Recommended System Design for the Occupational Health Management Information System (OHMIS). Volume 1.

DTIC Science & Technology

1983-04-01

Management Information System (OHMIS). The system design includes: detailed function data flows for each of the core data processing functions of OHMIS, in the form of input/processing/output algorithms; detailed descriptions of the inputs and outputs; performance specifications of OHMIS; resources required to develop and operate OHMIS (Vol II). In addition, the report provides a summary of the rationale used to develop the recommended system design, a description of the methodology used to develop the recommended system design, and a review of existing

Antipsychotic-induced hyperprolactinemia: synthesis of world-wide guidelines and integrated recommendations for assessment, management and future research.

PubMed

Grigg, Jasmin; Worsley, Roisin; Thew, Caroline; Gurvich, Caroline; Thomas, Natalie; Kulkarni, Jayashri

2017-11-01

Hyperprolactinemia is a highly prevalent adverse effect of many antipsychotic agents, with potentially serious health consequences. Several guidelines have been developed for the management of this condition; yet, their concordance has not been evaluated. The objectives of this paper were (1) to review current clinical guidelines; (2) to review key systematic evidence for management; and (3) based on our findings, to develop an integrated management recommendation specific to male and female patients who are otherwise clinically stabilised on antipsychotics. We performed searches of Medline and EMBASE, supplemented with guideline-specific database and general web searches, to identify clinical guidelines containing specific recommendations for antipsychotic-induced hyperprolactinemia, produced/updated 01/01/2010-15/09/2016. A separate systematic search was performed to identify emerging management approaches described in reviews and meta-analyses published ≥ 2010. There is some consensus among guidelines relating to baseline PRL screening (8/12 guidelines), screening for differential diagnosis (7/12) and discontinuing/switching PRL-raising agent (7/12). Guidelines otherwise diverge substantially regarding most aspects of screening, monitoring and management (e.g. treatment with dopamine agonists). There is an omission of clear sex-specific recommendations. Systematic literature on management approaches is promising; more research is needed. An integrated management recommendation is presented to guide sex-specific clinical response to antipsychotic-induced hyperprolactinemia. Key aspects include asymptomatic hyperprolactinemia monitoring and fertility considerations with PRL normalisation. Further empirical work is key to shaping robust guidelines for antipsychotic-induced hyperprolactinemia. The integrated management recommendation can assist clinician and patient decision-making, with the goal of balancing effective psychiatric treatment while minimising PRL-related adverse health effects in male and female patients.

Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death—Summary Report*

PubMed Central

Hornby, Laura; Rochwerg, Bram; van Manen, Michael; Dhanani, ; Sonny; Sivarajan, V. Ben; Appleby, Amber; Bennett, Mary; Buchman, Daniel; Farrell, Catherine; Goldberg, Aviva; Greenberg, Rebecca; Singh, Ram; Nakagawa, Thomas A.; Witteman, William; Barter, Jill; Beck, Allon; Coughlin, Kevin; Conradi, Alf; Cupido, Cynthia; Dawson, Rosanne; Dipchand, Anne; Freed, Darren; Hornby, Karen; Langlois, Valerie; Mack, Cheryl; Mahoney, Meagan; Manhas, Deepak; Tomlinson, Christopher; Zavalkoff, Samara; Shemie, Sam D.

2017-01-01

Objectives: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. Methods: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. Results: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report. Conclusions: This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation. PMID:28925929

Summary report for the Engineering Script Language (ESL)

NASA Technical Reports Server (NTRS)

1990-01-01

The following subject areas are covered: ESL methodology concept; ESL specification; user interface description; engineering scripting language command statements specification; and recommendations for further research and development.

Taxonomy Working Group Final Report

NASA Technical Reports Server (NTRS)

Parsons, Vickie S.; Beil, Robert J.; Terrone, Mark; Barth, Timothy S.; Panontin, Tina L.; Wales, Roxana; Rackley, Michael W.; Milne, James S.; McPherson, John W.; Dutra, Jayne E.;

[Patient safety in home care - A review of international recommendations].

PubMed

Czakert, Judith; Lehmann, Yvonne; Ewers, Michael

2018-06-08

In recent years there has been a growing trend towards nursing care at home in general as well as towards intensive home care being provided by specialized home care services in Germany. However, resulting challenges for patient safety have rarely been considered. Against this background we aimed to explore whether international recommendations for patient safety in home care in general and in intensive home care in particular already exist and how they can stimulate further practice development in Germany. A review of online English documents containing recommendations for patient safety in intensive home care was conducted. Available documents were analyzed and compared in terms of their form and content. Overall, a small number of relevant documents could be identified. None of these documents exclusively refer to the intensive home care sector. Despite their differences, however, the analysis of four selected documents showed similarities, e. g., regarding specific topics of patient safety (communication, involvement of patients and their relatives, risk assessment, medication management, qualification). Furthermore, strengths and weaknesses of the documents became apparent: e. g., an explicit understanding of patient safety, a literature-based introduction to safety topics or an adaptation of the recommendations to the specific features of home care were occasionally lacking. This document analysis provides interesting input to the formal and content-related development of specific recommendations and to practice development in Germany to improve patient safety in home care. Copyright © 2018. Published by Elsevier GmbH.

Management of Side Effects of Novel Therapies for Multiple Myeloma: Consensus Statements Developed by the International Myeloma Foundation’s Nurse Leadership Board

PubMed Central

Bertolotti, Page; Bilotti, Elizabeth; Colson, Kathleen; Curran, Kathleen; Doss, Deborah; Faiman, Beth; Gavino, Maria; Jenkins, Bonnie; Lilleby, Kathy; Love, Ginger; Mangan, Patricia A.; McCullagh, Emily; Miceli, Teresa; Miller, Kena; Rogers, Kathryn; Rome, Sandra; Sandifer, Stacey; Smith, Lisa C.; Tariman, Joseph D.; Westphal, Jeanne

2014-01-01

Nurses play an essential role in managing the care of patients with multiple myeloma, who require education and support to receive and adhere to optimal therapy. The International Myeloma Foundation created a Nurse Leadership Board comprised of oncology nurses from leading cancer centers and community practices. An assessment survey identified the need for specific recommendations for managing key side effects of novel antimyeloma agents. Myelosuppression, thromboembolic events, peripheral neuropathy, steroid toxicities, and gastrointestinal side effects were selected for the first consensus statements. The board developed recommendations for healthcare providers in any medical setting, including grading of side-effect toxicity and strategies for managing the side effects in general, with specific recommendations pertaining to the novel agents. PMID:18490252

ACR Appropriateness Criteria® Breast Cancer Screening.

PubMed

Mainiero, Martha B; Moy, Linda; Baron, Paul; Didwania, Aarati D; diFlorio, Roberta M; Green, Edward D; Heller, Samantha L; Holbrook, Anna I; Lee, Su-Ju; Lewin, Alana A; Lourenco, Ana P; Nance, Kara J; Niell, Bethany L; Slanetz, Priscilla J; Stuckey, Ashley R; Vincoff, Nina S; Weinstein, Susan P; Yepes, Monica M; Newell, Mary S

2017-11-01

Breast cancer screening recommendations are based on risk factors. For average-risk women, screening mammography and/or digital breast tomosynthesis is recommended beginning at age 40. Ultrasound (US) may be useful as an adjunct to mammography for incremental cancer detection in women with dense breasts, but the balance between increased cancer detection and the increased risk of a false-positive examination should be considered in the decision. For intermediate-risk women, US or MRI may be indicated as an adjunct to mammography depending upon specific risk factors. For women at high risk due to prior mantle radiation between the ages of 10 to 30, mammography is recommended starting 8 years after radiation therapy but not before age 25. For women with a genetic predisposition, annual screening mammography is recommended beginning 10 years earlier than the affected relative at the time of diagnosis but not before age 30. Annual screening MRI is recommended in high-risk women as an adjunct to mammography. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Moving from evidence to developing recommendations in guidelines: article 11 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Schünemann, Holger J; Oxman, Andy D; Akl, Elie A; Brozek, Jan L; Montori, Victor M; Heffner, John; Hill, Suzanne; Woodhead, Mark; Campos-Outcalt, Doug; Alderson, Phil; Woitalla, Thomas; Puhan, Milo A; Falck-Ytter, Yngve; Bousquet, Jean; Guyatt, Gordon

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that healthcare recommendations are informed by the best available research evidence. This is the 11th of a series of 14 articles that methodologists and researchers from around the world prepared to advise guideline developers for respiratory and other diseases on how to achieve this goal. For this article, we developed five key questions and updated a review of the literature on moving from evidence to recommendations. We addressed the following specific questions.What is the strength of a recommendation and what determines the strength? What are the implications of strong and weak recommendations for patients, clinicians, and policy makers? Should guideline panels make recommendations in the face of very low-quality evidence? Under which circumstances should guideline panels make research recommendations? How should recommendations be formulated and presented? We searched PubMed and other databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on available evidence, consideration of what guideline developers are doing, and pre- and postworkshop discussions. The strength of a recommendation reflects the extent to which guideline developers can, across the range of patients for whom the recommendations are intended, be confident that the desirable effects of following the recommendation outweigh the undesirable effects. Four factors influence the strength of a recommendation: the quality of evidence supporting the recommendation, the balance between desirable and undesirable effects, the uncertainty or variability of patient values and preferences, and costs. Strong and weak (also called "conditional") recommendations have distinct implications for patients, clinicians, and policy makers. Adherence to strong recommendations or, in the case of weak (conditional) recommendations, documentation of discussion or shared decision making with a patient, might be used as quality measures or performance indicators. Clinicians desire guidance regardless of the quality of the underlying evidence. Very low-quality evidence should ideally result in either appropriately labeled recommendations (i.e., as based on very low-quality evidence) or a statement that the guideline panel did not reach consensus on the recommendation due to the lack of confidence in the effect estimates. However, guideline panels often have more resources, time, and information than practicing clinicians. Therefore, they may be in a position to use their best judgments to make recommendations even when there is very low-quality evidence, although some guideline developers disagree with this approach and prefer a general approach of not making recommendations in the face of very low-quality evidence. Guideline panels should consider making research recommendations when there is important uncertainty about the desirable and undesirable effects of an intervention, further research could reduce that uncertainty, and the potential benefits and savings of reducing the uncertainty outweigh the potential harms of not making the research recommendation. Recommendations for additional research should be as precise and specific as possible.

Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure

PubMed Central

Brochard, Laurent; Elliott, Mark W.; Hess, Dean; Hill, Nicholas S.; Navalesi, Paolo; Antonelli, Massimo; Brozek, Jan; Conti, Giorgio; Ferrer, Miquel; Guntupalli, Kalpalatha; Jaber, Samir; Keenan, Sean; Mancebo, Jordi; Mehta, Sangeeta; Raoof, Suhail

2017-01-01

Noninvasive mechanical ventilation (NIV) is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of aetiologies. This document provides European Respiratory Society/American Thoracic Society recommendations for the clinical application of NIV based on the most current literature. The guideline committee was composed of clinicians, methodologists and experts in the field of NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology for each actionable question. The GRADE Evidence to Decision framework in the guideline development tool was used to generate recommendations. A number of topics were addressed using technical summaries without recommendations and these are discussed in the supplementary material. This guideline committee developed recommendations for 11 actionable questions in a PICO (population–intervention–comparison–outcome) format, all addressing the use of NIV for various aetiologies of ARF. The specific conditions where recommendations were made include exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, de novo hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation. This document summarises the current state of knowledge regarding the role of NIV in ARF. Evidence-based recommendations provide guidance to relevant stakeholders. PMID:28860265

WHO Expert Committee on Specifications for Pharmaceutical Preparations.

PubMed

2012-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use: Development of monographs for The International Pharmacopoeia; WHO good manufacturing practices: water for pharmaceutical use; Pharmaceutical development of multisource (generic) pharmaceutical products--points to consider; Guidelines on submission of documentation for a multisource (generic) finished pharmaceutical product for the WHO Prequalification of Medicines Programme: quality part; Development of paediatric medicines: points to consider in formulation; Recommendations for quality requirements for artemisinin as a starting material in the production of antimalarial active pharmaceutical ingredients.

Guide to Developing Performance-Related Specifications For PCC Pavements. Volume I: Practical Guide, Final Report and Appendix A

DOT National Transportation Integrated Search

1999-02-01

This report (FHWA-RD-98-155), the first of a four-volume set of reports, presents guidelines and recommendations to assist a highway agency in developing and using performance-related specifications for portland cement concrete pavement construction....

PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain.

PubMed

Neugebauer, E A M; Wilkinson, R C; Kehlet, H; Schug, S A

2007-07-01

Many patients still suffer severe acute pain in the postoperative period. Although guidelines for treating acute pain are widely published and promoted, most do not consider procedure-specific differences in pain experienced or in techniques that may be most effective and appropriate for different surgical settings. The procedure-specific postoperative pain management (PROSPECT) Working Group provides procedure-specific recommendations for postoperative pain management together with supporting evidence from systematic literature reviews and related procedures at http://www.postoppain.org The methodology for PROSPECT reviews was developed and refined by discussion of the Working Group, and it adapts existing methods for formulation of consensus recommendations to the specific requirements of PROSPECT. To formulate PROSPECT recommendations, we use a methodology that takes into account study quality and source and level of evidence, and we use recognized methods for achieving group consensus, thus reducing potential bias. The new methodology is first applied in full for the 2006 update of the PROSPECT review of postoperative pain management for laparoscopic cholecystectomy. Transparency in PROSPECT processes allows the users to be fully aware of any limitations of the evidence and recommendations, thereby allowing for appropriate decisions in their own practice setting.

Interagency Task Forces: The Right Tools for the Job

DTIC Science & Technology

2011-01-01

shortcomings. This analysis discusses four organizational reform models and recommends the interagency task force ( IATF ) as the preferred structure...model.64 Still others recommend creating and deploying ad hoc IATFs for crisis operations. These interagency task forces would be task- organized to...forces assigned for planning, exercises, and mission execution.65 A 2005 article in Policy Review recommended developing IATFs as needed for specific

[Consensus conference on providing information of adverse events to patients and relatives].

PubMed

Martín-Delgado, M C; Fernández-Maillo, M; Bañeres-Amella, J; Campillo-Artero, C; Cabré-Pericas, L; Anglés-Coll, R; Gutiérrez-Fernández, R; Aranaz-Andrés, J M; Pardo-Hernández, A; Wu, A

2013-01-01

To develop recommendations regarding «Information about adverse events to patients and their families», through the implementation of a consensus conference. A literature review was conducted to identify all relevant articles, the major policies and international guidelines, and the specific legislation developed in some countries on this process. The literature review was the basis for responding to a series of questions posed in a public session. A group of experts presented the best available evidence, interacting with stakeholders. At the end of the session, an interdisciplinary and multi-professional jury established the final recommendations of the consensus conference. The main recommendations advocate the need to develop policies and institutional guidelines in our field, favouring the patient adverse events disclosure process. The recommendations emphasize the need for the training of professionals in communication skills and patient safety, as well as the development of strategies for supporting professionals who are involved in an adverse event. The assessment of the interest and impact of specific legislation that would help the implementation of these policies was also considered. A cultural change is needed at all levels, nuanced and adapted to the specific social and cultural aspects of our social and health spheres, and involves all stakeholders in the system to create a framework of trust and credibility in which the processing of information about adverse events may become effective. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

The Day Care Needs of the Indigent Children of West Virginia, with Recommendations for a Model Day Care Program and Delivery System. Volume 2.

ERIC Educational Resources Information Center

Hodges, Walter L.; And Others

This volume describes and discusses six major proposals for a complete model system of day care for indigent children in West Virginia. The recommendations include: (1) developing more specific objectives to be accomplished for children, parents, care providers, and the state; (2) developing a public education program designed to help parents…

NSPWG-recommended safety requirements and guidelines for SEI nuclear propulsion

NASA Technical Reports Server (NTRS)

Marshall, Albert C.; Sawyer, J. C., Jr.; Bari, Robert A.; Brown, Neil W.; Cullingford, Hatice S.; Hardy, Alva C.; Lee, James H.; Mcculloch, William H.; Niederauer, George F.; Remp, Kerry

1992-01-01

An interagency Nuclear Safety Policy Working Group (NSPWG) was chartered to recommend nuclear safety policy, requirements, and guidelines for the Space Exploration Initiative (SEI) nuclear propulsion program to facilitate the implementation of mission planning and conceptual design studies. The NSPWG developed a top-level policy to provide the guiding principles for the development and implementation of the nuclear propulsion safety program and the development of safety functional requirements. In addition, the NSPWG reviewed safety issues for nuclear propulsion and recommended top-level safety requirements and guidelines to address these issues. Safety requirements were developed for reactor start-up, inadvertent criticality, radiological release and exposure, disposal, entry, and safeguards. Guidelines were recommended for risk/reliability, operational safety, flight trajectory and mission abort, space debris and meteoroids, and ground test safety. In this paper the specific requirements and guidelines will be discussed.

Return of results in translational iPS cell research: considerations for donor informed consent

PubMed Central

2013-01-01

Efforts have emerged internationally to recruit donors with specific disease indications and to derive induced pluripotent cell lines. These disease-specific induced pluripotent stem cell lines have the potential to accelerate translational goals such as drug discovery and testing. One consideration for donor recruitment and informed consent is the possibility that research will result in findings that are clinically relevant to the cell donor. Management protocols for such findings should be developed a priori and disclosed during the informed consent process. The California Institute for Regenerative Medicine has developed recommendations for informing donors in sponsored research. These recommendations include obtaining consent to recontact tissue donors for a range of scientific, medical and ethical considerations. This article reviews the basis for these recommendations and suggests conditions that may be appropriate when reporting findings to donors. PMID:23336317

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

PubMed Central

Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B.; Tomson, Göran; Holmqvist, Lotta Widén; Gifford, Wendy; Eldh, Ann Catrine

2016-01-01

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations. PMID:27694661

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness.

PubMed

Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B; Tomson, Göran; Holmqvist, Lotta Widén; Gifford, Wendy; Eldh, Ann Catrine

2016-04-11

Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations. © 2016 by Kerman University of Medical Sciences

Prudent Practices for Handling Hazardous Chemicals in Laboratories.

ERIC Educational Resources Information Center

National Academy of Sciences-National Research Council, Washington, DC. Assembly of Mathematical and Physical Sciences.

This guide recommends procedures for safe handling and disposal of hazardous substances, along with broad recommendations for developing comprehensive laboratory safety programs. Although specific information is provided, general principles which can be adapted to activities in any laboratory are emphasized. Section 1 focuses on procedures for…

Support of personalized medicine through risk-stratified treatment recommendations - an environmental scan of clinical practice guidelines

PubMed Central

2013-01-01

Background Risk-stratified treatment recommendations facilitate treatment decision-making that balances patient-specific risks and preferences. It is unclear if and how such recommendations are developed in clinical practice guidelines (CPGs). Our aim was to assess if and how CPGs develop risk-stratified treatment recommendations for the prevention or treatment of common chronic diseases. Methods We searched the United States National Guideline Clearinghouse for US, Canadian and National Institute for Health and Clinical Excellence (United Kingdom) CPGs for heart disease, stroke, cancer, chronic obstructive pulmonary disease and diabetes that make risk-stratified treatment recommendations. We included only those CPGs that made risk-stratified treatment recommendations based on risk assessment tools. Two reviewers independently identified CPGs and extracted information on recommended risk assessment tools; type of evidence about treatment benefits and harms; methods for linking risk estimates to treatment evidence and for developing treatment thresholds; and consideration of patient preferences. Results We identified 20 CPGs that made risk-stratified treatment recommendations out of 133 CPGs that made any type of treatment recommendations for the chronic diseases considered in this study. Of the included 20 CPGs, 16 (80%) used evidence about treatment benefits from randomized controlled trials, meta-analyses or other guidelines, and the source of evidence was unclear in the remaining four (20%) CPGs. Nine CPGs (45%) used evidence on harms from randomized controlled trials or observational studies, while 11 CPGs (55%) did not clearly refer to harms. Nine CPGs (45%) explained how risk prediction and evidence about treatments effects were linked (for example, applying estimates of relative risk reductions to absolute risks), but only one CPG (5%) assessed benefit and harm quantitatively and three CPGs (15%) explicitly reported consideration of patient preferences. Conclusions Only a small proportion of CPGs for chronic diseases make risk-stratified treatment recommendations with a focus on heart disease and stroke prevention, diabetes and breast cancer. For most CPGs it is unclear how risk-stratified treatment recommendations were developed. As a consequence, it is uncertain if CPGs support patients and physicians in finding an acceptable benefit- harm balance that reflects both profile-specific outcome risks and preferences. PMID:23302096

Learning material recommendation based on case-based reasoning similarity scores

NASA Astrophysics Data System (ADS)

Masood, Mona; Mokmin, Nur Azlina Mohamed

2017-10-01

A personalized learning material recommendation is important in any Intelligent Tutoring System (ITS). Case-based Reasoning (CBR) is an Artificial Intelligent Algorithm that has been widely used in the development of ITS applications. This study has developed an ITS application that applied the CBR algorithm in the development process. The application has the ability to recommend the most suitable learning material to the specific student based on information in the student profile. In order to test the ability of the application in recommending learning material, two versions of the application were created. The first version displayed the most suitable learning material and the second version displayed the least preferable learning material. The results show the application has successfully assigned the students to the most suitable learning material.

Synthesis of methods for developing transit vehicle specifications.

DOT National Transportation Integrated Search

2014-06-01

The Michigan Department of Transportation (MDOT) has the objective to thoroughly assess its : transit vehicle specification and procurement program in order to compare best practices from : peer states and identify recommendations for improved effici...

A Competitiveness Strategy for America. Reports of the Subcouncils. Second Report to the President & Congress.

ERIC Educational Resources Information Center

Competitiveness Policy Council, Washington, DC.

This publication contains detailed reports from the eight subcouncils established by the Competitiveness Policy Council to develop specific policy recommendations in eight areas. "Building a Standards-Based School System" (Education Subcouncil) recommends redirecting the education system toward achieving the National Education Goals,…

Women's experiences of developing musculoskeletal diseases: employment challenges and policy recommendations.

PubMed

Crooks, Valorie A

2007-07-30

To answer three specific questions: (i) How do women experience the workplace after the onset of a musculoskeletal disease; (ii) What employment policy and programme suggestions can they offer for ways to better support chronically ill women in their abilities to maintain workforce participation; and (iii) How are these women's employment policy and programme recommendations informed by their own lived experiences and desires? In-depth interviews were conducted with 18 women who had developed musculoskeletal diseases while involved in the labour market. Data were coded and analysed thematically. Participants identified three common workplace barriers experienced and three types of workplace accommodations commonly requested. They offered four specific employment policy and programme recommendations for ways to better support women who develop musculoskeletal diseases in maintaining labour market participation. It is found that their employment policy and programme recommendations are informed by their own experiences in the workplace and desires for being supported in maintaining involvement in paid labour. Creating employment programmes and policies that support chronically ill women in their attempts to remain involved in the workforce based on how much paid labour they are able to perform and where they are best able to work is of the utmost importance.

