical definition of shock against 28-day mortality. This prospective, observational, cross-sectional, single-center study was conducted in Hong Kong, China. Data were collected between July 1, 2012, and January 31, 2013. An a priori definition of shock was designed, whereby patients admitted to the resuscitation room or high dependency area of the emergency department were divided into 1 of 3 groups-no shock, possible shock, and shock. The primary outcome was 28-day mortality. Secondary outcomes were in-hospital mortality or admission to the intensive or coronary care unit. A total of 111 patients (mean age, 67.2 ± 17.1 years; male = 69 [62%]) were recruited, of which 22 were classified as no shock, 54 as possible shock, and 35 as shock. Systolic blood pressure, mean arterial pressure, lactate, and base deficit correlated well with shock classifications (P < .05). Patients who had 3 or more positively defined shock variables had a 100% poor composite outcome rate (5 of 5). Patients with 2 shock variables had a 66.7% (4 of 6) poor composite outcome rate. A simple, practical definition of undifferentiated shock has been proposed and validated in a group of patients presenting to an emergency department in Hong Kong. This definition needs further validation in a larger population and other settings. Copyright © 2014 Elsevier Inc. All rights reserved.

Historical review of and current progress in coal-resource estimation in the United States.

USGS Publications Warehouse

Wood, G.H.

1981-01-01

Nine estimates of US coal resources have been published in the past 71yr. Although many details of these estimates differ markedly, those for 1913, 1922, and 1974 are surprisingly similar. Some differences are due to increased data, others reflect changes in terminology, definitions, criteria, guidelines, and methodologies. Thus many early estimates are not particularly useful in modern resource assessments. Preliminary definitions that are being prepared in 1980 by the US Geological Survey are compared with those published in 1976 and currently in use. Anticipated results of the new definitions are: 1) to lessen existing confusion about estimation procedures; 2) to make such procedures easier and more precise; 3) to promote use of a commonly accepted terminology accompanied by standardized definitions, criteria, guidelines, and methodologies for estimating resources. -Author

Operational Definitions of Sexual Orientation and Estimates of Adolescent Health Risk Behaviors

PubMed Central

Matthews, Derrick D.; Blosnich, John R.; Farmer, Grant W.; Adams, Brian J.

2014-01-01

Purpose Increasing attention to the health of lesbian, gay, and bisexual (LGB) populations comes with requisite circumspection about measuring sexual orientation in surveys. However, operationalizing these variables also requires considerable thought. This research sought to document the consequences of different operational definitions of sexual orientation by examining variation in health risk behaviors. Methods Using Massachusetts Youth Risk Behavior Survey data, we examined how operational definitions of sexual behavior and sexual identity influenced differences among three health behaviors known to disparately affect LGB populations: smoking, suicide risk, and methamphetamine use. Sexual behavior and sexual identity were also examined together to explore if they captured unique sources of variability in behavior. Results Estimates of health disparities changed as a result of using either sexual behavior or sexual identity. Youth who reported their sexual identity as “not sure” also had increased odds of health risk behavior. Disaggregating bisexual identity and behavior from same-sex identity and behavior frequently resulted in the attenuation or elimination of health disparities that would have otherwise been attributable to exclusively same-sex sexual minorities. Finally, sexual behavior and sexual identity explained unique and significant sources of variability in all three health behaviors. Conclusion Researchers using different operational definitions of sexual orientation could draw different conclusions, even when analyzing the same data, depending upon how they chose to represent sexual orientation in analyses. We discuss implications that these manipulations have on data interpretation and provide specific recommendations for best-practices when analyzing sexual orientation data collected from adolescent populations. PMID:25110718

From pituitary adenoma to pituitary neuroendocrine tumor (PitNET): an International Pituitary Pathology Club proposal.

PubMed

Asa, S L; Casar-Borota, O; Chanson, P; Delgrange, E; Earls, P; Ezzat, S; Grossman, A; Ikeda, H; Inoshita, N; Karavitaki, N; Korbonits, M; Laws, E R; Lopes, M B; Maartens, N; McCutcheon, I E; Mete, O; Nishioka, H; Raverot, G; Roncaroli, F; Saeger, W; Syro, L V; Vasiljevic, A; Villa, C; Wierinckx, A; Trouillas, J

2017-04-01

The classification of neoplasms of adenohypophysial cells is misleading because of the simplistic distinction between adenoma and carcinoma, based solely on metastatic spread and the poor reproducibility and predictive value of the definition of atypical adenomas based on the detection of mitoses or expression of Ki-67 or p53. In addition, the current classification of neoplasms of the anterior pituitary does not accurately reflect the clinical spectrum of behavior. Invasion and regrowth of proliferative lesions and persistence of hormone hypersecretion cause significant morbidity and mortality. We propose a new terminology, pituitary neuroendocrine tumor (PitNET), which is consistent with that used for other neuroendocrine neoplasms and which recognizes the highly variable impact of these tumors on patients. © 2017 Society for Endocrinology.

Toward Clarity in Clinical Vitamin D Status Assessment: 25(OH)D Assay Standardization.

PubMed

Binkley, Neil; Carter, Graham D

2017-12-01

Widespread variation in 25-hydroxyvitamin D (25(OH)D) assays continues to compromise efforts to develop clinical and public health guidelines regarding vitamin D status. The Vitamin D Standardization Program helps alleviate this problem. Reference measurement procedures and standard reference materials have been developed to allow current, prospective, and retrospective standardization of 25(OH)D results. Despite advances in 25(OH)D measurement, substantial variability in clinical laboratory 25(OH)D measurement persists. Existing guidelines have not used standardized data and, as a result, it seems unlikely that consensus regarding definitions of vitamin D deficiency, inadequacy, sufficiency, and excess will soon be reached. Until evidence-based consensus is reached, a reasonable clinical approach is advocated. Copyright © 2017 Elsevier Inc. All rights reserved.

76 FR 10055 - Changes to the Public Housing Assessment System (PHAS): Physical Condition Scoring Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-23

... Weights and Criticality Levels, and Dictionary of Deficiency Definitions The Item Weights and Criticality Levels tables and the Dictionary of Deficiency Definitions, currently in use, were published as... Dictionary of Deficiency Definitions is found at http://www.hud.gov/offices/reac/pdf/pass_dict2.3.pdf . V...

Towards a broader understanding of agency in biomedical ethics.

PubMed

López Barreda, Rodrigo; Trachsel, Manuel; Biller-Andorno, Nikola

2016-09-01

With advances in medical science, the concept of agency has received increasing attention in biomedical ethics. However, most of the ethical discussion around definitions of agency has focused either on patients suffering from mental disorders or on patients receiving cutting-edge medical treatments in developed countries. Very little of the discussion around concepts of agency has focused on the situation of patients suffering from common diseases that affect populations worldwide. Therefore, the most widely-used definitions of agency may be not appropriate to analyse common diseases among large populations. The branch of social sciences known as development studies draw on their own definitions of the term agency that may provide a more applicable and accurate way of referring to common and general cases than the definitions currently used in bioethics. Moreover, the psychological Self-Determination Theory may improve the usefulness of these definitions in common situations. This article explains the characteristics and the shortcomings of current bioethical definitions of agency when they are applied to common medical conditions worldwide. A new, value-based concept of agency, informed by development studies, is proposed as more accurate and useful for biomedical ethics.

The definition of polytrauma: variable interrater versus intrarater agreement--a prospective international study among trauma surgeons.

PubMed

Butcher, Nerida E; Enninghorst, Natalie; Sisak, Krisztian; Balogh, Zsolt J

2013-03-01

The international trauma community has recognized the lack of a validated consensus definition of "polytrauma." We hypothesized that using a subjective definition, trauma surgeons will not have substantial agreement; thus, an objective definition is needed. A prospective observational study was conducted between December 2010 and June 2011 (John Hunter Hospital, Level I trauma center). Inclusion criteria were all trauma call patients with subsequent intensive care unit admission. The study was composed of four stages as follows: (1) four trauma surgeons assessed patients until 24 hours, then coded as either "yes" or "no" for polytrauma, and results compared for agreement; (2) eight trauma surgeons representing the United States, Germany, and the Netherlands graded the same prospectively assessed patients and coded as either "yes" or "no" for polytrauma; (3) 12 months later, the original four trauma surgeons repeated assessment via data sheets to test intrarater variability; and (4) individual subjective definitions were compared with three anatomic scores, namely, (a) Injury Severity Score (ISS) of greater than 15, (b) ISS of greater 17, and (c) Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions. A total of 52 trauma patients were included. Results for each stage were as follows: (1) κ score of 0.50, moderate agreement; (2) κ score of 0.41, moderate agreement; (3) Rater 1 had moderate intrarater agreement (κ score, 0.59), while Raters 2, 3, 4 had substantial intrarater agreement (κ scores, 0.75, 0.66, and 0.71, respectively); and (4) none had most agreement with ISS of greater than 15 (κ score, 0.16), while both definitions ISS greater than 17 and Abbreviated Injury Scale (AIS) score of greater than 2 in at least two ISS body regions had on average fair agreement (κ scores, 0.27 and 0.39, respectively). Based on subjective assessments, trauma surgeons do not agree on the definition of polytrauma, with the subjective definition differing both within and across institutions.

Life Expectancy as an Objective Factor of a Subjective Well-Being

ERIC Educational Resources Information Center

Papavlassopulos, Nikolas; Keppler, David

2011-01-01

The paper has two parts. In the first part we offer a definition of well-being which makes life expectancy an explicit variable. We recognize the importance of happiness as a significant aspect of any definition of well-being, but we side-step the issue of what determines its level or how to measure it, and concentrate instead on the consequences…

Local (L, [epsilon])-Approximation of a Function of Single Variable: An Alternative Way to Define Limit

ERIC Educational Resources Information Center

Bokhari, M. A.; Yushau, B.

2006-01-01

At the start of a freshman calculus course, many students conceive the classical definition of limit as the most problematic part of calculus. They not only find it difficult to understand, but also consider it of no use while solving most of the limit problems and therefore, skip it. This paper reformulates the rigorous definition of limit, which…

The Principal's Role in Setting School Climate (for School Improvement).

ERIC Educational Resources Information Center

Hall, Gene E.

Given that principals play a role in setting school climate, this paper focuses on how this actually happens. First, the paper explores different criteria and variables as possible frameworks for defining the term "climate." This task is complicated by problems in identifying consensus findings due to weak variable definitions and lack…

Socio-Demographic Variables, General Psychological Well-Being and the Mental Health Continuum in an African Context

ERIC Educational Resources Information Center

Khumalo, I. P.; Temane, Q. M.; Wissing, M. P.

2012-01-01

Age, gender, marital status, education attainment, employment status, and environmental setting explain different amounts of variance in psychological well-being and mental health. Inconsistent findings are reported for the socio-demographic variables in psychological well-being depending amongst others on the definition and measurement of…

Virtual continuity of measurable functions and its applications

NASA Astrophysics Data System (ADS)

Vershik, A. M.; Zatitskii, P. B.; Petrov, F. V.

2014-12-01

A classical theorem of Luzin states that a measurable function of one real variable is `almost' continuous. For measurable functions of several variables the analogous statement (continuity on a product of sets having almost full measure) does not hold in general. The search for a correct analogue of Luzin's theorem leads to a notion of virtually continuous functions of several variables. This apparently new notion implicitly appears in the statements of embedding theorems and trace theorems for Sobolev spaces. In fact it reveals the nature of such theorems as statements about virtual continuity. The authors' results imply that under the conditions of Sobolev theorems there is a well-defined integration of a function with respect to a wide class of singular measures, including measures concentrated on submanifolds. The notion of virtual continuity is also used for the classification of measurable functions of several variables and in some questions on dynamical systems, the theory of polymorphisms, and bistochastic measures. In this paper the necessary definitions and properties of admissible metrics are recalled, several definitions of virtual continuity are given, and some applications are discussed. Bibliography: 24 titles.

The enigma of nonarteritic anterior ischemic optic neuropathy: an update for the comprehensive ophthalmologist.

PubMed

Gaier, Eric D; Torun, Nurhan

2016-11-01

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic nerve injury, and frequently presents to comprehensive ophthalmologists. We review the typical and atypical clinical features and current literature on various treatment modalities for NAION. The epidemiology and clinical presentation of this disease can be variable, making a definitive diagnosis difficult in many cases. In addition, the differential diagnoses for this disorder, although comprising much less prevalent entities, are quite broad and can have substantial systemic implications if these alternatives go unrecognized. NAION has many systemic associations and comorbidities that deserve inquiry when the diagnosis is made. There are currently no widely accepted, evidence-based treatments for NAION. All recommendations made to patients to reduce their risk of sequential eye involvement, including avoidance of potential nocturnal hypotension, erectile dysfunction medication, and treatment of obstructive sleep apnea, have theoretical bases. NAION is a common cause of acute vision loss in adult and older patients, and thus, comprehensive ophthalmologists need to be able to diagnose and appropriately manage this disorder. We anticipate fruitful results from current and future trials aimed at neuroprotection in the affected eye and prevention of sequential eye involvement.

Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes.

PubMed

McAdams, Sean; Shukla, Aseem R

2010-10-01

Extracorporeal shock wave lithotripsy (ESWL) is currently a first-line procedure of most upper urinary tract stones <2 cm of size because of established success rates, its minimal invasiveness and long-term safety with minimal complications. Given that alternative surgical and endourological options exist for the management of stone disease and that ESWL failure often results in the need for repeat ESWL or secondary procedures, it is highly desirable to identify variables predicting successful outcomes of ESWL in the pediatric population. Despite numerous reports and growing experience, few prospective studies and guidelines for pediatric ESWL have been completed. Variation in the methods by which study parameters are measured and reported can make it difficult to compare individual studies or make definitive recommendations. There is ongoing work and a need for continuing improvement of imaging protocols in children with renal colic, with a current focus on minimizing exposure to ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety.

Counterfactual Definiteness and Bell's Inequality

NASA Astrophysics Data System (ADS)

Hess, Karl; Raedt, Hans De; Michielsen, Kristel

Counterfactual definiteness must be used as at least one of the postulates or axioms that are necessary to derive Bell-type inequalities. It is considered by many to be a postulate that is not only commensurate with classical physics (as for example Einstein's special relativity), but also separates and distinguishes classical physics from quantum mechanics. It is the purpose of this paper to show that Bell's choice of mathematical functions and independent variables implicitly includes counterfactual definiteness and reduces the generality of the physics of Bell-type theories so significantly that no meaningful comparison of these theories with actual Einstein-Podolsky-Rosen experiments can be made.

48 CFR 49.001 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TERMINATION OF CONTRACTS 49.001 Definitions. As used in this part— Other work means any current or scheduled... classification. The final phase of the plant clearance period means that period after receipt of acceptable...

48 CFR 49.001 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TERMINATION OF CONTRACTS 49.001 Definitions. As used in this part— Other work means any current or scheduled... classification. The final phase of the plant clearance period means that period after receipt of acceptable...

Non-precautionary aspects of toxicology

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

Grandjean, Philippe

2005-09-01

Empirical studies in toxicology aim at deciphering complex causal relationships, especially in regard to human disease etiologies. Several scientific traditions limit the usefulness of documentation from current toxicological research, in regard to decision-making based on the precautionary principle. Among non-precautionary aspects of toxicology are the focus on simplified model systems and the effects of single hazards, one by one. Thus, less attention is paid to sources of variability and uncertainty, including individual susceptibility, impacts of mixed and variable exposures, susceptible life-stages, and vulnerable communities. In emphasizing the need for confirmatory evidence, toxicology tends to penalize false positives more than falsemore » negatives. An important source of uncertainty is measurement error that results in misclassification, especially in regard to exposure assessment. Standard statistical analysis assumes that the exposure is measured without error, and imprecisions will usually result in an underestimation of the dose-effect relationship. In testing whether an effect could be considered a possible result of natural variability, a 5% limit for 'statistical significance' is usually applied, even though it may rule out many findings of causal associations, simply because the study was too small (and thus lacked statistical power) or because some imprecision or limited sensitivity of the parameters precluded a more definitive observation. These limitations may be aggravated when toxicology is influenced by vested interests. Because current toxicology overlooks the important goal of achieving a better characterization of uncertainties and their implications, research approaches should be revised and strengthened to counteract the innate ideological biases, thereby supporting our confidence in using toxicology as a main source of documentation and in using the precautionary principle as a decision procedure in the public policy arena.« less

Winter variability in the western Gulf of Maine: Part 1: Internal tides

NASA Astrophysics Data System (ADS)

Brown, W. S.

2011-09-01

During the winter 1997-1998, a field program was conducted in Wilkinson Basin-western Gulf of Maine-as part of a study of winter convective mixing. The field program consisted of (1) Wilkinson basin-scale hydrographic surveys, (2) a tight three-mooring array with ˜100 m separations measured temperature and conductivity at rates of 2-15 min and (3) a single pair of upward/downward-looking pair acoustic Doppler current profiling (ADCP) instruments measured currents with 8 m vertical resolution over the 270 m water column in north-central Wilkinson basin at a rate of 10 min. The moored array measurements below the mixed layer (˜100 m depth) between 11 January and 6 February 1998 were dominated by a combination of the relatively strong semidiurnal external (depth-independent or barotropic) tide; upon which were superposed a weaker phase-locked semidiurnal internal tide and a very weak water column mean currents of about 1 cm/s southward or approximately across the local isobaths. The harmonic analysis of a vertical average of the relatively uniform ADCP velocities in the well-mixed upper 123 m of the water column, defined the external tidal currents which were dominated by a nearly rectilinear, across-isobath (326°T) M 2 semidiurnal tidal current of about 15 cm/s. The depth-dependent residual current field, which was created by subtracting the external tidal current, consisted of (1) clockwise-rotating semidiurnal internal tidal currents of about 5 cm/s below the mixed layer; (2) clockwise-rotating inertial currents; and (3) a considerably less energetic subtidal current variability. The results from both frequency-domain empirical orthogonal function and tidal harmonic analyses of the of isotherm displacement series at each of the three moorings in the 100 m array mutually confirm an approximate east-northeastward phase propagation of the dominant M 2 semidiurnal internal tide across Wilkinson Basin. Further investigation supports the idea that this winter internal tide is very likely generated by the interaction of the external tidal currents and the southwestern wall of Wilkinson Basin. The definitions of the local Wilkinson Basin external tide and phase-locked internal tides will enable us to analyze a less "noisy" set of measurements for the subtle atmospherically forced convective and wind-driven motions.

Pediatric sepsis.

PubMed

Mathias, Brittany; Mira, Juan C; Larson, Shawn D

2016-06-01

Sepsis is the leading cause of pediatric death worldwide. In the United States alone, there are 72 000 children hospitalized for sepsis annually with a reported mortality rate of 25% and an economic cost estimated to be $4.8 billion. However, it is only recently that the definition and management of pediatric sepsis has been recognized as being distinct from adult sepsis. The definition of pediatric sepsis is currently in a state of evolution, and there is a large disconnect between the clinical and research definitions of sepsis which impacts the application of research findings into clinical practice. Despite this, it is the speed of diagnosis and the timely implementation of current treatment guidelines that has been shown to improve outcomes. However, adherence to treatment guidelines is currently low and it is only through the implementation of protocols that improved care and outcomes have been demonstrated. The current management of pediatric sepsis is largely based on adaptations from adult sepsis treatment; however, distinct physiology demands more prospective pediatric trials to tailor management to the pediatric population. Adherence to current and emerging practice guidelines will require that protocolized care pathways become a commonplace.

Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study.

PubMed

Perugi, Giulio; Angst, Jules; Azorin, Jean-Michel; Bowden, Charles L; Mosolov, Sergey; Reis, Joao; Vieta, Eduard; Young, Allan H

2015-03-01

To estimate the frequency of mixed states in patients diagnosed with major depressive episode (MDE) according to conceptually different definitions and to compare their clinical validity. This multicenter, multinational cross-sectional Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)-II-MIX study enrolled 2,811 adult patients experiencing an MDE. Data were collected per protocol on sociodemographic variables, current and past psychiatric symptoms, and clinical variables that are risk factors for bipolar disorder. The frequency of mixed features was determined by applying both DSM-5 criteria and a priori described Research-Based Diagnostic Criteria (RBDC). Clinical variables associated with mixed features were assessed using logistic regression. Overall, 212 patients (7.5%) fulfilled DSM-5 criteria for MDE with mixed features (DSM-5-MXS), and 818 patients (29.1%) fulfilled diagnostic criteria for a predefined RBDC depressive mixed state (RBDC-MXS). The most frequent manic/hypomanic symptoms were irritable mood (32.6%), emotional/mood lability (29.8%), distractibility (24.4%), psychomotor agitation (16.1%), impulsivity (14.5%), aggression (14.2%), racing thoughts (11.8%), and pressure to keep talking (11.4%). Euphoria (4.6%), grandiosity (3.7%), and hypersexuality (2.6%) were less represented. In multivariate logistic regression analysis, RBDC-MXS was associated with the largest number of variables including diagnosis of bipolar disorder, family history of mania, lifetime suicide attempts, duration of the current episode > 1 month, atypical features, early onset, history of antidepressant-induced mania/hypomania, and lifetime comorbidity with anxiety, alcohol and substance use disorders, attention-deficit/hyperactivity disorder, and borderline personality disorder. Depressive mixed state, defined as the presence of 3 or more manic/hypomanic features, was present in around one-third of patients experiencing an MDE. The valid symptom, illness course and family history RBDC criteria we assessed identified 4 times more MDE patients as having mixed features and yielded statistically more robust associations with several illness characteristics of bipolar disorder than did DSM-5 criteria. © Copyright 2015 Physicians Postgraduate Press, Inc.

76 FR 42078 - Approval and Promulgation of Implementation Plans; Texas; Revisions to the New Source Review (NSR...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-18

..., and new versions were submitted to EPA on July 22, 1998. This definition was later recodified from 30... Subparagraphs (C) and (D) of that definition for consistency with the CAA, NSR regulations for new and modified... definition ``modification of existing facility.'' EPA is currently reviewing the proposal on Subparagraph (G...

20 CFR 416.201 - General definitions and terms used in this subpart.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false General definitions and terms used in this... INCOME FOR THE AGED, BLIND, AND DISABLED Eligibility General § 416.201 General definitions and terms used... public institution and has no currently usable place to live. By custody we mean the care and control of...

Definitions of Success: Girls at Miss Porter's School Share Their Hopes, Dreams, and Fears

ERIC Educational Resources Information Center

Windsor, Katherine Gladstone

2010-01-01

This study explores how girls currently enrolled and recently graduated from Miss Porter's School, Farmington, Connecticut, define success and the role gender plays in their definition(s). Data were collected from semi-structured student interviews, written responses by the students to a prompt designed to elicit personal conceptions of success,…

Interim definitions for old growth Douglas-fir and mixed-conifer forests in the Pacific Northwest and California.

Treesearch

J.F. Franklin; F. Hall; W. Laudenslayer; C. Maser; J. Nunan; J. Poppino; C.J. Ralph; T. Spies

1986-01-01

Interim definitions of old-growth forests are provided to guide efforts in land-management planning until comprehensive definitions based on research that is currently underway can be formulated. The basic criteria for identifying old-growth Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) and mixed-conifer forests in western Washington and...

Aperiodic crystals and beyond.

PubMed

Grimm, Uwe

2015-06-01

Crystals are paradigms of ordered structures. While order was once seen as synonymous with lattice periodic arrangements, the discoveries of incommensurate crystals and quasicrystals led to a more general perception of crystalline order, encompassing both periodic and aperiodic crystals. The current definition of crystals rests on their essentially point-like diffraction. Considering a number of recently investigated toy systems, with particular emphasis on non-crystalline ordered structures, the limits of the current definition are explored.

Current situation of asthma-COPD overlap syndrome (ACOS) in Chinese patients older than 40 years with airflow limitation: rationale and design for a multicenter, cross-sectional trial (study protocol).

PubMed

Kang, Jian; Yao, Wanzhen; Cai, Baiqiang; Chen, Ping; Ling, Xia; Shang, Hongyan

2016-12-01

Asthma and chronic obstructive pulmonary disease (COPD) are the frequently occurring chronic airway diseases, and the overlapping syndrome observed in the majority of patients has been recently defined as asthma-COPD overlap syndrome (ACOS) by the Global Initiative for Chronic Obstructive Lung (GOLD, 2014) and Global initiative for Asthma (GINA, 2015). The proportion, features, and clinical practice of ACOS still remain elusive in China. We are conducting this multicenter, cross-sectional, observational study (NCT02600221) to investigate the distributions of chronic obstructive diseases in patients >40 years of age with chronic airflow limitation in China along with determination of the main clinical practice and features of these diseases. The study will also explore the factors that may influence the exacerbations and severity of ACOS in Chinese patients (>40 years of age). A total of 2,000 patients (age, ≥40 years; either sex) who are clinically diagnosed as having asthma, COPD/chronic bronchitis/emphysema, or ACOS for at least 12 months with airflow limitation [post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV 1 /FVC): <0.7] will be enrolled from approximately 20 sites in China between December 2015 and December 2016. The proportion of ACOS among patients older than 40 years based on GINA 2015 and GOLD 2014 definitions is the primary variable. Following were the secondary variables: the proportions of COPD and asthma among the patients, distributions of the severity of airflow limitation, distribution of groups according to GOLD 2011 group definition (A, B, C, D), and the distribution of medication by drug class in patients with ACOS, asthma, and COPD. Acute exacerbation history, hospitalization, and severity of ACOS as evaluated using COPD Assessment Test, Asthma Control Questionnaire-5, and Modified British Medical Research Council in patients with ACOS were also assessed. This will be the first study to disseminate scientific knowledge on the current situation, main clinical practice, and features of ACOS, asthma, and COPD conditions in Chinese patients. The insights will be helpful in designing optimal management strategies for ACOS and redefining the healthcare development programs.

Factors influencing householders' access to improved water in low-income urban areas of Accra, Ghana.