USGEO DMWG Cloud Computing Recommendations

NASA Astrophysics Data System (ADS)

de la Beaujardiere, J.; McInerney, M.; Frame, M. T.; Summers, C.

2017-12-01

The US Group on Earth Observations (USGEO) Data Management Working Group (DMWG) has been developing Cloud Computing Recommendations for Earth Observations. This inter-agency report is currently in draft form; DMWG hopes to have released the report as a public Request for Information (RFI) by the time of AGU. The recommendations are geared toward organizations that have already decided to use the Cloud for some of their activities (i.e., the focus is not on "why you should use the Cloud," but rather "If you plan to use the Cloud, consider these suggestions.") The report comprises Introductory Material, including Definitions, Potential Cloud Benefits, and Potential Cloud Disadvantages, followed by Recommendations in several areas: Assessing When to Use the Cloud, Transferring Data to the Cloud, Data and Metadata Contents, Developing Applications in the Cloud, Cost Minimization, Security Considerations, Monitoring and Metrics, Agency Support, and Earth Observations-specific recommendations. This talk will summarize the recommendations and invite comment on the RFI.

[Polish guidelines for the prevention and treatment of venous thromboembolism: 2009 update].

PubMed

Zawilska, Krystyna; Jaeschke, Roman; Tomkowski, Witold; Mayzner-Zawadzka, Ewa; Nizankowski, Rafał; Olejek, Anita; Pasierski, Tomasz; Torbicki, Adam; Undas, Anetta; Jawień, Arkadiusz; Gajewski, Piotr; Sznajd, Jan; Brozek, Jan

2009-01-01

The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia. We systematically identified all current clinical practice guidelines concerning the prevention and/or treatment of venous thromboembolism and assessed their methodological quality using the AGREE instrument. We chose to update existing Polish guidelines by adapting the most recent high quality guidelines that we identified to Polish cultural and organizational setting rather than develop all recommendations de novo. We based our recommendations primarily on the 8th edition of the American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines on Antithrombotic and Thrombolytic Therapy and on the European Society of Cardiology (ESC) Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism. To make recommendations regarding specific management issues that had not been addressed in ACCP guidelines, or whenever panel members felt they needed additional information to reach the decision we also consulted guidelines developed by other professional societies and organizations as well as additional sources of evidence. For each recommendation we explicitly assessed its relevance and applicability in the context of health care system in Poland. We adapted recommendations when necessary, explicitly stating the rationale for modification and judgements about the values and preferences we assumed. We developed original recommendations on the use of new oral anticoagulants that have recently become available, following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

NHF-McMaster Guideline on Care Models for Haemophilia Management.

PubMed

Pai, M; Key, N S; Skinner, M; Curtis, R; Feinstein, M; Kessler, C; Lane, S J; Makris, M; Riker, E; Santesso, N; Soucie, J M; Yeung, C H T; Iorio, A; Schünemann, H J

2016-07-01

This guideline was developed to identify evidence-based best practices in haemophilia care delivery, and discuss the range of care providers and services that are most important to optimize outcomes for persons with haemophilia (PWH) across the United States. The guideline was developed following specific methods described in detail in this supplement and based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation approach). Direct evidence from published literature and the haemophilia community, as well as indirect evidence from other chronic diseases, were reviewed, synthesized and applied to create evidence-based recommendations. The Guideline panel suggests that the integrated care model be used over non-integrated care models for PWH (conditional recommendation, moderate certainty in the evidence). For PWH with inhibitors and those at high risk for inhibitor development, the same recommendation was graded as strong, with moderate certainty in the evidence. The panel suggests that a haematologist, a specialized haemophilia nurse, a physical therapist, a social worker and round-the-clock access to a specialized coagulation laboratory be part of the integrated care team, over an integrated care team that does not include all of these components (conditional recommendation, very low certainty in the evidence). Based on available evidence, the integrated model of care in its current structure, is suggested for optimal care of PWH. There is a need for further appropriately designed studies that address unanswered questions about specific outcomes and the optimal structure of the integrated care delivery model in haemophilia. © 2016 John Wiley & Sons Ltd.

Developing a semantic web model for medical differential diagnosis recommendation.

PubMed

Mohammed, Osama; Benlamri, Rachid

2014-10-01

In this paper we describe a novel model for differential diagnosis designed to make recommendations by utilizing semantic web technologies. The model is a response to a number of requirements, ranging from incorporating essential clinical diagnostic semantics to the integration of data mining for the process of identifying candidate diseases that best explain a set of clinical features. We introduce two major components, which we find essential to the construction of an integral differential diagnosis recommendation model: the evidence-based recommender component and the proximity-based recommender component. Both approaches are driven by disease diagnosis ontologies designed specifically to enable the process of generating diagnostic recommendations. These ontologies are the disease symptom ontology and the patient ontology. The evidence-based diagnosis process develops dynamic rules based on standardized clinical pathways. The proximity-based component employs data mining to provide clinicians with diagnosis predictions, as well as generates new diagnosis rules from provided training datasets. This article describes the integration between these two components along with the developed diagnosis ontologies to form a novel medical differential diagnosis recommendation model. This article also provides test cases from the implementation of the overall model, which shows quite promising diagnostic recommendation results.

A study of mass data storage technology for rocket engine data

NASA Technical Reports Server (NTRS)

Ready, John F.; Benser, Earl T.; Fritz, Bernard S.; Nelson, Scott A.; Stauffer, Donald R.; Volna, William M.

1990-01-01

The results of a nine month study program on mass data storage technology for rocket engine (especially the Space Shuttle Main Engine) health monitoring and control are summarized. The program had the objective of recommending a candidate mass data storage technology development for rocket engine health monitoring and control and of formulating a project plan and specification for that technology development. The work was divided into three major technical tasks: (1) development of requirements; (2) survey of mass data storage technologies; and (3) definition of a project plan and specification for technology development. The first of these tasks reviewed current data storage technology and developed a prioritized set of requirements for the health monitoring and control applications. The second task included a survey of state-of-the-art and newly developing technologies and a matrix-based ranking of the technologies. It culminated in a recommendation of optical disk technology as the best candidate for technology development. The final task defined a proof-of-concept demonstration, including tasks required to develop, test, analyze, and demonstrate the technology advancement, plus an estimate of the level of effort required. The recommended demonstration emphasizes development of an optical disk system which incorporates an order-of-magnitude increase in writing speed above the current state of the art.

Work-life integration in neuropsychology: a review of the existing literature and preliminary recommendations.

PubMed

Feigon, Maia; Block, Cady; Guidotti Breting, Leslie; Boxley, Laura; Dawson, Erica; Cobia, Derin

2018-02-01

The purpose of the current review paper is to identify and describe challenges to work-life integration in neuropsychology, and from this review extrapolate an initial set of recommendations and present a set of scenarios in which the recommendations might apply in the hopes of improving quality of life for current and prospective neuropsychologists. Specific areas of focus include diversity, early and mid-career transitions, and potential barriers to advancement in specific practice settings. A broad review was conducted of extant literature on work-life integration. There is scant scientific literature in this area that is specific to neuropsychologists, or even psychology as a whole. Subsequently, the majority of this review was collected from more developed literatures in business and medical fields. The authors then provided recommendations based on experiences in their respective careers. Attempts were made to promote generalizability of recommendations for neuropsychologists in different settings. Evidence supports a potentially adverse impact on quality of life and overall life satisfaction when work and personal lives conflict. This manuscript identifies some of the potential risks when work and life responsibilities are not well integrated. It is anticipated this will serve as a catalyst for future studies on work-life integration in the field of neuropsychology, specifically.

Design implications for task-specific search utilities for retrieval and re-engineering of code

NASA Astrophysics Data System (ADS)

Iqbal, Rahat; Grzywaczewski, Adam; Halloran, John; Doctor, Faiyaz; Iqbal, Kashif

2017-05-01

The importance of information retrieval systems is unquestionable in the modern society and both individuals as well as enterprises recognise the benefits of being able to find information effectively. Current code-focused information retrieval systems such as Google Code Search, Codeplex or Koders produce results based on specific keywords. However, these systems do not take into account developers' context such as development language, technology framework, goal of the project, project complexity and developer's domain expertise. They also impose additional cognitive burden on users in switching between different interfaces and clicking through to find the relevant code. Hence, they are not used by software developers. In this paper, we discuss how software engineers interact with information and general-purpose information retrieval systems (e.g. Google, Yahoo!) and investigate to what extent domain-specific search and recommendation utilities can be developed in order to support their work-related activities. In order to investigate this, we conducted a user study and found that software engineers followed many identifiable and repeatable work tasks and behaviours. These behaviours can be used to develop implicit relevance feedback-based systems based on the observed retention actions. Moreover, we discuss the implications for the development of task-specific search and collaborative recommendation utilities embedded with the Google standard search engine and Microsoft IntelliSense for retrieval and re-engineering of code. Based on implicit relevance feedback, we have implemented a prototype of the proposed collaborative recommendation system, which was evaluated in a controlled environment simulating the real-world situation of professional software engineers. The evaluation has achieved promising initial results on the precision and recall performance of the system.

The kW power module evolution study: Executive summary

NASA Technical Reports Server (NTRS)

1979-01-01

Using the Marshall Space Flight Center 25 kW Power Module (PM) reference design as a point of departure, the study defined evolutionary growth paths to 100 kW and above. A recommended development approach and initial configurations were described. Specific hardware changes from the reference design are recommended for the initial PM configuration to ensure evolutionary growth, improved replicability, and reduced cost. Certain functional changes are also recommended to enhance system capabilities.

Cost consideration in the clinical guidance documents of physician specialty societies in the United States.

PubMed

Schwartz, Jennifer A T; Pearson, Steven D

2013-06-24

Despite increasing concerns regarding the cost of health care, the consideration of costs in the development of clinical guidance documents by physician specialty societies has received little analysis. To evaluate the approach to consideration of cost in publicly available clinical guidance documents and methodological statements produced between 2008 and 2012 by the 30 largest US physician specialty societies. Qualitative document review. Whether costs are considered in clinical guidance development, mechanism of cost consideration, and the way that cost issues were used in support of specific clinical practice recommendations. Methodological statements for clinical guidance documents indicated that 17 of 30 physician societies (57%) explicitly integrated costs, 4 (13%) implicitly considered costs, 3 (10%) intentionally excluded costs, and 6 (20%) made no mention. Of the 17 societies that explicitly integrated costs, 9 (53%) consistently used a formal system in which the strength of recommendation was influenced in part by costs, whereas 8 (47%) were inconsistent in their approach or failed to mention the exact mechanism for considering costs. Among the 138 specific recommendations in these guidance documents that included cost as part of the rationale, the most common form of recommendation (50 [36%]) encouraged the use of a specific medical service because of equal effectiveness and lower cost. Slightly more than half of the largest US physician societies explicitly consider costs in developing their clinical guidance documents; among these, approximately half use an explicit mechanism for integrating costs into the strength of recommendations. Many societies remain vague in their approach. Physician specialty societies should demonstrate greater transparency and rigor in their approach to cost consideration in documents meant to influence care decisions.

Recommended Practices for the Safe Design and Operation of Flywheels

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

Bender, Donald Arthur

2015-12-01

Flywheel energy storage systems are in use globally in increasing numbers . No codes pertaining specifically to flywheel energy storage exist. A number of industrial incidents have occurred. This protocol recommends a technical basis for safe flywheel de sign and operation for consideration by flywheel developers, users of flywheel systems and standards setting organizations.

50 CFR 648.96 - FMP review, specification, and framework adjustment process.

Code of Federal Regulations, 2012 CFR

2012-10-01

... and ACLs. (1) The Councils or the PDT may develop options for setting ABC, ACL, and OFL for each.... The Councils or the PDT may recommend to the SSC that ABC, ACL, and OFL are specified for each.... (ii) ACL recommendations. The Councils shall establish ACLs for each management area that are...

50 CFR 648.96 - FMP review, specification, and framework adjustment process.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Councils or the PDT may develop options for setting ABC, ACL, and OFL for each monkfish stock, as necessary... recommend to the SSC that ABC, ACL, and OFL are specified for each monkfish stock for multiple years as... not limited to, OFLs, ACLs, and management uncertainty. (ii) ACL recommendations. The Councils shall...

50 CFR 648.96 - FMP review, specification, and framework adjustment process.

Code of Federal Regulations, 2013 CFR

2013-10-01

... and ACLs. (1) The Councils or the PDT may develop options for setting ABC, ACL, and OFL for each.... The Councils or the PDT may recommend to the SSC that ABC, ACL, and OFL are specified for each.... (ii) ACL recommendations. The Councils shall establish ACLs for each management area that are...

50 CFR 648.96 - FMP review, specification, and framework adjustment process.

Code of Federal Regulations, 2014 CFR

2014-10-01

... and ACLs. (1) The Councils or the PDT may develop options for setting ABC, ACL, and OFL for each.... The Councils or the PDT may recommend to the SSC that ABC, ACL, and OFL are specified for each.... (ii) ACL recommendations. The Councils shall establish ACLs for each management area that are...

78 FR 66008 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-04

... developing recommendations, future research and program needs concerning home- testing for MSM. Specific Aims... Manhunt and Adam4Adam. This study also has a qualitative component that aims to examine the experiences of participants in the randomized control trial (RCT). Participants for the qualitative data collection will be...

Commission on Teacher Credentialing Approves 8 ELL-Related Credential Options

ERIC Educational Resources Information Center

Frost, Jeff; Cadiero-Kaplan, Karen; Kuhlman, Natalie

2011-01-01

On September 30, 2010, the California Commission on Teacher Credentialing (CTC) voted unanimously to approve a set of eight recommendations for authorization to teach English language learners. These recommendations approved by the CTC had been in development for almost two years and they focused on several issues, including: (1) a specific focus…

Consensus-based cross-European recommendations for the identification, measurement and valuation of costs in health economic evaluations: a European Delphi study.

PubMed

van Lier, Lisanne I; Bosmans, Judith E; van Hout, Hein P J; Mokkink, Lidwine B; van den Hout, Wilbert B; de Wit, G Ardine; Dirksen, Carmen D; Nies, Henk L G R; Hertogh, Cees M P M; van der Roest, Henriëtte G

2017-12-19

Differences between country-specific guidelines for economic evaluations complicate the execution of international economic evaluations. The aim of this study was to develop cross-European recommendations for the identification, measurement and valuation of resource use and lost productivity in economic evaluations using a Delphi procedure. A comprehensive literature search was conducted to identify European guidelines on the execution of economic evaluations or costing studies as part of economic evaluations. Guideline recommendations were extracted by two independent reviewers and formed the basis for the first round of the Delphi study, which was conducted among European health economic experts. During three written rounds, consensus (agreement of 67% or higher) was sought on items concerning the identification, measurement and valuation of costs. Recommendations from 18 guidelines were extracted. Consensus among 26 panellists from 17 European countries was reached on 61 of 68 items. The recommendations from the Delphi study are to adopt a societal perspective, to use patient report for measuring resource use and lost productivity, to value both constructs with use of country-specific standardized/unit costs and to use country-specific discounting rates. This study provides consensus-based cross-European recommendations on how to measure and value resource use and lost productivity in economic evaluations. These recommendations are expected to support researchers, healthcare professionals, and policymakers in executing and appraising economic evaluations performed in international contexts.

Summary of the Statement on International Travellers Who Intend to Visit Friends and Relatives

PubMed Central

Brophy, J

2015-01-01

Background Travellers intending to visit friends and relatives (VFRs) are a specific group of travellers who have been identified as having an increased risk of travel-related morbidity. Objective To provide recommendations for risk reduction in international VFRs. Methods Recommendations regarding VFRs were developed based on available travel medicine literature and CATMAT expert opinion. Specific travel-related risks, including infectious disease epidemiology and burden in this population, were reviewed and recommendations were provided to attempt to mitigate these risks. Previous CATMAT statements related to VFRs were referred to and reiterated. Recommendations Rates of travel-related illness in VFRs tend to be higher for many conditions. Disease-specific risk factors and recommendations are discussed throughout this Statement. CATMAT recommends that VFRs’ vaccinations be up-to-date and they be counselled on the importance of various risk reduction activities such as the use of malaria prophylaxis, safe sex practices and injury prevention. Pre- and/or post-travel tuberculosis testing is indicated in certain situations. Conclusion The pre-travel health assessment is an important opportunity to address with VFRs issues regarding health beliefs, health behaviours, current health status and the possibility of pre-existing conditions. Discussions addressing the importance of adherence to health advice and potential challenges to achieving adherence may be necessary. PMID:29769941

Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East.

PubMed

Al Sayed, Nasreen; Al Waili, Khalid; Alawadi, Fatheya; Al-Ghamdi, Saeed; Al Mahmeed, Wael; Al-Nouri, Fahad; Al Rukhaimi, Mona; Al-Rasadi, Khalid; Awan, Zuhier; Farghaly, Mohamed; Hassanein, Mohamed; Sabbour, Hani; Zubaid, Mohammad; Barter, Philip

2016-12-15

Plasma lipid disorders are key risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) and are prevalent in the Middle East, with rates increasing in recent decades. Despite this, no region-specific guidelines for managing plasma lipids exist and there is a lack of use of guidelines developed in other regions. A multidisciplinary panel of regional experts was convened to develop consensus clinical recommendations for the management of plasma lipids in the Middle East. The panel considered existing international guidelines and regional clinical experience to develop recommendations. The panel's recommendations include plasma lipid screening, ASCVD risk calculation and treatment considerations. The panel recommend that plasma lipid levels should be measured in all at-risk patients and at regular intervals in all adults from the age of 20years. A scoring system should be used to calculate ASCVD risk that includes known lipid and non-lipid risk factors. Primary treatment targets include low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Lifestyle modifications should be first-line treatment for all patients; the first-line pharmacological treatment targeting plasma lipids in patients at moderate-to-high risk of ASCVD is statin therapy, with a number of adjunctive or second-line agents available. Guidance is also provided on the management of underlying conditions and special populations; of particular pertinence in the region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. These consensus clinical recommendations provide practicing clinicians with comprehensive, region-specific guidance to improve the detection and management of plasma lipid disorders in patients in the Middle East. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Crew interface specifications development for inflight maintenance and stowage functions

NASA Technical Reports Server (NTRS)

Carl, J. G.

1974-01-01

Findings and data products developed during crew specification study for inflight maintenance and stowage functions are reported. From this information base, a family of data concepts to support crew inflight troubleshooting and corrective maintenance activities was developed and specified. Recommendations are made for the improvement of inflight maintenance planning, preparations and operations in future space flight programs through the establishment of an inflight maintenance organization and specific suggestions for techniques to improve the management of the inflight maintenance function.

Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).

PubMed

Kneyber, Martin C J; de Luca, Daniele; Calderini, Edoardo; Jarreau, Pierre-Henri; Javouhey, Etienne; Lopez-Herce, Jesus; Hammer, Jürg; Macrae, Duncan; Markhorst, Dick G; Medina, Alberto; Pons-Odena, Marti; Racca, Fabrizio; Wolf, Gerhard; Biban, Paolo; Brierley, Joe; Rimensberger, Peter C

2017-12-01

Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms. The Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with "strong agreement". The final iteration of the recommendations had none with equipoise or disagreement. These recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.

Peridigm summary report : lessons learned in development with agile components.

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

Salinger, Andrew Gerhard; Mitchell, John Anthony; Littlewood, David John

2011-09-01

This report details efforts to deploy Agile Components for rapid development of a peridynamics code, Peridigm. The goal of Agile Components is to enable the efficient development of production-quality software by providing a well-defined, unifying interface to a powerful set of component-based software. Specifically, Agile Components facilitate interoperability among packages within the Trilinos Project, including data management, time integration, uncertainty quantification, and optimization. Development of the Peridigm code served as a testbed for Agile Components and resulted in a number of recommendations for future development. Agile Components successfully enabled rapid integration of Trilinos packages into Peridigm. A cost of thismore » approach, however, was a set of restrictions on Peridigm's architecture which impacted the ability to track history-dependent material data, dynamically modify the model discretization, and interject user-defined routines into the time integration algorithm. These restrictions resulted in modifications to the Agile Components approach, as implemented in Peridigm, and in a set of recommendations for future Agile Components development. Specific recommendations include improved handling of material states, a more flexible flow control model, and improved documentation. A demonstration mini-application, SimpleODE, was developed at the onset of this project and is offered as a potential supplement to Agile Components documentation.« less

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis.

PubMed

Tuncer, Tiraje; Cay, Fatih Hasan; Altan, Lale; Gurer, Gulcan; Kacar, Cahit; Ozcakir, Suheda; Atik, Sahap; Ayhan, Figen; Durmaz, Berrin; Eskiyurt, Nurten; Genc, Hakan; GokceKutsal, Yesim; Gunaydin, Rezzan; Hepguler, Simin; Hizmetli, Sami; Kaya, Taciser; Kurtais, Yesim; Saridogan, Merih; Sindel, Dilsad; Sutbeyaz, Serap; Sendur, Omer Faruk; Ugurlu, Hatice; Unlu, Zeliha

2018-05-17

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

Occupational therapy-based and evidence-supported recommendations for assessment and exercises in hand osteoarthritis.

PubMed

Kjeken, Ingvild

2011-12-01

The aims of this study were to develop recommendations for occupational therapy assessment and design of hand exercise programmes in patients with hand osteoarthritis. An expert group followed a Delphi procedure to reach consensus for up to 10 recommendations for assessment and exercises, respectively. Thereafter, an evidence-based approach was used to identify and appraise research evidence supporting each recommendation, before the recommendations were validated by the expert group. The process resulted in 10 recommendations for assessment and eight for design of exercise programmes. The literature search revealed that there is a paucity of clinical trials to guide recommendations for hand osteoarthritis, and the evidence for the majority of the recommendations was based on expert opinions. Also, even if a systematic review demonstrates some evidence for the efficacy of strength training exercises in hand OA, the evidence for any specific exercise is limited to expert opinions. A first set of recommendations for assessment and exercise in hand osteoarthritis has been developed. For many of the recommendations there is a paucity of research evidence. High-quality studies are therefore needed to establish a high level of evidence concerning functional assessment and the effect of hand exercises in hand osteoarthritis.

Guidelines for the Pharmacotherapy of Schizophrenia in Adults.

PubMed

Remington, Gary; Addington, Donald; Honer, William; Ismail, Zahinoor; Raedler, Thomas; Teehan, Michael

2017-09-01

The present guidelines address the pharmacotherapy of schizophrenia in adults across different stages, phases, and symptom domains. Guidelines were developed using the ADAPTE process, which takes advantage of existing guidelines. Six guidelines were identified for adaptation, with recommendations extracted from each. For those specific to the pharmacotherapy of schizophrenia in adults, a working group selected between guidelines and recommendations to create an adapted guideline. Recommendations can be categorized into 6 areas that include 1) first-episode schizophrenia, 2) acute exacerbation, 3) relapse prevention and maintenance treatment, 4) treatment-resistant schizophrenia, 5) clozapine-resistant schizophrenia, and 6) specific symptom domains. For each category, recommendations are made based on the available evidence, which is discussed and linked to other established guidelines. In most cases, evidence-based recommendations are made that can be used to guide current clinical treatment and decision making. Notably, however, there is a paucity of established evidence to guide treatment decision making in the case of clozapine-resistant schizophrenia, a subsample that represents a sizable proportion of those with schizophrenia.

76 FR 4121 - Advisory Committee on Interdisciplinary, Community-Based Linkages; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-24

... Education, Professional Development and Lifelong Learning for the 21st Century Health Care Workforce. The... with experts, and discussion sessions specific to the development of recommendations to be addressed in...

[Quality indicators for National Disease Management Guidelines using the example of the National Disease Management Guideline for "Chronic Heart Failure"].

PubMed

Nothacker, Monika Judith; Langer, Thomas; Weinbrenner, Susanne

2011-01-01

Together with an expert committee a structured approach to determining quality indicators for National Disease Management Guidelines has been developed. The key steps of this approach include: introducing guideline authors to the methodology at an early stage of the process of guideline development, pre-selecting recommendations of the guideline which are potentially measurable by means of quality indicators, assessing the potentially measurable quality indicators in written form using five criteria (including their importance for the health care system and clarity of definitions) and approving them in a formal consensus process. For lack of a database these quality indicators must be regarded as preliminary. For the National Disease Management Guideline "Chronic Heart Failure" nine rate-based indicators have been chosen. The indicators correspond to important strong recommendations (grade of recommendation: A) from the fields of diagnosis (two), general therapeutic strategy (two), specific treatment (three), clinical monitoring (one) and co-ordination of care (one). In a second step, the quality indicators have to be validated within a pilot project. The determination and assessment of the potential quality indicators have revealed room for improvement of guideline development. In particular, there is a need for more health care data and for specification of recommendations.

An appraisal of practice guidelines for smoking cessation in people with severe mental illness.

PubMed

Sharma, Ratika; Alla, Kristel; Pfeffer, Daniel; Meurk, Carla; Ford, Pauline; Kisely, Steve; Gartner, Coral

2017-11-01

To review the quality of current smoking cessation guidelines that include recommendations for people with severe mental illness. A systematic search of scientific databases, central government health authority websites, psychiatry peak bodies, guideline clearing houses and Google was undertaken for relevant smoking cessation guidelines. Three reviewers independently assessed guideline quality using the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) instrument. Two reviewers extracted recommendations specific to smokers with severe mental illness. Thirteen guidelines met the inclusion criteria. Seven guidelines scored ⩾60% in at least four domains. Median scores for 'Editorial independence', 'Rigour of development', 'Stakeholder Involvement' and 'Applicability' were less than 60%. The highest median scores were for 'Scope and purpose' (87%, 69-96%) and 'Clarity of presentation' (87%, 56-98%). 'Editorial independence' (33.3%, 0-86%) and 'Rigour of development' (54%, 11-92%) had the lowest median domain scores. The guidelines varied greatly in their recommendations but the majority recommended nicotine replacement therapy, bupropion or varenicline as first-line pharmacotherapy, along with behavioural support. Many guidelines did not adequately report their methods or the competing interests of the authors. Future guidelines development may benefit from more specifically addressing AGREE II criteria and the needs of smokers with severe mental illness.

The International Liver Transplantation Society Living Donor Liver Transplant Recipient Guideline

PubMed Central

Miller, Charles M.; Quintini, Cristiano; Dhawan, Anil; Durand, Francois; Heimbach, Julie K.; Kim-Schluger, Hyung Leona; Kyrana, Eirini; Lee, Sung-Gyu; Lerut, Jan; Lo, Chung-Mau; Pomfret, Elizabeth Anne

2017-01-01

Abstract Living donor liver transplantation (LDLT) has been increasingly embraced around the world as an important strategy to address the shortage of deceased donor livers. The aim of this guideline, approved by the International Liver Transplantation Society (ILTS), is to provide a collection of expert opinions, consensus, and best practices surrounding LDLT. Recommendations were developed from an analysis of the National Library of Medicine living donor transplantation indexed literature using the Grading of Recommendations Assessment, Development and Evaluation methodology. Writing was guided by the ILTS Policy on the Development and Use of Practice Guidelines (www.ilts.org). Intended for use by physicians, these recommendations support specific approaches to the diagnostic, therapeutic, and preventive aspects of care of living donor liver transplant recipients. PMID:28437386

Adult Attitudes Toward the Military: Poll Two

DTIC Science & Technology

2002-04-01

military service, specifically, and (2) develop research-based communications strategies and recommendations for each market . The Defense Manpower...military, their recommendations to youth regarding post-high school options, and research-based message strategies that would resonate with each market ...of Defense’s recruitment advertising and market research programs. • The Research Methodology section provides details on the design of the

IMIA Educational Recommendations and Nursing Informatics.

PubMed

Mantas, John; Hasman, Arie

2017-01-01

The updated version of the IMIA educational recommendations has given an adequate guidelines platform for developing educational programs in Biomedical and Health Informatics at all levels of education, vocational training, and distance learning. This chapter will provide a brief introduction of the recommendations pinpointing aspects for developing and assessing educational programs. We will provide a review of the existing feedback we have acquired during the IMIA site visits of accrediting educational programs at a worldwide level and discuss implementations issues. A brief overview of existing academic programs in Europe, North America and in other regions, especially for programs related to Nursing and to Nursing Informatics is provided. Finally, we will draw conclusions as how the IMIA recommendations may be required to be fitted into the specific needs of the Nursing Informatics and the needs of the Nursing professionals when they apply the recommendations to their academic and/or hospital/professional environments.

ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis.

PubMed

Jacobson, Jon A; Roberts, Catherine C; Bencardino, Jenny T; Appel, Marc; Arnold, Erin; Baccei, Steven J; Cassidy, R Carter; Chang, Eric Y; Fox, Michael G; Greenspan, Bennett S; Gyftopoulos, Soterios; Hochman, Mary G; Mintz, Douglas N; Newman, Joel S; Rosenberg, Zehava S; Shah, Nehal A; Small, Kirstin M; Weissman, Barbara N

2017-05-01

Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. This review first discusses the characteristic osseous and soft tissue abnormalities seen with inflammatory arthritis and how they may be imaged. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity as there is significant overlap of imaging findings among the various types of arthritis. This review provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

NASA software specification and evaluation system design, part 2

NASA Technical Reports Server (NTRS)

1976-01-01

A survey and analysis of the existing methods, tools and techniques employed in the development of software are presented along with recommendations for the construction of reliable software. Functional designs for software specification language, and the data base verifier are presented.

Presence and Accuracy of Drug Dosage Recommendations for Continuous Renal Replacement Therapy in Tertiary Drug Information References

PubMed Central

Gorman, Sean K; Slavik, Richard S; Lam, Stefanie

2012-01-01

Background: Clinicians commonly rely on tertiary drug information references to guide drug dosages for patients who are receiving continuous renal replacement therapy (CRRT). It is unknown whether the dosage recommendations in these frequently used references reflect the most current evidence. Objective: To determine the presence and accuracy of drug dosage recommendations for patients undergoing CRRT in 4 drug information references. Methods: Medications commonly prescribed during CRRT were identified from an institutional medication inventory database, and evidence-based dosage recommendations for this setting were developed from the primary and secondary literature. The American Hospital Formulary System—Drug Information (AHFS–DI), Micromedex 2.0 (specifically the DRUGDEX and Martindale databases), and the 5th edition of Drug Prescribing in Renal Failure (DPRF5) were assessed for the presence of drug dosage recommendations in the CRRT setting. The dosage recommendations in these tertiary references were compared with the recommendations derived from the primary and secondary literature to determine concordance. Results: Evidence-based drug dosage recommendations were developed for 33 medications administered in patients undergoing CRRT. The AHFS–DI provided no dosage recommendations specific to CRRT, whereas the DPRF5 provided recommendations for 27 (82%) of the medications and the Micromedex 2.0 application for 20 (61%) (13 [39%] in the DRUGDEX database and 16 [48%] in the Martindale database, with 9 medications covered by both). The dosage recommendations were in concordance with evidence-based recommendations for 12 (92%) of the 13 medications in the DRUGDEX database, 26 (96%) of the 27 in the DPRF5, and all 16 (100%) of those in the Martindale database. Conclusions: One prominent tertiary drug information resource provided no drug dosage recommendations for patients undergoing CRRT. However, 2 of the databases in an Internet-based medical information application and the latest edition of a renal specialty drug information resource provided recommendations for a majority of the medications investigated. Most dosage recommendations were similar to those derived from the primary and secondary literature. The most recent edition of the DPRF is the preferred source of information when prescribing dosage regimens for patients receiving CRRT. PMID:22783029

75 FR 33311 - Guidance for Industry on Bioequivalence Recommendations for Specific Products; Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-11

... available recommendations on how to design product- specific bioequivalence (BE) studies to support... meaningful opportunity for the public to consider and comment on product-specific BE study recommendations... available recommendations on how to design product-specific BE studies to support ANDAs. Under this process...

Factors influencing intentions to use social recommender systems: a social exchange perspective.

PubMed

Chang, Tsung-Sheng; Hsiao, Wei-Hung

2013-05-01

This study employs the perspective of social exchange theory and seeks to understand users' intentions to use social recommender systems (SRS) through three psychological factors: trust, shared values, and reputation. We use structural equation modeling to analyze 221 valid questionnaires. The results show that trust has a direct positive influence on the intention to use SRS, followed by shared values, whereas reputation has an indirect influence on SRS use. We further discuss specific recommendations concerning these factors for developing SRS.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

PubMed

Munns, Craig F; Shaw, Nick; Kiely, Mairead; Specker, Bonny L; Thacher, Tom D; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary; Högler, Wolfgang

2016-02-01

Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.

Best practice recommendations for the development, implementation, and evaluation of online knowledge translation resources in rehabilitation.

PubMed

Levac, Danielle; Glegg, Stephanie M N; Camden, Chantal; Rivard, Lisa M; Missiuna, Cheryl

2015-04-01

The knowledge-to-practice gap in rehabilitation has spurred knowledge translation (KT) initiatives aimed at promoting clinician behavior change and improving patient care. Online KT resources for physical therapists and other rehabilitation clinicians are appealing because of their potential to reach large numbers of individuals through self-paced, self-directed learning. This article proposes best practice recommendations for developing online KT resources that are designed to translate evidence into practice. Four recommendations are proposed with specific steps in the development, implementation, and evaluation process: (1) develop evidence-based, user-centered content; (2) tailor content to online format; (3) evaluate impact; and (4) share results and disseminate knowledge. Based on KT evidence and instructional design principles, concrete examples are provided along with insights gained from experiences in creating and evaluating online KT resources for physical therapists. In proposing these recommendations, the next steps for research are suggested, and others are invited to contribute to the discussion. © 2015 American Physical Therapy Association.

Consensus statement on the methodology of injury and illness surveillance in FINA (aquatic sports).

PubMed

Mountjoy, M; Junge, A; Alonso, J M; Clarsen, B; Pluim, B M; Shrier, I; van den Hoogenband, C; Marks, S; Gerrard, D; Heyns, P; Kaneoka, K; Dijkstra, H P; Khan, K M

2016-05-01

Injury and illness surveillance in the aquatic disciplines has been conducted during the FINA World Championships and Olympic Games. The development of an aquatic-specific injury and illness surveillance system will improve the quality of the data collected and the development of preventive measures. Our ultimate objective is to enhance aquatic athlete health and performance. The objective was to refine the injury and illness surveillance protocols to develop aquatic-specific definitions of injury and illness; define aquatic-specific injury location and causation; better describe overuse injuries; regard pre-existing and recurrent injuries; more accurately define aquatic athlete exposures and develop a protocol to capture out-of-competition aquatic athlete health parameters. FINA compiled an Injury and Illness Surveillance Expert Working Group comprised of international experts to review the scientific literature in the field. A consensus meeting was convened to provide an opportunity for debate, following which recommendations were collated. Aquatic-specific injury and illness surveillance protocols covering both the in-competition and out-of-competition time periods were developed. Definitions for all relevant variables were outlined, and documentation forms for athletes and for clinicians were proposed. Recommendations for the implementation of an injury and illness surveillance system for FINA are presented. The FINA consensus authors recommend ongoing in-competition and out-of-competition surveillance to determine injury and illness trends over time. The implementation of the definitions and methodology outlined in this paper will improve the accuracy and value of injury and illness surveillance, and provide important information for injury prevention. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Development of clinical recommendations for progressive return to activity after military mild traumatic brain injury: guidance for rehabilitation providers.

PubMed

McCulloch, Karen L; Goldman, Sarah; Lowe, Lynn; Radomski, Mary Vining; Reynolds, John; Shapiro, Rita; West, Therese A

2015-01-01

Previously published mild traumatic brain injury (mTBI) management guidelines provide very general recommendations to return individuals with mTBI to activity. This lack of specific guidance creates variation in military rehabilitation. The Office of the Army Surgeon General in collaboration with the Defense and Veterans Brain Injury Center, a component center of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, convened an expert working group to review the existing literature and propose clinical recommendations that standardize rehabilitation activity progression following mTBI. A Progressive Activity Working Group consisted of 11 Department of Defense representatives across all service branches, 7 Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury representatives, and 8 academic/research/civilian experts with experience assessing and treating individuals with mTBI for return to activity. An expert working group meeting included the Progressive Activity Working Group and 15 additional subject matter experts. In February 2012, the Progressive Activity Working Group was established to determine the need and purpose of the rehabilitation recommendations. Following literature review, a table was created on the basis of the progression from the Zurich consensus statement on concussion in sport. Issues were identified for discussion with a meeting of the larger expert group during a July 2012 conference. Following development of rehabilitation guidance, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury coordinated a similar process for military primary care providers. End products for rehabilitation and primary care providers include specific recommendations for return to activity after concussion. A 6-stage progression specifies activities in physical, cognitive, and balance/vestibular domains and allows for resumption of activity for those with low-level or preinjury symptom complaints. The clinical recommendations for progressive return to activity represent an important effort to standardize activity progression across functional domains and offer providers duty-specific activities to incorporate into intervention. Recommendations were released in January 2014.

An Analysis of Adolescent Content in South Africa's Contraception Policy Using a Human Rights Framework.

PubMed

Hoopes, Andrea J; Chandra-Mouli, Venkatraman; Steyn, Petrus; Shilubane, Tlangelani; Pleaner, Melanie

2015-12-01

To evaluate whether the updated South African national contraception policy and guidelines adequately address the needs of adolescents. We used the World Health Organization (WHO) guidance and recommendations on ensuring human rights in the provision of contraceptive information and services as an analytic framework. We assessed the South African policy in relation to each WHO summary recommendation. Specifically, we determined where normative guidance pertaining to adolescents is present and whether it is adequate, normative guidance pertaining to all populations but not specifically adolescents is present, or normative guidance for that recommendation is missing from the policy. We developed an analytic table to discuss with coauthors and draw conclusions. We found specific guidance for adolescents relating to 6/9 WHO summary recommendations and 11/24 subrecommendations. Adolescents are highlighted throughout the policy as being at risk for discrimination or coercion, and laws protecting the rights of adolescents are cited. Confidentiality of services for young people is emphasized, and youth-friendly services are described as a key element of service delivery. Areas to strengthen include the need for normative guidance ensuring both availability of contraceptive information and services for young people and adolescent participation in development of community programs and services. South Africa's contraception policy and guidelines are comprehensive and forward looking. Nevertheless, there are gaps that may leave adolescents vulnerable to discrimination and coercion and create barriers to accessing contraceptive services. These findings provide insight for the revision and development of adolescent health policies in South Africa and other settings. Copyright © 2015. Published by Elsevier Inc.

Consensus statement on a framework for the management of comorbidity and extra-articular manifestations in rheumatoid arthritis.

PubMed

Loza, Estíbaliz; Lajas, Cristina; Andreu, Jose Luis; Balsa, Alejandro; González-Álvaro, Isidoro; Illera, Oscar; Jover, Juan Ángel; Mateo, Isabel; Orte, Javier; Rivera, Javier; Rodríguez Heredia, José Manuel; Romero, Fredeswinda; Martínez-López, Juan Antonio; Ortiz, Ana María; Toledano, Esther; Villaverde, Virginia; Carmona, Loreto; Castañeda, Santos

2015-03-01

The objective of the study was to develop evidence-based and practical recommendations for the detection and management of comorbidity in patients with rheumatoid arthritis (RA) in daily practice. We used a modified RAND/UCLA methodology and systematic review (SR). The process map and specific recommendations, based on the SR, were established in discussion groups. A two round Delphi survey permitted (1) to prioritize the recommendations, (2) to refine them, and (3) to evaluate their agreement by a large group of users. The recommendations cover: (1) which comorbidities should be investigated in clinical practice at the first and following visits (including treatments, risk factors and patient's features that might interfere with RA management); (2) how and when should comorbidities and risk factors be investigated; (3) how to manage specific comorbidities, related or non-related to RA, including major adverse events of RA treatment, and to promote health (general and musculoskeletal health); and (4) specific recommendations to assure an integral care approach for RA patients with any comorbidity, such as health care models for chronic inflammatory patients, early arthritis units, relationships with primary care, specialized nursing care, and self-management. These recommendations are intended to guide rheumatologists, patients, and other stakeholders, on the early diagnosis and management of comorbidity in RA, in order to improve disease outcomes.

How to Develop a Better Guidance Program.

ERIC Educational Resources Information Center

Lawrence, William W.

Designed for school board members, superintendents, administrators, counselors, and teachers, the paper outlines steps toward the systematic development of a guidance program. Following a rationale and introduction, the paper recommends a specific process for program development: (1) the identification of student needs through formal needs…

Somalia's Reconstruction: An Opportunity to Create a Responsive Information Infrastructure.

ERIC Educational Resources Information Center

Abdulla, Ali D.

1996-01-01

Argues that the development of an effective information infrastructure would contribute to Somalia's economic and social renewal. Outlines the attributes of such an infrastructure and makes specific recommendations to future Somali development planners and international donors supporting information development activities. (Author/PEN)

Raptor: An Enterprise Knowledge Discovery Engine Version 2.0

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

2011-08-31

The Raptor Version 2.0 computer code uses a set of documents as seed documents to recommend documents of interest from a large, target set of documents. The computer code provides results that show the recommended documents with the highest similarity to the seed documents. Version 2.0 was specifically developed to work with SharePoint 2007 and MS SQL server.

A Strategic Plan for Promoting and Expanding Apprenticeship in the U.S. (Phase II). Recommendations of the Federal Committee on Apprenticeship.

ERIC Educational Resources Information Center

Employment and Training Administration (DOL), Washington, DC. Office of Work-Based Learning.

In preparing Phase I of the Strategic Plan, the Federal Committee on Apprenticeship noted that efforts beyond education and technical assistance may be needed to develop apprenticeship fully in the United States. Specifically, the committee would examine and make recommendations with respect to such issues as incentives for participation,…

Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology.

PubMed

Nguyen, Geoffrey C; Bernstein, Charles N; Bitton, Alain; Chan, Anthony K; Griffiths, Anne M; Leontiadis, Grigorios I; Geerts, William; Bressler, Brian; Butzner, J Decker; Carrier, Marc; Chande, Nilesh; Marshall, John K; Williams, Chadwick; Kearon, Clive

2014-03-01

Guidelines for the management of venous thromboembolism (VTE) from the American College of Chest Physicians do not address patients with inflammatory bowel disease (IBD), a group with a high risk of both VTE and gastrointestinal bleeding. We present recommendations for the prevention and treatment of VTE in patients with IBD. A systematic literature search was performed to identify studies on VTE in IBD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Statements were developed through an iterative online platform, then finalized and voted on by a working group of adult and pediatric gastroenterologists and thrombosis specialists. IBD patients have an approximately 3-fold higher risk of VTE compared with individuals without IBD, and disease flares further increase this risk. Anticoagulant thromboprophylaxis is recommended for IBD patients who are hospitalized with IBD flares without active bleeding and is suggested when bleeding is nonsevere. Anticoagulant thromboprophylaxis is suggested during moderate-severe IBD flares in outpatients with a history of VTE provoked by an IBD flare or an unprovoked VTE, but not otherwise. The recommended duration of anticoagulation after a first VTE is based on the presence of provoking factors. Specific suggestions are made for the prevention and treatment of VTE in pediatric and pregnant IBD patients. Using the American College of Chest Physicians' guidelines as a foundation, we have integrated evidence from IBD studies to develop specific recommendations for the management of VTE in this high-risk population. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

ACOEM practice guidelines: elbow disorders.

PubMed

Hegmann, Kurt T; Hoffman, Harold E; Belcourt, Roger M; Byrne, Kevin; Glass, Lee; Melhorn, J Mark; Richman, Jack; Zinni, Phillip; Thiese, Matthew S; Ott, Ulrike; Tokita, Kylee; Passey, Deborah Gwenevere; Effiong, Atim Cecelia; Robbins, Riann Bree; Ording, Julie A

2013-11-01

The American College of Occupational and Environmental Medicine has updated the treatment guidelines in its Elbow Disorders chapter through revision processes begun in 2006. This abbreviated version of that chapter highlights some of the evidence and recommendations developed. Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 108 high- or moderate-quality trials were identified for elbow disorders. Guidance has been developed for 13 major diagnoses and includes 270 specific recommendations. Quality evidence is now available to guide treatment for elbow disorders, particularly for lateral epicondylalgia.

Racial/Ethnic Minority-Specific Instrumentation in Counseling Research: A Review, Critique, and Recommendations.

ERIC Educational Resources Information Center

Sabnani, Haresh B.; Ponterotto, Joseph G.

1992-01-01

Reviews eight instruments specifically conceptualized and developed for use in racial/ethnic minority-focused psychological research: Cultural Mistrust Inventory, African Self-Consciousness Scale, Cross-Cultural Counseling Inventory-Revised, Modern Racism Scale, Value Orientation Scale, Acculturation Rating Scale for Mexican Americans, Racial…

Exercise recommendations for childhood cancer survivors exposed to cardiotoxic therapies: an institutional clinical practice initiative.