PubMed

Mahama, Ayisha Matuamo; Anaman, Kwabena Asomanin; Osei-Akoto, Isaac

2014-06-01

We analysed householders' access to improved water for drinking and other domestic uses in five selected low-income urban areas of Accra, Ghana using a survey of 1,500 households. Our definitions of improved water were different from those suggested by the World Health Organization (WHO). The results revealed that only 4.4% of the respondents had access to improved drinking water compared to 40.7% using the WHO definition. However, 88.7% of respondents had access to improved water for domestic uses compared to 98.3% using the WHO definition. Using logistic regression analysis, we established that the significant determinant of householders' access to improved drinking water was income. However, for access to improved water for other domestic uses, the significant factors were education, income and location of the household. Compared to migrants, indigenous people and people from mixed areas were less likely to have access to improved water for other domestic purposes. For the analysis using the WHO definitions, most of the independent variables were not statistically significant in determining householders' access, and those variables that were significant generated parameter estimates inconsistent with evidence from the literature and anecdotal evidence from officials of public health and water supply companies in Ghana.

Detecting Periprocedural Myocardial Infarction in Contemporary Percutaneous Coronary Intervention Trials.

PubMed

Spitzer, Ernest; de Vries, Ton; Cavalcante, Rafael; Tuinman, Marieke; Rademaker-Havinga, Tessa; Alkema, Maaike; Morel, Marie-Angele; Soliman, Osama I; Onuma, Yoshinobu; van Es, Gerrit-Anne; Tijssen, Jan G P; McFadden, Eugene; Serruys, Patrick W

2017-04-10

This study sought to investigate the differences in detecting (e.g., triggering) periprocedural myocardial infarction (PMI) among 3 current definitions. PMI is a frequent component of primary endpoints in coronary device trials. Identification of all potential suspected events is critical for accurate event ascertainment. Automatic triggers based on study databases prevent underreporting of events. We generated automated algorithms to trigger PMI based on each definition and compared results using data from the RESOLUTE all comers trial. The operationalization of current PMI definitions was achieved by defining programmable algorithms used to interrogate the study database. From a total of 636 PMI triggers, we identified 234 for the World Health Organization extended definition, 382 for the Third Universal definition, and 216 for the Society for Cardiovascular Angiography and Interventions definition. Differences among the biomarkers used, different cutoff values, and in the hierarchy among biomarkers within definitions, yielded a different number of triggers, and identified unique triggers for each definition. Only 38 triggers were consistently identified by all definitions. Availability of ECG data, eCRF data on clinical presentation, and the reporting of >2 post-procedural values of the same biomarker influenced considerably the number of PMI triggers identified. PMI definitions are not interchangeable. The number of triggers identified and consequently the potential number of events varies significantly, highlighting the importance of rigorous methodology when PMI is a component of a powered endpoint. Emphasis on collection of biomarkers, ECG data, and clinical status at baseline may improve the correct identification of PMI triggers. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Validity of a simpler definition of major depressive disorder.

PubMed

Zimmerman, Mark; Galione, Janine N; Chelminski, Iwona; Young, Diane; Dalrymple, Kristy; Witt, Caren Francione

2010-10-01

In previous reports from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we developed a briefer definition of major depressive disorder (MDD), and found high levels of agreement between the simplified and DSM-IV definitions of MDD. The goal of the present study was to examine the validity of the simpler definition of MDD. We hypothesized that compared to patients with adjustment disorder, patients with MDD would be more severely depressed, have poorer psychosocial functioning, have greater suicidal ideation at the time of the intake evaluation, and have an increased morbid risk for depression in their first-degree family members. We compared 1,486 patients who met the symptom criteria for current MDD according to either DSM-IV or the simpler definition to 145 patients with a current diagnosis of adjustment disorder with depressed mood or depressed and anxious mood. The patients with MDD were more severely depressed, more likely to have missed time from work due to psychiatric reasons, reported higher levels of suicidal ideation, and had a significantly higher morbid risk for depression in their first-degree family members. Both definitions of MDD were valid. The simpler definition of MDD was as valid as the DSM-IV definition. This new definition offers two advantages over the DSM-IV definition-it is briefer and therefore more likely to be recalled and applied in clinical practice, and it is free of somatic symptoms thereby making it easier to apply with medically ill patients. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.

A sensitivity analysis on the variability in accelerometer data processing for monitoring physical activity.

PubMed

Lee, Paul H

2015-02-01

Accelerometers are gaining popularity for measuring physical activity, but there are many different ways to process accelerometer data. A sensitivity analysis was conducted to study the effect of varying accelerometer data processing protocols on estimating the association between PA level and socio-demographic characteristics using the National Health and Nutrition Examination Survey (NHANES) accelerometer data. The NHANES waves 2003-2004 and 2005-2006 accelerometer data (n=14,072) were used to investigate the effect of changing the accelerometer non-wearing time and valid day definitions on the demographic composition of the filtered datasets and the association between physical activity (PA) and socio-demographic characteristics (sex, age, race, educational level, marital status). Under different filtering rules (minimum number of valid day and definition of non-wear time), the demographic characteristics of the final sample varied. The proportion of participants aged 20-29 decreased from 18.9% to 15.8% when the minimum number of valid days required increased from 1 to 4 (p for trend<0.001), whereas that for aged ≥70 years increased from 18.9% to 20.6% (p for trend<0.001). Furthermore, with different filters, the effect of these demographic variables and PA varied, with some variables being significant under certain filtering rules but becoming insignificant under some other rules. The sensitivity analysis showed that the significance of the association between socio-demographic variables and PA could be varied with the definition of non-wearing time and minimum number of valid days. Copyright © 2014 Elsevier B.V. All rights reserved.

Effect of reference conditions on flow rate, modifier fraction and retention in supercritical fluid chromatography.

PubMed

De Pauw, Ruben; Shoykhet Choikhet, Konstantin; Desmet, Gert; Broeckhoven, Ken

2016-08-12

When using compressible mobile phases such as fluidic CO2, the density, the volumetric flow rates and volumetric fractions are pressure dependent. The pressure and temperature definition of these volumetric parameters (referred to as the reference conditions) may alter between systems, manufacturers and operating conditions. A supercritical fluid chromatography system was modified to operate in two modes with different definition of the eluent delivery parameters, referred to as fixed and variable mode. For the variable mode, the volumetric parameters are defined with reference to the pump operating pressure and actual pump head temperature. These conditions may vary when, e.g. changing the column length, permeability, flow rate, etc. and are thus variable reference conditions. For the fixed mode, the reference conditions were set at 150bar and 30°C, resulting in a mass flow rate and mass fraction of modifier definition which is independent of the operation conditions. For the variable mode, the mass flow rate of carbon dioxide increases with system pump operating pressure, decreasing the fraction of modifier. Comparing the void times and retention factor shows that the deviation between the two modes is almost independent of modifier percentage, but depends on the operating pressure. Recalculating the set volumetric fraction of modifier to the mass fraction results in the same retention behaviour for both modes. This shows that retention in SFC can be best modelled using the mass fraction of modifier. The fixed mode also simplifies method scaling as it only requires matching average column pressure. Copyright © 2016 Elsevier B.V. All rights reserved.

Translating Fatigue to Human Performance.

PubMed

Enoka, Roger M; Duchateau, Jacques

2016-11-01

Despite flourishing interest in the topic of fatigue-as indicated by the many presentations on fatigue at the 2015 Annual Meeting of the American College of Sports Medicine-surprisingly little is known about its effect on human performance. There are two main reasons for this dilemma: 1) the inability of current terminology to accommodate the scope of the conditions ascribed to fatigue, and 2) a paucity of validated experimental models. In contrast to current practice, a case is made for a unified definition of fatigue to facilitate its management in health and disease. On the basis of the classic two-domain concept of Mosso, fatigue is defined as a disabling symptom in which physical and cognitive function is limited by interactions between performance fatigability and perceived fatigability. As a symptom, fatigue can only be measured by self-report, quantified as either a trait characteristic or a state variable. One consequence of such a definition is that the word fatigue should not be preceded by an adjective (e.g., central, mental, muscle, peripheral, and supraspinal) to suggest the locus of the changes responsible for an observed level of fatigue. Rather, mechanistic studies should be performed with validated experimental models to identify the changes responsible for the reported fatigue. As indicated by three examples (walking endurance in old adults, time trials by endurance athletes, and fatigue in persons with multiple sclerosis) discussed in the review, however, it has proven challenging to develop valid experimental models of fatigue. The proposed framework provides a foundation to address the many gaps in knowledge of how laboratory measures of fatigue and fatigability affect real-world performance.

Translating Fatigue to Human Performance

PubMed Central

Enoka, Roger M.; Duchateau, Jacques

2016-01-01

Despite flourishing interest in the topic of fatigue—as indicated by the many presentations on fatigue at the 2015 annual meeting of the American College of Sports Medicine—surprisingly little is known about its impact on human performance. There are two main reasons for this dilemma: (1) the inability of current terminology to accommodate the scope of the conditions ascribed to fatigue, and (2) a paucity of validated experimental models. In contrast to current practice, a case is made for a unified definition of fatigue to facilitate its management in health and disease. Based on the classic two-domain concept of Mosso, fatigue is defined as a disabling symptom in which physical and cognitive function is limited by interactions between performance fatigability and perceived fatigability. As a symptom, fatigue can only be measured by self-report, quantified as either a trait characteristic or a state variable. One consequence of such a definition is that the word fatigue should not be preceded by an adjective (e.g., central, mental, muscle, peripheral, and supraspinal) to suggest the locus of the changes responsible for an observed level of fatigue. Rather, mechanistic studies should be performed with validated experimental models to identify the changes responsible for the reported fatigue. As indicated by three examples (walking endurance in old adults, time trials by endurance athletes, and fatigue in persons with multiple sclerosis) discussed in the review, however, it has proven challenging to develop valid experimental models of fatigue. The proposed framework provides a foundation to address the many gaps in knowledge of how laboratory measures of fatigue and fatigability impact real-world performance. PMID:27015386

Variability of total step activity in children with cerebral palsy: influence of definition of a day on participant retention within the study.

PubMed

Wilson, Nichola C; Mudge, Suzie; Stott, N Susan

2016-08-20

Activity monitoring is important to establish accurate daily physical activity levels in children with cerebral palsy (CP). However, few studies address issues around inclusion or exclusion of step count data; in particular, how a valid day should be defined and what impact different lengths of monitoring have on retention of participant data within a study. This study assessed how different 'valid day' definitions influenced inclusion of participant data in final analyses and the subsequent variability of the data. Sixty-nine children with CP were fitted with a StepWatch™ Activity Monitor and instructed to wear it for a week. Data analysis used two broad definitions of a day, based on either number of steps in a 24 h monitoring period or the number of hours of recorded activity in a 24 h monitoring period. Eight children either did not use the monitor, or used it for only 1 day. The remaining 61 children provided 2 valid days of monitoring defined as >100 recorded steps per 24 h period and 55 (90 %) completed 2 valid days of monitoring with ≥10 h recorded activity per 24 h period. Performance variability in daily step count was lower across 2 days of monitoring when a valid day was defined as ≥10 h recorded activity per 24 h period (ICC = 0.765) and, higher when the definition >100 recorded steps per 24 h period (ICC = 0.62). Only 46 participants (75 %) completed 5 days of monitoring with >100 recorded steps per 24 h period and only 23 (38 %) achieved 5 days of monitoring with ≥10 h recorded activity per 24 h period. Datasets of participants who functioned at GMFCS level II were differentially excluded when the criteria for inclusion in final analysis was 5 valid days of ≥10 h recorded activity per 24 h period, leaving datasets available for only 8 of 32 participant datasets retained in the study. We conclude that changes in definition of a valid day have significant impacts on both inclusion of participant data in final analysis and measured variability of total step count.

Aldosterone breakthrough in dogs with naturally occurring myxomatous mitral valve disease.

PubMed

Ames, M K; Atkins, C E; Eriksson, A; Hess, A M

2017-06-01

Aldosterone breakthrough (ABT) is the condition in which angiotensin converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers fail to effectively suppress the activity of the renin angiotensin aldosterone system. The objective of this study was to determine if ABT occurs in dogs with naturally occurring myxomatous mitral valve disease receiving an ACEI, using the urine aldosterone to creatinine ratio (UAldo:C) as a measure of renin angiotensin aldosterone system activation. This study includes 39 dogs with myxomatous mitral valve disease. A UAldo:C cut-off definition (derived from a normal population of healthy, adult, and client-owned dogs) was used to determine the prevalence of ABT in this population. Spearman analysis and univariate logistic regression were used to evaluate the relationship between UAldo:C and ABT (yes/no) and eight variables (age, serum K + concentration, serum creatinine concentration, ACEI therapy duration and ACEI dosage, furosemide therapy duration and furosemide dosage, and urine sample storage time). Finally, the UAldo:C in dogs receiving spironolactone, as part congestive heart failure (CHF) therapy, was compared to dogs with CHF that were not receiving spironolactone. The prevalence of ABT was 32% in dogs with CHF and 30% in dogs without CHF. There was no relationship between either the UAldo:C or the likelihood of ABT and the eight variables. Therapy with spironolactone lead to a significant elevation of the UAldo:C. Using the UAldo:C and a relatively stringent definition of ABT, it appears that incomplete RAAS blockade is common in dogs with MMVD receiving an ACEI. The prevalence of ABT in this canine population mirrors that reported in humans. While the mechanism of ABT is likely multifactorial and still poorly understood, the proven existence of ABT in dogs offers the potential to improve the prognosis for MMVD with the addition of a mineralocorticoid receptor blocker to current therapeutic regimens. Approximately 30% of dogs being treated for heart disease and CHF satisfied the definition of ABT. Identifying patient subpopulations experiencing ABT may help guide future study design and clinical decision-making. Copyright © 2017 Elsevier B.V. All rights reserved.

EPR and Bell's theorem: A critical review

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

Stapp, H.P.

1991-01-01

The argument of Einstein, Podolsky, and Rosen is reviewed with attention to logical structure and character of assumptions. Bohr's reply is discussed. Bell's contribution is formulated without use of hidden variables, and efforts to equate hidden variables to realism are critically examined. An alternative derivation of nonlocality that makes no use of hidden variables, microrealism, counterfactual definiteness, or any other assumption alien to orthodox quantum thinking is described in detail, with particular attention to the quartet or broken-square question.

Subjective cognitive impairment: Towards early identification of Alzheimer disease.

PubMed

Garcia-Ptacek, S; Eriksdotter, M; Jelic, V; Porta-Etessam, J; Kåreholt, I; Manzano Palomo, S

2016-10-01

Neurodegeneration in Alzheimer disease (AD) begins decades before dementia and patients with mild cognitive impairment (MCI) already demonstrate significant lesion loads. Lack of information about the early pathophysiology in AD complicates the search for therapeutic strategies.Subjective cognitive impairment is the description given to subjects who have memory-related complaints without pathological results on neuropsychological tests. There is no consensus regarding this heterogeneous syndrome, but at least some of these patients may represent the earliest stage in AD. We reviewed available literature in order to summarise current knowledge on subjective cognitive impairment. Although they may not present detectable signs of disease, SCI patients as a group score lower on neuropsychological tests than the general population does, and they also have a higher incidence of future cognitive decline. Depression and psychiatric co-morbidity play a role but cannot account for all cognitive complaints. Magnetic resonance imaging studies in these patients reveal a pattern of hippocampal atrophy similar to that of amnestic mild cognitive impairment and functional MRI shows increased activation during cognitive tasks which might indicate compensation for loss of function. Prevalence of an AD-like pattern of beta-amyloid (Aβ42) and tau proteins in cerebrospinal fluid is higher in SCI patients than in the general population. Memory complaints are relevant symptoms and may predict AD. Interpatient variability and methodological differences between clinical studies make it difficult to assign a definition to this syndrome. In the future, having a standard definition and longitudinal studies with sufficient follow-up times and an emphasis on quantifiable variables may clarify aspects of early AD. Copyright © 2012 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Contrast features of breast cancer in frequency-domain laser scanning mammography

NASA Astrophysics Data System (ADS)

Moesta, K. Thomas; Fantini, Sergio; Jess, Helge; Totkas, Susan; Franceschini, Maria-Angela; Kaschke, Michael; Schlag, Peter M.

1998-04-01

Frequency-domain optical mammography has been advocated to improve contrast and thus cancer detectability in breast transillumination. To the best of our knowledge, this report provides the first systematic clinical results of a frequency-domain laser scanning mammograph (FLM). The instrument provides monochromatic light at 690 and 810 nm, whose intensity is modulated at 110.0008 MHz, respectively. The breast is scanned by stepwise positioning of source and detector, and amplitude and phase for both wavelengths are measured by a photomultiplier tube using heterodyne detection. Images are formed representing amplitude or phase data on linear gray scales. Furthermore, various algorithms carrying on more than one signal were essayed. Twenty visible cancers out of 25 cancers in the first 59 investigations were analyzed for their quantitative contrast with respect to the whole breast or to defined reference areas. Contrast definitions refer to the signal itself, to the signal noise, or were based on nonparametric comparison. The amplitude signal provides better contrast than the phase signal. Ratio images between red and IR amplitudes gave variable results; in some cases the tumor contrast was canceled. The algorithms to determine (mu) a and (mu) sPRM from amplitude and phase data did not significantly improve upon objective contrast. The N algorithm, using the phase signal to flatten the amplitude signal did significantly improve upon contrast according to contrast definitions 1 and 2, however, did not improve upon nonparametric contrast. Thus, with the current instrumentation, the phase signal is helpful to correct for the complex and variable geometry of the breast. However, an independent informational content for tumor differentiation could not be determined. The flat field algorithm did greatly enhance optical contrast in comparison with amplitude or amplitude ratio images. Further evaluation of FLM will have to be based on the N-algorithm images.

A new definition of pharmaceutical quality: assembly of a risk simulation platform to investigate the impact of manufacturing/product variability on clinical performance.

PubMed

Short, Steven M; Cogdill, Robert P; D'Amico, Frank; Drennen, James K; Anderson, Carl A

2010-12-01

The absence of a unanimous, industry-specific definition of quality is, to a certain degree, impeding the progress of ongoing efforts to "modernize" the pharmaceutical industry. This work was predicated on requests by Dr. Woodcock (FDA) to re-define pharmaceutical quality in terms of risk by linking production characteristics to clinical attributes. A risk simulation platform that integrates population statistics, drug delivery system characteristics, dosing guidelines, patient compliance estimates, production metrics, and pharmacokinetic, pharmacodynamic, and in vitro-in vivo correlation models to investigate the impact of manufacturing variability on clinical performance of a model extended-release theophylline solid oral dosage system was developed. Manufacturing was characterized by inter- and intra-batch content uniformity and dissolution variability metrics, while clinical performance was described by a probabilistic pharmacodynamic model that expressed the probability of inefficacy and toxicity as a function of plasma concentrations. Least-squares regression revealed that both patient compliance variables, percent of doses taken and dosing time variability, significantly impacted efficacy and toxicity. Additionally, intra-batch content uniformity variability elicited a significant change in risk scores for the two adverse events and, therefore, was identified as a critical quality attribute. The proposed methodology demonstrates that pharmaceutical quality can be recast to explicitly reflect clinical performance. © 2010 Wiley-Liss, Inc. and the American Pharmacists Association

A new approach to identify, classify and count drugrelated events

PubMed Central

Bürkle, Thomas; Müller, Fabian; Patapovas, Andrius; Sonst, Anja; Pfistermeister, Barbara; Plank-Kiegele, Bettina; Dormann, Harald; Maas, Renke

2013-01-01

Aims The incidence of clinical events related to medication errors and/or adverse drug reactions reported in the literature varies by a degree that cannot solely be explained by the clinical setting, the varying scrutiny of investigators or varying definitions of drug-related events. Our hypothesis was that the individual complexity of many clinical cases may pose relevant limitations for current definitions and algorithms used to identify, classify and count adverse drug-related events. Methods Based on clinical cases derived from an observational study we identified and classified common clinical problems that cannot be adequately characterized by the currently used definitions and algorithms. Results It appears that some key models currently used to describe the relation of medication errors (MEs), adverse drug reactions (ADRs) and adverse drug events (ADEs) can easily be misinterpreted or contain logical inconsistencies that limit their accurate use to all but the simplest clinical cases. A key limitation of current models is the inability to deal with complex interactions such as one drug causing two clinically distinct side effects or multiple drugs contributing to a single clinical event. Using a large set of clinical cases we developed a revised model of the interdependence between MEs, ADEs and ADRs and extended current event definitions when multiple medications cause multiple types of problems. We propose algorithms that may help to improve the identification, classification and counting of drug-related events. Conclusions The new model may help to overcome some of the limitations that complex clinical cases pose to current paper- or software-based drug therapy safety. PMID:24007453

16 CFR 437.1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... use or operation of equipment, displays, vending machines, or similar devices, owned, leased... results based upon a combination of variables; and (2) Any statements from which a prospective purchaser...

16 CFR 437.1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... use or operation of equipment, displays, vending machines, or similar devices, owned, leased... results based upon a combination of variables; and (2) Any statements from which a prospective purchaser...

FOSSIL2 energy policy model documentation: FOSSIL2 documentation

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

None

1980-10-01

This report discusses the structure, derivations, assumptions, and mathematical formulation of the FOSSIL2 model. Each major facet of the model - supply/demand interactions, industry financing, and production - has been designed to parallel closely the actual cause/effect relationships determining the behavior of the United States energy system. The data base for the FOSSIL2 program is large, as is appropriate for a system dynamics simulation model. When possible, all data were obtained from sources well known to experts in the energy field. Cost and resource estimates are based on DOE data whenever possible. This report presents the FOSSIL2 model at severalmore » levels. Volumes II and III of this report list the equations that comprise the FOSSIL2 model, along with variable definitions and a cross-reference list of the model variables. Volume II provides the model equations with each of their variables defined, while Volume III lists the equations, and a one line definition for equations, in a shorter, more readable format.« less

Definitions of metabolic syndrome: Where are we now?

PubMed

Daskalopoulou, Stella S; Athyros, Vassilis G; Kolovou, Genovefa D; Anagnostopoulou, Katherine K; Mikhailidis, Dimitri P

2006-07-01

The metabolic syndrome (MetS) is a cluster of metabolic abnormalities including abdominal obesity, glucose intolerance, hypertension and dyslipidaemia and is associated with an increased risk of vascular events. Since the initial description of the MetS, several expert groups produced different definitions. This variability led to confusion and absence of comparability between studies. Although there is agreement that the MetS is a major public health challenge worldwide and consistent evidence stresses the need for intervention, the definition of the syndrome remains a matter of debate. This review considers the different definitions of the MetS. These include those proposed by the World Health Organisation, the European Group for the Study of Insulin Resistance, the National Cholesterol Education Program Adult Treatment Panel III, the American College of Endocrinology and American Association of Clinical Endocrinologists and the latest International Diabetes Federation definition which includes ethnic-specific waist circumference cut-off points. These definitions share several features but also include important differences; all have limitations. Selected (after a Medline search) studies comparing the different definitions are also considered. There is a need for a standardised definition of the MetS. Furthermore, a definition tailored for children and adolescents is essential. Prospective long-term studies are needed to validate the prognostic power of these definitions. As new information becomes available the definition of the MetS might be further modified.

Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community dwelling seniors age 65 and older

USDA-ARS?s Scientific Manuscript database

Purpose: To compare the extent to which 7 available definitions of sarcopenia and 2 related definitions predict the prospective rate of falling. Methods: We studied a cohort of 445 seniors (mean age 71 years, 45% men) living in the community who were followed with a detailed fall assessment for 3 ...

Nursing diagnosis: is it time for a new definition?

PubMed

Herdman, T Heather

2008-01-01

The Diagnosis Development Committee (DDC) of NANDA International frequently receives proposed "physiologic" and "surveillance diagnosis" submissions that may not meet the current definition of nursing diagnosis (NANDA, 2007, p. 332). There has been a request for a vote on newly proposed definitions of nursing diagnosis, risk diagnosis, and syndromes. The purpose of this article is to provide information which enables members and interested nurses to continue the dialogue and to share their thoughts and also to consider the thoughts and information generated by the participants in the NANDA-I interest survey on the definition of nursing diagnoses. An electronic survey of the current NANDA-I definitions, and potential changes to those definitions, was distributed via the NANDA-I Web site. This article summarizes the overall findings of that survey and provides an overview of commentary received from the 269 participants. It is necessary to continue the dialogue on this important decision and to provide a mechanism for input from members and interested nurses before reaching any conclusions on this subject. NANDA-I has been recognized as the leader in the development and implementation of nursing diagnoses and must act responsibly in assessing the changing and emerging trends in nursing practice and in responding to these trends.

Command and Control in a Complex World

DTIC Science & Technology

2012-05-22

definition of command and control does not adequately address changes introduced through technology trends, our understanding of the global operating...processes. The current joint definition of command and control does not adequately address changes introduced through technology trends, our...the problem is actually solved.  There are no  definitive ,  objective solutions to wicked problems.  For a complete  definition  of wicked problems, see

Acute respiratory distress syndrome: the Berlin Definition.

PubMed

Ranieri, V Marco; Rubenfeld, Gordon D; Thompson, B Taylor; Ferguson, Niall D; Caldwell, Ellen; Fan, Eddy; Camporota, Luigi; Slutsky, Arthur S

2012-06-20

The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg < PaO2/FIO2 ≤ 300 mm Hg), moderate (100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg), and severe (PaO2/FIO2 ≤ 100 mm Hg) and 4 ancillary variables for severe ARDS: radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive end-expiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min). The draft Berlin Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P < .001) and increased median duration of mechanical ventilation in survivors (5 days; interquartile [IQR], 2-11; 7 days; IQR, 4-14; and 9 days; IQR, 5-17, respectively; P < .001). Compared with the AECC definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P < .001). This updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.

Management of stroke as described by Ibn Sina (Avicenna) in the Canon of Medicine.

PubMed

Zargaran, Arman; Zarshenas, Mohammad M; Karimi, Aliasghar; Yarmohammadi, Hassan; Borhani-Haghighi, Afshin

2013-11-15

Stroke or cerebrovascular accident (CVA) is caused by a disturbance of the blood supply to the brain and an accruing loss of brain function. The first recorded observations were in 2455 BC and it has been studied intensely by ancient physicians throughout history. In the early medieval period, Ibn Sina (980-1025 AD) called stroke sekteh and described it extensively. Some of Ibn Sina's definitions and his etiology of stroke are based on humoral theories and cannot be compared with medical current concepts, but most of his descriptions concur with current definitions. This review examines the definition and etiology, clinical manifestations, prognosis, differential diagnosis, and interventions for stroke based on Ibn Sina's epic work, Canon of Medicine. The pharmacological effects of medicinal herbs suggested by Ibn Sina for stroke are examined in light of current knowledge. © 2013.