PubMed

Okada, Maki; Meeske, Kathleen A; Menteer, Jondavid; Freyer, David R

2012-01-01

Childhood cancer survivors who have received treatment with anthracyclines are at risk for developing cardiomyopathy in dose-dependent fashion. Historically, restrictions on certain types of physical activity that were intended to preserve cardiac function have been recommended, based on a mixture of evidence-based and consensus-based recommendations. In the LIFE Cancer Survivorship & Transition Program at Children's Hospital Los Angeles, the authors reevaluated their recommendations for exercise in survivors who were exposed to anthracyclines, with or without irradiation in proximity to the myocardium. The primary goal was to develop consistent, specific, practical, safe, and (where possible) evidence-based recommendations for at-risk survivors in the program. To accomplish this, the authors referred to current exercise guidelines for childhood cancer survivors, consulted recent literature for relevant populations, and obtained input from the program's pediatric cardiology consultant. The resulting risk-based exercise recommendations are designed to complement current published guidelines, maximize safe exercise, and help childhood cancer survivors return to a normal life that emphasizes overall wellness and physical activity. This article describes a single institution's experience in modifying exercise recommendations for at-risk childhood survivors and includes the methods, findings, and current institutional practice recommendations along with sample education materials.

Workshop to review problem-behavior research programs : pedestrian, bicycle, and pupil transportation safety

DOT National Transportation Integrated Search

1981-09-01

This report presents the proceedings of a workshop on pedestrian, bicycle, and pupil transportation safety. The purpose of this workshop was to develop specific recommendations for the planning and implementation of NHTSA research, development, and d...

Development of traffic data input resources for the mechanistic empirical pavement design process.

DOT National Transportation Integrated Search

2011-12-12

The Mechanistic-Empirical Pavement Design Guide (MEPDG) for New and Rehabilitated Pavement Structures uses : nationally based data traffic inputs and recommends that state DOTs develop their own site-specific and regional : values. To support the MEP...

Training of Trainers.

ERIC Educational Resources Information Center

Gormley, Wilma J.; Austin, John H.

1985-01-01

Discusses specific training methods and common characteristics of participants in workshops sponsored by Agency for International Development Water and Sanitation for Health Project for extension agents, who will act as trainers in transfer of sanitation technology in developing nations. Recommendations for conducting such workshops in…

Workshop to review problem-behavior research programs : alcohol, drugs, and highway safety

DOT National Transportation Integrated Search

1981-05-01

The report presents the proceedings of a workshop on alcohol, drugs, and highway safety. The purpose of this workshop was to develop specific recommendations for the planning and implementation of NHTSA research, development, and demonstration projec...

Proposing application of results in sport and exercise research reports.

PubMed

Knudson, Duane; Elliott, Bruce; Hamill, Joseph

2014-09-01

The application of sport and exercise research findings to practice requires careful interpretation and integration of evidence. This paper reviews principles of evidence-based practice and the application of research in sports and exercise, in order to provide recommendations on developing appropriate application sections in research reports for sport and exercise journals. The strength of recommendations for application fall into one of four levels, with potential applications qualified as strong, limited, preliminary, or hypothesized. Specific limitations that should be discussed in framing recommendations for practice are also noted for each of these levels that should be useful for authors, and for practitioners and clinicians in interpreting these recommendations.

The Development of Mobile Application to Introduce Historical Monuments in Manado

NASA Astrophysics Data System (ADS)

Rupilu, Moshe Markhasi; Suyoto; Santoso, Albertus Joko

2018-02-01

Learning the historical value of a monument is important because it preserves cultural and historical values, as well as expanding our personal insight. In Indonesia, particularly in Manado, North Sulawesi, there are many monuments. The monuments are erected for history, religion, culture and past war, however these aren't written in detail in the monuments. To get information on specific monument, manual search was required, i.e. asking related people or sources. Based on the problem, the development of an application which can utilize LBS (Location Based Service) method and some algorithmic methods specifically designed for mobile devices such as Smartphone, was required so that information on every monument in Manado can be displayed in detail using GPS coordinate. The application was developed by KNN method with K-means algorithm and collaborative filtering to recommend monument information to tourist. Tourists will get recommended options filtered by distance. Then, this method was also used to look for the closest monument from user. KNN algorithm determines the closest location by making comparisons according to calculation of longitude and latitude of several monuments tourist wants to visit. With this application, tourists who want to know and find information on monuments in Manado can do them easily and quickly because monument information is recommended directly to user without having to make selection. Moreover, tourist can see recommended monument information and search several monuments in Manado in real time.

Guidelines for the Pharmacotherapy of Schizophrenia in Adults

PubMed Central

Addington, Donald; Honer, William; Ismail, Zahinoor; Raedler, Thomas; Teehan, Michael

2017-01-01

Objective: The present guidelines address the pharmacotherapy of schizophrenia in adults across different stages, phases, and symptom domains. Method: Guidelines were developed using the ADAPTE process, which takes advantage of existing guidelines. Six guidelines were identified for adaptation, with recommendations extracted from each. For those specific to the pharmacotherapy of schizophrenia in adults, a working group selected between guidelines and recommendations to create an adapted guideline. Results: Recommendations can be categorized into 6 areas that include 1) first-episode schizophrenia, 2) acute exacerbation, 3) relapse prevention and maintenance treatment, 4) treatment-resistant schizophrenia, 5) clozapine-resistant schizophrenia, and 6) specific symptom domains. For each category, recommendations are made based on the available evidence, which is discussed and linked to other established guidelines. Conclusions: In most cases, evidence-based recommendations are made that can be used to guide current clinical treatment and decision making. Notably, however, there is a paucity of established evidence to guide treatment decision making in the case of clozapine-resistant schizophrenia, a subsample that represents a sizable proportion of those with schizophrenia. PMID:28703015

[Dual Antiplatelet Therapy in the Perioperative Period - To Continue or Discontinue Treatment?

PubMed

Koscielny, Jürgen; von Heymann, Christian; Zeymer, Uwe; Cremer, Jochen; Spannagl, Michael; Labenz, Joachim; Giannitsis, Evangelos; Goss, Franz

2017-08-01

Background  For secondary prevention of acute coronary syndrome, guidelines recommend dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 receptor antagonist such as clopidogrel, prasugrel or ticagrelor for a period of 12 months. Often, uncertainty exists with respect to surgical or diagnostic procedures in these high-risk patients: can the DAPT be continued without interruption? If not, what is the recommended withdrawal strategy? What should be considered for the perioperative management? Methods  An interdisciplinary group of experienced experts in the fields of cardiology, cardiac surgery, gastroenterology, anaesthesiology, intensive care and haemostaseology developed recommendations relevant to daily clinical practice based on the current scientific evidence. Results  These recommendations include instructions for evaluating the patient- and procedure-specific risks of bleeding and ischaemia, general recommendations regarding the DAPT withdrawal strategy, and specific guidance for frequent surgical or diagnostic procedures. Discussion  This article aims to facilitate the management of patients with DAPT for all medical disciplines involved, thereby ensuring optimal care of patients during the perioperative period. © Georg Thieme Verlag KG Stuttgart · New York.

Test Specifications and Blueprints: Reality and Expectations

ERIC Educational Resources Information Center

AlFallay, Ibrahim S.

2018-01-01

This study investigates to what extend do teachers of English as a school subject (ESS) in Saudi schools follow recommendations and guidelines suggested by language testing specialists in developing tables of specifications and preparing blueprints to their formative and summative language tests. To answer the study questions, a thirteen-statement…

Recommended practice for accepting new concrete pavement surfaces for tire/pavement noise : designation CPSCP PP 1-11 (rev 3/1/2011).

DOT National Transportation Integrated Search

2011-03-01

This practice provides guidance and example specification language intended for use by Owner- : Agencies in development of specific contract language when requiring the evaluation of : tire/pavement noise for new concrete pavement surfaces. The overa...

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

PubMed

Munns, Craig F; Shaw, Nick; Kiely, Mairead; Specker, Bonny L; Thacher, Tom D; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary; Högler, Wolfgang

2016-01-01

Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. © 2016 S. Karger AG, Basel and The Endocrine Society.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

PubMed Central

Munns, Craig F.; Shaw, Nick; Kiely, Mairead; Specker, Bonny L.; Thacher, Tom D.; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M. Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A.; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M.; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary

2016-01-01

Background: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. Evidence: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Process: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. Results: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Conclusion: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required. PMID:26745253

European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe.

PubMed

Jobst, A; Brakemeier, E-L; Buchheim, A; Caspar, F; Cuijpers, P; Ebmeier, K P; Falkai, P; Jan van der Gaag, R; Gaebel, W; Herpertz, S; Kurimay, T; Sabaß, L; Schnell, K; Schramm, E; Torrent, C; Wasserman, D; Wiersma, J; Padberg, F

2016-03-01

Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

USING FORMATIVE RESEARCH TO DEVELOP A CONTEXT-SPECIFIC APPROACH TO INFORMED CONSENT FOR CLINICAL TRIALS

PubMed Central

Corneli, Amy L.; Bentley, Margaret E.; Sorenson, James R.; Henderson, Gail E.; van der Horst, Charles; Moses, Agnes; Nkhoma, Jacqueline; Tenthani, Lyson; Ahmed, Yusuf; Heilig, Charles M.; Jamieson, Denise J.

2009-01-01

Participant understanding is of particular concern when obtaining informed consent. Recommendations for improving understanding include disclosing information using culturally appropriate and innovative approaches. To increase the effectiveness of the consent process for a clinical trial in Malawi on interventions to prevent mother-to-child transmission of HIV during breastfeeding, formative research was conducted to explore the community’s understanding of medical research as well as how to explain research through local terms and meanings. Contextual analogies and other approaches were identified to explain consent information. Guided by theory, strategies for developing culturally appropriate interventions, and recommendations from the literature, we demonstrate how the formative data were used to develop culturally appropriate counseling cards specifically for the trial in Malawi. With appropriate contextual modifications, the steps outlined here could be applied in other clinical trials conducted elsewhere, as well as in other types of research. PMID:19385837

White Paper: Recommendations on the Conduct of Superiority and Organism-Specific Clinical Trials of Antibacterial Agents for the Treatment of Infections Caused by Drug-Resistant Bacterial Pathogens

PubMed Central

2012-01-01

There is a critical need for new pathways to develop antibacterial agents to treat life-threatening infections caused by highly resistant bacteria. Traditionally, antibacterial agents have been studied in noninferiority clinical trials that focus on one site of infection (eg, pneumonia, intra-abdominal infection). Conduct of superiority trials for infections caused by highly antibiotic-resistant bacteria represents a new, and as yet, untested paradigm for antibacterial drug development. We sought to define feasible trial designs of antibacterial agents that could enable conduct of superiority and organism-specific clinical trials. These recommendations are the results of several years of active dialogue among the white paper's drafters as well as external collaborators and regulatory officials. Our goal is to facilitate conduct of new types of antibacterial clinical trials to enable development and ultimately approval of critically needed new antibacterial agents. PMID:22891041

Reducing Health Inequities in the United States: Insights and Recommendations from the National Heart, Lung, and Blood Institute’s Health Inequities Think Tank Meeting

PubMed Central

Sampson, Uchechukwu K.A.; Kaplan, Robert M.; Cooper, Richard S.; Diez Roux, Ana V.; Marks, James S.; Engelgau, Michael M.; Peprah, Emmanuel; Mishoe, Helena; Boulware, L. Ebony; Felix, Kaytura L.; Califf, Robert M.; Flack, John M.; Cooper, Lisa A.; Gracia, J. Nadine; Henderson, Jeffrey A.; Davidson, Karina W.; Krishnan, Jerry A.; Lewis, Tené T.; Sanchez, Eduardo; Luban, Naomi L.; Vaccarino, Viola; Wong, Winston F.; Wright, Jackson T.; Meyers, David; Ogedegbe, Olugbenga G.; Presley-Cantrell, Letitia; Chambers, David A.; Belis, Deshirée; Bennett, Glen C.; Boyington, Josephine E; Creazzo, Tony L.; de Jesus, Janet M.; Krishnamurti, Chitra; Lowden, Mia R.; Punturieri, Antonello; Shero, Susan T.; Young, Neal S.; Zou, Shimian; Mensah, George A.

2016-01-01

The National, Heart, Lung, and Blood Institute convened a Think Tank meeting to obtain insight and recommendations regarding the objectives and design of the next generation of research aimed at reducing health inequities in the United States. The panel recommended several specific actions, including: 1) Embrace broad and inclusive research themes; 2) Develop research platforms that optimize the ability to conduct informative and innovative research, and promote systems science approaches; 3) Develop networks of collaborators and stakeholders, and launch transformative studies that can serve as benchmarks; 4) Optimize the use of new data sources, platforms, and natural experiments; and 5) develop unique transdisciplinary training programs to build research capacity. Confronting health inequities will require engaging multiple disciplines and sectors (including communities), using systems science, and intervening through combinations of individual, family, provider, health system, and community-targeted approaches. Details of the panel’s remarks and recommendations are provided in this report. PMID:27470459

Surveillance Recommendations for Children with Overgrowth Syndromes and Predisposition to Wilms Tumors and Hepatoblastoma.

PubMed

Kalish, Jennifer M; Doros, Leslie; Helman, Lee J; Hennekam, Raoul C; Kuiper, Roland P; Maas, Saskia M; Maher, Eamonn R; Nichols, Kim E; Plon, Sharon E; Porter, Christopher C; Rednam, Surya; Schultz, Kris Ann P; States, Lisa J; Tomlinson, Gail E; Zelley, Kristin; Druley, Todd E

2017-07-01

A number of genetic syndromes have been linked to increased risk for Wilms tumor (WT), hepatoblastoma (HB), and other embryonal tumors. Here, we outline these rare syndromes with at least a 1% risk to develop these tumors and recommend uniform tumor screening recommendations for North America. Specifically, for syndromes with increased risk for WT, we recommend renal ultrasounds every 3 months from birth (or the time of diagnosis) through the seventh birthday. For HB, we recommend screening with full abdominal ultrasound and alpha-fetoprotein serum measurements every 3 months from birth (or the time of diagnosis) through the fourth birthday. We recommend that when possible, these patients be evaluated and monitored by cancer predisposition specialists. At this time, these recommendations are not based on the differential risk between different genetic or epigenetic causes for each syndrome, which some European centers have implemented. This differentiated approach largely represents distinct practice environments between the United States and Europe, and these guidelines are designed to be a broad framework within which physicians and families can work together to implement specific screening. Further study is expected to lead to modifications of these recommendations. Clin Cancer Res; 23(13); e115-e22. ©2017 AACR See all articles in the online-only CCR Pediatric Oncology Series . ©2017 American Association for Cancer Research.

Multimodal hybrid reasoning methodology for personalized wellbeing services.

PubMed

Ali, Rahman; Afzal, Muhammad; Hussain, Maqbool; Ali, Maqbool; Siddiqi, Muhammad Hameed; Lee, Sungyoung; Ho Kang, Byeong

2016-02-01

A wellness system provides wellbeing recommendations to support experts in promoting a healthier lifestyle and inducing individuals to adopt healthy habits. Adopting physical activity effectively promotes a healthier lifestyle. A physical activity recommendation system assists users to adopt daily routines to form a best practice of life by involving themselves in healthy physical activities. Traditional physical activity recommendation systems focus on general recommendations applicable to a community of users rather than specific individuals. These recommendations are general in nature and are fit for the community at a certain level, but they are not relevant to every individual based on specific requirements and personal interests. To cover this aspect, we propose a multimodal hybrid reasoning methodology (HRM) that generates personalized physical activity recommendations according to the user׳s specific needs and personal interests. The methodology integrates the rule-based reasoning (RBR), case-based reasoning (CBR), and preference-based reasoning (PBR) approaches in a linear combination that enables personalization of recommendations. RBR uses explicit knowledge rules from physical activity guidelines, CBR uses implicit knowledge from experts׳ past experiences, and PBR uses users׳ personal interests and preferences. To validate the methodology, a weight management scenario is considered and experimented with. The RBR part of the methodology generates goal, weight status, and plan recommendations, the CBR part suggests the top three relevant physical activities for executing the recommended plan, and the PBR part filters out irrelevant recommendations from the suggested ones using the user׳s personal preferences and interests. To evaluate the methodology, a baseline-RBR system is developed, which is improved first using ranged rules and ultimately using a hybrid-CBR. A comparison of the results of these systems shows that hybrid-CBR outperforms the modified-RBR and baseline-RBR systems. Hybrid-CBR yields a 0.94% recall, a 0.97% precision, a 0.95% f-score, and low Type I and Type II errors. Copyright © 2015 Elsevier Ltd. All rights reserved.

Current assessment of the effects of environmental chemicals on the mammary gland in guideline rodent studies by the U.S. Environmental Protection Agency (U.S. EPA), Organisation for Economic Co-operation and Development (OECD), and National Toxicology Program (NTP).

PubMed

Makris, Susan L

2011-08-01

Evaluation of the structural and/or functional integrity of the mammary gland (MG) across life stages is integral to the assessment of developmental, reproductive, and carcinogenic risk for environmental chemicals. In this commentary I characterize MG assessment recommended in U.S. Environmental Protection Agency, Organisation for Economic Co-operation and Development, and National Toxicology Program guideline toxicology study protocols and identify any information gaps for the evaluation of MG development, structure, and function. Several data gaps, issues, and challenges were identified. Current guidelines that include a lactation phase do not provide specific recommendations to record observations on maternal or offspring lactation or nursing behavior. In guideline studies, the assessment of MG toxicity often relies upon indirect, nonspecific, or surrogate end points, and information that could be useful in the interpretation of these data (e.g., mode of action or toxicokinetics) is often unavailable. Most guideline studies designed to assess general organ toxicity do not expose test animals during sensitive stages of MG development; histopathological evaluation of the developing MG is not routinely conducted; and evaluation of MG tissue for both sexes is inconsistently recommended. I propose the following general recommendations to enhance MG assessment in guideline toxicology studies: a) inclusion of more specific criteria for the evaluation of MG end points in guideline language, b) inclusion of histopathological evaluation of MG development (using whole-mount techniques) in existing or new guideline protocols that include offspring with perinatal and/or pubertal treatment, c) incorporation of perinatal exposures into rodent subchronic and carcinogenicity assays, and d) expansion of the histopathological evaluation of male MG tissue.

Current Assessment of the Effects of Environmental Chemicals on the Mammary Gland in Guideline Rodent Studies by the U.S. Environmental Protection Agency (U.S. EPA), Organisation for Economic Co-operation and Development (OECD), and National Toxicology Program (NTP)

PubMed Central

2010-01-01

Background: Evaluation of the structural and/or functional integrity of the mammary gland (MG) across life stages is integral to the assessment of developmental, reproductive, and carcinogenic risk for environmental chemicals. Objectives: In this commentary I characterize MG assessment recommended in U.S. Environmental Protection Agency, Organisation for Economic Co-operation and Development, and National Toxicology Program guideline toxicology study protocols and identify any information gaps for the evaluation of MG development, structure, and function. Discussion: Several data gaps, issues, and challenges were identified. Current guidelines that include a lactation phase do not provide specific recommendations to record observations on maternal or offspring lactation or nursing behavior. In guideline studies, the assessment of MG toxicity often relies upon indirect, nonspecific, or surrogate end points, and information that could be useful in the interpretation of these data (e.g., mode of action or toxicokinetics) is often unavailable. Most guideline studies designed to assess general organ toxicity do not expose test animals during sensitive stages of MG development; histopathological evaluation of the developing MG is not routinely conducted; and evaluation of MG tissue for both sexes is inconsistently recommended. Conclusions: I propose the following general recommendations to enhance MG assessment in guideline toxicology studies: a) inclusion of more specific criteria for the evaluation of MG end points in guideline language, b) inclusion of histopathological evaluation of MG development (using whole-mount techniques) in existing or new guideline protocols that include offspring with perinatal and/or pubertal treatment, c) incorporation of perinatal exposures into rodent subchronic and carcinogenicity assays, and d) expansion of the histopathological evaluation of male MG tissue. PMID:21118785

Development of emergency department load relief area--gauging benefits in empirical terms.

PubMed

Rasheed, Farrukh; Lee, Young Hoon; Kim, Seung Ho; Park, In Cheol

2012-12-01

The primary goal of this investigation was to develop a simulation model to evaluate the various internal and external factors affecting patient flow and crowding in the emergency department (ED). In addition, a few recommendations are proposed to reconfigure the patient flow to improve ED capacity while maintaining service quality. In this research, we present a simulation study conducted in the ED at the "S Hospital" located in Seoul. Based on patient flow data and process analysis, a simulation model of patient throughput in the ED has been developed. We evaluated simulations of diverting the specific patient load in the light of our proposed recommendations to a separately managed area named as the ED load relief area (ED-LRA) and analyzing potential effects on overall length of stay (LOS) and waiting time (WT). What-if analyses have been proposed to identify key issues and investigate the improvements as per our proposed recommendations. The simulation results suggest that specific patient load diversion is needed to ensure desired outcomes. With the diversion of specific patient load to ED-LRA, there is a reduction of 40.60% in mean LOS and 42.5% in WT with improved resource utilization. As a result, opening of an ED-LRA is justified. Real-world systems are often too intricate for analytical models and often too expensive to trial with directly. Simulation models allow the modeling of this intricacy and enable experimentation to make inferences about how the actual system might perform. Our simulation study modeled that diverting the specific patient load to ED-LRA produced an improvement in overall ED's LOS and WT.

Test techniques for evaluating flight displays

NASA Technical Reports Server (NTRS)

Haworth, Loran A.; Newman, Richard L.

1993-01-01

The rapid development of graphics technology allows for greater flexibility in aircraft displays, but display evaluation techniques have not kept pace. Historically, display evaluation has been based on subjective opinion and not on the actual aircraft/pilot performance. Existing electronic display specifications and evaluation techniques are reviewed. A display rating technique analogous to handling qualities ratings was developed and is recommended for future evaluations. The choice of evaluation pilots is also discussed and the use of a limited number of trained evaluators is recommended over the use of a large number of operational pilots.

Production of Reliable Flight Crucial Software: Validation Methods Research for Fault Tolerant Avionics and Control Systems Sub-Working Group Meeting

NASA Technical Reports Server (NTRS)

Dunham, J. R. (Editor); Knight, J. C. (Editor)

1982-01-01

The state of the art in the production of crucial software for flight control applications was addressed. The association between reliability metrics and software is considered. Thirteen software development projects are discussed. A short term need for research in the areas of tool development and software fault tolerance was indicated. For the long term, research in format verification or proof methods was recommended. Formal specification and software reliability modeling, were recommended as topics for both short and long term research.

Quality assessment of osteoporosis clinical practice guidelines for physical activity and safe movement: an AGREE II appraisal.

PubMed

Armstrong, James Jacob; Rodrigues, Isabel Braganca; Wasiuta, Tom; MacDermid, Joy C

2016-01-01

Many osteoporosis clinical practice guidelines are published, and the extent to which physical activity and safe movement is addressed varies. To better inform clinical decision-making, a quality assessment and structured analysis of recommendations was undertaken. Guideline quality varied substantially, and improvement is necessary in physical activity and safe movement recommendations. The purpose of the present study is to survey available osteoporosis clinical practice guidelines (CPGs) containing physical activity and safe movement recommendations in order to assess the methodological quality with which they were developed. An analysis of the various physical activity and safe movement recommendations was conducted to determine variability between CPGs. An online literature search revealed 19 CPGs meeting our inclusion criteria. Three independent scorers evaluated CPG quality using the Appraisal of Guidelines for Research and Evaluation version II (AGREE II) instrument. Two separate individuals used a standard table to extract relevant recommendations. Intra-reviewer AGREE II score agreement ranged from fair to good (intra-class correlation coefficient (ICC) = 0.34 to 0.65). The quality of the 19 included CPGs was variable (AGREE sub-scores: 14 to 100%). CPGs scored higher in the "scope and purpose" and "clarity of presentation" domains. They scored the lowest in "applicability" and "editorial independence." Four CPGs were classified as high quality, ten average quality, and five low quality. Most CPGs recommended weight-bearing, muscle-strengthening, and resistance exercises. Information on exercise dosage, progression, and contraindications was often absent. Immobility and movements involving spinal flexion and/or torsion were discouraged. There were several high-quality CPGs; however, variability in quality and lack of specific parameters for implementation necessitates caution and critical examination by readers. CPG development groups should pay special attention to the clinical applicability of their CPGs as well as fully disclosing conflicts of interest. CPGs were in general an agreement regarding safe physical activity and safe movement recommendations. However, recommendations were often vague and the more specific recommendations were inconsistent between CPGs.

The Canadian Rheumatology Association/ Spondyloarthritis Research Consortium of Canada treatment recommendations for the management of spondyloarthritis: a national multidisciplinary stakeholder project.

PubMed

Maksymowych, Walter P; Gladman, Dafna; Rahman, Proton; Boonen, Annelies; Bykerk, Vivien; Choquette, Denis; Dimond, Sherry; Fortin, Paul; Karsh, Jacob; Klinkhoff, Alice V; Mosher, Dianne; Mulholland, Ken; Olszynski, Wojciech P; Russell, Anthony S; Savage, Laurie; Shanner, Laura; Shojania, Kam; Starr, Michael; Thomson, Glen; Zummer, Michel; Inman, Robert

2007-11-01

Development of treatment recommendations for arthritis has traditionally relied on the compilation of evidence-based data by experts in the field despite recommendations by various bodies for broad stakeholder input. Our objectives were: (1) To develop evidence-based treatment recommendations for the management of spondyloarthritis (SpA) in Canada that also incorporate the perspective of multiple stakeholders. (2) To generate a procedural template for the multidisciplinary development of treatment recommendations. The process was directed by a steering committee comprising the SPARCC Executive, rheumatologists from academic and community-based practice, patient consumers, and a representative from the John Dossetor Health Ethics Centre. Guidelines established by EULAR and stipulated in the AGREE instrument were followed. First, a working document was drafted that included a referenced summary of the evidence-based data and the 12 national arthritis care standards developed by the Alliance for the Canadian Arthritis Program. Second, a Web-based survey was conducted among patient consumers to address the relevance to patients of 2 primary outcome instruments that assess the effectiveness of treatment. Third, a list of questions was generated for drafting propositions by the ethics consultant. A Delphi consensus exercise was then conducted. Consensus was generated on a final list of 38 treatment recommendations categorized under the subject headings of general management principles, ethical considerations, target groups, definition of target disease, disease monitoring, and specific management recommendations. Using broad stakeholder input, we provide treatment recommendations to guide clinical practice and access to care for patients with SpA in Canada.

Current Perspectives on Physical Activity and Exercise Recommendations for Children and Adolescents With Autism Spectrum Disorders

PubMed Central

Srinivasan, Sudha M.; Pescatello, Linda S.

2014-01-01

Recent evidence suggests that childhood obesity is increasing in children who are developing typically as well as in children with developmental disabilities such as autism spectrum disorders (ASDs). Impairments specific to autism as well as general environmental factors could lead to an imbalance between the intake and expenditure of energy, leading to obesity. In this article, we describe the mechanisms by which autism-specific impairments contribute to obesity. The evidence on exercise interventions to improve physical fitness, address obesity, and reduce autism-specific impairments in children and adolescents with ASDs is discussed. Limited evidence is currently available for exercise interventions in individuals with ASDs. Therefore, literature on other pediatric developmental disabilities and children who are developing typically was reviewed to provide recommendations for clinicians to assess physical activity levels, to promote physical fitness, and to reduce obesity in children and adolescents with ASDs. There is a clear need for further systematic research to develop sensitive assessment tools and holistic multisystem and multifactorial obesity interventions that accommodate the social communication, motor, and behavioral impairments of individuals with ASDs. PMID:24525861

[National Disease Management Guideline for Asthma: recommendations and evidence for "asthma prevention" issues].

PubMed

Berdel, Dietrich; Buhl, Roland; Dierkesmann, Rainer; Niebling, Wilhelm; Schultz, Konrad; Ukena, Dieter; Worth, Heinrich; von Wichert, Peter; Ollenschläger, Günter; Kopp, Ina

2006-01-01

The National Disease Management Program (NDM Program) represents the basic content of structured, cross-sectoral healthcare. In particular, the NDM Program is directed towards coordinating different disciplines and areas of healthcare. The recommendations are developed through interdisciplinary consensus of the scientific medical societies on the basis of the best available evidence. Within this scope the scientific medical societies concerned with the prevention, diagnosis, therapy and rehabilitation of asthma consented upon a National Disease Management Guideline for Asthma in 2005. Among other things, the following cornerstones of asthma prevention were agreed upon: Breastfeeding and non-smoking were suggested as primary prevention measures for (expectant) parents. With respect to secondary prevention, recommendations have been made for allergen avoidance, active/passive smoking and immunotherapy. Regarding tertiary prevention, position statements on vaccination and specific immunotherapy are developed. The present paper presents both the original texts of the recommendations and the evidence underlying them.

[Algorithms for early mobilization in intensive care units].

PubMed

Nydahl, P; Dubb, R; Filipovic, S; Hermes, C; Jüttner, F; Kaltwasser, A; Klarmann, S; Mende, H; Nessizius, S; Rottensteiner, C

2017-03-01

Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters.

Adaptive Signal Processing Testbed: VME-based DSP board market survey

NASA Astrophysics Data System (ADS)

Ingram, Rick E.

1992-04-01

The Adaptive Signal Processing Testbed (ASPT) is a real-time multiprocessor system utilizing digital signal processor technology on VMEbus based printed circuit boards installed on a Sun workstation. The ASPT has specific requirements, particularly as regards to the signal excision application, with respect to interfacing with current and planned data generation equipment, processing of the data, storage to disk of final and intermediate results, and the development tools for applications development and integration into the overall EW/COM computing environment. A prototype ASPT was implemented using three VME-C-30 boards from Applied Silicon. Experience gained during the prototype development led to the conclusions that interprocessor communications capability is the most significant contributor to overall ASPT performance. In addition, the host involvement should be minimized. Boards using different processors were evaluated with respect to the ASPT system requirements, pricing, and availability. Specific recommendations based on various priorities are made as well as recommendations concerning the integration and interaction of various tools developed during the prototype implementation.

Modular space station, phase B extension. Information management advanced development. Volume 5: Software assembly

NASA Technical Reports Server (NTRS)

Gerber, C. R.

1972-01-01

The development of uniform computer program standards and conventions for the modular space station is discussed. The accomplishments analyzed are: (1) development of computer program specification hierarchy, (2) definition of computer program development plan, and (3) recommendations for utilization of all operating on-board space station related data processing facilities.

In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM).

PubMed

Hinkelbein, Jochen; Böhm, Lennert; Braunecker, Stefan; Genzwürker, Harald V; Kalina, Steffen; Cirillo, Fabrizio; Komorowski, Matthieu; Hohn, Andreas; Siedenburg, Jörg; Bernhard, Michael; Janicke, Ilse; Adler, Christoph; Jansen, Stefanie; Glaser, Eckard; Krawczyk, Pawel; Miesen, Mirko; Andres, Janusz; De Robertis, Edoardo; Neuhaus, Christopher

2018-05-05

By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.

Study for Agricultural Engineering Development in Brazil. Summary Report of Joint Study Group on Agricultural Engineering in Brazil (July 24-August 12, 1972).

ERIC Educational Resources Information Center

National Academy of Sciences, Washington, DC.

The joint study group was established to identify the most urgent research and training needs in agricultural engineering in Brazil and to recommend how best to meet those needs. Specific recommendations are given for a long-term program to establish quality programs in education and research in agricultural engineering in Brazil and means to gain…

Indochina Policy for the Next Administration. Report of the Strategy for Peace, US Foreign Policy Conference (29th, Warrenton, Virginia, October 13-15, 1988).

ERIC Educational Resources Information Center

Stanley Foundation, Muscatine, IA.

Recommended guidelines for U.S. policy toward Cambodia, Vietnam, and Laos were developed by a bipartisan group of experts. General premises are stated first, followed by specific recommendations on how to assist in bringing about a settlement in Cambodia; how to pursue U.S. bilateral relations with Vietnam on refugees, the prisoner of war/missing…

Purdue Plane Structures Analyzer II : a computerized wood engineering system

Treesearch

S. K. Suddarth; R. W. Wolfe

1984-01-01

The Purdue Plane Structures Analyzer (PPSA) is a computer program developed specifically for the analysis of wood structures. It uses recognized analysis procedures, in conjunction with recommendations of the 1982 National Design Specification for Wood Construction, to determine stresses and deflections of wood trusses and frames. The program offers several options for...

MINIMUM CHECK LIST FOR MECHANICAL PLANS AND SPECIFICATIONS.

ERIC Educational Resources Information Center

PIERCE, J.L.

THIS BULLETIN HAS BEEN PREPARED FOR USE AS A MINIMUM CHECK LIST IN THE DEVELOPMENT AND REVIEW OF MECHANICAL AND ELECTRICAL PLANS AND SPECIFICATIONS BY ENGINEERS, ARCHITECTS, AND SUPERINTENDENTS IN PLANNING PUBLIC SCHOOL FACILITIES. THREE LEVELS OF GUIDELINES ARE MENTIONED--(1) MANDATORY BECAUSE OF LAW, CODE, OR REGULATION, (2) RECOMMENDED AS MOST…

TU-E-BRB-03: Overview of Proposed TG-132 Recommendations

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

Brock, K.

2015-06-15

Deformable image registration (DIR) is developing rapidly and is poised to substantially improve dose fusion accuracy for adaptive and retreatment planning and motion management and PET fusion to enhance contour delineation for treatment planning. However, DIR dose warping accuracy is difficult to quantify, in general, and particularly difficult to do so on a patient-specific basis. As clinical DIR options become more widely available, there is an increased need to understand the implications of incorporating DIR into clinical workflow. Several groups have assessed DIR accuracy in clinically relevant scenarios, but no comprehensive review material is yet available. This session will alsomore » discuss aspects of the AAPM Task Group 132 on the Use of Image Registration and Data Fusion Algorithms and Techniques in Radiotherapy Treatment Planning official report, which provides recommendations for DIR clinical use. We will summarize and compare various commercial DIR software options, outline successful clinical techniques, show specific examples with discussion of appropriate and inappropriate applications of DIR, discuss the clinical implications of DIR, provide an overview of current DIR error analysis research, review QA options and research phantom development and present TG-132 recommendations. Learning Objectives: Compare/contrast commercial DIR software and QA options Overview clinical DIR workflow for retreatment To understand uncertainties introduced by DIR Review TG-132 proposed recommendations.« less

Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations

PubMed Central

Sommers, Juultje; Engelbert, Raoul HH; Dettling-Ihnenfeldt, Daniela; Gosselink, Rik; Spronk, Peter E; Nollet, Frans; van der Schaaf, Marike

2015-01-01

Objective: To develop evidence-based recommendations for effective and safe diagnostic assessment and intervention strategies for the physiotherapy treatment of patients in intensive care units. Methods: We used the EBRO method, as recommended by the ‘Dutch Evidence Based Guideline Development Platform’ to develop an ‘evidence statement for physiotherapy in the intensive care unit’. This method consists of the identification of clinically relevant questions, followed by a systematic literature search, and summary of the evidence with final recommendations being moderated by feedback from experts. Results: Three relevant clinical domains were identified by experts: criteria to initiate treatment; measures to assess patients; evidence for effectiveness of treatments. In a systematic literature search, 129 relevant studies were identified and assessed for methodological quality and classified according to the level of evidence. The final evidence statement consisted of recommendations on eight absolute and four relative contra-indications to mobilization; a core set of nine specific instruments to assess impairments and activity restrictions; and six passive and four active effective interventions, with advice on (a) physiological measures to observe during treatment (with stopping criteria) and (b) what to record after the treatment. Conclusions: These recommendations form a protocol for treating people in an intensive care unit, based on best available evidence in mid-2014. PMID:25681407

Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations.

PubMed

Sommers, Juultje; Engelbert, Raoul H H; Dettling-Ihnenfeldt, Daniela; Gosselink, Rik; Spronk, Peter E; Nollet, Frans; van der Schaaf, Marike

2015-11-01

To develop evidence-based recommendations for effective and safe diagnostic assessment and intervention strategies for the physiotherapy treatment of patients in intensive care units. We used the EBRO method, as recommended by the 'Dutch Evidence Based Guideline Development Platform' to develop an 'evidence statement for physiotherapy in the intensive care unit'. This method consists of the identification of clinically relevant questions, followed by a systematic literature search, and summary of the evidence with final recommendations being moderated by feedback from experts. Three relevant clinical domains were identified by experts: criteria to initiate treatment; measures to assess patients; evidence for effectiveness of treatments. In a systematic literature search, 129 relevant studies were identified and assessed for methodological quality and classified according to the level of evidence. The final evidence statement consisted of recommendations on eight absolute and four relative contra-indications to mobilization; a core set of nine specific instruments to assess impairments and activity restrictions; and six passive and four active effective interventions, with advice on (a) physiological measures to observe during treatment (with stopping criteria) and (b) what to record after the treatment. These recommendations form a protocol for treating people in an intensive care unit, based on best available evidence in mid-2014. © The Author(s) 2015.

Recommended dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids: a systematic review.

PubMed

Aranceta, Javier; Pérez-Rodrigo, Carmen

2012-06-01

Dietary fat and its effects on health and disease has attracted interest for research and Public Health. Since the 1980s many bodies and organizations have published recommendations regarding fat intake. In this paper different sets of recommendations are analyzed following a systematic review process to examine dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids. A literature search was conducted in relevant literature databases along a search for suitable grey literature reports. Documents were included if they reported information on either recommended intake levels or dietary reference values or nutritional objectives or dietary guidelines regarding fat and/or fatty acids and/or cholesterol intake or if reported background information on the process followed to produce the recommendations. There is no standard approach for deriving nutrient recommendations. Recommendations vary between countries regarding the levels of intake advised, the process followed to set the recommendations. Recommendations on fat intake share similar figures regarding total fat intake, saturated fats and trans fats. Many sets do not include a recommendation about cholesterol intake. Most recent documents provide advice regarding specific n-3 fatty acids. Despite efforts to develop evidence based nutrient recommendations and dietary guidelines that may contribute to enhance health, there are still many gaps in research. It would be desirable that all bodies concerned remain transparent about the development of dietary recommendations. In order to achieve this, the type of evidence selected to base the recommendations should be specified and ranked. Regular updates of such recommendations should be planned.

2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.

PubMed

Dejaco, Christian; Singh, Yogesh P; Perel, Pablo; Hutchings, Andrew; Camellino, Dario; Mackie, Sarah; Abril, Andy; Bachta, Artur; Balint, Peter; Barraclough, Kevin; Bianconi, Lina; Buttgereit, Frank; Carsons, Steven; Ching, Daniel; Cid, Maria; Cimmino, Marco; Diamantopoulos, Andreas; Docken, William; Duftner, Christina; Fashanu, Billy; Gilbert, Kate; Hildreth, Pamela; Hollywood, Jane; Jayne, David; Lima, Manuella; Maharaj, Ajesh; Mallen, Christian; Martinez-Taboada, Victor; Maz, Mehrdad; Merry, Steven; Miller, Jean; Mori, Shunsuke; Neill, Lorna; Nordborg, Elisabeth; Nott, Jennifer; Padbury, Hannah; Pease, Colin; Salvarani, Carlo; Schirmer, Michael; Schmidt, Wolfgang; Spiera, Robert; Tronnier, David; Wagner, Alexandre; Whitlock, Madeline; Matteson, Eric L; Dasgupta, Bhaskar

2015-10-01

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR. © 2015, American College of Rheumatology.

Improving Professional Development to Enhance Reading Outcomes for Students in Special Education.

PubMed

Lemons, Christopher J; Otaiba, Stephanie Al; Conway, Sheila J; Mellado De La Cruz, Veronica

2016-12-01

The purpose of this article is to focus specifically on professional development that is needed to ensure that preservice and in-service teachers are prepared to deliver intensive intervention to enhance reading outcomes of students in special education. Our aim is to provide recommendations to ensure that special educators are prepared to design and implement data-based individualization in the area of reading. We highlight what special educators need to know to implement data-based individualization and provide recommendations for improving professional development using findings from federally funded projects. Implications for practice and next steps for research and policy are provided. © 2016 Wiley Periodicals, Inc.

An information adaptive system study report and development plan

NASA Technical Reports Server (NTRS)

Ataras, W. S.; Eng, K.; Morone, J. J.; Beaudet, P. R.; Chin, R.

1980-01-01

The purpose of the information adaptive system (IAS) study was to determine how some selected Earth resource applications may be processed onboard a spacecraft and to provide a detailed preliminary IAS design for these applications. Detailed investigations of a number of applications were conducted with regard to IAS and three were selected for further analysis. Areas of future research and development include algorithmic specifications, system design specifications, and IAS recommended time lines.

Evaluation of management measures of software development. Volume 1: Analysis summary

NASA Technical Reports Server (NTRS)

Page, J.; Card, D.; Mcgarry, F.

1982-01-01

The conceptual model, the data classification scheme, and the analytic procedures are explained. The analytic results are summarized and specific software measures for collection and monitoring are recommended.

Evaluation of evidence-based literature and formulation of recommendations for the clinical preventive guidelines for immigrants and refugees in Canada

PubMed Central

Tugwell, Peter; Pottie, Kevin; Welch, Vivian; Ueffing, Erin; Chambers, Andrea; Feightner, John

2011-01-01

Background: This article describes the evidence review and guideline development method developed for the Clinical Preventive Guidelines for Immigrants and Refugees in Canada by the Canadian Collaboration for Immigrant and Refugee Health Guideline Committee. Methods: The Appraisal of Guidelines for Research and Evaluation (AGREE) best-practice framework was combined with the recently developed Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to produce evidence-based clinical guidelines for immigrants and refugees in Canada. Results: A systematic approach was designed to produce the evidence reviews and apply the GRADE approach, including building on evidence from previous systematic reviews, searching for and comparing evidence between general and specific immigrant populations, and applying the GRADE criteria for making recommendations. This method was used for priority health conditions that had been selected by practitioners caring for immigrants and refugees in Canada. Interpretation: This article outlines the 14-step method that was defined to standardize the guideline development process for each priority health condition. PMID:20573711

British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update).

PubMed

McKenzie, Y A; Thompson, J; Gulia, P; Lomer, M C E

2016-10-01

Probiotics are often taken by individuals with irritable bowel syndrome (IBS). Which products are effective is unclear, despite an increasing research base. This project will systematically review which strain- and dose- specific probiotics can be recommended to adults with IBS to improve symptoms and quality of life (QoL). It is part of a broader systematic review to update British Dietetic Association guidelines for the dietary management of IBS in adults. CINAHL, Cochrane, Embase, Medline, Scopus and Web of Science were searched for systematic reviews (SRs) of randomised controlled trial (RCT)s recruiting adults with IBS comparing probiotic intervention with placebo. AMSTAR, risk of bias and diet bias tools were used to appraise methodological quality. Symptom and QoL data were appraised to develop probiotic-specific evidence statements on clinically meaningful and marginal outcomes in various settings, graded clinical practice recommendations and practical considerations. Nine systematic reviews and 35 RCTs were included (3406 participants) using 29 dose-specific probiotic formulations. None of the RCTs were at low risk of bias. Twelve out of 29 probiotics (41%) showed no symptom or QoL benefits. Evidence indicated that no strain or dose specific probiotic was consistently effective to improve any IBS symptoms or QoL. Two general clinical practice recommendations were made. Symptom outcomes for dose-specific probiotics were heterogeneous. Specific probiotic recommendations for IBS management in adults were not possible at this time. More data from high-quality RCTs treating specific symptom profiles are needed to support probiotic therapy in the management of IBS. © 2016 The British Dietetic Association Ltd.

Implementation of Ramadan-specific diabetes management recommendations: a multi-centered prospective study from Pakistan

PubMed Central

2014-01-01

Background To observe the outcome of implementation of Ramadan-specific diabetes management recommendations in fasting individuals with diabetes through health care providers. Methods This multi-centered prospective study was conducted at nine diabetes specialist centers in four provinces of Pakistan. The study was carried out in two phases; pre-Ramadan recruitment interview (visit A) and post-Ramadan follow up interview (visit B) of the same patients. Pre-Ramadan individual counseling was given and educational material provided to each patient by health care providers during visit A. Results Out of 388 patients with diabetes, blood glucose level was checked by all patients with type 1 and 71.43% patients with type 2 diabetes when they developed hypoglycemic symptoms during Ramadan. Of patients with type 1 and type 2 diabetes, 33.33% and 48% discontinued their fast when they felt hypoglycemic symptoms, respectively. None of the patient with type 1, while 18.87% patients with type 2 diabetes discontinued fast on the development of hyperglycemic symptoms. Drug dosage and timing were altered in 80% patients with type 1 and 90.5% patients with type 2 diabetes during Ramadan. Majority of the patients with type 2 diabetes changed from moderate/severe levels of physical activity before Ramadan to light physical activity during Ramadan (p<0.000). None of the patients required hospitalization when they developed symptomatic hypoglycemia or hyperglycemia and none developed diabetic ketoacidosis and hyperglycemic hyperosmolar state during Ramadan. Conclusion We observed that it is practicable to implement Ramadan-specific diabetes management recommendations through health care providers. PMID:24559109

The Health Services Researcher of 2020: A Summit to Assess the Field's Workforce Needs

PubMed Central

Pittman, Patricia; Holve, Erin

2009-01-01

Objective To summarize the current state of the health services research (HSR) workforce and recommend ways to improve the field's ability to respond to future challenges facing the health system. Data Summaries of workgroup discussions and recommendations at a stakeholder meeting. Study Design In late 2007, 50 educators, students, employers, and funders of HSR participated in a meeting to discuss findings of three commissioned papers on the HSR workforce. The group undertook a consultative process to develop recommendations for the field. Principal Findings Stakeholders developed recommendations in five major areas focused on HSR workforce needs: (1) improving the size and composition of the field; (2) understanding the growth of HSR in the private sector; (3) improving the graduate training of health services researchers, especially at the master's level; (4) expanding postgraduate training and continuing education opportunities; and (5) increasing awareness of the value of HSR. Conclusions Specific recommendations in the five major areas emphasized developing partnerships between HSR organizations and other professional societies or health organizations, as well as ways to improve training for the future workforce. The need to develop a “client orientation” toward research by improving communication and dissemination skills was discussed, as was the importance of improving diversity in the field. PMID:20459583

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care.