Prevalence of Sarcopenic Obesity in Adults with Class II/III Obesity Using Different Diagnostic Criteria.

PubMed

Johnson Stoklossa, Carlene A; Sharma, Arya M; Forhan, Mary; Siervo, Mario; Padwal, Raj S; Prado, Carla M

2017-01-01

Background/Objective . Sarcopenic obesity (SO) is a hidden condition of reduced lean soft tissue (LST) in context of excess adiposity. SO is most commonly reported in older adults and both its risk and prevalence increase with age. A variety of body composition indices and cut points have been used to define this condition, leading to conflicting prevalence and risk prediction. Here, we investigate variability in the prevalence of SO in an adult sample of individuals with class II/III obesity (BMI ≥ 35 kg/m 2 ) using different diagnostic criteria. Methods . SO definitions were identified from a literature review of studies using dual-energy X-ray absorptiometry (DXA) to assess LST. Demographics, anthropometrics, and body composition (by DXA) were measured in n = 120, 86% female (46.9 ± 11.1 years). Results . LST was extremely variable in individuals, even with similar body sizes, and observed across the age spectrum. The prevalence of SO ranged from 0 to 84.5% in females and 0 to 100% in males, depending upon the definition applied, with higher prevalence among definitions accounting for measures of body size or fat mass. Conclusion . SO is present, yet variable, in adults with class II/III obesity. Accounting for body mass or fat mass may identify a higher number of individuals with SO, although risk prediction remains to be studied.

What Is Real-World Data? A Review of Definitions Based on Literature and Stakeholder Interviews.

PubMed

Makady, Amr; de Boer, Anthonius; Hillege, Hans; Klungel, Olaf; Goettsch, Wim

Despite increasing recognition of the value of real-world data (RWD), consensus on the definition of RWD is lacking. To review definitions publicly available for RWD to shed light on similarities and differences between them. A literature review and stakeholder interviews were used to compile data from eight groups of stakeholders. Data from documents and interviews were subjected to coding analysis. Definitions identified were classified into four categories: 1) data collected in a non-randomized controlled trial setting, 2) data collected in a non-interventional/non-controlled setting, 3) data collected in a non-experimental setting, and 4) others (i.e., data that do not fit into the other three categories). The frequency of definitions identified per category was recorded. Fifty-three documents and 20 interviews were assessed. Thirty-eight definitions were identified: 20 out of 38 definitions (53%) were category 1 definitions, 9 (24%) were category 2 definitions, 5 (13%) were category 3 definitions, and 4 (11%) were category 4 definitions. Differences were identified between, and within, definition categories. For example, opinions differed on the aspects of intervention with which non-interventional/non-controlled settings should abide. No definitions were provided in two interviews or identified in 33 documents. Most of the definitions defined RWD as data collected in a non-randomized controlled trial setting. A considerable number of definitions, however, diverged from this concept. Moreover, a significant number of authors and stakeholders did not have an official, institutional definition for RWD. Persisting variability in stakeholder definitions of RWD may lead to disparities among different stakeholders when discussing RWD use in decision making. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

What is the definition of sports-related concussion: a systematic review.

PubMed

McCrory, Paul; Feddermann-Demont, Nina; Dvořák, Jiří; Cassidy, J David; McIntosh, Andrew; Vos, Pieter E; Echemendia, Ruben J; Meeuwisse, Willem; Tarnutzer, Alexander A

2017-06-01

Various definitions for concussion have been proposed, each having its strengths and weaknesses. We reviewed and compared current definitions and identified criteria necessary for an operational definition of sports-related concussion (SRC) in preparation of the 5th Concussion Consensus Conference (Berlin, Germany). We also assessed the role of biomechanical studies in informing an operational definition of SRC. This is a systematic literature review. Data sources include MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Clinical Trials and SPORT Discus (accessed 14 September 2016). Eligibility criteria were studies reporting (clinical) criteria for diagnosing SRC and studies containing SRC impact data. Out of 1601 articles screened, 36 studies were included (2.2%), 14 reported on criteria for SRC definitions and 22 on biomechanical aspects of concussions. Six different operational definitions focusing on clinical findings and their dynamics were identified. Biomechanical studies were obtained almost exclusively on American football players. Angular and linear head accelerations linked to clinically confirmed concussions demonstrated considerable individual variation. SRC is a traumatic brain injury that is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces with several common features that help define its nature. Limitations identified include that the current criteria for diagnosing SRC are clinically oriented and that there is no gold/standard to assess their diagnostic properties. A future, more valid definition of SRC would better identify concussed players by demonstrating high predictive positive/negative values. Currently, the use of helmet-based systems to study the biomechanics of SRC is limited to few collision sports. New approaches need to be developed to provide objective markers for SRC. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Problem of Defining Intelligence.

ERIC Educational Resources Information Center

Lubar, David

1981-01-01

The major philosophical issues surrounding the concept of intelligence are reviewed with respect to the problems surrounding the process of defining and developing artificial intelligence (AI) in computers. Various current definitions and problems with these definitions are presented. (MP)

Defining sarcopenia

USDA-ARS?s Scientific Manuscript database

Currently there is no standardized definition of sarcopenia. This hampers the clinical management of sarcopenia and retards the development and regulatory approval of interventions to reduce the progression of this common and debilitating condition in the elderly. Nine definitions of sarcopenia have...

32 CFR 2103.21 - Definition and application.

Code of Federal Regulations, 2010 CFR

2010-07-01

....21 National Defense Other Regulations Relating to National Defense NATIONAL SECURITY COUNCIL... DECLASSIFIED Derivative Classification § 2103.21 Definition and application. Derivative classification is the... substance as information that is currently classified. Thus, derivative classification may be accomplished...

Insufficient evidence to support separate BMI definitions for obesity in children and adolescents from south Asian ethnic groups in the UK.

PubMed

Viner, R M; Cole, Tim J; Fry, T; Gupta, S; Kinra, S; McCarthy, D; Saxena, S; Taylor, S; Wells, J C K; Whincup, P; Zaman, M J S

2010-04-01

Re-evaluation of adult obesity thresholds in some ethnic groups has led to the questioning of childhood obesity thresholds. An expert group was convened to examine the representativeness of childhood obesity definitions, evidence for ethnic differences in body composition in UK children and the extent of misclassification of adiposity by current body mass index (BMI) thresholds in south Asian and black groups. The group concluded that the current International Obesity Task Force (IOTF) definitions remained the most appropriate for use in the United Kingdom, but further research was needed on the relationship of body shape, fat mass, metabolic markers and ethnicity in children and adolescents.

Systematic Model-in-the-Loop Test of Embedded Control Systems

NASA Astrophysics Data System (ADS)

Krupp, Alexander; Müller, Wolfgang

Current model-based development processes offer new opportunities for verification automation, e.g., in automotive development. The duty of functional verification is the detection of design flaws. Current functional verification approaches exhibit a major gap between requirement definition and formal property definition, especially when analog signals are involved. Besides lack of methodical support for natural language formalization, there does not exist a standardized and accepted means for formal property definition as a target for verification planning. This article addresses several shortcomings of embedded system verification. An Enhanced Classification Tree Method is developed based on the established Classification Tree Method for Embeded Systems CTM/ES which applies a hardware verification language to define a verification environment.

Obsessionality & compulsivity: a phenomenology of obsessive-compulsive disorder.

PubMed

Denys, Damiaan

2011-02-01

Progress in psychiatry depends on accurate definitions of disorders. As long as there are no known biologic markers available that are highly specific for a particular psychiatric disorder, clinical practice as well as scientific research is forced to appeal to clinical symptoms. Currently, the nosology of obsessive-compulsive disorder is being reconsidered in view of the publication of DSM-V. Since our diagnostic entities are often simplifications of the complicated clinical profile of patients, definitions of psychiatric disorders are imprecise and always indeterminate. This urges researchers and clinicians to constantly think and rethink well-established definitions that in psychiatry are at risk of being fossilised. In this paper, we offer an alternative view to the current definition of obsessive-compulsive disorder from a phenomenological perspective. TRANSLATION: This article is translated from Dutch, originally published in [Handbook Obsessive-compulsive disorders, Damiaan Denys, Femke de Geus (Eds.), (2007). De Tijdstroom uitgeverij BV, Utrecht. ISBN13: 9789058980878.].

Determining the value of the fine-structure constant from a current balance: Getting acquainted with some upcoming changes to the SI

NASA Astrophysics Data System (ADS)

Davis, Richard S.

2017-05-01

The revised International System of Units (SI), expected to be approved late in 2018, has implications for physics pedagogy. The ampere definition, which dates from 1948, will be replaced by a definition that fixes the numerical value of the elementary charge e in coulombs. The kilogram definition, which dates from 1889, will be replaced by a definition that fixes the numerical value of the Planck constant h in joule seconds. Existing SI equations will be completely unaffected. However, there will be a largely negligible, but nevertheless necessary, change to published numerical factors relating SI electrical units to their corresponding units in the Gaussian and other CGS systems of units. The implications of the revised SI for electrical metrology are neatly illustrated by considering the interpretation of results obtained from a current balance in the present SI and in the revised SI.

What Is the Impact of Smoking on Revision Total Knee Arthroplasty?

PubMed

Bedard, Nicholas A; Dowdle, S Blake; Wilkinson, Brandon G; Duchman, Kyle R; Gao, Yubo; Callaghan, John J

2018-07-01

There is a paucity of literature evaluating the impact of smoking on revision arthroplasty procedures. The purpose of this study was to identify the effect of smoking on complications after revision total knee arthroplasty (rTKA). We queried the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patients who underwent rTKA between 2006 and 2014. Patients were divided into current smokers and nonsmokers according to the NSQIP definitions. Each cohort was compared in terms of demographic data, preoperative comorbidities, and operative time. Infection end points were created from composite surgical site infection variables defined by the NSQIP database. Multivariate logistic regression analysis was utilized to adjust for confounding variables and calculate adjusted odds ratios (ORs) and associated 95% confidence intervals (95% CIs). In total, 8776 patients underwent rTKA. Of these patients, 11.6% were current smokers. Univariate analyses demonstrated that smokers had a higher rate of any wound complication (3.8% vs 1.8%, P < .0001), deep infection (2.5% vs 1.0%, P < .0001), pneumonia (1.3% vs 0.4%, P < .0001), and reoperation (5.0% vs 3.1%, P = .001) compared to nonsmokers undergoing revision total knee arthroplasty. Multivariate analysis identified current smokers as being at a significantly increased risk of any wound complication (OR 2.1; 95% CI 1.4-3.1) and deep infection (OR 2.1, 95% CI 1.2-3.6) after rTKA. This study demonstrates that smoking significantly increases the risk of infection, wound complications, and reoperation after rTKA. The results are even more magnified for revision procedures compared to published effects of smoking on primary total knee arthroplasty complications. Further research is needed regarding the impact of smoking cessation on mitigation of these observed risks. Copyright © 2018 Elsevier Inc. All rights reserved.

How do parents label their physical disciplinary practices? A focus on the definition of corporal punishment.

PubMed

Fréchette, Sabrina; Romano, Elisa

2017-09-01

The lack of consensus about the definition of corporal punishment (CP) contributes to the varying research findings and fuels the debate surrounding its use. Related to the problem of definitional variability is also the possibility that some parents may not be aware that their physical disciplinary strategies (PDS) are forms of CP. As a first step to move beyond the debate and to tailor educational efforts to change cultural norms and parents' behaviors, the objective of the current study was to clarify what parents self-label as CP. Using a sample of 338 Canadian parents, the study assessed the relationship between endorsement of CP and self-reports of specific PDS ranging in level of severity. Predictors (i.e., cultural norms, attitudes toward and childhood experiences of CP) of this relationship were investigated. Results revealed that general questions on CP may best reflect parental use of milder forms of PDS, such as spanking (Φ=0.62; r=-0.65) and slapping on the hand, arm, or leg (r=-0.47). Results also suggested that some parents (19.8%) do not endorse CP but use mild PDS. To move beyond the debate and to reach parents at risk of underreporting their use of CP, educational messages need to be tailored to specific and mild forms of PDS rather than to broad concepts such as CP. Moreover, factors such as attitudes toward corporal punishment (p ˂0.001) can help identify those parents who use PDS but who do not endorse CP. Copyright © 2017 Elsevier Ltd. All rights reserved.

Searching for Genes That Matter in Acute Kidney Injury: A Systematic Review

PubMed Central

Lu, Jonathan C. T.; Coca, Steven G.; Patel, Uptal D.; Cantley, Lloyd; Parikh, Chirag R.

2009-01-01

Background and Objectives: Identifying patients who may develop acute kidney injury (AKI) remains challenging, as clinical determinants explain only a portion of individual risk. Another factor that likely affects risk is intrinsic genetic variability. Therefore, a systematic review of studies was performed that related the development or prognosis of AKI to genetic variation. Design, setting, participants, and measurements: MEDLINE, EMBASE, HuGEnet, SCOPUS, and Web of Science were searched for articles from 1950 to Dec 2007. Two independent researchers screened articles using predetermined criteria. Studies were assessed for methodological quality via an aggregate scoring system. Results: The 16 included studies were of cohort or case-cohort design and investigated 35 polymorphisms in 21 genes in association with AKI. Fifteen gene-gene interactions were also investigated in four separate studies. Study populations were primarily premature infants or adults who were critically ill or postcardiac bypass patients. Among the studies, five different definitions of AKI were used. Only one polymorphism, APO E e2/e3/e4, had greater than one study showing a significant impact (P < 0.05) on AKI incidence. The mean quality score of 5.8/10 (range four to nine), heterogeneity in the studies, and the dearth of studies precluded additional meta-analysis of the results. Conclusions: Current association studies are unable to provide definitive evidence linking genetic variation to AKI. Future success will require a narrow consensus definition of AKI, rigorous epidemiologic techniques, and a shift from a priori hypothesis-driven to genome-wide association studies. PMID:19443624

Exploring Robust and Resilient Pathways to Water Security (Invited)

NASA Astrophysics Data System (ADS)

Brown, C. M.

2013-12-01

Lack of water security and the resultant cumulative effects of water-related hazards are understood to hinder economic growth throughout the world. Traditional methods for achieving water security as exemplified in the industrialized world have exerted negative externalities such as degradation of aquatic ecosystems. There is also growing concern that such methods may not be robust to climate variability change. It has been proposed that alternative pathways to water security must be followed in the developing world. However, it is not clear such pathways currently exist and there is an inherent moral hazard in such recommendations. This presentation will present a multidimensional definition of water security, explore the conflict in norms between engineering and ecologically oriented communities, and present a framework synthesizing those norms for assessing and innovating robust and resilient pathways to water security.

Genital Warts

PubMed Central

Yanofsky, Valerie R.; Patel, Rita V.

2012-01-01

External genital warts, also known as condylomata acuminata, are extremely common, with between 500,000 to one million new cases diagnosed each year in the United States alone. To date, more than 120 distinct subtypes of human papillomavirus have been identified. Human papillomavirus types 6 and 11 rarely give rise to cervical cancers, but are responsible for 90 percent of the cases of genital warts. The current treatment options are largely centered upon removal of the warts rather than elimination of the underlying viral infection. A wide range of therapies are presently in use, which are highly variable and can differ dramatically with respect to cost, side-effect profiles, dosing schedules, duration of treatment, and overall effectiveness. As of yet, no definitive therapy has emerged as the ideal standard of care in the treatment of genital warts, and therapy selection generally occurs in a patient-specific manner. PMID:22768354

PLUMED-GUI: An environment for the interactive development of molecular dynamics analysis and biasing scripts

NASA Astrophysics Data System (ADS)

Giorgino, Toni

2014-03-01

PLUMED-GUI is an interactive environment to develop and test complex PLUMED scripts within the Visual Molecular Dynamics (VMD) environment. Computational biophysicists can take advantage of both PLUMED’s rich syntax to define collective variables (CVs) and VMD’s chemically-aware atom selection language, while working within a natural point-and-click interface. Pre-defined templates and syntax mnemonics facilitate the definition of well-known reaction coordinates. Complex CVs, e.g. involving reference snapshots used for RMSD or native contacts calculations, can be built through dialogs that provide a synoptic view of the available options. Scripts can be either exported for use in simulation programs, or evaluated on the currently loaded molecular trajectories. Script development takes place without leaving VMD, thus enabling an incremental try-see-modify development model for molecular metrics.

Childhood Bullying: A Review of Constructs, Contexts, and Nursing Implications

PubMed Central

Liu, Jianghong; Graves, Nicola

2011-01-01

Bullying among children as a pervasive problem has been increasingly recognized as an important public health issue. However, while much attention has been given to understanding the impact of bullying on victims, it is equally important to examine predictors of bullying and potential outcomes for bullies themselves. The current literature on bullying lacks consensus on a utilizable definition of bullying in research, which can vary by theoretical framework. In an attempt to bridge the gaps in the literature, this paper will provide a review of the state of the science on bullying among children, including the major theoretical constructs of bullying and their respective viewpoints on predictors and correlates of bullying. A secondary aim for this paper is to summarize empirical evidence for predictors of bullying and victimization, which can provide strategies for intervention and prevention by public health nursing professionals. By calling attention to the variability in the bullying literature and the limitations of current evidence available, researchers can better address methodological gaps and effectively move toward developing studies to inform nursing treatment programs and enhance public health initiatives that reduce violence in school settings. PMID:22092466

On the validity of language: speaking, knowing and understanding in medical geography.

PubMed

Scarpaci, J L

1993-09-01

This essay examines methodological problems concerning the conceptualization and operationalization of phenomena central to medical geography. Its main argument is that qualitative research can be strengthened if the differences between instrumental and apparent validity are better understood than the current research in medical geography suggests. Its premise is that our definitions of key terms and concepts must be reinforced throughout the design of research should our knowledge and understanding be enhanced. In doing so, the paper aims to move the methodological debate beyond the simple dichotomies of quantitative vs qualitative approaches and logical positivism vs phenomenology. Instead, the argument is couched in a postmodernist hermeneutic sense which questions the validity of one discourse of investigation over another. The paper begins by discussing methods used in conceptualizing and operationalizing variables in quantitative and qualitative research design. Examples derive from concepts central to a geography of health-care behavior and well-being. The latter half of the essay shows the uses and misuses of validity studies in selected health services research and the current debate on national health insurance.

Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.

PubMed

Carroll, Linda J; Cassidy, J David; Holm, Lena; Kraus, Jess; Coronado, Victor G

2004-02-01

The WHO Collaborating Centre for Neurotrauma Task Force on Mild Traumatic Brain Injury performed a comprehensive search and critical review of the literature published between 1980 and 2002 to assemble the best evidence on the epidemiology, diagnosis, prognosis and treatment of mild traumatic brain injury. Of 743 relevant studies, 313 were accepted on scientific merit and comprise our best-evidence synthesis. The current literature on mild traumatic brain injury is of variable quality and we report the most common methodological flaws. We make recommendations for avoiding the shortcomings evident in much of the current literature and identify topic areas in urgent need of further research. This includes the need for large, well-designed studies to support evidence-based guidelines for emergency room triage of children with mild traumatic brain injury and to explore more fully the issue of prognosis after mild traumatic brain injury in the elderly population. We also advocate use of standard criteria for defining mild traumatic brain injury and propose a definition.

Variable Cycle Engine Technology Program Planning and Definition Study

NASA Technical Reports Server (NTRS)

Westmoreland, J. S.; Stern, A. M.

1978-01-01

The variable stream control engine, VSCE-502B, was selected as the base engine, with the inverted flow engine concept selected as a backup. Critical component technologies were identified, and technology programs were formulated. Several engine configurations were defined on a preliminary basis to serve as demonstration vehicles for the various technologies. The different configurations present compromises in cost, technical risk, and technology return. Plans for possible variably cycle engine technology programs were formulated by synthesizing the technology requirements with the different demonstrator configurations.

Appendix to a Measure of Scientific Reasoning: The Springs Task (Details for Construction, Administration, and Scoring).

ERIC Educational Resources Information Center

Linn, Marcia C.; Rice, Marian R.

The Springs Task measures the ability to conduct controlled experiments, name variables, and criticize variables which are demonstrated to the subject. It provides an operational definition of formal thought. Subjects aged ten to adult can be tested with this instrument, an apparatus-based task administered individually in a 15-minute interview.…

Sensitivity Analysis and Optimization of Aerodynamic Configurations with Blend Surfaces

NASA Technical Reports Server (NTRS)

Thomas, A. M.; Tiwari, S. N.

1997-01-01

A novel (geometrical) parametrization procedure using solutions to a suitably chosen fourth order partial differential equation is used to define a class of airplane configurations. Inclusive in this definition are surface grids, volume grids, and grid sensitivity. The general airplane configuration has wing, fuselage, vertical tail and horizontal tail. The design variables are incorporated into the boundary conditions, and the solution is expressed as a Fourier series. The fuselage has circular cross section, and the radius is an algebraic function of four design parameters and an independent computational variable. Volume grids are obtained through an application of the Control Point Form method. A graphic interface software is developed which dynamically changes the surface of the airplane configuration with the change in input design variable. The software is made user friendly and is targeted towards the initial conceptual development of any aerodynamic configurations. Grid sensitivity with respect to surface design parameters and aerodynamic sensitivity coefficients based on potential flow is obtained using an Automatic Differentiation precompiler software tool ADIFOR. Aerodynamic shape optimization of the complete aircraft with twenty four design variables is performed. Unstructured and structured volume grids and Euler solutions are obtained with standard software to demonstrate the feasibility of the new surface definition.

An evolving effective stress approach to anisotropic distortional hardening

DOE PAGES

Lester, B. T.; Scherzinger, W. M.

2018-03-11

A new yield surface with an evolving effective stress definition is proposed for consistently and efficiently describing anisotropic distortional hardening. Specifically, a new internal state variable is introduced to capture the thermodynamic evolution between different effective stress definitions. The corresponding yield surface and evolution equations of the internal variables are derived from thermodynamic considerations enabling satisfaction of the second law. A closest point projection return mapping algorithm for the proposed model is formulated and implemented for use in finite element analyses. Finally, select constitutive and larger scale boundary value problems are solved to explore the capabilities of the model andmore » examine the impact of distortional hardening on constitutive and structural responses. Importantly, these simulations demonstrate the tractability of the proposed formulation in investigating large-scale problems of interest.« less

An evolving effective stress approach to anisotropic distortional hardening

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

Lester, B. T.; Scherzinger, W. M.

A new yield surface with an evolving effective stress definition is proposed for consistently and efficiently describing anisotropic distortional hardening. Specifically, a new internal state variable is introduced to capture the thermodynamic evolution between different effective stress definitions. The corresponding yield surface and evolution equations of the internal variables are derived from thermodynamic considerations enabling satisfaction of the second law. A closest point projection return mapping algorithm for the proposed model is formulated and implemented for use in finite element analyses. Finally, select constitutive and larger scale boundary value problems are solved to explore the capabilities of the model andmore » examine the impact of distortional hardening on constitutive and structural responses. Importantly, these simulations demonstrate the tractability of the proposed formulation in investigating large-scale problems of interest.« less

An Agenda for Research on the Sustainability of Public Health Programs

PubMed Central

Dearing, James W.

2011-01-01

Funders of programs in public health and community health are increasingly concerned about the sustainability of changes they initiate. Despite a recent increase in sustainability research and evaluation, this literature has not developed a widely used paradigm for conducting research that can accumulate into generalizable findings. We provide guidance for research and evaluation of health program sustainability, including definitions and types of sustainability, specifications and measurements of dependent variables, definitions of independent variables or factors that influence sustainability, and suggestions for designs for research and data collection. We suggest viewing sustainability research as a further stage in the translation or dissemination of research-based interventions into practice. This perspective emphasizes ongoing relationships with earlier stages of a broader diffusion framework, including adoption and implementation processes. PMID:21940916

Pediatric Sepsis

PubMed Central

Mathias, Brittany; Mira, Juan; Larson, Shawn D.

2016-01-01

Purpose of Review Sepsis is the leading cause of pediatric death worldwide. In the United States alone, there are 72,000 children hospitalized for sepsis annually with a reported mortality rate of 25% and an economic cost estimated to be $4.8 billion. However, it is only recently that the definition and management of pediatric sepsis has been recognized as being distinct from adult sepsis. Recent Findings The definition of pediatric sepsis is currently in a state of evolution and there is a large disconnect between the clinical and research definitions of sepsis which impacts the application of research findings into clinical practice. Despite this, it is the speed of diagnosis and the timely implementation of current treatment guidelines that has been shown to improve outcomes. However, adherence to treatment guidelines is currently low and it is only through the implementation of protocols that improved care and outcomes have been demonstrated. Summary Current management of pediatric sepsis is largely based on adaptations from adult sepsis treatment; however, distinct physiology demands more prospective pediatric trials to tailor management to the pediatric population. Adherence to current and emerging practice guidelines will require that protocolized care pathways become commonplace. PMID:26983000

The impact of culture upon child rearing practices and definitions of maltreatment.

PubMed

Ferrari, Anne M

2002-08-01

The aim of the present study was to assess the relationship between a childhood history of abuse that a parent may have experienced and the cultural beliefs/factors that an individual may subscribe to with current parenting behaviors and attitudes. It was hypothesized that cultural factors would be more predictive of parenting behaviors and attitudes than ethnicity as a demographic label. Using a survey design, 150 parents of Hispanic, African American and European American descent participated. Participants completed the Conflict Tactics Scale, a Familism Scale, a Machismo Scale, a Valuing Children Scale, the Childhood Trauma Questionnaire, and assigned seriousness ratings to vignettes depicting child maltreatment. A history of childhood abuse was found to be predictive of the use of both physical and verbal punishment by mothers, but not for fathers. Cultural factors/beliefs were predictive of fathers' parenting behaviors, but not mothers'. Ethnicity, as a demographic variable, continued to be a significant predictor of parenting behaviors and attitudes for all parents, controlling for cultural factors. The present study adds to our understanding of diverse parenting styles, of definitions of child abuse and neglect, and of ethnicity. The findings indicate that ethnicity is a complex factor, one demanding further examination with regard to its components.

Structure-function relations in physiology education: Where's the mechanism?