PubMed

Sanello, Ashley; Gausche-Hill, Marianne; Mulkerin, William; Sporer, Karl A; Brown, John F; Koenig, Kristi L; Rudnick, Eric M; Salvucci, Angelo A; Gilbert, Gregory H

2018-05-01

In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management. Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol. Protocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

Measurement instruments to assess posture, gait, and balance in Parkinson's disease: Critique and recommendations.

PubMed

Bloem, Bastiaan R; Marinus, Johan; Almeida, Quincy; Dibble, Lee; Nieuwboer, Alice; Post, Bart; Ruzicka, Evzen; Goetz, Christopher; Stebbins, Glenn; Martinez-Martin, Pablo; Schrag, Anette

2016-09-01

Disorders of posture, gait, and balance in Parkinson's disease (PD) are common and debilitating. This MDS-commissioned task force assessed clinimetric properties of existing rating scales, questionnaires, and timed tests that assess these features in PD. A literature review was conducted. Identified instruments were evaluated systematically and classified as "recommended," "suggested," or "listed." Inclusion of rating scales was restricted to those that could be used readily in clinical research and practice. One rating scale was classified as "recommended" (UPDRS-derived Postural Instability and Gait Difficulty score) and 2 as "suggested" (Tinetti Balance Scale, Rating Scale for Gait Evaluation). Three scales requiring equipment (Berg Balance Scale, Mini-BESTest, Dynamic Gait Index) also fulfilled criteria for "recommended" and 2 for "suggested" (FOG score, Gait and Balance Scale). Four questionnaires were "recommended" (Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Survey of Activities, and Fear of Falling in the Elderly-Modified). Four tests were classified as "recommended" (6-minute and 10-m walk tests, Timed Up-and-Go, Functional Reach). We identified several questionnaires that adequately assess freezing of gait and balance confidence in PD and a number of useful clinical tests. However, most clinical rating scales for gait, balance, and posture perform suboptimally or have been evaluated insufficiently. No instrument comprehensively and separately evaluates all relevant PD-specific gait characteristics with good clinimetric properties, and none provides separate balance and gait scores with adequate content validity for PD. We therefore recommend the development of such a PD-specific, easily administered, comprehensive gait and balance scale that separately assesses all relevant constructs. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

Heads Up to High School Sports

MedlinePlus

... submit" value="Submit" /> HEADS UP to School Sports Recommend on Facebook Tweet Share Compartir To help ... organizations, developed the HEADS UP: Concussion in School Sports initiative and materials. Specific Concussion Information for... Coaches ...

Recommendations from the Investigational New Drug/Investigational Device Exemption Task Force of the clInical and Translational Science Award Consortium: developing and implementing a sponsor-investigators training program.

PubMed

Holbein, M E Blair; Berglund, Jelena Petrovic; O'Reilly, Erin K; Hartman, Karen; Speicher, Lisa A; Adamo, Joan E; O'Riordan, Gerri; Brown, Jennifer Swanton; Schuff, Kathryn G

2014-06-01

The objective of this study was to provide recommendations for provision of training for sponsor and investigators at Academic Health Centers. A subgroup of the Investigational New Drug/Investigational Device Exemption (IND/IDE) Task Force of the Clinical and Translational Science Award (CTSA) program Regulatory Knowledge Key Function Committee was assembled to specifically address how clinical investigators who hold an IND/IDE and thus assume the role of sponsor-investigators are adequately trained to meet the additional regulatory requirements of this role. The participants who developed the recommendations were representatives of institutions with IND/IDE support programs. Through an informal survey, the task force determined that a variety and mix of models are used to provide support for IND/IDE holders within CTSA institutions. In addition, a CTSA consortium-wide resources survey was used. The participants worked from the models and survey results to develop consensus recommendations to address institutional support, training content, and implementation. The CTSA IND/IDE Task Force recommendations are as follows: (1) Institutions should assess the scope of Food and Drug Administration-regulated research, perform a needs analysis, and provide resources to implement a suitable training program; (2) The model of training program should be tailored to each institution; (3) The training should specifically address the unique role of sponsor-investigators, and the effectiveness of training should be evaluated regularly by methods that fit the model adopted by the institution; and (4) Institutional leadership should mandate sponsor-investigator training and effectively communicate the necessity and availability of training.

Promoting active transportation as a partnership between urban planning and public health: the columbus healthy places program.

PubMed

Green, Christine Godward; Klein, Elizabeth G

2011-01-01

Active transportation has been considered as one method to address the American obesity epidemic. To address obesity prevention through built-environment change, the local public health department in Columbus, Ohio, established the Columbus Healthy Places (CHP) program to formally promote active transportation in numerous aspects of community design for the city. In this article, we present a case study of the CHP program and discuss the review of city development rezoning applications as a successful strategy to link public health to urban planning. Prior to the CHP review, 7% of development applications in Columbus included active transportation components; in 2009, 64% of development applications adopted active transportation components specifically recommended by the CHP review. Active transportation recommendations generally included adding bike racks, widening or adding sidewalks, and providing sidewalk connectivity. Recommendations and lessons learned from CHP are provided.

Promoting Active Transportation as a Partnership Between Urban Planning and Public Health: The Columbus Healthy Places Program

PubMed Central

Green, Christine Godward; Klein, Elizabeth G.

2011-01-01

Active transportation has been considered as one method to address the American obesity epidemic. To address obesity prevention through built-environment change, the local public health department in Columbus, Ohio, established the Columbus Healthy Places (CHP) program to formally promote active transportation in numerous aspects of community design for the city. In this article, we present a case study of the CHP program and discuss the review of city development rezoning applications as a successful strategy to link public health to urban planning. Prior to the CHP review, 7% of development applications in Columbus included active transportation components; in 2009, 64% of development applications adopted active transportation components specifically recommended by the CHP review. Active transportation recommendations generally included adding bike racks, widening or adding sidewalks, and providing sidewalk connectivity. Recommendations and lessons learned from CHP are provided. PMID:21563711

Raising the quality of rheumatology management recommendations: lessons from the EULAR process 10 years after provision of standard operating procedures.

PubMed

Colebatch-Bourn, Alexandra N; Conaghan, Philip G; Arden, Nigel K; Cooper, Cyrus; Dougados, Maxime; Edwards, Christopher J

2015-08-01

To increase understanding of how to raise the quality of rheumatology guidelines by reviewing European League Against Rheumatism (EULAR) management recommendations, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, 10 years after publication of the EULAR standardized operating procedures (SOP) for the production of recommendations. It was hoped that this work could help inform improvements in guideline development by other societies and organizations. The SOP were published in 2004 to ensure the quality of EULAR-endorsed recommendations. We reviewed 27 published EULAR recommendations for management using the AGREE II tool. This provides a framework to assess the quality of guidelines across six broad domains using 23 specific questions. Overall the EULAR recommendations reviewed have been performed to a high standard. There are particular strengths in the methodology and presentation of the guidelines; however, the results indicate areas for development in future recommendations: in particular, stakeholder involvement and applicability of the recommendations. Improvements in quality were evident in recent years, with patient representation in 9 of 15 (60.0%) recommendations published 2010-14 compared with 4 of 12 (33.3%) published 2000-09. In the last 10 years the overall quality of recommendations was good, with standards improving over the decade following publication of the SOP. However, this review process has identified potential areas for improvement, especially in patient representation and provision of implementation tools. The lessons from this work can be applied to the development of rheumatology guidelines by other societies and organizations. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Pathway to Prevention of Nosocomial Clostridium difficile Infection.

PubMed

Goldstein, Ellie J C; Johnson, Stuart; Maziade, Pierre-Jean; McFarland, Lynne V; Trick, William; Dresser, Linda; Millette, Mathieu; Mazloum, Hadi; Low, Donald E

2015-05-15

To address the significant morbidity and mortality rates associated with nosocomial Clostridium difficile-associated diarrhea (CDAD), a series of recommendations and a pathway to prevention were developed. An expert panel of infectious disease (ID) specialists participated in a modified Delphi process with specific objectives: (1) conduct a review for CDAD and prevention; (2) develop statements based upon panel members' opinions; (3) hold a panel meeting during the 2012 IDWeek; and (4) review the final recommendations and prevention pathway prior to submission for publication. The panel voted on (1) antibiotic stewardship (7 of 8 panelists); (2) reduction of other potentially modifiable risk factors (variable); (3) utilization of specific probiotics to prevent C. difficile overgrowth (8/8); (4) staff education regarding CDAD preventive measures (8/8); (5) appropriate hand hygiene for everyone (7/8); (6) environmental cleaning (8/8); (7) medical equipment disinfection (7/8); (8) early detection of CDAD in symptomatic patients (7/8); (9) usage of protective clothing/gloves (8/8); (10) proper measures during outbreak (8/8); and (11) surveillance to monitor efficacy data of preventive measures (8/8). The panel members agreed with 11 of 17 recommendations presented. The additional recommendations by the panel were proton pump inhibitor use as a risk factor and the use of adjunctive therapy with specific probiotic, as it was approved by Health Canada for the risk reduction of CDAD in hospitalized patients. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Development of a Plan for Research, Development and Instruction in Adult Vocational Education. Final Report.

ERIC Educational Resources Information Center

Illinois Univ., Urbana. Dept. of Vocational and Technical Education.

This report of a project to begin to develop a plan for research, development, and instruction in adult vocational education in Illinois has two specific goals: (1) to identify the current status of adult vocational education in Illinois and (2) to recommend key directions for state actions. It presents information collected through a…

Implementing AORN recommended practices for environmental cleaning.

PubMed

Allen, George

2014-05-01

In recent years, researchers have developed an increasing awareness of the role of the environment in the development of health care-associated infections. AORN's "Recommended practices for environmental cleaning" is an evidence-based document that provides specific guidance for cleaning processes, for the selection of appropriate cleaning equipment and supplies, and for ongoing education and quality improvement. This updated recommended practices document has an expanded focus on the need for health care personnel to work collaboratively to accomplish adequately thorough cleanliness in a culture of safety and mutual support. Perioperative nurses, as the primary advocates for patients while they are being cared for in the perioperative setting, should help ensure that a safe, clean environment is reestablished after each surgical procedure. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Publishing web-based guidelines using interactive decision models.

PubMed

Sanders, G D; Nease, R F; Owens, D K

2001-05-01

Commonly used methods for guideline development and dissemination do not enable developers to tailor guidelines systematically to specific patient populations and update guidelines easily. We developed a web-based system, ALCHEMIST, that uses decision models and automatically creates evidence-based guidelines that can be disseminated, tailored and updated over the web. Our objective was to demonstrate the use of this system with clinical scenarios that provide challenges for guideline development. We used the ALCHEMIST system to develop guidelines for three clinical scenarios: (1) Chlamydia screening for adolescent women, (2) antiarrhythmic therapy for the prevention of sudden cardiac death; and (3) genetic testing for the BRCA breast-cancer mutation. ALCHEMIST uses information extracted directly from the decision model, combined with the additional information from the author of the decision model, to generate global guidelines. ALCHEMIST generated electronic web-based guidelines for each of the three scenarios. Using ALCHEMIST, we demonstrate that tailoring a guideline for a population at high-risk for Chlamydia changes the recommended policy for control of Chlamydia from contact tracing of reported cases to a population-based screening programme. We used ALCHEMIST to incorporate new evidence about the effectiveness of implantable cardioverter defibrillators (ICD) and demonstrate that the cost-effectiveness of use of ICDs improves from $74 400 per quality-adjusted life year (QALY) gained to $34 500 per QALY gained. Finally, we demonstrate how a clinician could use ALCHEMIST to incorporate a woman's utilities for relevant health states and thereby develop patient-specific recommendations for BRCA testing; the patient-specific recommendation improved quality-adjusted life expectancy by 37 days. The ALCHEMIST system enables guideline developers to publish both a guideline and an interactive decision model on the web. This web-based tool enables guideline developers to tailor guidelines systematically, to update guidelines easily, and to make the underlying evidence and analysis transparent for users.

Factors That Influence Faculty Adoption of Learning-Centered Approaches

ERIC Educational Resources Information Center

Blumberg, Phyllis

2016-01-01

This article proposes a recommended course of action for faculty development based upon Rogers' theory of Diffusion of Innovations and data collected in a study looking at the prevalence of use of learning-centered teaching practices. Specific faculty development strategies are aligned with Rogers' factors influencing decisions to adopt…

Developing and Assessing Students' Abilities To Interpret Research.

ERIC Educational Resources Information Center

Forsyth, G. Alfred; And Others

A recent conference on statistics education recommended that more emphasis be placed on the interpretation of research (IOR). Ways for developing and assessing IOR and providing a systematic framework for creating and selecting instructional materials for the independent assessment of specific IOR concepts are the focus of this paper. The…

Plan for the Development of Library Service in Montana.

ERIC Educational Resources Information Center

Warncke, Ruth

This plan for the development of Montana library service is based on the experiences of other states, opinions of library experts, written information on Montana libraries, visits to several libraries, and attendance at meetings of the Montana Library Association and its committees. Specific recommendations include: moving the State Library…

Development and Exploratory Validation of an Organizational Efficacy Scale

ERIC Educational Resources Information Center

Bohn, James G.

2010-01-01

Although many instruments have been developed to measure organizational constructs such as citizenship, climate, and organization-based esteem, to date no scale has been designed specifically to measure efficacy at the organizational level. Tools to measure organizational efficacy in a business context have been recommended for over two decades.…

Requirement Specifications for a Design and Verification Unit.

ERIC Educational Resources Information Center

Pelton, Warren G.; And Others

A research and development activity to introduce new and improved education and training technology into Bureau of Medicine and Surgery training is recommended. The activity, called a design and verification unit, would be administered by the Education and Training Sciences Department. Initial research and development are centered on the…

Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group

PubMed Central

Deutsch, Madeline B; Green, Jamison; Keatley, JoAnne; Mayer, Gal; Hastings, Jennifer; Hall, Alexandra M

2013-01-01

Transgender patients have particular needs with respect to demographic information and health records; specifically, transgender patients may have a chosen name and gender identity that differs from their current legally designated name and sex. Additionally, sex-specific health information, for example, a man with a cervix or a woman with a prostate, requires special attention in electronic health record (EHR) systems. The World Professional Association for Transgender Health (WPATH) is an international multidisciplinary professional association that publishes recognized standards for the care of transgender and gender variant persons. In September 2011, the WPATH Executive Committee convened an Electronic Medical Records Working Group comprised of both expert clinicians and medical information technology specialists, to make recommendations for developers, vendors, and users of EHR systems with respect to transgender patients. These recommendations and supporting rationale are presented here. PMID:23631835

A First Step towards a Clinical Decision Support System for Post-traumatic Stress Disorders.

PubMed

Ma, Sisi; Galatzer-Levy, Isaac R; Wang, Xuya; Fenyö, David; Shalev, Arieh Y

2016-01-01

PTSD is distressful and debilitating, following a non-remitting course in about 10% to 20% of trauma survivors. Numerous risk indicators of PTSD have been identified, but individual level prediction remains elusive. As an effort to bridge the gap between scientific discovery and practical application, we designed and implemented a clinical decision support pipeline to provide clinically relevant recommendation for trauma survivors. To meet the specific challenge of early prediction, this work uses data obtained within ten days of a traumatic event. The pipeline creates personalized predictive model for each individual, and computes quality metrics for each predictive model. Clinical recommendations are made based on both the prediction of the model and its quality, thus avoiding making potentially detrimental recommendations based on insufficient information or suboptimal model. The current pipeline outperforms the acute stress disorder, a commonly used clinical risk factor for PTSD development, both in terms of sensitivity and specificity.

[Guidelines in RA treatment: concepts on safety and recommendations using anti-TNF-alpha inhibitors. Grupo de Estudio de Nuevas Terapias de Enfermedades reumáticas (GENTE)].

PubMed

Díaz-Jouanen, Efraín; Abud-Mendoza, Carlos; Garza-Elizondo, Mario Alberto; Medrano-Ramírez, Gabriel; Burgos-Vargas, Rubén; Orozco-Alcalá, José Javier; Pacheco-Tena, César Francisco; Pineda, Carlos; Pozos-Espíndola, Juan Carlos; Ramos-Niembro, Francisco; Robles-San-Román, Manuel; Santana-Sahagún, Jesús Ernesto

2009-01-01

Recommendations for the use of Disease-Modifying Antirheumatic Drugs (DMARD) with both conventional and biological agents in Rheumatoid Arthritis (RA) must be based on their safety profile, adverse effects, risks, and advantages. With the purpose of presenting the most updated information about the safety of tumor necrosis factor alpha (TNFalpha) antagonists, in this article we summarize the literature published during the last three years about this sort of biological agents in specific clinical situations, such as risk of developing infections, cancer, cardiovascular diseases, and autoimmunity; as well as their administration to patients who will undergo surgical procedures, pregnant and/or breast-feeding women, and patients who need immunizations. Likewise, in this analysis we offer specific recommendations, based on evidence, for the best anti-TNF-alfa management.

Department of the Navy FY 1992/FY 1993 Budget Estimates Descriptive Summaries Submitted to Congress February 1991, Research, Development, Test and Evaluation, Navy

DTIC Science & Technology

1991-02-01

FY 1990 ACCOMPLISHMENTS: a. (U) Completed physical functional and operational audit of system, subcomponents and interfaces related to digital...receiver hardware. b. (U) Developed system specification reflecting audit results. c. (U) Established reliability assessment and recommended changes and/or...interoperability testing and demonstrations. d. (U) Updated joint terminal specifications and standards. e. (U) Audited Army/Navy/Air Force terminal designs. f. (U

Development of water quality standards criteria. [for consumables (spacecrew supplies)

NASA Technical Reports Server (NTRS)

1976-01-01

Qualitative and semiquantitative analyses were made of volatile organic compounds in water supplies collected at various stages of processing in the space station prototype vacuum compression distillation unit to evaluate the process and the product water. Additional evaluation was made of specific ingredients required to adequately enhance the taste of the reclaimed water. A concept for the in-flight addition of these ingredients was developed. Revisions to previously recommended potable water criteria and specifications are included.

Development of an Instrument to Evaluate the Knowledge of Elementary Teachers about Venereal Disease.

ERIC Educational Resources Information Center

Schmidt, Norma G.

The purpose of this study was to develop a valid, reliable test to measure the knowledge of elementary school teachers about venereal disease. Recommended scientific test construction procedures were carefully followed. These included the development of a content outline and a table of specification; submitting potential test items to a review…

Design Exception In-Service Monitoring Program Development

DOT National Transportation Integrated Search

2017-05-01

This study evaluates various possible program designs for in-service monitoring of design exceptions (DEs) for the Georgia Department of Transportation. The study recommends a multitier stepwise approach to the evaluation of DEs. Specifically, the pr...

Maintenance and operations plan for intelligent transportation systems in Kentucky.

DOT National Transportation Integrated Search

2004-06-01

This report presents a Maintenance and Operations Plan for Intelligent Transportation Systems (ITS) in Kentucky. It was developed using substantial stakeholder input and provides recommendations and specific strategies for supporting and coordinating...

[Implementation of clinical practice guidelines: how can we close the evidence-practice gap?].

PubMed

Muche-Borowski, Cathleen; Nothacker, M; Kopp, I

2015-01-01

Guidelines are intended as instruments of knowledge transfer to support decision-making by physicians, other health professionals and patients in clinical practice and thereby contribute to quality improvements in healthcare. To date they are an indispensable tool for healthcare. Their benefit for patients can only be seen in application, i.e. the implementation of guideline recommendations. For successful implementation, implementability and practicability play a crucial role and these characteristics can be influenced and should be promoted by the guideline development group. In addition, a force field analysis to identify barriers against and facilitators for the implementation of specific guideline recommendations from the perspective of physicians and patients is recommended to guide the development of an individual implementation strategy and the selection of appropriate interventions. However, implementation cannot be achieved by the guideline development group alone and a universal implementation strategy does not exist. Therefore, a process using theory, analysis, experience and shared responsibility of stakeholders in healthcare is recommended, with the aim to achieve sustainable behavioral change and improve the quality of care by guideline-oriented behavior.

Design of Phase I Combination Trials: Recommendations of the Clinical Trial Design Task Force of the NCI Investigational Drug Steering Committee

PubMed Central

Paller, Channing J.; Bradbury, Penelope A.; Ivy, S. Percy; Seymour, Lesley; LoRusso, Patricia M.; Baker, Laurence; Rubinstein, Larry; Huang, Erich; Collyar, Deborah; Groshen, Susan; Reeves, Steven; Ellis, Lee M.; Sargent, Daniel J.; Rosner, Gary L.; LeBlanc, Michael L.; Ratain, Mark J.

2014-01-01

Anticancer drugs are combined in an effort to treat a heterogeneous tumor or to maximize the pharmacodynamic effect. The development of combination regimens, while desirable, poses unique challenges. These include the selection of agents for combination therapy that may lead to improved efficacy while maintaining acceptable toxicity, the design of clinical trials that provide informative results for individual agents and combinations, and logistical and regulatory challenges. The phase 1 trial is often the initial step in the clinical evaluation of a combination regimen. In view of the importance of combination regimens and the challenges associated with developing them, the Clinical Trial Design (CTD) Task Force of the National Cancer Institute (NCI) Investigational Drug Steering Committee developed a set of recommendations for the phase 1 development of a combination regimen. The first two recommendations focus on the scientific rationale and development plans for the combination regimen; subsequent recommendations encompass clinical design aspects. The CTD Task Force recommends that selection of the proposed regimens be based on a biological or pharmacological rationale supported by clinical and/or robust and validated preclinical evidence, and accompanied by a plan for subsequent development of the combination. The design of the phase 1 clinical trial should take into consideration the potential pharmacokinetic and pharmacodynamic interactions as well as overlapping toxicity. Depending on the specific hypothesized interaction, the primary endpoint may be dose optimization, pharmacokinetics, and/or pharmacodynamic (i.e., biomarker). PMID:25125258

77 FR 56851 - Draft and Revised Draft Guidances for Industry Describing Product-Specific Bioequivalence...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-14

... Bioequivalence Recommendations; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY... draft product-specific bioequivalence (BE) recommendations. The recommendations provide product-specific guidance on the design of BE studies to support abbreviated new drug applications (ANDAs). In the Federal...