PubMed

Lira, Matthew E; Gardner, Stephanie M

2017-06-01

Physiology demands systems thinking: reasoning within and between levels of biological organization and across different organ systems. Many physiological mechanisms explain how structures and their properties interact at one level of organization to produce emergent functions at a higher level of organization. Current physiology principles, such as structure-function relations, selectively neglect mechanisms by not mentioning this term explicitly. We explored how students characterized mechanisms and functions to shed light on how students make sense of these terms. Students characterized mechanisms as 1 ) processes that occur at levels of organization lower than that of functions; and 2 ) as detailed events with many steps involved. We also found that students produced more variability in how they characterized functions compared with mechanisms: students characterized functions in relation to multiple levels of organization and multiple definitions. We interpret these results as evidence that students see mechanisms as holding a more narrow definition than used in the biological sciences, and that students struggle to coordinate and distinguish mechanisms from functions due to cognitive processes germane to learning in many domains. We offer the instructional suggestion that we scaffold student learning by affording students opportunities to relate and also distinguish between these terms so central to understanding physiology. Copyright © 2017 the American Physiological Society.

Definition of sizes for the design of school furniture for Bogotá schools based on anthropometric criteria.

PubMed

García-Acosta, G; Lange-Morales, K

2007-10-01

The current paper deals with the definition of sizes for the design of school furniture for schools in Bogotá, Colombia, based on an analysis of available anthropometric data on Latin American children. State-of-the-art anthropometric, national and international standards were considered, in order to define the anthropometric variables that were to be used for defining the furniture. Matrices relating age and specific anthropometric dimensions were constructed, as a visualization method for establishing the dimensional differences between children of the same age and the ranges that should be covered by the items of furniture. Dimensional data were grouped by establishing the minimum sizes and general dimensions of furniture needed to cover the 5-95th percentile of school children between the ages of 5 and 18 years. The distribution of the furniture in the different school grades was also indicated. Apart from the need for an adequate match between child anthropometry and school furniture dimensions, this study shows the importance of a proper distribution of furniture sizes in the different school grades, as a complementary and decisive aspect to be considered in order to meet the heterogenic, anthropometrical requirements of children of the same age and school grade.

Slice regular functions of several Clifford variables

NASA Astrophysics Data System (ADS)

Ghiloni, R.; Perotti, A.

2012-11-01

We introduce a class of slice regular functions of several Clifford variables. Our approach to the definition of slice functions is based on the concept of stem functions of several variables and on the introduction on real Clifford algebras of a family of commuting complex structures. The class of slice regular functions include, in particular, the family of (ordered) polynomials in several Clifford variables. We prove some basic properties of slice and slice regular functions and give examples to illustrate this function theory. In particular, we give integral representation formulas for slice regular functions and a Hartogs type extension result.

Understanding logistic regression analysis.

PubMed

Sperandei, Sandro

2014-01-01

Logistic regression is used to obtain odds ratio in the presence of more than one explanatory variable. The procedure is quite similar to multiple linear regression, with the exception that the response variable is binomial. The result is the impact of each variable on the odds ratio of the observed event of interest. The main advantage is to avoid confounding effects by analyzing the association of all variables together. In this article, we explain the logistic regression procedure using examples to make it as simple as possible. After definition of the technique, the basic interpretation of the results is highlighted and then some special issues are discussed.

Understanding the Spatiotemporal Variability of Inherent Water Use Efficiency

NASA Astrophysics Data System (ADS)

Boese, Sven; Jung, Martin; Carvalhais, Nuno; Reichstein, Markus

2015-04-01

The global carbon and water cycles are coupled via plant physiology. However, the resulting spatial and temporal covariability of both fluxes on a global scale lacks sufficient understanding. This is required to estimate the impact of atmospheric drought on photosynthesis in water-limited ecosystems. Water use efficiency (WUE) is an essential ecosystem diagnostic defined as the ratio between gross primary productivity (GPP) and transpiration (T). WUE is known to vary with vapour-pressure deficit (VPD) and therefore also in time. The inherent water use efficiency (iWUE) accounts for the VPD effect on WUE and aims at representing a largely time-invariant ecosystem property. However, different ways of describing the functional response of iWUE to VPD are found in the literature. One established iWUE definition was proposed by Beer et al. (2009) and takes the form of iWUE = GPP--VPD- . T (1) A similar definition can be derived from stomatal conductance theories such as Katul et al. (2010) and takes the form of √ -- GPP---VPD- iWUE = T . (2) Here, we use eddy covariance measurements from the FLUXNET database to evaluate both approaches for a globally representative set of biomes including tropical, temperate and semi-arid ecosystems. Testing both definitions in a model-data fusion setup indicated that (2) is more consistent with FLUXNET observations than (1). However, there still remains considerable temporal variability of iWUE which is linked to seasonal changes in VPD. To explore up to which extent the temporal variability of iWUE may be related to the prescribed functional responses to VPD, we treated the exponent of VPD as a global parameter, here termed γ. When γ = 1 the functional response is equivalent to (1), while when γ = 0.5 it corresponds to formulation of model (2)). The global estimate was found to be significantly lower than 0.5, which would have been expected from stomatal conductance theory at leaf level. We assessed whether adding γ as site-specific parameter could be justified. The additional model complexity was warranted by an increased goodness-of-fit as quantified by the Akaike information criterion. However, temporal variations in iWUE persist. The structural adequacy of the models was assessed via the correlation structure of the residuals. Ultimately, changing γ in the definition impacts the between-site variability of iWUE. The iWUE estimates with γ = 1.0 were only weakly correlated with those with γ = 0.5. This has crucial implications for spatial analyses on the drought response of water-limited ecosystems. We discuss uncertainties involved in the analysis and highlight possible mechanisms responsible for the remaining temporal variability of iWUE. The consequences of differing iWUE definitions for the analysis of global carbon and water cycles are explored.

The NASA Energy and Water Cycle Extreme (NEWSE) Integration Project

NASA Technical Reports Server (NTRS)

House, P. R.; Lapenta, W.; Schiffer, R.

2008-01-01

Skillful predictions of water and energy cycle extremes (flood and drought) are elusive. To better understand the mechanisms responsible for water and energy extremes, and to make decisive progress in predicting these extremes, the collaborative NASA Energy and Water cycle Extremes (NEWSE) Integration Project, is studying these extremes in the U.S. Southern Great Plains (SGP) during 2006-2007, including their relationships with continental and global scale processes, and assessment of their predictability on multiple space and time scales. It is our hypothesis that an integrative analysis of observed extremes which reflects the current understanding of the role of SST and soil moisture variability influences on atmospheric heating and forcing of planetary waves, incorporating recently available global and regional hydro- meteorological datasets (i.e., precipitation, water vapor, clouds, etc.) in conjunction with advances in data assimilation, can lead to new insights into the factors that lead to persistent drought and flooding. We will show initial results of this project, whose goals are to provide an improved definition, attribution and prediction on sub-seasonal to interannual time scales, improved understanding of the mechanisms of decadal drought and its predictability, including the impacts of SST variability and deep soil moisture variability, and improved monitoring/attributions, with transition to applications; a bridging of the gap between hydrological forecasts and stakeholders (utilization of probabilistic forecasts, education, forecast interpretation for different sectors, assessment of uncertainties for different sectors, etc.).

Marine heatwaves off eastern Tasmania: Trends, interannual variability, and predictability

NASA Astrophysics Data System (ADS)

Oliver, Eric C. J.; Lago, Véronique; Hobday, Alistair J.; Holbrook, Neil J.; Ling, Scott D.; Mundy, Craig N.

2018-02-01

Surface waters off eastern Tasmania are a global warming hotspot. Here, mean temperatures have been rising over several decades at nearly four times the global average rate, with concomitant changes in extreme temperatures - marine heatwaves. These changes have recently caused the marine biodiversity, fisheries and aquaculture industries off Tasmania's east coast to come under stress. In this study we quantify the long-term trends, variability and predictability of marine heatwaves off eastern Tasmania. We use a high-resolution ocean model for Tasmania's eastern continental shelf. The ocean state over the 1993-2015 period is hindcast, providing daily estimates of the three-dimensional temperature and circulation fields. Marine heatwaves are identified at the surface and subsurface from ocean temperature time series using a consistent definition. Trends in marine heatwave frequency are positive nearly everywhere and annual marine heatwave days and penetration depths indicate significant positive changes, particularly off southeastern Tasmania. A decomposition into modes of variability indicates that the East Australian Current is the dominant driver of marine heatwaves across the domain. Self-organising maps are used to identify 12 marine heatwave types, each with its own regionality, seasonality, and associated large-scale oceanic and atmospheric circulation patterns. The implications of this work for marine ecosystems and their management were revealed through review of past impacts and stakeholder discussions regarding use of these data.

Development of a validated clinical case definition of generalized tonic-clonic seizures for use by community-based health care providers.

PubMed

Anand, Krishnan; Jain, Satish; Paul, Eldho; Srivastava, Achal; Sahariah, Sirazul A; Kapoor, Suresh K

2005-05-01

To develop and test a clinical case definition for identification of generalized tonic-clonic seizures (GTCSs) by community-based health care providers. To identify symptoms that can help identify GTCSs, patients with history of a jerky movements or rigidity in any part of the body ever in life were recruited from three sites: the community, secondary care hospital, and tertiary care hospital. These patients were administered a 14-item structured interview schedule focusing on the circumstances surrounding the seizure. Subsequently, a neurologist examined each patient and, based on available investigations, classified them as GTCS or non-GTCS cases. A logistic regression analysis was performed to select symptoms that were to be used for case definition of GTCSs. Validity parameters for the case definition at different cutoff points were calculated in another set of subjects. In total, 339 patients were enrolled in the first phase of the study. The tertiary care hospital contributed the maximal number of GTCS cases, whereas cases of non-GTCS were mainly from the community. At the end of phase I, the questionnaire was shortened from 14 to eight questions based on statistical association and clinical judgment. After phase II, which was conducted among 170 subjects, three variables were found to be significantly related to the presence of GTCSs by logistic regression: absence of stress (13.1; 4.1-41.3), presence of frothing (13.7; 4.0-47.3), and occurrence in sleep (8.3; 2.0-34.9). As a case definition using only three variables did not provide sufficient specificity, three more variables were added based on univariate analysis of the data (incontinence during the episode and unconsciousness) and review of literature (injury during episode). A case definition consisting of giving one point to an affirmative answer for each of the six questions was tested. At a cutoff point of four, sensitivity was 56.9 (47.4-66.0) and specificity, 96.3 (86.2-99.4). Among the 197 GTCS and 26 new non-GTCS patients recruited from hospitals from select SEAR Member Countries, in phase III, the sensitivity of this clinical case definition was 72% and specificity, 100%. A stratified analysis by gender in all the three phases did not show any differences between the sexes. Based on these criteria, we recommend that all patients with a history of two or more episodes of jerking or rigidity of limbs, having a score of > or =4 in the case definition, be identified as having GTCSs and started on antiepileptic medications. This clinical case definition can be very useful for community-based health care providers to identify and manage cases of GTCSs in the community. This should play a major role in the reduction of treatment gap for epilepsy in developing countries.

Recursive partitioning identifies greater than 4 U of packed red blood cells per hour as an improved massive transfusion definition.

PubMed

Moren, Alexis Marika; Hamptom, David; Diggs, Brian; Kiraly, Laszlo; Fox, Erin E; Holcomb, John B; Rahbar, Mohammad Hossein; Brasel, Karen J; Cohen, Mitchell Jay; Bulger, Eileen M; Schreiber, Martin A

2015-12-01

Massive transfusion (MT) is classically defined as greater than 10 U of packed red blood cells (PRBCs) in 24 hours. This fails to capture the most severely injured patients. Extending the previous work of Savage and Rahbar, a rolling hourly rate-based definition of MT may more accurately define critically injured patients requiring early, aggressive resuscitation. The Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) trial collected data from 10 Level 1 trauma centers. Patients were placed into rate-based transfusion groups by maximal number of PRBCs transfused in any hour within the first 6 hours. A nonparametric analysis using classification trees partitioned data according to mortality at 24 hours using a predictor variable of maximum number PRBC units transfused in an hour. Dichotomous variables significant in previous scores and models as predictors of MT were used to identify critically ill patients: a positive finding on Focused Assessment with Sonography in Trauma (FAST) examination, Glasgow Coma Scale (GCS) score less than 8, heart rate greater than 120 beats/min, systolic blood pressure less than 90 mm Hg, penetrating mechanism of injury, international normalized ratio greater than 1.5, hemoglobin less than 11, and base deficit greater than 5. These critical indicators were then compared among the nodes of the classification tree. Patients omitted included those who did not receive PRBCs (n = 24) and those who did not have all eight critical indicators reported (n = 449). In a population of 1,245 patients, the classification tree included 772 patients. Analysis by recursive partitioning showed increased mortality among patients receiving greater than 13 U/h (73.9%, p < 0.01). In those patients receiving less than or equal to 13 U/h, mortality was greater in patients who received more than 4 U/h (16.7% vs. 6.0%, p < 0.01) (Fig. 1). Nodal analysis showed that the median number of critical indicators for each node was 3 (2-4) (≤4 U/h), 4 (3-5) (>4 U/h and ≤13 U/h), and 5 (4-5.5) (>13 U/h). A rate-based transfusion definition identifies a difference in mortality in patients who receive greater than 4 U/h of PRBCs. Redefining MT to greater than 4 U/h allows early identification of patients with a significant mortality risk who may be missed by the current definition. Prognostic/epidemiologic study, level III.

Heterogeneous phenotypes of insulin resistance and its implications for defining metabolic syndrome in Asian Indian adolescents.

PubMed

Vikram, Naval K; Misra, Anoop; Pandey, Ravindra M; Luthra, Kalpana; Wasir, Jasjeet S; Dhingra, Vibha

2006-05-01

To assess the phenotypic correlations of insulin resistance with obesity and its relationship with the metabolic syndrome in Asian Indian adolescents. We analyzed clinical, anthropometric (body mass index [BMI], waist circumference [WC]) and laboratory (fasting blood glucose [FBG], lipids and fasting serum insulin) data from 793 subjects (401 males and 392 females) aged 14-19 years randomly selected from Epidemiological Study of Adolescents and Young (ESAY) adults (n=1447). The percentile cut-offs for 14-19 years age from ESAY cohort were used for defining abnormal values of variables. We devised three sets of definitions of metabolic syndrome by including BMI and fasting insulin levels with other defining variables. Nearly 28.9% of adolescents had fasting hyperinsulinemia despite normal values of BMI, WC, FBG, lipids, and blood pressure. Remarkably, NCEP criteria with appropriate percentile cut-off points for Asian Indian adolescents identified metabolic syndrome in only six (0.8%) subjects. Inclusion of both BMI and WC in the definition resulted in increase in the prevalence of metabolic syndrome to 4.3%. With inclusion of hyperinsulinemia, the prevalence of metabolic syndrome increased to 4.2% (from 0.8%) in the modified NCEP definition, 5.2% (from 0.9%) when BMI was substituted for WC, and 10.2 (from 4.3%) when both BMI and WC were included. Our data show marked heterogeneity of phenotypes of insulin resistance and poor value of NCEP definition to identify metabolic syndrome. We propose that BMI and fasting insulin should be evaluated in candidate definitions of metabolic syndrome in Asian Indian adolescents.

Measuring nanoparticles size distribution in food and consumer products: a review.

PubMed

Calzolai, L; Gilliland, D; Rossi, F

2012-08-01

Nanoparticles are already used in several consumer products including food, food packaging and cosmetics, and their detection and measurement in food represent a particularly difficult challenge. In order to fill the void in the official definition of what constitutes a nanomaterial, the European Commission published in October 2011 its recommendation on the definition of 'nanomaterial'. This will have an impact in many different areas of legislation, such as the European Cosmetic Products Regulation, where the current definitions of nanomaterial will come under discussion regarding how they should be adapted in light of this new definition. This new definition calls for the measurement of the number-based particle size distribution in the 1-100 nm size range of all the primary particles present in the sample independently of whether they are in a free, unbound state or as part of an aggregate/agglomerate. This definition does present great technical challenges for those who must develop valid and compatible measuring methods. This review will give an overview of the current state of the art, focusing particularly on the suitability of the most used techniques for the size measurement of nanoparticles when addressing this new definition of nanomaterials. The problems to be overcome in measuring nanoparticles in food and consumer products will be illustrated with some practical examples. Finally, a possible way forward (based on the combination of different measuring techniques) for solving this challenging analytical problem is illustrated.

A New Empirical Definition of Major Depressive Episode Recovery and Its Positive Impact on Future Course of Illness.

PubMed

Judd, Lewis L; Schettler, Pamela J; Rush, A John; Coryell, William H; Fiedorowicz, Jess G; Solomon, David A

2016-08-01

To provide the first head-to-head test of the predictive validity of 2 resolution levels included in the current consensus definition of major depressive episode (MDE) recovery and provide an empirically based, clinically useful definition of the end of an MDE. 322 participants entering the National Institute of Mental Health Collaborative Depression Study with MDE (diagnosed by Research Diagnostic Criteria) in 1978-1981, and followed thereafter for up to 31 years, were divided into those with 8 consecutive weeks of asymptomatic MDE recovery or residual subsyndromal depressive symptom (SSD) resolution of their index MDE. These 2 levels of recovery were defined based on weekly symptom status on all depressive conditions, assessed by Longitudinal Interval Follow-Up Evaluation (LIFE) interviews conducted every 6 months. Primary measures of validity of these 2 alternative definitions were first well interval duration and long-term depressive illness burden. Groups were also compared on clinical variables, antidepressant treatment, and psychosocial function. 61.2% of subjects recovered asymptomatically from their index MDE. By survival analysis, they remained free of a depressive episode relapse or recurrence 4.2 times longer than those with SSD resolution (median = 135 vs 32 weeks; χ² = 70.65; P < .0001). This was not attributable to a difference in intensity of antidepressant medication. Compared to asymptomatic recovery, SSD resolution was associated with significantly longer and more severe index MDEs, with more miscellaneous psychopathology as well as increased long-term psychosocial dysfunction and a greater depressive illness burden during the ensuing 10 or 20 years. Asymptomatic MDE resolution was a stronger predictor of time well than any of 18 other predictors, singly or combined. Eight consecutive weeks of asymptomatic recovery had 93% overlap with a 4-week definition and conferred little benefit over 4 weeks. Four consecutive weeks of asymptomatic recovery defines the end of an MDE and the beginning of a stable well state with improved psychosocial function. Residual symptom resolution is a continuation of an active state of the episode, not the end of an MDE. © Copyright 2016 Physicians Postgraduate Press, Inc.

An international delphi survey for the definition of the variables for the development of new classification criteria for periodic fever aphtous stomatitis pharingitis cervical adenitis (PFAPA).

PubMed

Vanoni, Federica; Federici, Silvia; Antón, Jordi; Barron, Karyl S; Brogan, Paul; De Benedetti, Fabrizio; Dedeoglu, Fatma; Demirkaya, Erkan; Hentgen, Veronique; Kallinich, Tilmann; Laxer, Ronald; Russo, Ricardo; Toplak, Natasa; Uziel, Yosef; Martini, Alberto; Ruperto, Nicolino; Gattorno, Marco; Hofer, Michael

2018-04-18

Diagnosis of Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) is currently based on a set of criteria proposed in 1999 modified from Marshall's criteria. Nevertheless no validated evidence based set of classification criteria for PFAPA has been established so far. The aim of this study was to identify candidate classification criteria PFAPA syndrome using international consensus formation through a Delphi questionnaire survey. A first open-ended questionnaire was sent to adult and pediatric clinicians/researchers, asking to identify the variables thought most likely to be helpful and relevant for the diagnosis of PFAPA. In a second survey, respondents were asked to select, from the list of variables coming from the first survey, the 10 features that they felt were most important, and to rank them in descending order from most important to least important. The response rate to the first and second Delphi was respectively 109/124 (88%) and 141/162 (87%). The number of participants that completed the first and second Delphi was 69/124 (56%) and 110/162 (68%). From the first Delphi we obtained a list of 92 variables, of which 62 were selected in the second Delphi. Variables reaching the top five position of the rank were regular periodicity, aphthous stomatitis, response to corticosteroids, cervical adenitis, and well-being between flares. Our process led to identification of features that were felt to be the most important as candidate classification criteria for PFAPA by a large sample of international rheumatologists. The performance of these items will be tested further in the next phase of the study, through analysis of real patient data.

Benchmarking the mesoscale variability in global ocean eddy-permitting numerical systems

NASA Astrophysics Data System (ADS)

Cipollone, Andrea; Masina, Simona; Storto, Andrea; Iovino, Doroteaciro

2017-10-01

The role of data assimilation procedures on representing ocean mesoscale variability is assessed by applying eddy statistics to a state-of-the-art global ocean reanalysis (C-GLORS), a free global ocean simulation (performed with the NEMO system) and an observation-based dataset (ARMOR3D) used as an independent benchmark. Numerical results are computed on a 1/4 ∘ horizontal grid (ORCA025) and share the same resolution with ARMOR3D dataset. This "eddy-permitting" resolution is sufficient to allow ocean eddies to form. Further to assessing the eddy statistics from three different datasets, a global three-dimensional eddy detection system is implemented in order to bypass the need of regional-dependent definition of thresholds, typical of commonly adopted eddy detection algorithms. It thus provides full three-dimensional eddy statistics segmenting vertical profiles from local rotational velocities. This criterion is crucial for discerning real eddies from transient surface noise that inevitably affects any two-dimensional algorithm. Data assimilation enhances and corrects mesoscale variability on a wide range of features that cannot be well reproduced otherwise. The free simulation fairly reproduces eddies emerging from western boundary currents and deep baroclinic instabilities, while underestimates shallower vortexes that populate the full basin. The ocean reanalysis recovers most of the missing turbulence, shown by satellite products , that is not generated by the model itself and consistently projects surface variability deep into the water column. The comparison with the statistically reconstructed vertical profiles from ARMOR3D show that ocean data assimilation is able to embed variability into the model dynamics, constraining eddies with in situ and altimetry observation and generating them consistently with local environment.

32 CFR 2700.21 - Definition and application.

Code of Federal Regulations, 2011 CFR

2011-07-01

... NEGOTIATIONS SECURITY INFORMATION REGULATIONS Derivative Classification § 2700.21 Definition and application. Derivative classification is the act of assigning a level of classification to information which is determined to be the same in substance as information which is currently classified. Thus, derivative...

Current Issues Concerning Korea’s Anti-Terrorism Programs

DTIC Science & Technology

2011-06-10

Terrorism. New York: Columbia University Press, 1998. Laitin, David. Hegemony and Culture : Politics and Religious Change Among the Yoruba . Chicago...such improvements might take. Definitions Terrorism: Definitions of terrorism differ among nations and organizations, because the social and cultural

32 CFR 2700.21 - Definition and application.

Code of Federal Regulations, 2010 CFR

2010-07-01

... NEGOTIATIONS SECURITY INFORMATION REGULATIONS Derivative Classification § 2700.21 Definition and application. Derivative classification is the act of assigning a level of classification to information which is determined to be the same in substance as information which is currently classified. Thus, derivative...

The Incidence and the Prognostic Impact of Acute Kidney Injury in Acute Myocardial Infarction Patients: Current Preventive Strategies.

PubMed

Kaltsas, Evangelos; Chalikias, George; Tziakas, Dimitrios

2018-02-01

Acute kidney injury (AKI) is one of the most common complications during hospitalization in various clinical settings. The goal of this review was to assess the incidence of AKI in acute myocardial infarction patients (AMI), how this incidence is affected by the diverse definitions, and if there is variability in the reported rates over recent years. Additionally, we sought to appraise the impact of AKI on short- and long-term prognosis of these patients. Finally, we report on the current preventive measures as they are suggested in the current guidelines of various societies, we comment on the evidence that support them, and we review the literature for other proposed therapeutic strategies, which either failed to prove their efficacy or they are not adequately confirmed yet. Due to the heterogeneity in AKI definition and in the population studied of the published data, the incidence of AKI ranged from 5.2 to 59%. A recent meta-analysis reported a median value of 15.8%. All studies assessing AKI-related prognosis in AMI patients suggested that presence of AKI has detrimental effect on patients prognosis, raising mortality two- to threefold not only during the 30 first days but also during the first year after the acute event. Various treatment modalities have been proposed for prevention of AKI in AMI patients; however, the majority of them failed to prove their efficacy in the clinical trial arena. Hydration, use of iso- or low-osmolar agents at the lowest possible dose during coronary interventions, and use of statins have been proposed among others. Nonetheless, the prevalence of AKI after an AMI still remains high today and therefore it is crucial for the practicing physician to be aware of its presence and for the scientific community to identify novel measures for a more efficacious prevention.

Distribution of Reynolds stress carried by mesoscale variability in the Antarctic Circumpolar Current

NASA Technical Reports Server (NTRS)

Johnson, Thomas J.; Stewart, Robert H.; Shum, C. K.; Tapley, Byron D.

1992-01-01

Satellite altimeter data collected by the Geosat Exact Repeat Mission were used to investigate turbulent stress resulting from the variability of surface geostrophic currents in the Antarctic Circumpolar Current. The altimeter measured sea level along the subsatellite track. The variability of the along-track slope of sea level is directly proportional to the variability of surface geostrophic currents in the cross-track direction. Because the grid of crossover points is dense at high latitudes, the satellite data could be used for mapping the temporal and spatial variability of the current. Two and a half years of data were used to compute the statistical structure of the variability. The statistics included the probability distribution functions for each component of the current, the time-lagged autocorrelation functions of the variability, and the Reynolds stress produced by the variability. The results demonstrate that stress is correlated with bathymetry. In some areas the distribution of negative stress indicate that eddies contribute to an acceleration of the mean flow, strengthening the hypothesis that baroclinic instability makes important contributions to strong oceanic currents.

Lack of specific alleles for the bovine chemokine (C-X-C) receptor type 4 (CXCR4) gene in West African cattle questions its role as a candidate for trypanotolerance.

PubMed

Álvarez, Isabel; Pérez-Pardal, Lucía; Traoré, Amadou; Fernández, Iván; Goyache, Félix

2016-08-01

A panel of 81 Asian, African and European cattle (Bos taurus and B. indicus) was analysed for the whole sequence of the CXCR4 gene (3844bp), a strong candidate for cattle trypanotolerance. Thirty-one polymorphic sites identified gave 31 different haplotypes. Neutrality tests rejected the hypothesis of either positive or purifying selection. Bayesian phylogenetic tree showed differentiation of haplotypes into two clades gathering genetic variability predating domestication. Related with clades definition, linkage disequilibrium analyses suggested the existence of one only linkage block on the CXCR4 gene. Two tag SNPs identified on exon 2 captured 50% of variability. Whatever the analysis carried out, no clear separation between cattle groups was identified. Most haplotypes identified in West African taurine cattle were also found in European cattle and in Asian and West African zebu. West African taurine samples did not carry unique variants on the CXCR4 gene sequence. The current analysis failed in identifying a causal mutation on the CXCR4 gene underlying a previously reported QTL for cattle trypanotolerance on BTA2. Copyright © 2016 Elsevier B.V. All rights reserved.

On Lagrangian residual currents with applications in south San Francisco Bay, California

USGS Publications Warehouse

Cheng, Ralph T.; Casulli, Vincenzo

1982-01-01

The Lagrangian residual circulation has often been introduced as the sum of the Eulerian residual circulation and the Stokes' drift. Unfortunately, this definition of the Lagrangian residual circulation is conceptually incorrect because both the Eulerian residual circulation and the Stokes' drift are Eulerian variables. In this paper a classification of various residual variables are reviewed and properly defined. The Lagrangian residual circulation is then studied by means of a two-stage formulation of a computer model. The tidal circulation is first computed in a conventional Eulerian way, and then the Lagrangian residual circulation is determined by a method patterned after the method of markers and cells. To demonstrate properties of the Lagrangian residual circulation, application of this approach in South San Francisco Bay, California, is considered. With the aid of the model results, properties of the Eulerian and Lagrangian residual circulation are examined. It can be concluded that estimation of the Lagrangian residual circulation from Eulerian data may lead to unacceptable error, particularly in a tidal estuary where the tidal excursion is of the same order of magnitude as the length scale of the basin. A direction calculation of the Lagrangian residual circulation must be made and has been shown to be feasible.

Simulation verification techniques study

NASA Technical Reports Server (NTRS)

Schoonmaker, P. B.; Wenglinski, T. H.

1975-01-01

Results are summarized of the simulation verification techniques study which consisted of two tasks: to develop techniques for simulator hardware checkout and to develop techniques for simulation performance verification (validation). The hardware verification task involved definition of simulation hardware (hardware units and integrated simulator configurations), survey of current hardware self-test techniques, and definition of hardware and software techniques for checkout of simulator subsystems. The performance verification task included definition of simulation performance parameters (and critical performance parameters), definition of methods for establishing standards of performance (sources of reference data or validation), and definition of methods for validating performance. Both major tasks included definition of verification software and assessment of verification data base impact. An annotated bibliography of all documents generated during this study is provided.

Building a Definition of Irritability From Academic Definitions and Lay Descriptions.

PubMed

Barata, Paula C; Holtzman, Susan; Cunningham, Shannon; O'Connor, Brian P; Stewart, Donna E

2016-04-08

The current work builds a definition of irritability from both academic definitions and lay perspectives. In Study 1, a quantitative content analysis of academic definitions resulted in eight main content categories (i.e., behaviour, emotion or affect, cognition, physiological, qualifiers, irritant, stability or endurance, and other). In Study 2, a community sample of 39 adults participated in qualitative interviews. A deductive thematic analysis resulted in two main themes. The first main theme dealt with how participants positioned irritability in relation to other negative states. The second dealt with how participants constructed irritability as both a loss of control and as an experience that should be controlled. The discussion integrates the findings of both studies and provides a concise, but comprehensive definition.

Violence exposure among children with disabilities.

PubMed

Sullivan, Patricia M

2009-06-01

The focus of this paper is children with disabilities exposed to a broad range of violence types including child maltreatment, domestic violence, community violence, and war and terrorism. Because disability research must be interpreted on the basis of the definitional paradigm employed, definitions of disability status and current prevalence estimates as a function of a given paradigm are initially considered. These disability paradigms include those used in federal, education, juvenile justice, and health care arenas. Current prevalence estimates of childhood disability in the U.S. are presented within the frameworks of these varying definitions of disability status in childhood. Summaries of research from 2000 to 2008 on the four types of violence victimization addressed among children with disabilities are presented and directions for future research suggested.

Ontology for Life-Cycle Modeling of Electrical Distribution Systems: Application of Model View Definition Attributes

DTIC Science & Technology

2013-06-01

Building in- formation exchange (COBie), Building Information Modeling ( BIM ) 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF...to develop a life-cycle building model have resulted in the definition of a “core” building information model that contains general information de...develop an information -exchange Model View Definition (MVD) for building electrical systems. The objective of the current work was to document the

Updating the definition and role of public health nursing to advance and guide the specialty.

PubMed

Bekemeier, Betty; Walker Linderman, Tessa; Kneipp, Shawn; Zahner, Susan J

2015-01-01

National changes in the context for public health services are influencing the nature of public health nursing practice. Despite this, the document that defines public health nursing as a specialty--The Definition and Role of Public Health Nursing--has remained in wide use since its publication in 1996 without a review or update. With support from the American Public Health Association (APHA) Public Health Nursing Section, a national Task Force, was formed in November 2012 to update the definition of public health nursing, using processes that reflected deliberative democratic principles. A yearlong process was employed that included a modified Delphi technique and various modes of engagement such as online discussion boards, questionnaires, and public comment to review. The resulting 2013 document consisted of a reaffirmation of the one-sentence 1996 definition, while updating supporting documentation to align with the current social, economic, political, and health care context. The 2013 document was strongly endorsed by vote of the APHA Public Health Nursing Section elected leadership. The 2013 definition and document affirm the relevance of a population-focused definition of public health nursing to complex systems addressed in current practice and articulate critical roles of public health nurses (PHN) in these settings. © 2014 Wiley Periodicals, Inc.

A systematic review on definitions and assessments of psychotic-like experiences.

PubMed

Lee, Kit-Wai; Chan, Kit-Wa; Chang, Wing-Chung; Lee, Edwin Ho-Ming; Hui, Christy Lai-Ming; Chen, Eric Yu-Hai

2016-02-01

Psychotic-like experiences (PLEs) or subclinical psychotic experiences have received increased attention as some studies have suggested continuity between PLEs and psychotic disorders. However, epidemiological and correlational studies of PLEs showed mixed findings - it is observed that different studies use a wide variety of definitions of PLEs, as well as different assessment tools that are designed to capture such described experiences. The differences in definitions and assessment tools adopted could contribute to the discrepancy of findings. The current review aims to examine the definitions and assessment tools adopted in the studies of PLEs. Literature search was conducted between October 2013 and February 2014 using three search engines: Medline, Web of Science and PubMed. A total of 76 papers met the selection criteria and were included in the current review. It is found that the majority of papers reviewed defined PLEs quantitatively using assessment tools and do not have a specific phenomenological definition, whereas assessment tools adopted have a wide variety. Furthermore, phenomenological studies of PLEs were rare. The variations in definitions and assessment tools of PLEs might contribute to mixed findings in researches. Reaching to a consensus through the study of phenomenology of PLEs is essential to further advancement of the research in this area. © 2015 Wiley Publishing Asia Pty Ltd.

Process for applying control variables having fractal structures

DOEpatents

Bullock, IV, Jonathan S.; Lawson, Roger L.

1996-01-01

A process and apparatus for the application of a control variable having a fractal structure to a body or process. The process of the present invention comprises the steps of generating a control variable having a fractal structure and applying the control variable to a body or process reacting in accordance with the control variable. The process is applicable to electroforming where first, second and successive pulsed-currents are applied to cause the deposition of material onto a substrate, such that the first pulsed-current, the second pulsed-current, and successive pulsed currents form a fractal pulsed-current waveform.

Process for applying control variables having fractal structures

DOEpatents

Bullock, J.S. IV; Lawson, R.L.

1996-01-23

A process and apparatus are disclosed for the application of a control variable having a fractal structure to a body or process. The process of the present invention comprises the steps of generating a control variable having a fractal structure and applying the control variable to a body or process reacting in accordance with the control variable. The process is applicable to electroforming where first, second and successive pulsed-currents are applied to cause the deposition of material onto a substrate, such that the first pulsed-current, the second pulsed-current, and successive pulsed currents form a fractal pulsed-current waveform. 3 figs.

12 CFR 218.700 - Defined terms relating to the networking exception from the definition of “broker.”

Code of Federal Regulations, 2014 CFR

2014-01-01

... overall profitability or revenue of: (i) The bank, either on a stand-alone or consolidated basis; (ii) Any...) Such measure of overall profitability or revenue is only one of multiple factors or variables used to... variables that are not related to the profitability or revenue of the broker or dealer; (C) A referral made...

17 CFR 247.700 - Defined terms relating to the networking exception from the definition of “broker.”

Code of Federal Regulations, 2011 CFR

2011-04-01

... overall profitability or revenue of: (i) The bank, either on a stand-alone or consolidated basis; (ii) Any...) Such measure of overall profitability or revenue is only one of multiple factors or variables used to... variables that are not related to the profitability or revenue of the broker or dealer; (C) A referral made...

12 CFR 218.700 - Defined terms relating to the networking exception from the definition of “broker.”

Code of Federal Regulations, 2013 CFR

2013-01-01

... overall profitability or revenue of: (i) The bank, either on a stand-alone or consolidated basis; (ii) Any...) Such measure of overall profitability or revenue is only one of multiple factors or variables used to... variables that are not related to the profitability or revenue of the broker or dealer; (C) A referral made...

12 CFR 218.700 - Defined terms relating to the networking exception from the definition of “broker.”

Code of Federal Regulations, 2012 CFR

2012-01-01

... overall profitability or revenue of: (i) The bank, either on a stand-alone or consolidated basis; (ii) Any...) Such measure of overall profitability or revenue is only one of multiple factors or variables used to... variables that are not related to the profitability or revenue of the broker or dealer; (C) A referral made...

17 CFR 247.700 - Defined terms relating to the networking exception from the definition of “broker.”

Code of Federal Regulations, 2013 CFR

2013-04-01

... overall profitability or revenue of: (i) The bank, either on a stand-alone or consolidated basis; (ii) Any...) Such measure of overall profitability or revenue is only one of multiple factors or variables used to... variables that are not related to the profitability or revenue of the broker or dealer; (C) A referral made...

17 CFR 247.700 - Defined terms relating to the networking exception from the definition of “broker.”

Code of Federal Regulations, 2012 CFR

2012-04-01

... overall profitability or revenue of: (i) The bank, either on a stand-alone or consolidated basis; (ii) Any...) Such measure of overall profitability or revenue is only one of multiple factors or variables used to... variables that are not related to the profitability or revenue of the broker or dealer; (C) A referral made...

12 CFR 218.700 - Defined terms relating to the networking exception from the definition of “broker.”

Code of Federal Regulations, 2011 CFR

2011-01-01

... overall profitability or revenue of: (i) The bank, either on a stand-alone or consolidated basis; (ii) Any...) Such measure of overall profitability or revenue is only one of multiple factors or variables used to... variables that are not related to the profitability or revenue of the broker or dealer; (C) A referral made...

17 CFR 247.700 - Defined terms relating to the networking exception from the definition of “broker.”

Code of Federal Regulations, 2014 CFR

2014-04-01

... overall profitability or revenue of: (i) The bank, either on a stand-alone or consolidated basis; (ii) Any...) Such measure of overall profitability or revenue is only one of multiple factors or variables used to... variables that are not related to the profitability or revenue of the broker or dealer; (C) A referral made...

[Biometric bases: basic concepts of probability calculation].

PubMed

Dinya, E

1998-04-26

The author gives or outline of the basic concepts of probability theory. The bases of the event algebra, definition of the probability, the classical probability model and the random variable are presented.

ROMPS critical design review. Volume 3: Furnace module design documentation

NASA Technical Reports Server (NTRS)

Dobbs, M. E.

1992-01-01

As part of the furnace module design documentation, the furnace module Easylab programs definitions and command variables are described. Also included are Easylab commands flow charts and fault conditions.

SEER Data & Software

Cancer.gov

Options for accessing datasets for incidence, mortality, county populations, standard populations, expected survival, and SEER-linked and specialized data. Plus variable definitions, documentation for reporting and using datasets, statistical software (SEER*Stat), and observational research resources.

The European Cystic Fibrosis Society Patient Registry: valuable lessons learned on how to sustain a disease registry.

PubMed

Viviani, Laura; Zolin, Anna; Mehta, Anil; Olesen, Hanne Vebert

2014-06-07

Disease registries have the invaluable potential to provide an insight into the natural history of the disease under investigation, to provide useful information (e.g. through health indicators) for planning health care services and to identify suitable groups of patients for clinical trials enrolment. However, the establishment and maintenance of disease registries is a burdensome initiative from economical and organisational points of view and experience sharing on registries management is important to avoid waste of resources. The aim of this paper is to discuss the problems embedded in the institution and management of an international disease registry to warn against common mistakes that can derail the best of intentions: we share the experience of the European Cystic Fibrosis Society Patient Registry, which collects data on almost 30,000 patients from 23 countries. We discuss the major problems that researchers often encounter in the creation and management of disease registries: definition of the aims the registry has to reach, definition of the criteria for patients referral to the registry, definition of the information to record, set up of a data quality process, handling of missing data, maintenance of data confidentiality, regulation of data use and dissemination of research results. We give examples on how many crucial aspects were solved by the European Cystic Fibrosis Society Patient Registry regarding objectives, inclusion criteria and variables definition, data management, data quality controls, missing data handling, confidentiality maintenance, data use and results dissemination. We suggest an extensive literature research and discussions in working groups with different stake holders, including patient representatives, on the objectives, inclusion criteria and the information to record. We propose to pilot the recording of few variables and test the applicability of their definition first. The use of a shared electronic platform for data collection that automatically computes derived variables, and automatically performs basic data quality controls is a good data management practice, that also helps in reducing missing data. We found crucial for success the collaboration with existing national and international registries, cystic fibrosis organisations and patients' associations.

The European Cystic Fibrosis Society Patient Registry: valuable lessons learned on how to sustain a disease registry

PubMed Central

2014-01-01

Background Disease registries have the invaluable potential to provide an insight into the natural history of the disease under investigation, to provide useful information (e.g. through health indicators) for planning health care services and to identify suitable groups of patients for clinical trials enrolment. However, the establishment and maintenance of disease registries is a burdensome initiative from economical and organisational points of view and experience sharing on registries management is important to avoid waste of resources. The aim of this paper is to discuss the problems embedded in the institution and management of an international disease registry to warn against common mistakes that can derail the best of intentions: we share the experience of the European Cystic Fibrosis Society Patient Registry, which collects data on almost 30,000 patients from 23 countries. Methods We discuss the major problems that researchers often encounter in the creation and management of disease registries: definition of the aims the registry has to reach, definition of the criteria for patients referral to the registry, definition of the information to record, set up of a data quality process, handling of missing data, maintenance of data confidentiality, regulation of data use and dissemination of research results. Results We give examples on how many crucial aspects were solved by the European Cystic Fibrosis Society Patient Registry regarding objectives, inclusion criteria and variables definition, data management, data quality controls, missing data handling, confidentiality maintenance, data use and results dissemination. Conclusions We suggest an extensive literature research and discussions in working groups with different stake holders, including patient representatives, on the objectives, inclusion criteria and the information to record. We propose to pilot the recording of few variables and test the applicability of their definition first. The use of a shared electronic platform for data collection that automatically computes derived variables, and automatically performs basic data quality controls is a good data management practice, that also helps in reducing missing data. We found crucial for success the collaboration with existing national and international registries, cystic fibrosis organisations and patients’ associations. PMID:24908055

Poorly Differentiated Thyroid Carcinoma.

PubMed

Setia, Namrata; Barletta, Justine A

2014-12-01

Poorly differentiated thyroid carcinoma (PDTC) has been recognized for the past 30 years as an entity showing intermediate differentiation and clinical behavior between well-differentiated thyroid carcinomas (ie, papillary thyroid carcinoma and follicular thyroid carcinoma) and anaplastic thyroid carcinoma; however, there has been considerable controversy around the definition of PDTC. In this review, the evolution in the definition of PDTC, current diagnostic criteria, differential diagnoses, potentially helpful immunohistochemical studies, and molecular alterations are discussed with the aim of highlighting where the diagnosis of PDTC currently stands. Published by Elsevier Inc.

On the definition of a confounder

PubMed Central

VanderWeele, Tyler J.; Shpitser, Ilya

2014-01-01

Summary The causal inference literature has provided a clear formal definition of confounding expressed in terms of counterfactual independence. The causal inference literature has not, however, produced a clear formal definition of a confounder, as it has given priority to the concept of confounding over that of a confounder. We consider a number of candidate definitions arising from various more informal statements made in the literature. We consider the properties satisfied by each candidate definition, principally focusing on (i) whether under the candidate definition control for all “confounders” suffices to control for “confounding” and (ii) whether each confounder in some context helps eliminate or reduce confounding bias. Several of the candidate definitions do not have these two properties. Only one candidate definition of those considered satisfies both properties. We propose that a “confounder” be defined as a pre-exposure covariate C for which there exists a set of other covariates X such that effect of the exposure on the outcome is unconfounded conditional on (X, C) but such that for no proper subset of (X, C) is the effect of the exposure on the outcome unconfounded given the subset. A variable that helps reduce bias but not eliminate bias we propose referring to as a “surrogate confounder.” PMID:25544784

Internal versus external controls on age variability: Definitions, origins and implications in a changing climate

NASA Astrophysics Data System (ADS)

Helton, A. M.; Poole, G. C.; Payn, R. A.; Izurieta, C.; Wright, M.; Bernhardt, E. S.; Stanford, J. A.

2014-12-01

The unsteadiness of stream water age is now well established, but the controls on the age dynamics, and the adequate representation and prediction of those dynamics, are not. A basic distinction can be made between internal variability that arises from changes in the proportions of flow moving through the diverse flow pathways of a hydrologic system, and external variability that arises from the stochasticity of inputs and outputs (such as precipitation and streamflow). In this talk I will show how these two types of age variability can be formally defined and distinguished within the framework of rank StorAge Selection (rSAS) functions. Internal variability implies variations in time in the rSAS function, while external variability does not. This leads naturally to the definition of several modes of internal variability, reflecting generic ways that system flowpaths may be rearranged. This rearrangement may be induced by fluctuations in the system state (such as catchment wetness), or by longer-term changes in catchment structure (such as land use change). One type of change, the 'inverse storage effect' is characterized by an increase in the release of young water from the system in response to an increase in overall system storage. This effect can be seen in many hydrologic settings, and has important implications for the effect of altered hydroclimatic conditions on solute transport through a landscape. External variability, such as increased precipitation, can induce a decrease in mean transit time (and vice versa), but this effect is greatly enhanced if accompanied by an internal shift in flow pathways that increases the relative importance of younger water. These effects will be illustrated using data from field and experimental studies.

Internal versus external controls on age variability: Definitions, origins and implications in a changing climate

NASA Astrophysics Data System (ADS)

Harman, C. J.

2015-12-01

The unsteadiness of stream water age is now well established, but the controls on the age dynamics, and the adequate representation and prediction of those dynamics, are not. A basic distinction can be made between internal variability that arises from changes in the proportions of flow moving through the diverse flow pathways of a hydrologic system, and external variability that arises from the stochasticity of inputs and outputs (such as precipitation and streamflow). In this talk I will show how these two types of age variability can be formally defined and distinguished within the framework of rank StorAge Selection (rSAS) functions. Internal variability implies variations in time in the rSAS function, while external variability does not. This leads naturally to the definition of several modes of internal variability, reflecting generic ways that system flowpaths may be rearranged. This rearrangement may be induced by fluctuations in the system state (such as catchment wetness), or by longer-term changes in catchment structure (such as land use change). One type of change, the 'inverse storage effect' is characterized by an increase in the release of young water from the system in response to an increase in overall system storage. This effect can be seen in many hydrologic settings, and has important implications for the effect of altered hydroclimatic conditions on solute transport through a landscape. External variability, such as increased precipitation, can induce a decrease in mean transit time (and vice versa), but this effect is greatly enhanced if accompanied by an internal shift in flow pathways that increases the relative importance of younger water. These effects will be illustrated using data from field and experimental studies.

Current and Future Targets for Mucosal Healing in Inflammatory Bowel Disease

PubMed Central

Atreya, Raja; Neurath, Markus F.

2017-01-01

The induction and subsequent maintenance of mucosal healing has emerged as one of the central therapeutic goals in the management of patients with inflammatory bowel disease (IBD) (Crohn's disease and ulcerative colitis). Current and novel treatment options are assessed regarding their therapeutic efficacy on the basis of their ability to induce mucosal healing. However, there is still substantial debate about the precise definition of mucosal healing. Here, we will give an overview regarding the definitions of mucosal healing as well as its probable effects on long-term disease behavior and finally focus on current and potential therapeutic targets to achieve this therapeutic goal in IBD patients. PMID:28612022

16 CFR 1407.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... GENERATORS: REQUIREMENTS TO PROVIDE PERFORMANCE AND TECHNICAL DATA BY LABELING § 1407.2 Definitions. (a) The... portable generator is an internal combustion engine-driven electric generator rated no higher than 15..., and may have alternating- or direct-current (DC) sections for supplying energy to battery charging...

44 CFR 206.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... organization: Any nongovernmental agency or entity that currently has: (i) An effective ruling letter from the... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Definitions. 206.2 Section 206.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND...

44 CFR 206.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... organization: Any nongovernmental agency or entity that currently has: (i) An effective ruling letter from the... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Definitions. 206.2 Section 206.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND...

5 CFR 1215.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Definitions. 1215.2 Section 1215.2 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Salary Offset... the debt and authorizes the payment of his/her current pay. (h) Salary offset. An administrative...

Reading Fluency and Its Intervention.

ERIC Educational Resources Information Center

Wolf, Maryanne; Katzir-Cohen, Tami

2001-01-01

Confronts 3 large lacunae in research on reading fluency: definition, component structure, and theory-based intervention. Presents a developmental- and component-based definition of reading fluency. Discusses how different types of current fluency interventions correspond to particular components in fluency's structure and to particular phases of…

Case definition and classification of leukodystrophies and leukoencephalopathies.

PubMed

Vanderver, Adeline; Prust, Morgan; Tonduti, Davide; Mochel, Fanny; Hussey, Heather M; Helman, Guy; Garbern, James; Eichler, Florian; Labauge, Pierre; Aubourg, Patrick; Rodriguez, Diana; Patterson, Marc C; Van Hove, Johan L K; Schmidt, Johanna; Wolf, Nicole I; Boespflug-Tanguy, Odile; Schiffmann, Raphael; van der Knaap, Marjo S

2015-04-01

An approved definition of the term leukodystrophy does not currently exist. The lack of a precise case definition hampers efforts to study the epidemiology and the relevance of genetic white matter disorders to public health. Thirteen experts at multiple institutions participated in iterative consensus building surveys to achieve definition and classification of disorders as leukodystrophies using a modified Delphi approach. A case definition for the leukodystrophies was achieved, and a total of 30 disorders were classified under this definition. In addition, a separate set of disorders with heritable white matter abnormalities but not meeting criteria for leukodystrophy, due to presumed primary neuronal involvement and prominent systemic manifestations, was classified as genetic leukoencephalopathies (gLE). A case definition of leukodystrophies and classification of heritable white matter disorders will permit more detailed epidemiologic studies of these disorders. Copyright © 2015 Elsevier Inc. All rights reserved.

Developing a dimensional model for successful cognitive and emotional aging.

PubMed

Vahia, Ipsit V; Thompson, Wesley K; Depp, Colin A; Allison, Matthew; Jeste, Dilip V

2012-04-01

There is currently a lack of consensus on the definition of successful aging (SA) and existing implementations have omitted constructs associated with SA. We used empirical methods to develop a dimensional model of SA that incorporates a wider range of associated variables, and we examined the relationship among these components using factor analysis and Bayesian Belief Nets. We administered a successful aging questionnaire comprising several standardized measures related to SA to a sample of 1948 older women enrolled in the San Diego site of the Women's Health Initiative study. The SA-related variables we included in the model were self-rated successful aging, depression severity, physical and emotional functioning, optimism, resilience, attitude towards own aging, self-efficacy, and cognitive ability. After adjusting for age, education and income, we fitted an exploratory factor analysis model to the SA-related variables and then, in order to address relationships among these factors, we computed a Bayesian Belief Net (BBN) using rotated factor scores. The SA-related variables loaded onto five factors. Based on the loading, we labeled the factors as follows: self-rated successful aging, cognition, psychosocial protective factors, physical functioning, and emotional functioning. In the BBN, self-rated successful aging emerged as the primary downstream factor and exhibited significant partial correlations with psychosocial protective factors, physical/general status and mental/emotional status but not with cognitive ability. Our study represents a step forward in developing a dimensional model of SA. Our findings also point to a potential role for psychiatry in improving successful aging by managing depressive symptoms and developing psychosocial interventions to improve self-efficacy, resilience, and optimism.

Breakage mechanics—Part I: Theory

NASA Astrophysics Data System (ADS)

Einav, Itai

2007-06-01

Different measures have been suggested for quantifying the amount of fragmentation in randomly compacted crushable aggregates. A most effective and popular measure is to adopt variants of Hardin's [1985. Crushing of soil particles. J. Geotech. Eng. ASCE 111(10), 1177-1192] definition of relative breakage ' Br'. In this paper we further develop the concept of breakage to formulate a new continuum mechanics theory for crushable granular materials based on statistical and thermomechanical principles. Analogous to the damage internal variable ' D' which is used in continuum damage mechanics (CDM), here the breakage internal variable ' B' is adopted. This internal variable represents a particular form of the relative breakage ' Br' and measures the relative distance of the current grain size distribution from the initial and ultimate distributions. Similar to ' D', ' B' varies from zero to one and describes processes of micro-fractures and the growth of surface area. However, unlike damage that is most suitable to tensioned solid-like materials, the breakage is aimed towards compressed granular matter. While damage effectively represents the opening of micro-cavities and cracks, breakage represents comminution of particles. We term the new theory continuum breakage mechanics (CBM), reflecting the analogy with CDM. A focus is given to developing fundamental concepts and postulates, and identifying the physical meaning of the various variables. In this part of the paper we limit the study to describe an ideal dissipative process that includes breakage without plasticity. Plastic strains are essential, however, in representing aspects that relate to frictional dissipation, and this is covered in Part II of this paper together with model examples.