Impact of Gender-Specific Human Papillomavirus Vaccine Recommendations on Uptake of Other Adolescent Vaccines: Analysis of the NIS-Teen (2008-2012).

PubMed

Bednarczyk, Robert A; Orenstein, Walter A; Omer, Saad B

In the United States, human papillomavirus vaccination was routinely recommended for adolescent females in 2006 and provisionally recommended for adolescent males in 2009. We evaluated the hypothesis that gender-specific human papillomavirus vaccination recommendations would impact gender-specific uptake of other vaccines using National Immunization Survey-Teen public use data sets (2008-2012). Female adolescents had higher coverage than males of at least 1 other adolescent vaccine in 2008 (3.0% higher) and 2009 (4.3% higher). Gender differences abated in 2010, 2011, and 2012 (0.2%, 0.9%, and 0.4%, respectively). To evaluate unintended consequences of gender-based recommendations, countries with female-only human papillomavirus vaccination recommendations should evaluate gender-specific uptake of other adolescent vaccines.

PubMed Central

Toth, Bettina; Würfel, Wolfgang; Bohlmann, Michael; Zschocke, Johannes; Rudnik-Schöneborn, Sabine; Nawroth, Frank; Schleußner, Ekkehard; Rogenhofer, Nina; Wischmann, Tewes; von Wolff, Michael; Hancke, Katharina; von Otte, Sören; Kuon, Ruben; Feil, Katharina; Tempfer, Clemens

2018-01-01

Purpose Official guideline of the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (ÖGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). The aim of this guideline was to standardize the diagnosis and treatment of couples with recurrent miscarriage (RM). Recommendations were based on the current literature and the views of the involved committee members. Methods Based on the current literature, the committee members developed the statements and recommendations of this guideline in a formalized process which included DELPHI rounds and a formal consensus meeting. Recommendations Recommendations for the diagnosis and treatment of patients with RM were compiled based on the international literature. Specific established risk factors such as chromosomal, anatomical, endocrine, hemostatic, psychological, infectious and immunological disorders were taken into consideration. PMID:29720743

The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Bleeding and Coagulation Management in Neurostimulation Devices.

PubMed

Deer, Timothy R; Narouze, Samer; Provenzano, David A; Pope, Jason E; Falowski, Steven M; Russo, Marc A; Benzon, Honorio; Slavin, Konstantin; Pilitsis, Julie G; Alo, Kenneth; Carlson, Jonathan D; McRoberts, Porter; Lad, Shivanand P; Arle, Jeffrey; Levy, Robert M; Simpson, Brian; Mekhail, Nagy

2017-01-01

The Neurostimulation Appropriateness Consensus Committee (NACC) was formed by the International Neuromodulation Society (INS) in 2012 to evaluate the evidence to reduce the risk of complications and improve the efficacy of neurostimulation. The first series of papers, published in 2014, focused on the general principles of appropriate practice in the surgical implantation of neurostimulation devices. The NACC was reconvened in 2014 to address specific patient care issues, including bleeding and coagulation. The INS strives to improve patient care in an evidence-based fashion. The NACC members were appointed or recruited by the INS leadership for diverse expertise, including international clinical expertise in many areas of neurostimulation, evidence evaluation, and publication. The group developed best practices based on peer-reviewed evidence and, in the absence of specific evidence, on expert opinion. Recommendations were based on international evidence in accordance with guideline creation. The NACC has recommended specific measures to reduce the risk of bleeding and neurological injury secondary to impairment of coagulation in the setting of implantable neurostimulation devices in the spine, brain, and periphery. © 2017 International Neuromodulation Society.

Developing prehospital clinical practice guidelines for resource limited settings: why re-invent the wheel?

PubMed

McCaul, Michael; de Waal, Ben; Hodkinson, Peter; Pigoga, Jennifer L; Young, Taryn; Wallis, Lee A

2018-02-05

Methods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, the volume of literature is not matched by research into alternative methods of CPG development using existing CPG documents-a specific issue for guideline development groups in low- and middle-income countries. We report on how we developed a context specific prehospital CPG using an alternative guideline development method. Difficulties experienced and lessons learnt in applying existing global guidelines' recommendations to a national context are highlighted. The project produced the first emergency care CPG for prehospital providers in Africa. It included > 270 CPGs and produced over 1000 recommendations for prehospital emergency care. We encountered various difficulties, including (1) applicability issues: few pre-hospital CPGs applicable to Africa, (2) evidence synthesis: heterogeneous levels of evidence classifications and (3) guideline quality. Learning points included (1) focusing on key CPGs and evidence mapping, (2) searching other resources for CPGs, (3) broad representation on CPG advisory boards and (4) transparency and knowledge translation. Re-inventing the wheel to produce CPGs is not always feasible. We hope this paper will encourage further projects to use existing CPGs in developing guidance to improve patient care in resource-limited settings.

Planning for the worst in Washington State: initial response planning for improvised nuclear device explosions.

PubMed

Poeton, Richard W; Glines, Wayne M; McBaugh, Debra

2009-01-01

Since 11 September 2001, improvised nuclear devices have become recognized as an important radiological threat requiring emergency response planning. Although Protective Action Guidance is well established for fixed nuclear facilities, correspondingly well-developed guidance does not exist for nuclear explosions. The Washington State Department of Health has developed preplanned Protective Action Recommendations for improvised nuclear device explosions. These recommendations recognize the need for advice to the public soon after such an event, before significant data are available. They can be used before significant outside support is available locally, and reference observable effects so people can use them if communications were disabled. The recommendations focus on early actions (24-48 h) and place priority on actions to avoid deterministic health effects due to residual fallout. Specific emphasis is placed on determining recommendations for evacuation, as well as the extent of the area for sheltering. The key recommendations developed for an initial public response are: (1) if there is ready access to robust shelter such as an underground basement or interior spaces in a multi-story structure, immediate sheltering in these areas is the best action, regardless of location; (2) if robust shelter is not available, and if fallout is observed in the area, then evacuation is the best general recommendation for locations within 16 km (10 miles) of the explosion; and (3) beyond 16 km (10 miles), the generally recommended protective action is to shelter in the best-protected location which is readily available.

Current Practices in Hosting Non-US Pharmacy Students at US Pharmacy Schools in Experiential Clerkships

PubMed Central

Al-Dahir, Sara; Alsharif, Naser Z.; Gleason, Shaun E.; Tofade, Toyin; Flores, Emily K.; Katz, Michael; Dornblaser, Emily K.

2017-01-01

Objective: To provide specific considerations for hosting non-U.S. pharmacy students at U.S.-based colleges/schools of pharmacy (C/SOP) for experiential clerkships and training. Findings: A literature review (2000-2016) in PubMed, Google Scholar and IPA databases was conducted using specific keywords. Recommendations and future directions for development of experiential rotations for non-U.S. students in U.S. experiential rotations are presented for both the home and host country. Summary articles and best practices across the disciplines, as well as expert opinion, were found across U.S. models for hosting non-U.S. students in advanced practice rotations in the medical disciplines. Consistent themes regarding legal agreements, acculturation, standardized calendars and social and safety considerations were considered for inclusion in the final document. Conclusion: Development of a successful experiential rotation/training for non-U.S. students requires consideration for well-developed objectives, qualified preceptors, multitude of legal and cultural considerations and recommendations for longevity and sustainability. PMID:29302084

Recommendations for Promoting Physical Activity for Children and Adolescents in Germany. A Consensus Statement

PubMed Central

Graf, Christine; Beneke, Ralph; Bloch, Wilhelm; Bucksch, Jens; Dordel, Sigrid; Eiser, Stefanie; Ferrari, Nina; Koch, Benjamin; Krug, Susanne; Lawrenz, Wolfgang; Manz, Kristin; Naul, Roland; Oberhoffer, Renate; Quilling, Eike; Schulz, Henry; Stemper, Theo; Stibbe, Günter; Tokarski, Walter; Völker, Klaus; Woll, Alexander

2014-01-01

Increasing physical activity and reduction of sedentary behaviour play important roles in health promotion and prevention of lifestyle-related diseases in children and adolescents. However, the question of how much physical activity is useful for which target group is still a matter of debate. International guidelines (World Health Organization; European Association for the Study of Obesity), which are mainly based on expert opinions, recommend 60 min of physical activity every day. Age- and sex-specific features and regional differences are not taken into account. Therefore, expert consensus recommendations for promoting physical activity of children and adolescents in Germany were developed with special respect to national data, but also with respect to aspects of specific target groups, e.g., children with a lower socio-economic status (SES) or with migration background. They propose 90 min/day of physical activity, or at least 12,000 steps daily. Additionally, lifestyle factors, especially restriction of media consumption, were integrated. The recommendations provide orientation for parents and caregivers, for institutions such as schools and kindergartens as well as for communities and stakeholders. PMID:24821136

Specific character of sustainable innovative development of transport construction in self-regulation conditions

NASA Astrophysics Data System (ADS)

Gumba, Khuta; Belyaeva, Svetlana

2017-10-01

The providing of sustainable development is impossible without activating the innovative activity of backbone economical sectors, in particular of transport construction. The system of self-regulation of activities is a specific feature of the transport industry development. The authors carried out the correlation analysis of innovative activity of construction enterprises, which proved the necessity of improving the normative and technical documents. The authors proposed and calculated the index of the legislation stability in the industry. The article suggests recommendations on the activation of innovative development in construction industry basing on the results of the modeling.

78 FR 20925 - Draft and Revised Draft Guidances for Industry Describing Product-Specific Bioequivalence...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-08

... Recommendations; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and...-specific bioequivalence (BE) recommendations. The recommendations provide product-specific guidance on the design of BE studies to support abbreviated new drug applications (ANDAs). In the Federal Register of...

77 FR 35688 - Draft and Revised Draft Guidances for Industry Describing Product-Specific Bioequivalence...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-14

... Recommendations; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and...-specific bioequivalence (BE) recommendations. The recommendations provide product-specific guidance on the design of BE studies to support abbreviated new drug applications (ANDAs). In the Federal Register of...

77 FR 16842 - Draft and Revised Draft Guidances for Industry Describing Product-Specific Bioequivalence...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-22

... Recommendations; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and...-specific bioequivalence (BE) recommendations. The recommendations provide product-specific guidance on the design of BE studies to support abbreviated new drug applications (ANDAs). In the Federal Register of...

The patient presenting with acute dysentery--a systematic review.

PubMed

Pfeiffer, Margaret L; DuPont, Herbert L; Ochoa, Theresa J

2012-04-01

The etiologies, clinical presentations and diagnosis of acute pathogen-specific dysentery in children and adults in industrialized and developing regions is described to help develop recommendations for therapy. We conducted a systematic review of literature published between January 2000 and June 2011 to determine the frequency of occurrence of pathogen-specific dysentery. Shigella, Salmonella, and Campylobacter remain the most frequent bacterial causes of dysentery worldwide. Shiga toxin-producing Escherichia coli (STEC) is potentially important in industrialized countries. Entamoeba histolytica must be considered in the developing world, particularly in rural or periurban areas. Clinicians should use epidemiological clues and knowledge of endemicity to suspect Vibrio spp., Aeromonas spp., Plesiomonas spp., Yersinia enterocolitica, Clostridium difficile, Cytomegalovirus or Schistosoma mansoni in cases presenting with dysentery. A single fecal sample studied for etiologic agents is the customary way to make an etiologic diagnosis. While a majority of dysenteric cases will not have an identifiable agent causing the illness, when an etiologic organism is identified, other than STEC, each has a specific recommended form of therapy, which is provided in this review. Copyright © 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Practical recommendations for the evaluation of improvement initiatives

PubMed Central

Parry, Gareth; Coly, Astou; Goldmann, Don; Rowe, Alexander K; Chattu, Vijay; Logiudice, Deneil; Rabrenovic, Mihajlo; Nambiar, Bejoy

2018-01-01

Abstract A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. PMID:29447410

Assessment of DoD Enterprise Resource Planning Business Systems

DTIC Science & Technology

2011-02-01

activities, and processes to the organizational units that execute them • Architecture standards, such as application of the BPMN • Recommended...Recommendation: • Create and use style guides for the development of BPMN based process models. The style guide would probably include specifications such as...o All processes must have ‘entry points’ or ‘triggers’ in the form of BPMN Events o All processes must have ‘outcomes’ also in the form of BPMN

Brownfields City of Houston Solar Project: Solar Power Analysis and Design Specifications

EPA Pesticide Factsheets

This document details the scope of work elements completed in support of this project, as well as recommendations for next steps towards solar project development and power purchase agreement negotiation and finalization.

Contrails/cirrus optics and radiation

DOT National Transportation Integrated Search

2008-01-25

In this subject-specific white paper, we present a literature survey of past and current developments regarding the impact of contrails and contrail cirrus on the radiation field of the Earths atmosphere and climate. A number of recommendations fo...

Development of a Washington State freight data system

DOT National Transportation Integrated Search

2007-08-01

This study identified freight data uses, needs, and gaps, both nationally and in the state of Washington. Specific recommendations for providing the needed data and data generating processes include the following: : Phase I: Identification of Dat...

Development of food-based complementary feeding recommendations for 9- to 11-month-old peri-urban Indonesian infants using linear programming.

PubMed

Santika, Otte; Fahmida, Umi; Ferguson, Elaine L

2009-01-01

Effective population-specific, food-based complementary feeding recommendations (CFR) are required to combat micronutrient deficiencies. To facilitate their formulation, a modeling approach was recently developed. However, it has not yet been used in practice. This study therefore aimed to use this approach to develop CFR for 9- to 11-mo-old Indonesian infants and to identify nutrients that will likely remain low in their diets. The CFR were developed using a 4-phase approach based on linear and goal programming. Model parameters were defined using dietary data collected in a cross-sectional survey of 9- to 11-mo-old infants (n = 100) living in the Bogor District, West-Java, Indonesia and a market survey of 3 local markets. Results showed theoretical iron requirements could not be achieved using local food sources (highest level achievable, 63% of recommendations) and adequate levels of iron, niacin, zinc, and calcium were difficult to achieve. Fortified foods, meatballs, chicken liver, eggs, tempe-tofu, banana, and spinach were the best local food sources to improve dietary quality. The final CFR were: breast-feed on demand, provide 3 meals/d, of which 1 is a fortified infant cereal; > or = 5 servings/wk of tempe/tofu; > or = 3 servings/wk of animal-source foods, of which 2 servings/wk are chicken liver; vegetables, daily; snacks, 2 times/d, including > or = 2 servings/wk of banana; and > or = 4 servings/wk of fortified-biscuits. Results showed that the approach can be used to objectively formulate population-specific CFR and identify key problem nutrients to strengthen nutrition program planning and policy decisions. Before recommending these CFR, their long-term acceptability, affordability, and effectiveness should be assessed.

Patient-Reported Outcome (PRO) Assessment in Clinical Trials: A Systematic Review of Guidance for Trial Protocol Writers

PubMed Central

Calvert, Melanie; Kyte, Derek; Duffy, Helen; Gheorghe, Adrian; Mercieca-Bebber, Rebecca; Ives, Jonathan; Draper, Heather; Brundage, Michael; Blazeby, Jane; King, Madeleine

2014-01-01

Background Evidence suggests there are inconsistencies in patient-reported outcome (PRO) assessment and reporting in clinical trials, which may limit the use of these data to inform patient care. For trials with a PRO endpoint, routine inclusion of key PRO information in the protocol may help improve trial conduct and the reporting and appraisal of PRO results; however, it is currently unclear exactly what PRO-specific information should be included. The aim of this review was to summarize the current PRO-specific guidance for clinical trial protocol developers. Methods and Findings We searched the MEDLINE, EMBASE, CINHAL and Cochrane Library databases (inception to February 2013) for PRO-specific guidance regarding trial protocol development. Further guidance documents were identified via Google, Google scholar, requests to members of the UK Clinical Research Collaboration registered clinical trials units and international experts. Two independent investigators undertook title/abstract screening, full text review and data extraction, with a third involved in the event of disagreement. 21,175 citations were screened and 54 met the inclusion criteria. Guidance documents were difficult to access: electronic database searches identified just 8 documents, with the remaining 46 sourced elsewhere (5 from citation tracking, 27 from hand searching, 7 from the grey literature review and 7 from experts). 162 unique PRO-specific protocol recommendations were extracted from included documents. A further 10 PRO recommendations were identified relating to supporting trial documentation. Only 5/162 (3%) recommendations appeared in ≥50% of guidance documents reviewed, indicating a lack of consistency. Conclusions PRO-specific protocol guidelines were difficult to access, lacked consistency and may be challenging to implement in practice. There is a need to develop easily accessible consensus-driven PRO protocol guidance. Guidance should be aimed at ensuring key PRO information is routinely included in appropriate trial protocols, in order to facilitate rigorous collection/reporting of PRO data, to effectively inform patient care. PMID:25333995

Statistical and Economic Techniques for Site-specific Nematode Management.

PubMed

Liu, Zheng; Griffin, Terry; Kirkpatrick, Terrence L

2014-03-01

Recent advances in precision agriculture technologies and spatial statistics allow realistic, site-specific estimation of nematode damage to field crops and provide a platform for the site-specific delivery of nematicides within individual fields. This paper reviews the spatial statistical techniques that model correlations among neighboring observations and develop a spatial economic analysis to determine the potential of site-specific nematicide application. The spatial econometric methodology applied in the context of site-specific crop yield response contributes to closing the gap between data analysis and realistic site-specific nematicide recommendations and helps to provide a practical method of site-specifically controlling nematodes.

EFFECTS ASSESSMENT. IN: REEVALUATION OF THE STATE OF THE SCIENCE FOR WATER-QUALITY CRITERIA DEVELOPMENT

EPA Science Inventory

The Effects Workgroup reviewed the state of the science with regard to the measurement and prediction of ecological effect, in the context of WQC development...Specific recommendations and research needs identified by the group are given in bullet form at the end of the applicabl...

Health Education Program. Kanawha County Schools.

ERIC Educational Resources Information Center

Kanawha County Schools, Charleston, WV.

A task force, after a 2-year study, recommended a curriculum on health education which would meet the specific needs of both teachers and students. This teacher developed curriculum guide is comprised of five units on: human growth and development, diseases, nutrition, personal hygiene, drug education, safety and first aid. Each unit contains a…

Beyond ABCs and 123s: Enhancing Teacher-Child Relationship Quality to Promote Children's Behavioral Development

ERIC Educational Resources Information Center

Vick Whittaker, Jessica E.; Jones Harden, Brenda

2010-01-01

Results from a study of 100 Head Start children and their teachers suggested that teacher-child relationship quality was associated with children's classroom behaviors. Specifically, teacher-child conflict was strongly related to children's externalizing behaviors. Based on these findings, we present recommendations for the development of policies…

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

PubMed Central

Arnold, J Malcolm O; Howlett, Jonathan G; Dorian, Paul; Ducharme, Anique; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Ignaszewski, Andrew; Isaac, Debra; Jong, Philip; Liu, Peter; Mann, Elizabeth; McKelvie, Robert S; Moe, Gordon W; Parker, John D; Svendsen, Anna M; Tsuyuki, Ross T; O’Halloran, Kelly; Ross, Heather J; Rao, Vivek; Sequeira, Errol J; White, Michel

2007-01-01

Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care. Specific clinical questions that are addressed include: which patients should be identified as being at high risk of developing heart failure and which interventions should be used? What complications can occur in heart failure patients during an intercurrent illness, how should these patients be monitored and which medications may require a dose adjustment or discontinuation? What are the best therapeutic, both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in the treatment of heart failure, and when and how should BNP be measured in heart failure patients? The goals of the present update are to translate best evidence into practice, to apply clinical wisdom where evidence for specific strategies is weaker, and to aid physicians and other health care providers to optimally treat heart failure patients to result in a measurable impact on patient health and clinical outcomes in Canada. PMID:17245481

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers.

PubMed

Arnold, J Malcom O; Howlett, Jonathan G; Dorian, Paul; Ducharme, Anique; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Ignaszewski, Andrew; Isaac, Debra; Jong, Philip; Liu, Peter; Mann, Elizabeth; McKelvie, Robert S; Moe, Gordon W; Parker, John D; Svendsen, Anna M; Tsuyuki, Ross T; O'Halloran, Kelly; Ross, Heather J; Rao, Vivek; Sequeira, Errol J; White, Michel

2007-01-01

Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care. Specific clinical questions that are addressed include: which patients should be identified as being at high risk of developing heart failure and which interventions should be used? What complications can occur in heart failure patients during an intercurrent illness, how should these patients be monitored and which medications may require a dose adjustment or discontinuation? What are the best therapeutic, both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in the treatment of heart failure, and when and how should BNP be measured in heart failure patients? The goals of the present update are to translate best evidence into practice, to apply clinical wisdom where evidence for specific strategies is weaker, and to aid physicians and other health care providers to optimally treat heart failure patients to result in a measurable impact on patient health and clinical outcomes in Canada.

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations

PubMed Central

Dakkuri, Adnan; Abrons, Jeanine P.; Williams, Dennis; Ombengi, David N.; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O’Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

2016-01-01

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education. PMID:27170809

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

PubMed

Alsharif, Naser Z; Dakkuri, Adnan; Abrons, Jeanine P; Williams, Dennis; Ombengi, David N; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O'Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

2016-04-25

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

Recommendation Method for Build-to-Order Products Considering Substitutability of Specifications and Stock Consumption Balance of Components

NASA Astrophysics Data System (ADS)

Shimoda, Atsushi; Kosugi, Hidenori; Karino, Takafumi; Komoda, Norihisa

This study focuses on a stock reduction method for build-to-order (BTO) products to flow surplus parts out to the market using sale by recommendation. A sale by recommendation is repeated in an each business negotiation using a recommended configuration selected from the inventory of parts to minimize the stock deficiency or excess at the end of a certain period of the production plan. The method is based on the potential of a customer specification to be replaced by an alternative one if the alternative one is close to the initial customer specification. A recommendation method is proposed that decides the recommended product configuration by balancing the part consumption so that the alternative specification of the configuration is close enough to the initial customer specification for substitutability. The method was evaluated by a simulation using real BTO manufacturing data and the result demonstrates that the unbalance of the consumption of parts inventory is improved.

Advising vaccinations for the elderly: a cross-sectional survey on differences between general practitioners and physician assistants in Germany.