Sikorsky interactive graphics surface design/manufacturing system

NASA Technical Reports Server (NTRS)

Robbins, R.

1975-01-01

An interactive graphics system conceived to be used in the design, analysis, and manufacturing of aircraft components with free form surfaces was described. In addition to the basic surface definition and viewing capabilities inherent in such a system, numerous other features are present: surface editing, automated smoothing of control curves, variable milling patch boundary definitions, surface intersection definition and viewing, automatic creation of true offset surfaces, digitizer and drafting machine interfaces, and cutter path optimization. Documented costs and time savings of better than six to one are being realized with this system. The system was written in FORTRAN and GSP for use on IBM 2250 CRT's in conjunction with an IBM 370/158 computer.

Definition of Recurrent Urinary Tract Infections in Women: Which One to Adopt?

PubMed

Malik, Rena D; Wu, Yuefeng Rose; Zimmern, Philippe E

2017-11-13

The aim of this study was to systematically review the various definitions of recurrent urinary tract infection (RUTI) recommended by experts and specialty societies cited in biomedical literature. A systematic review of RUTI in women was conducted using MEDLINE, EMBASE, and PubMed between 1966 and 2016 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Statement. Twenty-five publications were selected for inclusion in this analysis. From review of included publications, 14 definitions of RUTI were obtained. Each source was searched for a textual definition of RUTI as well as presence or absence of specific key elements including urinary symptoms, colony forming unit count, bacterial species, number of UTIs per year, interval time between infections and a negative intervening culture. All data were reviewed by 2 separate investigators. The definition of RUTI was found highly variable in the literature. The tallying of key elements in included definitions suggests that a minimum RUTI definition should include urinary symptoms, urine culture colony forming unit/mL threshold, differentiation of bacterial persistence versus reinfection by bacterial species, and number of UTIs per year. This review of major RUTI definition recommendations by expert individuals and specialty societies underlines the lack of uniformity and the need for a more robust and generally agreeable RUTI definition for use in clinical and academic practice.

Automated MRI segmentation for individualized modeling of current flow in the human head.

PubMed

Huang, Yu; Dmochowski, Jacek P; Su, Yuzhuo; Datta, Abhishek; Rorden, Christopher; Parra, Lucas C

2013-12-01

High-definition transcranial direct current stimulation (HD-tDCS) and high-density electroencephalography require accurate models of current flow for precise targeting and current source reconstruction. At a minimum, such modeling must capture the idiosyncratic anatomy of the brain, cerebrospinal fluid (CSF) and skull for each individual subject. Currently, the process to build such high-resolution individualized models from structural magnetic resonance images requires labor-intensive manual segmentation, even when utilizing available automated segmentation tools. Also, accurate placement of many high-density electrodes on an individual scalp is a tedious procedure. The goal was to develop fully automated techniques to reduce the manual effort in such a modeling process. A fully automated segmentation technique based on Statical Parametric Mapping 8, including an improved tissue probability map and an automated correction routine for segmentation errors, was developed, along with an automated electrode placement tool for high-density arrays. The performance of these automated routines was evaluated against results from manual segmentation on four healthy subjects and seven stroke patients. The criteria include segmentation accuracy, the difference of current flow distributions in resulting HD-tDCS models and the optimized current flow intensities on cortical targets. The segmentation tool can segment out not just the brain but also provide accurate results for CSF, skull and other soft tissues with a field of view extending to the neck. Compared to manual results, automated segmentation deviates by only 7% and 18% for normal and stroke subjects, respectively. The predicted electric fields in the brain deviate by 12% and 29% respectively, which is well within the variability observed for various modeling choices. Finally, optimized current flow intensities on cortical targets do not differ significantly. Fully automated individualized modeling may now be feasible for large-sample EEG research studies and tDCS clinical trials.

A systematic review of definitions and classification systems of adjacent segment pathology.

PubMed

Kraemer, Paul; Fehlings, Michael G; Hashimoto, Robin; Lee, Michael J; Anderson, Paul A; Chapman, Jens R; Raich, Annie; Norvell, Daniel C

2012-10-15

Systematic review. To undertake a systematic review to determine how "adjacent segment degeneration," "adjacent segment disease," or clinical pathological processes that serve as surrogates for adjacent segment pathology are classified and defined in the peer-reviewed literature. Adjacent segment degeneration and adjacent segment disease are terms referring to degenerative changes known to occur after reconstructive spine surgery, most commonly at an immediately adjacent functional spinal unit. These can include disc degeneration, instability, spinal stenosis, facet degeneration, and deformity. The true incidence and clinical impact of degenerative changes at the adjacent segment is unclear because there is lack of a universally accepted classification system that rigorously addresses clinical and radiological issues. A systematic review of the English language literature was undertaken and articles were classified using the Grades of Recommendation Assessment, Development, and Evaluation criteria. RESULTS.: Seven classification systems of spinal degeneration, including degeneration at the adjacent segment, were identified. None have been evaluated for reliability or validity specific to patients with degeneration at the adjacent segment. The ways in which terms related to adjacent segment "degeneration" or "disease" are defined in the peer-reviewed literature are highly variable. On the basis of the systematic review presented in this article, no formal classification system for either cervical or thoracolumbar adjacent segment disorders currently exists. No recommendations regarding the use of current classification of degeneration at any segments can be made based on the available literature. A new comprehensive definition for adjacent segment pathology (ASP, the now preferred terminology) has been proposed in this Focus Issue, which reflects the diverse pathology observed at functional spinal units adjacent to previous spinal reconstruction and balances detailed stratification with clinical utility. A comprehensive classification system is being developed through expert opinion and will require validation as well as peer review. Strength of Statement: Strong.

In Vivo Predictive Dissolution (IPD) and Biopharmaceutical Modeling and Simulation: Future Use of Modern Approaches and Methodologies in a Regulatory Context.

PubMed

Lennernäs, H; Lindahl, A; Van Peer, A; Ollier, C; Flanagan, T; Lionberger, R; Nordmark, A; Yamashita, S; Yu, L; Amidon, G L; Fischer, V; Sjögren, E; Zane, P; McAllister, M; Abrahamsson, B

2017-04-03

The overall objective of OrBiTo, a project within Innovative Medicines Initiative (IMI), is to streamline and optimize the development of orally administered drug products through the creation and efficient application of biopharmaceutics tools. This toolkit will include both experimental and computational models developed on improved understanding of the highly dynamic gastrointestinal (GI) physiology relevant to the GI absorption of drug products in both fasted and fed states. A part of the annual OrBiTo meeting in 2015 was dedicated to the presentation of the most recent progress in the development of the regulatory use of PBPK in silico modeling, in vivo predictive dissolution (IPD) tests, and their application to biowaivers. There are still several areas for improvement of in vitro dissolution testing by means of generating results relevant for the intraluminal conditions in the GI tract. The major opportunity is probably in combining IPD testing and physiologically based in silico models where the in vitro data provide input to the absorption predictions. The OrBiTo project and other current research projects include definition of test media representative for the more distal parts of the GI tract, models capturing supersaturation and precipitation phenomena, and influence of motility waves on shear and other forces of hydrodynamic origin, addressing the interindividual variability in composition and characteristics of GI fluids, food effects, definition of biorelevant buffer systems, and intestinal water volumes. In conclusion, there is currently a mismatch between the extensive industrial usage of modern in vivo predictive tools and very limited inclusion of such data in regulatory files. However, there is a great interest among all stakeholders to introduce recent progresses in prediction of in vivo GI drug absorption into regulatory context.

ACR Appropriateness Criteria®  Resectable Rectal Cancer

PubMed Central

2012-01-01

The management of resectable rectal cancer continues to be guided by clinical trials and advances in technique. Although surgical advances including total mesorectal excision continue to decrease rates of local recurrence, the management of locally advanced disease (T3-T4 or N+) benefits from a multimodality approach including neoadjuvant concomitant chemotherapy and radiation. Circumferential resection margin, which can be determined preoperatively via MRI, is prognostic. Toxicity associated with radiation therapy is decreased by placing the patient in the prone position on a belly board, however for patients who cannot tolerate prone positioning, IMRT decreases the volume of normal tissue irradiated. The use of IMRT requires knowledge of the patterns of spreads and anatomy. Clinical trials demonstrate high variability in target delineation without specific guidance demonstrating the need for peer review and the use of a consensus atlas. Concomitant with radiation, fluorouracil based chemotherapy remains the standard, and although toxicity is decreased with continuous infusion fluorouracil, oral capecitabine is non-inferior to the continuous infusion regimen. Additional chemotherapeutic agents, including oxaliplatin, continue to be investigated, however currently should only be utilized on clinical trials as increased toxicity and no definitive benefit has been demonstrated in clinical trials. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:23006527

An examination of the disparity between self-identified versus legally identified rape victimization: A pilot study.

PubMed

Marsil, Dorothy F; McNamara, Corinne

2016-07-01

Researchers compared rape victimization based on self-identification to the current federal legal definition in a pilot study of college students. The sample was comprised of 1,648 (69.8% female; 30.2% male) college students who completed the Sexual Experiences Survey-Short Form Victimization (SES-SFV) online. Based on the current legal definition of rape, 9.4% (11.1% female; 5.2% male) of students had been raped since being enrolled, but only 2.9% of students self-identified as being raped. Moreover, 15.1% of students reported ever being raped, with females acknowledging higher rates (19.7%) than males (4.3%). Rape continues to be a major issue for colleges and universities. A serious concern is the disparity between the number of those who met the behavioral criteria for rape victimization based on the current legal definition, but who did not self-identify as a victim. Universities must address this disparity by using multiple measures to assess the prevalence of sexual violence on campus.

APPLICATIONS OF A CONCEPTUAL MODEL (THE BIOLOGICAL CONDITION GRADIENT) TO DEFINE AQUATIC REFERENCE CONDITIONS

EPA Science Inventory

The United States Clean Water Act currently offers no definitions to interpret the Act's objective to "restore and maintain physical, chemical and biological integrity of the Nation's waters". Operative definitions, independent of differences in assessment methodologies, are nee...

36 CFR 218.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Authorized by the Healthy Forests Restoration Act of 2003 § 218.2 Definitions. Address: An individual's or organization's current physical mailing address. An e-mail address is not sufficient. Authorized hazardous fuel reduction project: A hazardous fuel reduction project authorized by the Healthy Forests Restoration Act of...

36 CFR 218.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Authorized by the Healthy Forests Restoration Act of 2003 § 218.2 Definitions. Address: An individual's or organization's current physical mailing address. An e-mail address is not sufficient. Authorized hazardous fuel reduction project: A hazardous fuel reduction project authorized by the Healthy Forests Restoration Act of...

A current perspective on medical informatics and health sciences librarianship.

PubMed

Perry, Gerald J; Roderer, Nancy K; Assar, Soraya

2005-04-01

The article offers a current perspective on medical informatics and health sciences librarianship. The authors: (1) discuss how definitions of medical informatics have changed in relation to health sciences librarianship and the broader domain of information science; (2) compare the missions of health sciences librarianship and health sciences informatics, reviewing the characteristics of both disciplines; (3) propose a new definition of health sciences informatics; (4) consider the research agendas of both disciplines and the possibility that they have merged; and (5) conclude with some comments about actions and roles for health sciences librarians to flourish in the biomedical information environment of today and tomorrow. Boundaries are disappearing between the sources and types of and uses for health information managed by informaticians and librarians. Definitions of the professional domains of each have been impacted by these changes in information. Evolving definitions reflect the increasingly overlapping research agendas of both disciplines. Professionals in these disciplines are increasingly functioning collaboratively as "boundary spanners," incorporating human factors that unite technology with health care delivery.

Development of a Vision-Based Particle Tracking Velocimetry Method and Post-Processing of Scattered Velocity Data

DTIC Science & Technology

2012-01-01

the performance of the VB-PTV algorithm. Particle yield is changed subtly from the definition above and defined as the number of matches made over the...methods have been developed for use in fields as varied as cosmology (Bernardeau and van de Weygaert, 1996; Schaap and van de Weygaert, 2000) and...becomes a long list of equations and variable definitions , interested readers are referred to Gunes et al., (2006); Sacks et al., (1989); and Lophaven

Observation of arterial blood pressure of the primate

NASA Technical Reports Server (NTRS)

Meehan, J. P.; Henry, J. P.

1973-01-01

The developments are reported in physiological instrumentation, surgical procedures, measurement and data analysis techniques, and the definition of flight experiments to determine the effects of prolonged weightlessness on the cardiovascular system of subhuman primates. The development of an implantable telemetric data acquisition system is discussed along with cardiovascular research applications in renal hemodynamics. It is concluded that the implant technique permits a valid interpretation, free of emotional response, for the manipulated variable on physiological functions. It also allows a better definition of normal physiological baseline conditions.

A redefinition of water masses in the Vietnamese upwelling area

NASA Astrophysics Data System (ADS)

Dippner, Joachim W.; Loick-Wilde, Natalie

2011-01-01

A redefinition of characteristic water masses in the Vietnamese upwelling area is presented based on five interdisciplinary cruises during different seasons and 331 CTD casts. In contrast to the previous definition of Rojana-anawat et al. (2001), we clearly can define water masses which serve as end members of mixing. This new definition is useful for an improved understanding of geographical positions of different water masses with respect to climate variability, the phytoplankton distribution and complex nutrient cycle in this area.

The definition of massive transfusion in trauma: a critical variable in examining evidence for resuscitation.

PubMed

Mitra, Biswadev; Cameron, Peter A; Gruen, Russell L; Mori, Alfredo; Fitzgerald, Mark; Street, Alison

2011-06-01

'Massive' transfusion is a poorly defined inclusion criteria for studies examining the blood and blood product that are used during trauma resuscitation. We aimed to compare the traditional definition of massive transfusion (≥10 units in 24 h) to a more acute definition of at least 5 units in 4 h. Multitrauma patients were subgrouped according to the traditional definition and compared with the acute definition. Demographics, presenting vital signs and blood results, management including transfusion practice and outcomes were retrospectively studied. Associations of transfused fresh frozen plasma:packed red blood cells (PRBC) ratios with mortality were studied. There were 927 patients who received PRBCs in the first 24 h, with 314 patients identified using the traditional definition and 303 patients using the acute definition. The patients identified using the traditional definition received 18 (12-29) units of PRBC in 24 h, significantly higher than those identified using the acute definition [15 (9-29) units, P<0.001]. The traditional definition excluded a significant proportion of patients who died in the emergency department. By using the acute definition to select a study sample, there seems to be an increase in mortality with fresh frozen plasma:PRBC ratio of 1 : 1 ratio compared with a 1 : 2 ratio. The traditional 'massive' transfusion definition not only 'dilutes' the potential study samples with a less acute group of patients, but also further excludes patients who die early. This latter group is most likely to be benefitted from any change to resuscitation practice. An acute definition of massive transfusion should be adopted when examining clinical practice during initial trauma resuscitation.

Continuing Development of a Hybrid Model (VSH) of the Neutral Thermosphere

NASA Technical Reports Server (NTRS)

Burns, Alan

1996-01-01

We propose to continue the development of a new operational model of neutral thermospheric density, composition, temperatures and winds to improve current engineering environment definitions of the neutral thermosphere. This model will be based on simulations made with the National Center for Atmospheric Research (NCAR) Thermosphere-Ionosphere- Electrodynamic General Circulation Model (TIEGCM) and on empirical data. It will be capable of using real-time geophysical indices or data from ground-based and satellite inputs and provides neutral variables at specified locations and times. This "hybrid" model will be based on a Vector Spherical Harmonic (VSH) analysis technique developed (over the last 8 years) at the University of Michigan that permits the incorporation of the TIGCM outputs and data into the model. The VSH model will be a more accurate version of existing models of the neutral thermospheric, and will thus improve density specification for satellites flying in low Earth orbit (LEO).

Perspectives on Current Issues Is ``Anthropic Selection'' Science?

NASA Astrophysics Data System (ADS)

Larson, Ronald G.

2007-01-01

I argue that there are strong reasons for resisting as a principle of science the concept of “anthropic selection.” This concept asserts that the existence of “observers” in a universe can be used as a condition that selects physical laws and constants necessary for intelligent life from different laws or physical constants prevailing in a vast number of other universes, to thereby explain why the properties of our universe are conducive to intelligent life. My reasons for limiting “anthropic selection” to the realm of speculation rather than permitting it to creep into mainstream science include our inability to estimate the probabilities of emergence of “observers” in a universe, the lack of testability through direct observation of the assumed high variability of the constants of nature, the lack of a clear definition of an “observer,” and the arbitrariness in how and to what questions anthropic selection is applied.

The Psychology of Sustainable Seafood Consumption: A Comprehensive Approach

PubMed Central

Richter, Isabel G. M.; Klöckner, Christian A.

2017-01-01

This paper discusses conceptual confusions of sustainable seafood consumption, practical challenges, and potential anchors from where this behaviour can be fostered. The main focus lies on psychological variables. The resulting framework comprises (1) a definition of sustainable seafood consumption, (2) suggestions for corresponding behaviours, (3) the identification of facilitating and hindering factors, (4) an assemblage of these factors into a theoretical model, and (5) a short discussion of how the model adds up value to the current state of the art in marine resource conservation. Behavioural models significantly contribute to behavioural change research. The originality and value of this research are that it tackles the so far relatively neglected field of sustainable seafood consumption as important part of sustainable development and marine conservation in the future. From an interventional perspective, the developed model facilitates the identification of contact points to approach consumers and disseminate sustainable seafood consumption among modern Western consumers. PMID:28956851

Culture, cultural factors and psychiatric diagnosis: review and projections.

PubMed

Alarcón, Renato D

2009-10-01

This paper aims to provide conceptual justifications for the inclusion of culture and cultural factors in psychiatric diagnosis, and logistic suggestions as to the content and use of this approach. A discussion of the scope and limitations of current diagnostic practice, criticisms from different quarters, and the role and relevance of culture in the diagnostic encounter, precede the examination of advantages and disadvantages of the approach. The cultural content of psychiatric diagnosis should include the main, well-recognized cultural variables, adequate family data, explanatory models, and strengths and weaknesses of every individual patient. The practical aspects include the acceptance of "cultural discordances" as a component of an updated definition of mental disorder, and the use of a refurbished cultural formulation. Clinical "telescoping" strategies to obtain relevant cultural data during the diagnostic interview, and areas of future research (including field trials on the cultural formulation and on "culture bound syndromes"), are outlined.

What physicians need to know about dreams and dreaming.

PubMed

Pagel, James F

2012-11-01

An overview of the current status of dream science is given, designed to provide a basic background of this field for the sleep-interested physician. No cognitive state has been more extensively studied and is yet more misunderstood than dreaming. Much older work is methodologically limited by lack of definitions, small sample size, and constraints of theoretical perspective, with evidence equivocal as to whether any special relationship exists between rapid eye movement (REM) sleep and dreaming. As the relationship between dreams and REM sleep is so poorly defined, evidence-based studies of dreaming require a dream report. The different aspects of dreaming that can be studied include dream and nightmare recall frequency, dream content, dreaming effect on waking behaviors, dream/nightmare associated medications, and pathophysiology affecting dreaming. Whether studied from behavioral, neuroanatomical, neurochemical, pathophysiological or electrophysiological perspectives, dreaming reveals itself to be a complex cognitive state affected by a wide variety of medical, psychological, sleep and social variables.

The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates

PubMed Central

2012-01-01

Although attempted suicide and non-suicidal self-injury (NSSI) are distinct behaviors differing in intent, form, and function, the behaviors co-occur at a high rate in both adults and adolescents. Researchers have begun to investigate the association between attempted suicide and NSSI among adolescents. The purpose of this paper is to present current research on this association. First, we discuss definitional issues associated with self-injurious behaviors. Next, we present research on the co-occurrence of attempted suicide and NSSI, including prevalence and associations with self-injury characteristics. We then discuss psychosocial variables associated with engaging in both NSSI and attempted suicide or one type of self-injury alone. Finally, we present the research to date on risk factors uniquely associated with either attempted suicide or NSSI. Implications for mental health professionals and future avenues of research are discussed. PMID:22463065

Welfare status, illness and subjective health definition.

PubMed Central

Prince, E O

1978-01-01

The self-defined health status of welfare recipients hospitalized for illness during the preceding year was compared to that of persons not on welfare but hospitalized for illness during the same period. Data were derived from a systematic probability sample of household residents of the Harlem Hospital inpatient district population surveyed July 1967-June 1970. Welfare recipient respondents were more likely to perceive their health as fair/poor than were persons not on welfare. This difference persisted when the data were analyzed by sex, age, reported levels and type of illness, hospital days and number of stays, and current usual activity; usual activity was a major explanatory variable but only partially accounted for the relationship. It has been hypothesized that in achievement-oriented societies, illness may be used as justification for a culturally-induced sense of personal failure to fulfill socially prescribed role obligations. The data are consistent with this hypothesis. PMID:686211

The Psychology of Sustainable Seafood Consumption: A Comprehensive Approach.

PubMed

Richter, Isabel G M; Klöckner, Christian A

2017-09-28

This paper discusses conceptual confusions of sustainable seafood consumption, practical challenges, and potential anchors from where this behaviour can be fostered. The main focus lies on psychological variables. The resulting framework comprises (1) a definition of sustainable seafood consumption, (2) suggestions for corresponding behaviours, (3) the identification of facilitating and hindering factors, (4) an assemblage of these factors into a theoretical model, and (5) a short discussion of how the model adds up value to the current state of the art in marine resource conservation. Behavioural models significantly contribute to behavioural change research. The originality and value of this research are that it tackles the so far relatively neglected field of sustainable seafood consumption as important part of sustainable development and marine conservation in the future. From an interventional perspective, the developed model facilitates the identification of contact points to approach consumers and disseminate sustainable seafood consumption among modern Western consumers.

Helminths and HIV infection: epidemiological observations on immunological hypotheses

PubMed Central

BROWN, M; MAWA, P A; KALEEBU, P; ELLIOTT, A M

2006-01-01

Parasitic helminths have co-evolved with the mammalian immune system. Current hypotheses suggest that immunological stimulation in the presence of helminths is balanced by immuno-regulation and by the broad spectrum of mechanisms possessed by helminths for countering the host immune response. The degree to which this balance is perfected, and the mechanisms by which this is achieved, vary between helminth species; we suggest that this is reflected not only in the degree of pathology induced by helminths but also in a variety of relationships with HIV infection and HIV disease. Available epidemiological data regarding interactions between helminths and HIV are largely observational; results are variable and generally inconclusive. Well designed, controlled intervention studies are required to provide definitive information on the species-specific nature of these interactions and on the advantages, disadvantages and optimal timing of de-worming in relation to HIV infection. PMID:17042933

Statistics Anxiety Update: Refining the Construct and Recommendations for a New Research Agenda.

PubMed

Chew, Peter K H; Dillon, Denise B

2014-03-01

Appreciation of the importance of statistics literacy for citizens of a democracy has resulted in an increasing number of degree programs making statistics courses mandatory for university students. Unfortunately, empirical evidence suggests that students in nonmathematical disciplines (e.g., social sciences) regard statistics courses as the most anxiety-inducing course in their degree programs. Although a literature review exists for statistics anxiety, it was done more than a decade ago, and newer studies have since added findings for consideration. In this article, we provide a current review of the statistics anxiety literature. Specifically, related variables, definitions, and measures of statistics anxiety are reviewed with the goal of refining the statistics anxiety construct. Antecedents, effects, and interventions of statistics anxiety are also reviewed to provide recommendations for statistics instructors and for a new research agenda. © The Author(s) 2014.

AC/DC current ratio in a current superimposition variable flux reluctance machine

NASA Astrophysics Data System (ADS)

Kohara, Akira; Hirata, Katsuhiro; Niguchi, Noboru; Takahara, Kazuaki

2018-05-01

We have proposed a current superimposition variable flux reluctance machine for traction motors. The torque-speed characteristics of this machine can be controlled by increasing or decreasing the DC current. In this paper, we discuss an AC/DC current ratio in the current superimposition variable flux reluctance machine. The structure and control method are described, and the characteristics are computed using FEA in several AC/DC ratios.

Flight Dynamic Model Exchange using XML

NASA Technical Reports Server (NTRS)

Jackson, E. Bruce; Hildreth, Bruce L.

2002-01-01

The AIAA Modeling and Simulation Technical Committee has worked for several years to develop a standard by which the information needed to develop physics-based models of aircraft can be specified. The purpose of this standard is to provide a well-defined set of information, definitions, data tables and axis systems so that cooperating organizations can transfer a model from one simulation facility to another with maximum efficiency. This paper proposes using an application of the eXtensible Markup Language (XML) to implement the AIAA simulation standard. The motivation and justification for using a standard such as XML is discussed. Necessary data elements to be supported are outlined. An example of an aerodynamic model as an XML file is given. This example includes definition of independent and dependent variables for function tables, definition of key variables used to define the model, and axis systems used. The final steps necessary for implementation of the standard are presented. Software to take an XML-defined model and import/export it to/from a given simulation facility is discussed, but not demonstrated. That would be the next step in final implementation of standards for physics-based aircraft dynamic models.

The polar caps

NASA Astrophysics Data System (ADS)

Akasofu, S.-I.

1985-12-01

According to the most common definition, the 'polar cap' is the region bounded by the average or statistical auroral oval. Studies of the effects of the interplanetary magnetic field (IMF) on various upper atmospheric phenomena are reviewed. The Antarctic region and the Arctic region represent an area for such investigations. Particular attention is given in this paper to those observations in the highest latitude region which provide some information concerning corresponding changes of the internal structure of the magnetosphere. A definition and working definition of the polar cap are considered along with the IMF and magnetospheric models, the entry of solar energetic electrons, statistical studies regarding the aurora, individual events, polar cap arcs, the cusp aurora, auroral electron precipitation, convection, ionospheric currents and field-aligned currents, the ionosphere, the thermosphere, polar rain, polar wind, and hopping motions of heavy ions.

Clustering of Tuberculosis Cases Based on Variable-Number Tandem-Repeat Typing in Relation to the Population Structure of Mycobacterium tuberculosis in the Netherlands

PubMed Central

Sloot, Rosa; Borgdorff, Martien W.; de Beer, Jessica L.; van Ingen, Jakko; Supply, Philip

2013-01-01

The population structure of 3,776 Mycobacterium tuberculosis isolates was determined using variable-number tandem-repeat (VNTR) typing. The degree of clonality was so high that a more relaxed definition of clustering cannot be applied. Among recent immigrants with non-Euro-American isolates, transmission is overestimated if based on identical VNTR patterns. PMID:23658260

Evaluating application of the National Healthcare Safety Network central line-associated bloodstream infection surveillance definition: a survey of pediatric intensive care and hematology/oncology units.

PubMed

Gaur, Aditya H; Miller, Marlene R; Gao, Cuilan; Rosenberg, Carol; Morrell, Gloria C; Coffin, Susan E; Huskins, W Charles

2013-07-01

To evaluate the application of the National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) definition in pediatric intensive care units (PICUs) and pediatric hematology/oncology units (PHOUs) participating in a multicenter quality improvement collaborative to reduce CLABSIs; to identify sources of variability in the application of the definition. Online survey using 18 standardized case scenarios. Each described a positive blood culture in a patient and required a yes- or-no answer to the question "Is this a CLABSI?" NHSN staff responses were the reference standard. Sixty-five US PICUs and PHOUs. Staff who routinely adjudicate CLABSIs using NHSN definitions. Sixty responses were received from 58 (89%) of 65 institutions; 78% of respondents were infection preventionists, infection control officers, or infectious disease physicians. Responses matched those of NHSN staff for 78% of questions. The mean (SE) percentage of concurring answers did not differ for scenarios evaluating application of 1 of the 3 criteria ("known pathogen," 78% [1.7%]; "skin contaminant, >1 year of age," 76% [SE, 2.5%]; "skin contaminant, ≤1 year of age," 81% [3.8%]; [Formula: see text]). The mean percentage of concurring answers was lower for scenarios requiring respondents to determine whether a CLABSI was present or incubating on admission (64% [4.6%]; [Formula: see text]) or to distinguish between primary and secondary bacteremia (65% [2.5%]; [Formula: see text]). The accuracy of application of the CLABSI definition was suboptimal. Efforts to reduce variability in identifying CLABSIs that are present or incubating on admission and in distinguishing primary from secondary bloodstream infection are needed.

A stepwedge-based method for measuring breast density: observer variability and comparison with human reading

NASA Astrophysics Data System (ADS)

Diffey, Jenny; Berks, Michael; Hufton, Alan; Chung, Camilla; Verow, Rosanne; Morrison, Joanna; Wilson, Mary; Boggis, Caroline; Morris, Julie; Maxwell, Anthony; Astley, Susan

2010-04-01

Breast density is positively linked to the risk of developing breast cancer. We have developed a semi-automated, stepwedge-based method that has been applied to the mammograms of 1,289 women in the UK breast screening programme to measure breast density by volume and area. 116 images were analysed by three independent operators to assess inter-observer variability; 24 of these were analysed on 10 separate occasions by the same operator to determine intra-observer variability. 168 separate images were analysed using the stepwedge method and by two radiologists who independently estimated percentage breast density by area. There was little intra-observer variability in the stepwedge method (average coefficients of variation 3.49% - 5.73%). There were significant differences in the volumes of glandular tissue obtained by the three operators. This was attributed to variations in the operators' definition of the breast edge. For fatty and dense breasts, there was good correlation between breast density assessed by the stepwedge method and the radiologists. This was also observed between radiologists, despite significant inter-observer variation. Based on analysis of thresholds used in the stepwedge method, radiologists' definition of a dense pixel is one in which the percentage of glandular tissue is between 10 and 20% of the total thickness of tissue.

Intellectual Capital.

ERIC Educational Resources Information Center

Snyder, Herbert W.; Pierce, Jennifer Burek

2002-01-01

This review focuses on intellectual capital and its relationship to information professionals. Discusses asset recognition; national practices and the acceptance of intellectual capital; definitions of intellectual capital; measuring intellectual capital, including multiple and single variable measures; managing intellectual capital; and knowledge…

Mission Analysis Program for Solar Electric Propulsion (MAPSEP). Volume 3: Program manual

NASA Technical Reports Server (NTRS)

Huling, K. R.; Boain, R. J.; Wilson, T.; Hong, P. E.; Shults, G. L.

1974-01-01

The internal structure of MAPSEP is described. Topics discussed include: macrologic, variable definition, subroutines, and logical flow. Information is given to facilitate modifications to the models and algorithms of MAPSEP.

Theoretical and practical issues in the definition of health: insights from Aboriginal Australia.

PubMed

Boddington, Paula; Räisänen, Ulla

2009-02-01

This paper discusses attempts to define health within a public policy arena and practical and conceptual difficulties that arise. An Australian Aboriginal definition of health is examined. Although there are certain difficulties of translation, this definition is prominent in current Australian health policy and discourse about health. The definition can be seen as broadly holistic in comparison to other holistic definitions such as that of the World Health Organization. The nature of this holism and its grounding within the context of Aboriginal Australia is discussed. In particular, its implications for the phenomenon of medicalization, which may be associated with a holistic notion of health, is critically explored, as is the link of notions of health to culture and the question of the possibility of a universal definition of health. The question of to what extent a definition of health is inspirational or operational is also raised.

46 CFR 25.25-3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 1 2014-10-01 2014-10-01 false Definitions. 25.25-3 Section 25.25-3 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY UNINSPECTED VESSELS REQUIREMENTS Life Preservers and Other... listing of current and formerly approved equipment and materials may be found on the Internet at: http...

Violence Exposure among Children with Disabilities

ERIC Educational Resources Information Center

Sullivan, Patricia M.

2009-01-01

The focus of this paper is children with disabilities exposed to a broad range of violence types including child maltreatment, domestic violence, community violence, and war and terrorism. Because disability research must be interpreted on the basis of the definitional paradigm employed, definitions of disability status and current prevalence…

5 CFR 843.102 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... EMPLOYEES RETIREMENT SYSTEM-DEATH BENEFITS AND EMPLOYEE REFUNDS General Provisions § 843.102 Definitions. In this part— Accrued benefit means the accrued, unpaid annuity payable after the death of a retiree... death of an employee, separated employee, or retiree) made to a current or former spouse of a deceased...

5 CFR 843.102 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... EMPLOYEES RETIREMENT SYSTEM-DEATH BENEFITS AND EMPLOYEE REFUNDS General Provisions § 843.102 Definitions. In this part— Accrued benefit means the accrued, unpaid annuity payable after the death of a retiree... death of an employee, separated employee, or retiree) made to a current or former spouse of a deceased...

5 CFR 843.102 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... EMPLOYEES RETIREMENT SYSTEM-DEATH BENEFITS AND EMPLOYEE REFUNDS General Provisions § 843.102 Definitions. In this part— Accrued benefit means the accrued, unpaid annuity payable after the death of a retiree... death of an employee, separated employee, or retiree) made to a current or former spouse of a deceased...

5 CFR 843.102 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... EMPLOYEES RETIREMENT SYSTEM-DEATH BENEFITS AND EMPLOYEE REFUNDS General Provisions § 843.102 Definitions. In this part— Accrued benefit means the accrued, unpaid annuity payable after the death of a retiree... death of an employee, separated employee, or retiree) made to a current or former spouse of a deceased...

5 CFR 843.102 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... EMPLOYEES RETIREMENT SYSTEM-DEATH BENEFITS AND EMPLOYEE REFUNDS General Provisions § 843.102 Definitions. In this part— Accrued benefit means the accrued, unpaid annuity payable after the death of a retiree... death of an employee, separated employee, or retiree) made to a current or former spouse of a deceased...

The Definition and Measurement of Reasoning.

ERIC Educational Resources Information Center

Northrop, Lois C.

The complex and multi-faceted nature of the cognitive process of reasoning is discussed. The factor-analytic history of the isolation and definition of the three most important currently recognized reasoning factors (general reasoning, induction, and logical or deductive reasoning) is traced through the psychometric literature, and the…

"Paideia," Then and Now.

ERIC Educational Resources Information Center

Keppel, Francis

1990-01-01

Discusses two widely practiced principles of management (protecting the rear and knowing the limits of a job) as they relate to the philosophy of education. The article examines Werner Jaeger's definition of education in his 1939 book, "Paideia," as well as other definitions that have helped shape current educational management. (SM)

30 CFR 28.4 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MINING PRODUCTS FUSES FOR USE WITH DIRECT CURRENT IN PROVIDING SHORT-CIRCUIT PROTECTION FOR TRAILING... provides short-circuit protection for trailing cables in coal mines by interrupting an excessive current in...

Image quality in low-dose coronary computed tomography angiography with a new high-definition CT scanner.

PubMed

Kazakauskaite, Egle; Husmann, Lars; Stehli, Julia; Fuchs, Tobias; Fiechter, Michael; Klaeser, Bernd; Ghadri, Jelena R; Gebhard, Catherine; Gaemperli, Oliver; Kaufmann, Philipp A

2013-02-01

A new generation of high definition computed tomography (HDCT) 64-slice devices complemented by a new iterative image reconstruction algorithm-adaptive statistical iterative reconstruction, offer substantially higher resolution compared to standard definition CT (SDCT) scanners. As high resolution confers higher noise we have compared image quality and radiation dose of coronary computed tomography angiography (CCTA) from HDCT versus SDCT. Consecutive patients (n = 93) underwent HDCT, and were compared to 93 patients who had previously undergone CCTA with SDCT matched for heart rate (HR), HR variability and body mass index (BMI). Tube voltage and current were adapted to the patient's BMI, using identical protocols in both groups. The image quality of all CCTA scans was evaluated by two independent readers in all coronary segments using a 4-point scale (1, excellent image quality; 2, blurring of the vessel wall; 3, image with artefacts but evaluative; 4, non-evaluative). Effective radiation dose was calculated from DLP multiplied by a conversion factor (0.014 mSv/mGy × cm). The mean image quality score from HDCT versus SDCT was comparable (2.02 ± 0.68 vs. 2.00 ± 0.76). Mean effective radiation dose did not significantly differ between HDCT (1.7 ± 0.6 mSv, range 1.0-3.7 mSv) and SDCT (1.9 ± 0.8 mSv, range 0.8-5.5 mSv; P = n.s.). HDCT scanners allow low-dose 64-slice CCTA scanning with higher resolution than SDCT but maintained image quality and equally low radiation dose. Whether this will translate into higher accuracy of HDCT for CAD detection remains to be evaluated.

Subthreshold posttraumatic stress disorder: A meta-analytic review of DSM-IV prevalence and a proposed DSM-5 approach to measurement.

PubMed

Brancu, Mira; Mann-Wrobel, Monica; Beckham, Jean C; Wagner, H Ryan; Elliott, Alyssa; Robbins, Allison T; Wong, Madrianne; Berchuck, Ania E; Runnals, Jennifer J

2016-03-01

Subthreshold posttraumatic stress disorder (PTSD) is a chronic condition that is often ignored, the cumulative effects of which can negatively impact an individual's quality of life and overall health care costs. However, subthreshold PTSD prevalence rates and impairment remain unclear due to variations in research methodology. This study examined the existing literature in order to recommend approaches to standardize subthreshold PTSD assessment. We conducted (a) a meta-analysis of subthreshold PTSD prevalence rates and (b) compared functional impairment associated with the 3 most commonly studied subthreshold PTSD definitions. Meta-analytic results revealed that the average prevalence rate of subthreshold PTSD across studies was 14.7%, with a lower rate (12.6%) among the most methodologically rigorous studies and higher rate (15.6%) across less rigorous studies. There were significant methodological differences among reviewed studies with regard to definition, measurement, and population. Different definitions led to prevalence rates ranging between 13.7% and 16.4%. Variability in prevalence rates most related to population and sample composition, with trauma type and community (vs. epidemiological) samples significantly impacting heterogeneity. Qualitative information gathered from studies presenting functional correlates supported current evidence that psychological and behavioral parameters were worse among subthreshold PTSD groups compared with no-PTSD groups, but not as severe as impairment in PTSD groups. Several studies also reported significant increased risk of suicidality and hopelessness as well as higher health care utilization rates among those with subthreshold PTSD (compared with trauma exposed no-PTSD samples). Based on findings, we propose recommendations for developing a standard approach to evaluation of subthreshold PTSD. (c) 2016 APA, all rights reserved).

Global distribution of soil organic carbon, based on the Harmonized World Soil Database - Part 1: Masses and frequency distribution of SOC stocks for the tropics, permafrost regions, wetlands, and the world

NASA Astrophysics Data System (ADS)

Köchy, M.; Hiederer, R.; Freibauer, A.

2014-09-01

The global soil organic carbon (SOC) mass is relevant for the carbon cycle budget. We review current estimates of soil organic carbon stocks (mass/area) and mass (stock × area) in wetlands, permafrost and tropical regions and the world in the upper 1 m of soil. The Harmonized World Soil Database (HWSD) v.1.2 provides one of the most recent and coherent global data sets of SOC, giving a total mass of 2476 Pg. Correcting the HWSD's bulk density of organic soils, especially Histosols, results in a mass of 1062 Pg. The uncertainty of bulk density of Histosols alone introduces a range of -56 to +180 Pg for the estimate of global SOC in the top 1 m, larger than estimates of global soil respiration. We report the spatial distribution of SOC stocks per 0.5 arc minutes, the areal masses of SOC and the quantiles of SOC stocks by continents, wetland types, and permafrost types. Depending on the definition of "wetland", wetland soils contain between 82 and 158 Pg SOC. Incorporating more detailed estimates for permafrost from the Northern Circumpolar Soil Carbon Data Base (496 Pg SOC) and tropical peatland carbon, global soils contain 1324 Pg SOC in the upper 1 m including 421 Pg in tropical soils, whereof 40 Pg occur in tropical wetlands. Global SOC amounts to just under 3000 Pg when estimates for deeper soil layers are included. Variability in estimates is due to variation in definitions of soil units, differences in soil property databases, scarcity of information about soil carbon at depths > 1 m in peatlands, and variation in definitions of "peatland".

[Are the current concepts of obsessive disorders a novelty? From Westphal (1877) and Thomsen (1895) to ICD-10 and DSM-5].

PubMed

Oberbeck, A; Steinberg, H

2015-09-01

In German-speaking countries it was Carl Westphal who in 1877 offered the first precise definition of obsessive ideas and distinguished obsessive compulsive disorder (OCD) as an independent disorder in its own right. The criteria mentioned by him for establishing OCD gave rise to a debate on the character and classification of OCD but were not fully acknowledged by his colleagues at the time. In 1895 Westphal's student Robert Thomsen tried to substantiate all points in his teacher's theory that had raised criticism. Thus the works by Westphal and Thomsen are most relevant for the current conceptualization and definition of OCD, for they laid the basis for the present phenomenology, definition and classification of OCD according to ICD-10 and DSM-5. Apart from phenomenologically differentiating between obsessions (i.e. obsessive thoughts and impulses) and compulsions (i.e. compulsive actions and inhibitions), Westphal and Thomsen also laid the basis for most of the current diagnostic criteria. Thomsen led the way to current classifications by subdifferentiating OCD as an illness on its own on the one hand and obsessions and compulsions as symptoms accompanying other conditions on the other.

Factors other than the Duke criteria associated with infective endocarditis among injection drug users.

PubMed

Palepu, Anita; Cheung, Stephen S; Montessori, Valentina; Woods, Ryan; Thompson, Christopher R

2002-08-01

Modified Duke criteria were applied to consecutive injection drug users (IDUs) who were admitted to an inner-city hospital with a clinical suspicion of infective endocarditis, and the presence of any other clinical variables that were predictive of the presence of infective endocarditis was determined. Clinical data on consecutive IDUs who were hospitalized over 15 months in Vancouver were collected. Data included the admission history, and findings on physical examination and on initial laboratory investigations. Each subject's course in hospital was followed until discharge or death during the index hospitalization. Follow-up data collected included culture results, the interpretation of the echocardiogram and the discharge diagnosis. The modified Duke criteria were used for the diagnosis of infective endocarditis (definite, possible or rejected). Multiple logistic regression was used to determine what clinical variables (exclusive of the Duke criteria) available within 48 hours of presentation were independent predictors of infective endocarditis. One hundred IDUs were enrolled. Fifty-one were female, and 58 were HIV-positive. Twenty-three met the modified Duke criteria for definite infective endocarditis, and 25 had possible infective endocarditis. IDUs with definite infective endocarditis were more commonly noted to have evidence of vascular phenomena (arterial embolism, septic pulmonary infarction, mycotic aneurysm, intracranial hemorrhage or Janeway lesions) (6 [26%]) than those who had possible endocarditis (1 [4%]). Those with definite infective endocarditis more often had multiple opacities on chest radiography (56% v. < 12%), and fewer had an obvious source of infection (52% v. 72% and 81% of possible and rejected infective endocarditis, respectively). Among febrile IDUs, definite endocarditis was highly associated with having no obvious source of infection (odds ratio 3.1 [95% confidence interval 1.1-8.7]) compared with febrile IDUs with an obvious source of infection. In similarly compared groups, the presence of hematuria, proteinuria or pyuria was also predictive of definite endocarditis (odds ratio 2.9 [95% CI 1.1-8.6]). Among IDUs, the modified Duke criteria are useful for classifying cases with definite infective endocarditis and rejecting cases without infective endocarditis. The classification of possible infective endocarditis is suitable for this population.

Angiographic assessment of initial balloon angioplasty results.

PubMed

Gardiner, Geoffrey A; Sullivan, Kevin L; Halpern, Ethan J; Parker, Laurence; Beck, Margaret; Bonn, Joseph; Levin, David C

2004-10-01

To determine the influence of three factors involved in the angiographic assessment of balloon angioplasty-interobserver variability, operator bias, and the definition used to determine success-on the primary (technical) results of angioplasty in the peripheral arteries. Percent stenosis in 107 lesions in lower-extremity arteries was graded by three independent, experienced vascular radiologists ("observers") before and after balloon angioplasty and their estimates were compared with the initial interpretations reported by the physician performing the procedure ("operator") and an automated quantitative computer analysis. Observer variability was measured with use of intraclass correlation coefficients and SD. Differences among the operator, observers, and the computer were analyzed with use of the Wilcoxon signed-rank test and analysis of variance. For each evaluator, the results in this series of lesions were interpreted with three different definitions of success. Estimation of residual stenosis varied by an average range of 22.76% with an average SD of 8.99. The intraclass correlation coefficients averaged 0.59 for residual stenosis after angioplasty for the three observers but decreased to 0.36 when the operator was included as the fourth evaluator. There was good to very good agreement among the three independent observers and the computer, but poor correlation with the operator (P

Antiretroviral therapy suppressed participants with low CD4+ T-cell counts segregate according to opposite immunological phenotypes

PubMed Central

Pérez-Santiago, Josué; Ouchi, Dan; Urrea, Victor; Carrillo, Jorge; Cabrera, Cecilia; Villà-Freixa, Jordi; Puig, Jordi; Paredes, Roger; Negredo, Eugènia; Clotet, Bonaventura; Massanella, Marta; Blanco, Julià

2016-01-01

Background: The failure to increase CD4+ T-cell counts in some antiretroviral therapy suppressed participants (immunodiscordance) has been related to perturbed CD4+ T-cell homeostasis and impacts clinical evolution. Methods: We evaluated different definitions of immunodiscordance based on CD4+ T-cell counts (cutoff) or CD4+ T-cell increases from nadir value (ΔCD4) using supervised random forest classification of 74 immunological and clinical variables from 196 antiretroviral therapy suppressed individuals. Unsupervised clustering was performed using relevant variables identified in the supervised approach from 191 individuals. Results: Cutoff definition of CD4+ cell count 400 cells/μl performed better than any other definition in segregating immunoconcordant and immunodiscordant individuals (85% accuracy), using markers of activation, nadir and death of CD4+ T cells. Unsupervised clustering of relevant variables using this definition revealed large heterogeneity between immunodiscordant individuals and segregated participants into three distinct subgroups with distinct production, programmed cell-death protein-1 (PD-1) expression, activation and death of T cells. Surprisingly, a nonnegligible number of immunodiscordant participants (22%) showed high frequency of recent thymic emigrants and low CD4+ T-cell activation and death, very similar to immunoconcordant participants. Notably, human leukocyte antigen - antigen D related (HLA-DR) PD-1 and CD45RA expression in CD4+ T cells allowed reproducing subgroup segregation (81.4% accuracy). Despite sharp immunological differences, similar and persistently low CD4+ values were maintained in these participants over time. Conclusion: A cutoff value of CD4+ T-cell count 400 cells/μl classified better immunodiscordant and immunoconcordant individuals than any ΔCD4 classification. Immunodiscordance may present several, even opposite, immunological patterns that are identified by a simple immunological follow-up. Subgroup classification may help clinicians to delineate diverse approaches that may be needed to boost CD4+ T-cell recovery. PMID:27427875

Research on infertility: which definition should we use?

PubMed

Larsen, Ulla

2005-04-01

Different definitions of infertility are used in clinical practice as well as in epidemiological and demographic research. This study assessed whether the definition makes a difference for estimates of the prevalence and sociodemographic differentials of infertility and whether one definition would be applicable in both research and clinical practice. Cross-sectional study. Moshi town in northern Tanzania. Community-based sample of 1,125 women, ages 20 to 44 years, in first union. Six definitions of infertility. Similar levels and sociodemographic characteristics of infertile women were obtained from asking the question "How long have you tried to get pregnant?" and from secondary data collected in a birth history that included date of marriage, date of last birth, current contraceptive use, and whether the woman wants another child. The infertility definition made a difference. The World Health Organization definition based on 24 months of trying to get pregnant is recommended as the definition that is useful in clinical practice and research among different disciplines.

Are greenhouse gas emissions from international shipping a type of marine pollution?

PubMed

Shi, Yubing

2016-12-15

Whether greenhouse gas emissions from international shipping are a type of marine pollution is a controversial issue and is currently open to debate. This article examines the current treaty definitions of marine pollution, and applies them to greenhouse gas emissions from ships. Based on the legal analysis of treaty definitions and relevant international and national regulation on this issue, this article asserts that greenhouse gas emissions from international shipping are a type of 'conditional' marine pollution. Copyright © 2016 Elsevier Ltd. All rights reserved.

A new approach used to explore associations of current Ambrosia pollen levels with current and past meteorological elements

NASA Astrophysics Data System (ADS)

Matyasovszky, István; Makra, László; Csépe, Zoltán; Deák, Áron József; Pál-Molnár, Elemér; Fülöp, Andrea; Tusnády, Gábor

2015-09-01

The paper examines the sensitivity of daily airborne Ambrosia (ragweed) pollen levels of a current pollen season not only on daily values of meteorological variables during this season but also on the past meteorological conditions. The results obtained from a 19-year data set including daily ragweed pollen counts and ten daily meteorological variables are evaluated with special focus on the interactions between the phyto-physiological processes and the meteorological elements. Instead of a Pearson correlation measuring the strength of the linear relationship between two random variables, a generalised correlation that measures every kind of relationship between random vectors was used. These latter correlations between arrays of daily values of the ten meteorological elements and the array of daily ragweed pollen concentrations during the current pollen season were calculated. For the current pollen season, the six most important variables are two temperature variables (mean and minimum temperatures), two humidity variables (dew point depression and rainfall) and two variables characterising the mixing of the air (wind speed and the height of the planetary boundary layer). The six most important meteorological variables before the current pollen season contain four temperature variables (mean, maximum, minimum temperatures and soil temperature) and two variables that characterise large-scale weather patterns (sea level pressure and the height of the planetary boundary layer). Key periods of the past meteorological variables before the current pollen season have been identified. The importance of this kind of analysis is that a knowledge of the past meteorological conditions may contribute to a better prediction of the upcoming pollen season.

A new approach used to explore associations of current Ambrosia pollen levels with current and past meteorological elements.

PubMed

Matyasovszky, István; Makra, László; Csépe, Zoltán; Deák, Áron József; Pál-Molnár, Elemér; Fülöp, Andrea; Tusnády, Gábor

2015-09-01

The paper examines the sensitivity of daily airborne Ambrosia (ragweed) pollen levels of a current pollen season not only on daily values of meteorological variables during this season but also on the past meteorological conditions. The results obtained from a 19-year data set including daily ragweed pollen counts and ten daily meteorological variables are evaluated with special focus on the interactions between the phyto-physiological processes and the meteorological elements. Instead of a Pearson correlation measuring the strength of the linear relationship between two random variables, a generalised correlation that measures every kind of relationship between random vectors was used. These latter correlations between arrays of daily values of the ten meteorological elements and the array of daily ragweed pollen concentrations during the current pollen season were calculated. For the current pollen season, the six most important variables are two temperature variables (mean and minimum temperatures), two humidity variables (dew point depression and rainfall) and two variables characterising the mixing of the air (wind speed and the height of the planetary boundary layer). The six most important meteorological variables before the current pollen season contain four temperature variables (mean, maximum, minimum temperatures and soil temperature) and two variables that characterise large-scale weather patterns (sea level pressure and the height of the planetary boundary layer). Key periods of the past meteorological variables before the current pollen season have been identified. The importance of this kind of analysis is that a knowledge of the past meteorological conditions may contribute to a better prediction of the upcoming pollen season.

50 CFR 665.421 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Definitions. As used in §§ 665.420 through 665.439: Mariana coral reef ecosystem management unit species (Mariana coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic (post...

50 CFR 665.621 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... § 665.621 Definitions. As used in §§ 665.620 through 665.639: PRIA coral reef ecosystem management unit species (PRIA coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic...

50 CFR 665.621 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... § 665.621 Definitions. As used in §§ 665.620 through 665.639: PRIA coral reef ecosystem management unit species (PRIA coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic...

50 CFR 665.421 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Definitions. As used in §§ 665.420 through 665.439: Mariana coral reef ecosystem management unit species (Mariana coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic (post...

50 CFR 665.621 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... § 665.621 Definitions. As used in §§ 665.620 through 665.639: PRIA coral reef ecosystem management unit species (PRIA coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic...

50 CFR 665.421 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Definitions. As used in §§ 665.420 through 665.439: Mariana coral reef ecosystem management unit species (Mariana coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic (post...

Women's Self-definition in Adulthood: From a Different Model?

ERIC Educational Resources Information Center

Peck, Teresa A.

1986-01-01

Examines criticisms of existing models of adult development from both feminist and developmental psychologists. A model of women's adult self-definition is presented, based upon current research on women's adult experience. The model combines a dialectical approach, which considers the effects of social/historical factors, with a feminist…

Comparing the Major Definitions of Mathematics Pedagogical Content Knowledge

ERIC Educational Resources Information Center

Johnson, Jeffrey

2017-01-01

The purpose of this research was to compare two definitions and assessments of Mathematics Pedagogical Content Knowledge (PCK). As part of a larger study, nine current and future teachers took an online version of the Measures of Knowledge for Teaching (MKT)--Mathematics assessment and the Cognitively Activating Instruction in Mathematics…

30 CFR 77.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Definitions. For the purpose of this part 77, the term: (a) Active workings means any place in a coal mine where miners are normally required to work or travel; (b) American Table of Distances means the current... detonators, and delay electric blasting caps. (p) Electrical grounding means to connect with the ground to...

Atmosphere, Magnetosphere and Plasmas in Space (AMPS). Spacelab payload definition study. Volume 4, book 1: Labcraft payload general specification

NASA Technical Reports Server (NTRS)

1976-01-01

The performance, design, verification and operational requirements for Labcraft equipment and Labcraft integrated payloads are described. The requirements are based on the current definition of Spacelab and Space Transportation System equipment and the constraints associated with their use.

An Analysis of Social Justice Research in School Psychology

ERIC Educational Resources Information Center

Graybill, Emily; Baker, Courtney N.; Cloth, Allison H.; Fisher, Sycarah; Nastasi, Bonnie K.

2018-01-01

The purpose of the current content analysis was to build upon previous empirical research both within school psychology and in other subdisciplines of psychology to refine the operationalized definition of social justice within school psychology research. Operationalizing the definition and substantiating it within the empirical literature is a…

50 CFR 665.121 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Definitions. As used in §§ 665.120 through 665.139: American Samoa coral reef ecosystem management unit species (American Samoa coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic...

50 CFR 665.421 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Definitions. As used in §§ 665.420 through 665.439: Mariana coral reef ecosystem management unit species (Mariana coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic (post...

50 CFR 665.121 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Definitions. As used in §§ 665.120 through 665.139: American Samoa coral reef ecosystem management unit species (American Samoa coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic...

50 CFR 665.421 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Definitions. As used in §§ 665.420 through 665.439: Mariana coral reef ecosystem management unit species (Mariana coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic (post...

50 CFR 665.621 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... § 665.621 Definitions. As used in §§ 665.620 through 665.639: PRIA coral reef ecosystem management unit species (PRIA coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic...

50 CFR 665.621 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... § 665.621 Definitions. As used in §§ 665.620 through 665.639: PRIA coral reef ecosystem management unit species (PRIA coral reef ecosystem MUS) means all of the Currently Harvested Coral Reef Taxa and Potentially Harvested Coral Reef Taxa listed in this section and which spend the majority of their non-pelagic...

Visually Handicapped People and the Law.

ERIC Educational Resources Information Center

Bishop, V. E.

1987-01-01

The paper explores the definitional problems of visual handicaps, especially in terms of the legal definition of blindness. A brief history of relevant laws and a discussion of current case law precede a section providing suggestions for strengthening the legal position of the visually handicapped in future litigation. (Author/DB)

12 CFR 1710.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Definitions. 1710.2 Section 1710.2 Banks and Banking OFFICE OF FEDERAL HOUSING ENTERPRISE OVERSIGHT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SAFETY..., respectively. (e) Compensation means any payment of money or the provision of any other thing of current or...

7 CFR 1423.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Definitions. Active shipping order means an early shipping order or shipping order, as defined in this section, scheduled for a current cotton warehouse reporting week or for a prior reporting week, but not picked up... for storage. Early shipping order means a list of bale tag numbers sent to a cotton warehouse operator...

12 CFR 944.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... requirements of paragraph (1) of this definition. (3) A single parent who, except for owning a residence with... or renew any maturing advance for a term to maturity greater than one year. Single parent means an... remuneration to care for a home and family, and currently is unemployed or underemployed and is experiencing...

Chronically Low-Performing Schools and Turnaround: Evidence from Three States

ERIC Educational Resources Information Center

Hansen, Michael; Choi, Kilchan

2012-01-01

The criteria for determining the student outcomes that define a school as having "turned around" are not well defined, and the definition of turnaround performance varies across studies. Although current policy initiatives offer guidelines for identifying CLP schools, there is no standard definition or methodology in common usage. This…

77 FR 75936 - Control of Communicable Diseases: Interstate; Scope and Definitions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

... add more current medical terminology where appropriate. HHS/CDC has determined that this NPRM is... proposing to update the definitions for interstate quarantine regulations to reflect modern terminology and..., under section 70.1, to reflect modern terminology and plain language commonly used by private sector...

9 CFR 203.10 - Statement with respect to insolvency; definition of current assets and current liabilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... cycle of the business, which is considered to be one year. (2) Current liabilities means obligations... consumed in the normal operating cycle of the business; (7) accounts due from employees, if collectable; (8... classifiable as current assets or the creation of other current liabilities during the one year operating cycle...

[Opinions of healthcare professionals on the definition of severe mental illness: a qualitative study].

PubMed

Conejo Cerón, S; Moreno Peral, P; Morales Asencio, J M; Alot Montes, A; García-Herrera, J M; González López, M J; Quemada González, C; Requena Albarracín, J; Moreno Küstner, B

2014-01-01

Over the years, a number of definitions of severe mental illness (SMI) have been proposed and substantial controversy about the definition still remains. The aim of this study was to evaluate the views of a group of mental health professionals on the appropriate criteria for defining SMI. This was a qualitative study, based on five focus groups with mental health professionals (psychiatrists, psychologists, nurses, general practitioners, monitors and social workers) from Carlos Haya Hospital in Malaga, Spain. A content analysis was performed on the transcriptions by three independent researchers. The professionals agreed that a certain degree of dysfunctionality must be present for a definition of SMI. There was some disagreement between the different categories of professionals regarding the inclusion of dimensions such as diagnosis, family and social support, use of healthcare resources and duration of the illness as necessary and sufficient criteria for the definition of SMI. From the professionals' discourse, some personal patient variables such as age of onset of illness, lack of insight and level of education emerged as relevant for the definition of SMI. Apart from the dimensions considered in the literature, the interviewed mental health professionals discussed other criteria that could be taken into account in the definition of SMI. Perceptions differ between categories of professional and work settings in which they operate.

The San Diego definition of SIDS: practical application and comparison with the GeSID classification.

PubMed

Bajanowski, T; Brinkmann, B; Vennemann, M

2006-11-01

The new definition of the term sudden infant death syndrome (SIDS) and the criteria introduced in San Diego for the subclassification of cases have been used to re-classify the first 100 consecutive cases of sudden and unexpected infant deaths that were registered with the German SIDS study (GeSID). Although there are 30 different variables that have to be considered in the general and stratified sections of the San Diego definition, it is practical, in particular, as an international standard to perform scientific studies. The comparison of the San Diego definition and the classification used for GeSID shows similarities in the methods but differences in the criteria used. Nevertheless, the numbers of cases classified as SIDS and borderline SIDS are similar (San Diego n=69, GeSID n=74). The SIDS IA criteria of the San Diego definition were not fulfilled by any case because metabolic screening and vitreous chemistry were not included in the GeSID investigation scheme. An important advantage of the San Diego definition is the introduction of the category of unclassified sudden infant death, which includes cases for which no autopsy was performed. This demonstrates that such cases cannot be classified as SIDS. In conclusion, we recommend the universal acceptance and use of the San Diego SIDS definition.

Paratonia: a Delphi procedure for consensus definition.

PubMed

Hobbelen, Johannes S M; Koopmans, Raymond T C M; Verhey, Frans R J; Van Peppen, Roland P S; de Bie, Rob A

2006-01-01

Paratonia is a motor problem that develops during the course of dementia. Definitions of paratonia used in the literature differ considerably, which has clinical implications and may lead to an undesirable heterogeneity in study populations. For this reason, we initiated a Delphi procedure with known experts in the field to establish an operational consensus definition of paratonia. The Delphi procedure involved an anonymous and multistage approach presented as a questionnaire, with each stage building on the results of the previous one in order to reach consensus on the definition of paratonia. Eight of 17 experts agreed to participate in the study. After 4 rounds, the participants reached consensus on the following definition: paratonia is a form of hypertonia with an involuntary variable resistance during passive movement. The nature of paratonia may change with progression of dementia (eg, from active assistance (aka Mitgehen) to active resistance). The degree of resistance depends on the speed of movement (eg, slow > low resistance, fast > high resistance). The degree of paratonia is proportional to the amount of force applied and increases with progression of dementia. The resistance to passive movement is in any direction and there is no clasp-knife phenomenon. The Delphi procedure resulted in a comprehensive, operational definition of paratonia. Future research should focus on the reliability and validity of this definition.

Filgrastim use in patients receiving chemotherapy for early-stage breast cancer-a survey of physicians and patients.

PubMed

Hilton, John; Vandermeer, Lisa; Sienkiewicz, Marta; Mazzarello, Sasha; Hutton, Brian; Stober, Carol; Fergusson, Dean; Blanchette, Phillip; Joy, Anil A; Brianne Bota, A; Clemons, Mark

2018-07-01

Despite its widespread use as primary febrile neutropenia (FN) prophylaxis during chemotherapy for early-stage breast cancer, the optimal duration of daily filgrastim is unknown. Using the minimum effective duration may improve patient comfort and acceptability while reducing costs. Yet, suboptimal dosing may also negatively impact patient care. A survey was performed to obtain information regarding current practices for granulocyte colony-stimulating factor (G-CSF) use. Canadian oncologists involved in the treatment of breast cancer patients, as well as patients who had received neo/adjuvant chemotherapy for breast cancer, were surveyed. Standardized surveys were designed to collect information on perceived reasons for G-CSF use and current practices. The surveys were completed by 38/50 (76%) physicians and 95/97 (98%) patients. For physicians, there was variability in the choice of chemotherapy regimens that required G-CSF support, the dose of filgrastim prescribed and the number of days prescribed. The majority of physicians reported using 5 (31.6%), 7 (47.4%), or 10 (13.2%) days of therapy. Nearly half of the patients (46.3%) recalled having experienced at least one of the chemotherapy-related complications including chemotherapy delays, dose reductions, and FN. While on filgrastim, 66.3% of patients reported myalgia and bone pain. Both physicians and patients expressed interest in participating in clinical trials designed to optimize the duration of filgrastim administration. Significant variability in practice exists with respect to filgrastim administration. Definitive studies are therefore required to standardize and improve care, as this has the potential to impact treatment outcomes, patient quality of life, and cost savings.

Analysis to evaluate predictors of fiberboard aging to guide surveillance sampling for the 9975 life extension program

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

Kelly, Elizabeth J.; Daugherty, William L.; Hackney, Elizabeth R.

During surveillance of the 9975 shipping package at the Savannah River Site K-Area Complex, several package dimensions are recorded. The analysis described in this report shows that, based on the current data analysis, two of these measurements, Upper Assembly Outer Diameter (UAOD) and Upper Assembly Inside Height (UAIH), do not have statistically significant aging trends regardless of wattage levels. In contrast, this analysis indicates that the measurement of Air Shield Gap (ASGap) does show a significant increase with age. It appears that the increase is greater for high wattage containers, but this result is dominated by two measurements from high-wattagemore » containers. For all three indicators, additional high-wattage, older containers need to be examined before any definitive conclusions can be reached. In addition, the current analysis indicates that ASGap measurements for low and medium wattage containers are increasing slowly over time. To reduce uncertainties and better capture the aging trend for these containers, additional low and medium wattage older containers should also be examined. Based on this analysis, surveillance guidance is to augment surveillance containers resulting from 3013 surveillance with 9975-focused sampling that targets older, high wattage containers and also includes some older, low and medium wattage containers. This focused sampling began in 2015 and will continue in 2016. The UAOD, UAIH and ASGap data are highly variable. It is possible that additional factors such as seasonal variation and packaging site location might reduce variability and be useful for focusing surveillance and predicting aging.« less

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

Lim, Karen; Small, William; Portelance, Lorraine

Purpose: Accurate target definition is vitally important for definitive treatment of cervix cancer with intensity-modulated radiotherapy (IMRT), yet a definition of clinical target volume (CTV) remains variable within the literature. The aim of this study was to develop a consensus CTV definition in preparation for a Phase 2 clinical trial being planned by the Radiation Therapy Oncology Group. Methods and Materials: A guidelines consensus working group meeting was convened in June 2008 for the purposes of developing target definition guidelines for IMRT for the intact cervix. A draft document of recommendations for CTV definition was created and used to aidmore » in contouring a clinical case. The clinical case was then analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with kappa statistics as a measure of agreement between participants. Results: Nineteen experts in gynecological radiation oncology generated contours on axial magnetic resonance images of the pelvis. Substantial STAPLE agreement sensitivity and specificity values were seen for gross tumor volume (GTV) delineation (0.84 and 0.96, respectively) with a kappa statistic of 0.68 (p < 0.0001). Agreement for delineation of cervix, uterus, vagina, and parametria was moderate. Conclusions: This report provides guidelines for CTV definition in the definitive cervix cancer setting for the purposes of IMRT, building on previously published guidelines for IMRT in the postoperative setting.« less

Will the right Robin patient rise, please? Definitions and criteria during management of Robin sequence patients in the Netherlands and Belgium.

PubMed

Basart, Hanneke; Kruisinga, Frea H; Breugem, Corstiaan C; Don Griot, J Peter W; Hennekam, Raoul C; Van der Horst, Chantal M A M

2015-01-01

Robin Sequence (RS) is characterized by micrognathia and upper airway obstruction (UAO), with or without cleft palate, causing respiratory and feeding problems. Management options are: positioning; nasopharyngeal airway (NPA); tongue-lip adhesion (TLA); mandibular distraction (MDO); and tracheostomy. Controversy exists in literature regarding RS definition and management. Here we describe definitions, management strategies and criteria in opting for management strategies, used by Dutch and Belgian cleft teams. A specifically designed questionnaire was sent to members of all 16 Dutch and Belgian cleft teams. 14 cleft teams returned 35 questionnaires. All used micrognathia as definition criterion, 93.4% cleft palate, 51.5%glossoptosis and 45.7% UAO. Six different RS definitions were used; even within a single team >1 definition was used. All teams used different management strategies: all used positioning, 10 NPA, 6 TLA, 7 MDO, 8 tracheostomy, 5 refer patients with invasive treatment indication. Criteria in opting management modalities were: O2-saturation (89.3%), clinical presentation (86.2%), growth and feeding problems (69.0%), polysomnography (62.1%), and differed within teams. The Dutch and Belgian cleft teams use variable RS definitions, different management modalities and criteria in choosing management strategies. A single, strict definition and evidence-based management guidelines should be formulated for optimal patient care. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Stress-induced electric current fluctuations in rocks: a superstatistical model

NASA Astrophysics Data System (ADS)

Cartwright-Taylor, Alexis; Vallianatos, Filippos; Sammonds, Peter

2017-04-01

We recorded spontaneous electric current flow in non-piezoelectric Carrara marble samples during triaxial deformation. Mechanical data, ultrasonic velocities and acoustic emissions were acquired simultaneously with electric current to constrain the relationship between electric current flow, differential stress and damage. Under strain-controlled loading, spontaneous electric current signals (nA) were generated and sustained under all conditions tested. In dry samples, a detectable electric current arises only during dilatancy and the overall signal is correlated with the damage induced by microcracking. Our results show that fracture plays a key role in the generation of electric currents in deforming rocks (Cartwright-Taylor et al., in prep). We also analysed the high-frequency fluctuations of these electric current signals and found that they are not normally distributed - they exhibit power-law tails (Cartwright-Taylor et al., 2014). We modelled these distributions with q-Gaussian statistics, derived by maximising the Tsallis entropy. This definition of entropy is particularly applicable to systems which are strongly correlated and far from equilibrium. Good agreement, at all experimental conditions, between the distributions of electric current fluctuations and the q-Gaussian function with q-values far from one, illustrates the highly correlated, fractal nature of the electric source network within the samples and provides further evidence that the source of the electric signals is the developing fractal network of cracks. It has been shown (Beck, 2001) that q-Gaussian distributions can arise from the superposition of local relaxations in the presence of a slowly varying driving force, thus providing a dynamic reason for the appearance of Tsallis statistics in systems with a fluctuating energy dissipation rate. So, the probability distribution for a dynamic variable, u under some external slow forcing, β, can be obtained as a superposition of temporary local equilibrium processes whose variance fluctuates over time. The appearance of q-Gaussian statistics are caused by the fluctuating β parameter, which effectively models the fluctuating energy dissipation rate in the system. This concept is known as superstatistics and is physically relevant for modelling driven non-equilibrium systems where the environmental conditions fluctuate on a large scale. The idea is that the environmental variable, such as temperature or pressure, changes so slowly that a rapidly fluctuating variable within that environment has time to relax back to equilibrium between each change in the environment. The application of superstatistical techniques to our experimental electric current fluctuations show that they can indeed be described, to good approximation, by the superposition of local Gaussian processes with fluctuating variance. We conclude, then, that the measured electric current fluctuates in response to intermittent energy dissipation and is driven to varying temporary local equilibria during deformation by the variations in stress intensity. The advantage of this technique is that, once the model has been established to be a good description of the system in question, the average β parameter (a measure of the average energy dissipation rate) for the system can be obtained simply from the macroscopic q-Gaussian distribution parameters.

Treatment integrity of school-based interventions with children in the journal of applied behavior analysis 1991-2005.

PubMed

McIntyre, Laura Lee; Gresham, Frank M; DiGennaro, Florence D; Reed, Derek D

2007-01-01

We reviewed all school-based experimental studies with individuals 0 to 18 years published in the Journal of Applied Behavior Analysis (JABA) between 1991 and 2005. A total of 142 articles (152 studies) that met review criteria were included. Nearly all (95%) of these experiments provided an operational definition of the independent variable, but only 30% of the studies provided treatment integrity data. Nearly half of studies (45%) were judged to be at high risk for treatment inaccuracies. Treatment integrity data were more likely to be included in studies that used teachers, multiple treatment agents, or both. Although there was a substantial increase in reporting operational definitions of independent variables, results suggest that there was only a modest improvement in reported integrity over the past 30 years of JABA studies. Recommendations for research and practice are discussed.

"Monogamy" in Primates: Variability, Trends, and Synthesis: Introduction to special issue on Primate Monogamy.

PubMed

Díaz-Muñoz, Samuel L; Bales, Karen L

2016-03-01

This paper is the introduction to a special issue on "'Monogamy' in Primates: Variability, Trends, and Synthesis." The term "monogamy" has undergone redefinition over the years, and is now generally understood to refer to certain social characteristics rather than to genetic monogamy. However, even the term "social monogamy" is used loosely to refer to species which exhibit a spectrum of social structures, mating patterns, and breeding systems. Papers in this volume address key issues including whether or not our definitions of monogamy should change in order to better represent the social and mating behaviors that characterize wild primates; whether or not primate groups traditionally considered monogamous are actually so (by any definition); ways in which captive studies can contribute to our understanding of monogamy; and what selective pressures might have driven the evolution of monogamous and non-monogamous single female breeding systems. © 2015 Wiley Periodicals, Inc.

FOSSIL2 energy policy model documentation: FOSSIL2 documentation

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

None

1980-10-01

This report discusses the structure, derivations, assumptions, and mathematical formulation of the FOSSIL2 model. Each major facet of the model - supply/demand interactions, industry financing, and production - has been designed to parallel closely the actual cause/effect relationships determining the behavior of the United States energy system. The data base for the FOSSIL2 program is large, as is appropriate for a system dynamics simulation model. When possible, all data were obtained from sources well known to experts in the energy field. Cost and resource estimates are based on DOE data whenever possible. This report presents the FOSSIL2 model at severalmore » levels. Volumes II and III of this report list the equations that comprise the FOSSIL2 model, along with variable definitions and a cross-reference list of the model variables. Volume III lists the model equations and a one line definition for equations, in a short, readable format.« less

Hamiltonian approach to second order gauge invariant cosmological perturbations

NASA Astrophysics Data System (ADS)

Domènech, Guillem; Sasaki, Misao

2018-01-01

In view of growing interest in tensor modes and their possible detection, we clarify the definition of tensor modes up to 2nd order in perturbation theory within the Hamiltonian formalism. Like in gauge theory, in cosmology the Hamiltonian is a suitable and consistent approach to reduce the gauge degrees of freedom. In this paper we employ the Faddeev-Jackiw method of Hamiltonian reduction. An appropriate set of gauge invariant variables that describe the dynamical degrees of freedom may be obtained by suitable canonical transformations in the phase space. We derive a set of gauge invariant variables up to 2nd order in perturbation expansion and for the first time we reduce the 3rd order action without adding gauge fixing terms. In particular, we are able to show the relation between the uniform-ϕ and Newtonian slicings, and study the difference in the definition of tensor modes in these two slicings.

Standards for Environmental Measurement Using GIS: Toward a Protocol for Protocols.

PubMed

Forsyth, Ann; Schmitz, Kathryn H; Oakes, Michael; Zimmerman, Jason; Koepp, Joel

2006-02-01

Interdisciplinary research regarding how the built environment influences physical activity has recently increased. Many research projects conducted jointly by public health and environmental design professionals are using geographic information systems (GIS) to objectively measure the built environment. Numerous methodological issues remain, however, and environmental measurements have not been well documented with accepted, common definitions of valid, reliable variables. This paper proposes how to create and document standardized definitions for measures of environmental variables using GIS with the ultimate goal of developing reliable, valid measures. Inherent problems with software and data that hamper environmental measurement can be offset by protocols combining clear conceptual bases with detailed measurement instructions. Examples demonstrate how protocols can more clearly translate concepts into specific measurement. This paper provides a model for developing protocols to allow high quality comparative research on relationships between the environment and physical activity and other outcomes of public health interest.

“Monogamy” in Primates: Variability, Trends and Synthesis

PubMed Central

Díaz-Muñoz, Samuel L.; Bales, Karen

2017-01-01

This paper is the introduction to a special issue on “'Monogamy' in Primates: Variability, Trends, and Synthesis”. The term “monogamy” has undergone redefinition over the years, and is now generally understood to refer to certain social characteristics rather than to genetic monogamy. However, even the term “social monogamy” is used loosely to refer to species which exhibit a spectrum of social structures, mating patterns, and breeding systems. Papers in this volume address key issues including whether or not our definitions of monogamy should change in order to better represent the social and mating behaviors that characterize wild primates; whether or not primate groups traditionally considered monogamous are actually so (by any definition); ways in which captive studies can contribute to our understanding of monogamy; and what selective pressures might have driven the evolution of monogamous and nonmonogamous single female breeding systems. PMID:26317875

Development of the Paris definition of early Crohn's disease for disease-modification trials: results of an international expert opinion process.

PubMed

Peyrin-Biroulet, Laurent; Billioud, Vincent; D'Haens, Geert; Panaccione, Remo; Feagan, Brian; Panés, Julian; Danese, Silvio; Schreiber, Stefan; Ogata, Haruhiko; Hibi, Toshifumi; Higgins, Peter D R; Beaugerie, Laurent; Chowers, Yehuda; Louis, Edouard; Steinwurz, Flávio; Reinisch, Walter; Rutgeerts, Paul; Colombel, Jean-Frédéric; Travis, Simon; Sandborn, William J

2012-12-01

We report the findings and outputs of an international expert opinion process to develop a definition of early Crohn's disease (CD) that could be used in future disease-modification trials. Nineteen experts on inflammatory bowel diseases held an international expert opinion meeting to discuss and agree on a definition for early CD to be used in disease-modification trials. The process included literature searches for the relevant basic-science and clinical evidence. A published preliminary definition of early CD was used as the basis for development of a proposed definition that was discussed at the expert opinion meeting. The participants then derived a final definition, based on best current knowledge, that it is hoped will be of practical use in disease-modification trials in CD.

Defining delirium for the International Classification of Diseases, 11th Revision.

PubMed

Meagher, David J; Maclullich, Alasdair M J; Laurila, Jouko V

2008-09-01

The development of ICD-11 provides an opportunity to update the description of delirium according to emerging data that have added to our understanding of this complex neuropsychiatric syndrome. Synthetic article based on published work considered by the authors to be relevant to the definition of delirium. The current DSM-IV definition of delirium is preferred to the ICD-10 because of its greater inclusivity. Evidence does not support major changes in the principal components of present definitions but a number of key issues for the updated definition were identified. These include better account of non-cognitive features, more guidance for rating contextual diagnostic items, clearer definition regarding the interface with dementia, and accounting for illness severity, clinical subtypes and course. Development of the ICD definition of delirium can allow for more targeted research and clinical effort.

Diagnosing acute respiratory distress syndrome in resource limited settings: the Kigali modification of the Berlin definition.

PubMed

Riviello, Elisabeth D; Buregeya, Egide; Twagirumugabe, Theogene

2017-02-01

The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda. This review synthesizes literature from the last 18 months relevant to the Kigali modification. In the last 18 months, the need for a universally applicable ARDS definition was reinforced by advances in supportive care that can be implemented in resource poor settings. Research demonstrating the variable impact of positive end expiratory pressure on hypoxemia, the validity of using pulse oximetry rather than arterial blood gas to categorize hypoxemia, and the accuracy of lung ultrasound support the use of the Kigali modification of the Berlin definition. Studies directly comparing the Berlin definition to the Kigali modification are needed. Ongoing clinical research on ARDS needs to include low-income countries.

Biopharming, bananas and bureaucracy: the banana vaccine as a case study for products that straddle the definitional food/drug divide.

PubMed

Birdsall, Margaux

2011-01-01

This paper examines the definition of the terms "food" and "drug" as used in the Food, Drug and Cosmetic Act through the lens of biopharmed products. The paper uses the so-called "banana vaccine" as a case study to highlight the problems that occur when attempting to regulate a product that could be safely used as a food or as a drug. Specifically, the examination of this model illustrates the problems in the current definitional scheme. The paper considers how a product that straddles the definitional line between food and drug could be regulated and proposes a reformation to how the definitions are applied to products to better suit new technology in food and drugs.