PubMed

Klett-Tammen, Carolina Judith; Krause, Gérard; von Lengerke, Thomas; Castell, Stefanie

2016-07-29

In Germany, the coverage of officially recommended vaccinations for the elderly is below a desirable level. It is known that advice provided by General Practitioners and Physician Assistants influences the uptake in patients ≥60 years. Therefore, the predictors of advice-giving behavior by these professions should be investigated to develop recommendations for possible actions for improvement. We conducted a postal cross-sectional survey on knowledge, attitudes and advice - giving behavior regarding vaccinations in the elderly among General Practitioners and Physician Assistants in 4995 practices in Germany. To find specific predictors, we performed logistic regressions with non-advising on any officially recommended vaccination or on three specific vaccinations as four separate outcomes, first using all participants, then only General Practitioners and lastly only Physician Assistants as our study population. Participants consisted of 774 General Practitioners and 563 Physician Assistants, of whom overall 21 % stated to have not advised an officially recommended vaccination in elderly patients. The most frequent explanation was having forgotten about it. The habit of not counselling on vaccinations at regular intervals was associated with not advising any vaccination (OR: 2.8), influenza vaccination (OR: 2.3), and pneumococcal vaccination (OR: 3.1). While more General Practitioners than Physician Assistants felt sufficiently informed (90 % vs. 79 %, p < 0.001), General Practitioners displayed higher odds to not advise specific vaccinations (ORs: 1.8-2.8). To reduce the high risk of forgetting to advice on vaccinations, we recommend improving and promoting standing recall-systems, encouraging General Practitioners and Physician Assistants to counsel routinely at regular intervals regarding vaccinations, and providing Physician Assistants with better, tailor-made information on official recommendations and their changes.

RASSP final technical report

NASA Astrophysics Data System (ADS)

1992-10-01

The overall objective of the DARPA/Tri-Service RASSP program is to demonstrate a capability to rapidly specify, produce, and yield domain-specific, affordable signal processors for use in Department of Defense systems such as automatic target acquisition, tracking, and recognition, electronic countermeasures, communications, and SIGINT. The objective of the study phase is to specify a recommended program plan for the government to use as a template for procurement of the RASSP design system and demonstration program. To accomplish that objective, the study phase program tasks are to specify a development methodology for signal processors (adaptable to various organizational design styles, and application areas), analyze the requirements in CAD/CAE tools to support the development methodology, identify the state and development plans of the industry relative to this area, and to recommend the additional developments not currently being addressed by the industry, which are recommended as RASSP developments. In addition, the RASSP study phase will define a linking approach for electronically linking design centers to manufacturing centers so a complete cycle for prototyping can be accomplished with significantly reduced cycle time.

Systematic and transparent inclusion of ethical issues and recommendations in clinical practice guidelines: a six-step approach.

PubMed

Mertz, Marcel; Strech, Daniel

2014-12-04

Clinical practice guidelines (CPGs), a core tool to foster medical professionalism, differ widely in whether and how they address disease-specific ethical issues (DSEIs), and current manuals for CPG development are silent on this issue. The implementation of an explicit method faces two core challenges: first, it adds further complexity to CPG development and requires human and financial resources. Second, in contrast to the in-depth treatment of ethical issues that is standard in bioethics, the inclusion of DSEIs in CPGs need to be more pragmatic, reductive, and simplistic, but without rendering the resulting recommendations useless or insufficiently justified. This paper outlines a six-step approach, EthicsGuide, for the systematic and transparent inclusion of ethical issues and recommendations in CPGs. The development of EthicsGuide is based on (a) methodological standards in evidence-based CPG development, (b) principles of bioethics, (c) research findings on how DSEIs are currently addressed in CPGs, and (d) findings from two proof-of-concept analyses of the EthicsGuide approach. The six steps are 1) determine the DSEI spectrum and the need for ethical recommendations; 2) develop statements on which to base ethical recommendations; 3) categorize, classify, condense, and paraphrase the statements; 4) write recommendations in a standard form; 5) validate and justify recommendations, making any necessary modifications; and 6) address consent. All six steps necessarily come into play when including DSEIs in CPGs. If DSEIs are not explicitly addressed, they are unavoidably dealt with implicitly. We believe that as ethicists gain greater involvement in decision-making about health, personal rights, or economic issues, they should make their methods transparent and replicable by other researchers; and as ethical issues become more widely reflected in CPGs, CPG developers have to learn how to address them in a methodologically adequate way. The approach proposed should serve as a basis for further discussion on how to reach these goals. It breaks open the black box of what ethicists implicitly do when they develop recommendations. Further, interdisciplinary discussion and pilot tests are needed to explore the minimal requirements that guarantee a simplified procedure which is still acceptable and does not become mere window dressing.

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

PubMed

Narouze, Samer; Benzon, Honorio T; Provenzano, David; Buvanendran, Asokumar; De Andres, José; Deer, Timothy; Rauck, Richard; Huntoon, Marc A

2018-04-01

The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation. The first guidelines specific to interventional spine and pain procedures were published in 2015. Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines. The latest evidence was sought through extensive database search strategies and the recommendations were evidence based when available and pharmacology driven otherwise. We could not provide strength and grading of these recommendations because there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations. This publication is intended as a living document to be updated periodically with consideration of new evidence.

Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations.

PubMed

Hadjiliadis, Denis; Khoruts, Alexander; Zauber, Ann G; Hempstead, Sarah E; Maisonneuve, Patrick; Lowenfels, Albert B

2018-02-01

Improved therapy has substantially increased survival of persons with cystic fibrosis (CF). But the risk of colorectal cancer (CRC) in adults with CF is 5-10 times greater compared to the general population, and 25-30 times greater in CF patients after an organ transplantation. To address this risk, the CF Foundation convened a multi-stakeholder task force to develop CRC screening recommendations. The 18-member task force consisted of experts including pulmonologists, gastroenterologists, a social worker, nurse coordinator, surgeon, epidemiologist, statistician, CF adult, and a parent. The committee comprised 3 workgroups: Cancer Risk, Transplant, and Procedure and Preparation. A guidelines specialist at the CF Foundation conducted an evidence synthesis February-March 2016 based on PubMed literature searches. Task force members conducted additional independent searches. A total of 1159 articles were retrieved. After initial screening, the committee read 198 articles in full and analyzed 123 articles to develop recommendation statements. An independent decision analysis evaluating the benefits of screening relative to harms and resources required was conducted by the Department of Public Health at Erasmus Medical Center, Netherlands using the Microsimulation Screening Analysis model from the Cancer Innervation and Surveillance Modeling Network. The task force included recommendation statements in the final guideline only if they reached an 80% acceptance threshold. The task force makes 10 CRC screening recommendations that emphasize shared, individualized decision-making and familiarity with CF-specific gastrointestinal challenges. We recommend colonoscopy as the preferred screening method, initiation of screening at age 40 years, 5-year re-screening and 3-year surveillance intervals (unless shorter interval is indicated by individual findings), and a CF-specific intensive bowel preparation. Organ transplant recipients with CF should initiate CRC screening at age 30 years within 2 years of the transplantation because of the additional risk for colon cancer associated with immunosuppression. These recommendations aim to help CF adults, families, primary care physicians, gastroenterologists, and CF and transplantation centers address the issue of CRC screening. They differ from guidelines developed for the general population with respect to the recommended age of screening initiation, screening method, preparation, and the interval for repeat screening and surveillance. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians.

PubMed

Qaseem, Amir; Wilt, Timothy J; Rich, Robert; Humphrey, Linda L; Frost, Jennifer; Forciea, Mary Ann

2017-03-21

The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older. This guideline is based on a systematic review of published randomized, controlled trials for primary outcomes and observational studies for harms only (identified through EMBASE, the Cochrane Database of Systematic Reviews, MEDLINE, and ClinicalTrials.gov), from database inception through January 2015. The MEDLINE search was updated through September 2016. Evaluated outcomes included all-cause mortality, morbidity and mortality related to stroke, major cardiac events (fatal and nonfatal myocardial infarction and sudden cardiac death), and harms. This guideline grades the evidence and recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method. The target audience for this guideline includes all clinicians, and the target patient population includes all adults aged 60 years or older with hypertension. ACP and AAFP recommend that clinicians initiate treatment in adults aged 60 years or older with systolic blood pressure persistently at or above 150 mm Hg to achieve a target systolic blood pressure of less than 150 mm Hg to reduce the risk for mortality, stroke, and cardiac events. (Grade: strong recommendation, high-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient. ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for recurrent stroke. (Grade: weak recommendation, moderate-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient. ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for stroke or cardiac events. (Grade: weak recommendation, low-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient.

Calibration of load and resistance factors in LRFD foundation design specifications

DOT National Transportation Integrated Search

2011-02-01

This report summarizes the findings and recommendations on the impact of foundation settlements on the reliability of bridge superstructures. As a collaborative effort of an overall initiative for the development of LRFD foundation design specificati...

ACR Appropriateness Criteria® Headache-Child.

PubMed

Hayes, Laura L; Palasis, Susan; Bartel, Twyla B; Booth, Timothy N; Iyer, Ramesh S; Jones, Jeremy Y; Kadom, Nadja; Milla, Sarah S; Myseros, John S; Pakalnis, Ann; Partap, Sonia; Robertson, Richard L; Ryan, Maura E; Saigal, Gaurav; Soares, Bruno P; Tekes, Aylin; Karmazyn, Boaz K

2018-05-01

Headaches in children are not uncommon and have various causes. Proper neuroimaging of these children is very specific to the headache type. Care must be taken to choose and perform the most appropriate initial imaging examination in order to maximize the ability to properly determine the cause with minimum risk to the child. This evidence-based report discusses the different headache types in children and provides appropriate guidelines for imaging these children. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Treating foodborne illness.

PubMed

Steiner, Theodore

2013-09-01

In healthy adults and children in developed countries, most foodborne and water-borne infections are short-lived and resolve without specific treatment. In developing areas, these infections may produce acute mortality and chronic morbidity caused by developmental impairment. Immune-compromised hosts are at increased risk of life-threatening complications. This article reviews recommendations for the treatment of the most common and important foodborne illnesses, focusing on those caused by infections or toxins of microbial origin. The cornerstone of life-saving treatment remains oral rehydration therapy, although the use of other supportive measures as well as antibiotics for certain infections is also recommended. Copyright © 2013 Elsevier Inc. All rights reserved.

[Quality of the pharmacotherapeutic recommendations for the integrated care procedures in Andalusia].

PubMed

Corte, Rosa María Muñoz; Estepa, Raúl García; Ramos, Bernardo Santos; Paloma, Francisco Javier Bautista

2009-01-01

To evaluate the quality of the pharmacotherapeutic recommendations included in the Integrated Care Procedures (PAIs regarding its initials in Spanish) of the Andalusian Ministry of Health, published up to March 2008, through the design and validation of a tool. The assessment tool was designed based on similar instruments, specifically the AGREE. Other criteria included were taken from various literature sources or were devised by ourselves. The tool was validated prior to being used. After applying it to all the PAIs, we examined the degree of compliance with these pharmacotherapeutic criteria, both as a whole and by PAIs subgroups. The developed tool is a questionnaire of 20 items, divided into 4 sections. The first section consists of the essential criteria, and the rest make reference to more specific, non essential criteria: definition of the level of evidence, thoroughness of information and definition of indicators. It was found that 4 of the 60 PAIs do not contain any type of therapeutic recommendation. No PAI fulfils all the items listed in the tool, however, 70 % of them fulfil the essential quality criteria established. There is a great variability in the content of pharmacotherapeutic recommendations for each PAI. Once the validity of the tool has been proved, it could be used to assess the quality of the therapeutic recommendations in clinical practice guidelines.

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

PubMed Central

Sanello, Ashley; Mulkerin, William; Sporer, Karl A.; Brown, John F.; Koenig, Kristi L.; Rudnick, Eric M.; Salvucci, Angelo A.; Gilbert, Gregory H.

2018-01-01

Introduction In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management. Results Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol. Conclusion Protocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols. PMID:29760852

Earth Observatory Satellite system definition study. Report 4: Low cost management approach and recommendations

NASA Technical Reports Server (NTRS)

1974-01-01

An analysis of low cost management approaches for the development of the Earth Observatory Satellite (EOS) is presented. The factors of the program which tend to increase costs are identified. The NASA/Industry interface is stressed to show how the interface can be improved to produce reduced program costs. Techniques and examples of cost reduction which can be applied to the EOS program are tabulated. Specific recommendations for actions to be taken to reduce costs in prescribed areas are submitted.

Opioid Therapy for Chronic Pain: Overview of the 2017 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline.

PubMed

Rosenberg, Jack M; Bilka, Brandon M; Wilson, Sara M; Spevak, Christopher

2018-05-01

The US Department of Veterans Affairs (VA) and US Department of Defense (DoD) revised the 2010 clinical practice guideline (CPG) for the management of opioid therapy for chronic pain, considering the specific needs of the VA and DoD and new evidence regarding prescribing opioid medication for non-end-of-life-related chronic pain. This paper summarizes the major recommendations and compares them with the US Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids. This Opioid Therapy CPG was developed for VA-DoD service members, veterans, and their families. The VA/DoD Evidence-Based Practice Work Group convened a VA/DoD guideline renewal development effort and conformed to the guidelines established by the VA/DoD Joint Executive Council (JEC) and VA/DoD Health Executive Council (HEC). The panel developed questions, searched and evaluated the literature, developed recommendations using GRADE methodology, and developed algorithms. Passage of the CARA Act by Congress compelled consideration and comparison with the CDC opioid therapy guideline mid-development. There were 18 recommendations made. This article focuses on guideline development and key recommendations with CDC comparisons taken from four major areas, including: initiation and continuation of opioids;type, dose, follow-up, and taper of opioids;risk mitigation;acute pain. Guideline development and recommendations are presented. There was substantial overlap with the CDC opioid guideline. Additionally, there were items particularly relevant to the VA-DoD, including risk mitigation, suicide prevention, and preventing opioid use disorder in young patients. Our guideline highlights avoiding opioid therapy longer than 90 days as a critical juncture.

Standardization of formulations for the acute amino acid depletion and loading tests.

PubMed

Badawy, Abdulla A-B; Dougherty, Donald M

2015-04-01

The acute tryptophan depletion and loading and the acute tyrosine plus phenylalanine depletion tests are powerful tools for studying the roles of cerebral monoamines in behaviour and symptoms related to various disorders. The tests use either amino acid mixtures or proteins. Current amino acid mixtures lack specificity in humans, but not in rodents, because of the faster disposal of branched-chain amino acids (BCAAs) by the latter. The high content of BCAA (30-60%) is responsible for the poor specificity in humans and we recommend, in a 50g dose, a control formulation with a lowered BCAA content (18%) as a common control for the above tests. With protein-based formulations, α-lactalbumin is specific for acute tryptophan loading, whereas gelatine is only partially effective for acute tryptophan depletion. We recommend the use of the whey protein fraction glycomacropeptide as an alternative protein. Its BCAA content is ideal for specificity and the absence of tryptophan, tyrosine and phenylalanine render it suitable as a template for seven formulations (separate and combined depletion or loading and a truly balanced control). We invite the research community to participate in standardization of the depletion and loading methodologies by using our recommended amino acid formulation and developing those based on glycomacropeptide. © The Author(s) 2015.

Standardization of formulations for the acute amino acid depletion and loading test

PubMed Central

Badawy, Abdulla A-B; Dougherty, Donald M

2017-01-01

The acute tryptophan (Trp) depletion (ATD) and loading (ATL) and the acute tyrosine (Tyr) plus phenylalanine (Phe) depletion (ATPD) tests are powerful tools for studying the roles of cerebral monoamines in behaviour and symptoms related to various disorders. The tests use either amino acid mixtures or proteins. Current amino acid mixtures lack specificity in humans, but not in rodents, because of the faster disposal of branched-chain amino acids (BCAA) by the latter. The high content of BCAA (30-60%) is responsible for the poor specificity in humans and we recommend, in a 50g dose, the control formulation of Young et al. (1985) with a lowered BCAA content (18%) and minor modifications as a common control for the above tests. With protein-based formulations, α-lactalbumin is specific for ATL, whereas gelatine is only partially effective for ATD. We recommend the use of the whey protein fraction glycomacropeptide (GMP) as an alternative protein. Its BCAA content is ideal for specificity and the absence of Trp, Tyr and Phe render it suitable as a template for 7 formulations (separate and combined depletion or loading and a truly balanced control). We invite the research community to participate in standardization of the depletion and loading methodologies by using our recommended amino acid formulation and developing those based on GMP. PMID:25586395

Recent advances and opportunities in research on lupus: environmental influences and mechanisms of disease.

PubMed

Cooper, Glinda S; Gilbert, Kathleen M; Greidinger, Eric L; James, Judith A; Pfau, Jean C; Reinlib, Leslie; Richardson, Bruce C; Rose, Noel R

2008-06-01

In this review we summarize research on mechanisms through which environmental agents may affect the pathogenesis of lupus, discuss three exposures that have been the focus of research in this area, and propose recommendations for new research initiatives. We examined studies pertaining to key mechanistic events and specific exposures. Apoptosis leading to increased production or decreased clearance of immunogenic intracellular self-antigens and defective apoptosis of autoreactive immune cells both have been implicated in the loss of self-tolerance. The adjuvant or bystander effect is also needed to produce a sustained autoimmune response. Activation of toll-like receptors is one mechanism through which these effects may occur. Abnormal DNA methylation may also contribute to the pathogenesis of lupus. Each of the specific exposures we examined--Epstein-Barr virus, silica, and trichloroethylene--has been shown, in humans or in mice, to act upon one or more of these pathogenic steps. Specific recommendations for the continued advancement of our understanding of environmental influences on lupus and other autoimmune diseases include the development and use of mouse models with varying degrees of penetrance and manifestations of disease, identification of molecular or physiologic targets of specific exposures, development and use of improved exposure assessment methodologies, and multisite collaborations designed to examine understudied environmental exposures in humans. The advances made in the past decade concerning our understanding of mechanisms involved in the development of lupus and the influence of environmental agents on this process provide a strong foundation for further developments in this field.

Preschool Multiple-Breath Washout Testing. An Official American Thoracic Society Technical Statement.

PubMed

Robinson, Paul D; Latzin, Philipp; Ramsey, Kathryn A; Stanojevic, Sanja; Aurora, Paul; Davis, Stephanie D; Gappa, Monika; Hall, Graham L; Horsley, Alex; Jensen, Renee; Lum, Sooky; Milla, Carlos; Nielsen, Kim G; Pittman, Jessica E; Rosenfeld, Margaret; Singer, Florian; Subbarao, Padmaja; Gustafsson, Per M; Ratjen, Felix

2018-03-01

Obstructive airway disease is nonuniformly distributed throughout the bronchial tree, although the extent to which this occurs can vary among conditions. The multiple-breath washout (MBW) test offers important insights into pediatric lung disease, not available through spirometry or resistance measurements. The European Respiratory Society/American Thoracic Society inert gas washout consensus statement led to the emergence of validated commercial equipment for the age group 6 years and above; specific recommendations for preschool children were beyond the scope of the document. Subsequently, the focus has shifted to MBW applications within preschool subjects (aged 2-6 yr), where a "window of opportunity" exists for early diagnosis of obstructive lung disease and intervention. This preschool-specific technical standards document was developed by an international group of experts, with expertise in both custom-built and commercial MBW equipment. A comprehensive review of published evidence was performed. Recommendations were devised across areas that place specific age-related demands on MBW systems. Citing evidence where available in the literature, recommendations are made regarding procedures that should be used to achieve robust MBW results in the preschool age range. The present work also highlights the important unanswered questions that need to be addressed in future work. Consensus recommendations are outlined to direct interested groups of manufacturers, researchers, and clinicians in preschool device design, test performance, and data analysis for the MBW technique.

Apollo experience report: Lunar module electrical power subsystem

NASA Technical Reports Server (NTRS)

Campos, A. B.

1972-01-01

The design and development of the electrical power subsystem for the lunar module are discussed. The initial requirements, the concepts used to design the subsystem, and the testing program are explained. Specific problems and the modifications or compromises (or both) imposed for resolution are detailed. The flight performance of the subsystem is described, and recommendations pertaining to power specifications for future space applications are made.

Creating A Choral Sound.

ERIC Educational Resources Information Center

Leenman, Tracy E.

1996-01-01

Covers a variety of strategies for creating a unique and identifiable choral sound. Provides specific instructions for developing singing in unison and recommends a standing arrangement of soprano, alto, tenor, and bass quartets. Provides other tips for instrumentation, sight reading, and quality rehearsal time. (MJP)

Project 2d: Calibration of Load and Resistance Factors in LRFD Foundation Design Specifications

DOT National Transportation Integrated Search

2011-02-01

This report summarizes the findings and recommendations on the impact of foundation settlements on the reliability of bridge superstructures. As a : collaborative effort of an overall initiative for the development of LRFD foundation design specifica...

Micronesian agroforestry: evidence from the past, implications for the future

Treesearch

Marjorie V. C. Falanruw

1993-01-01

Traditional agroforest systems exist throughout Micronesia. The system found on one Micronesian group of islands, Yap, is described and evaluated in ecological terms. Implications for future development of agriculture in Micronesia are discussed and some specific recommendations are given.

The Continuous Quality Improvement Book Club: Developing a Book Club to Promote Praxis

ERIC Educational Resources Information Center

Lyons, Becky; Ray, Chris

2014-01-01

This article poses a model for developing a book club to promote praxis. This model is built upon a basic four step framework for developing book clubs and includes specific recommendations to focus the book club on reflection of theory and how to incorporate it into practice. This model will be used to start a book club examining Continuous…

Cultural theories of nursing responsive to human needs and values.

PubMed

Kikuchi, June F

2005-01-01

To present an alternative to the recent proposal that the extant theories of nursing be replaced with culture-specific theories of nursing in order to have theories of nursing that are culturally responsive. A philosophical analysis of the implications for nursing practice of adopting the proposal serves as the basis for recommending a different philosophically based theoretical solution. Anticipated probable objections to that recommendation are considered. Culture-specific theories of nursing might allow nurses to be culturally sensitive. However, because nurses must be humanly responsive to the needs of people as human beings and not just as cultural beings, cultural theories of nursing should be developed within the precepts of a transcultural theory of nursing grounded in a conception of objective human needs and values.

Functional Specifications for Computer Aided Training Systems Development and Management (CATSDM) Support Functions. Final Report.

ERIC Educational Resources Information Center

Hughes, John; And Others

This report provides a description of a Computer Aided Training System Development and Management (CATSDM) environment based on state-of-the-art hardware and software technology, and including recommendations for off the shelf systems to be utilized as a starting point in addressing the particular systematic training and instruction design and…

Physical activity, sedentary behaviour and sleep in COPD guidelines: A systematic review.

PubMed

Lewthwaite, Hayley; Effing, Tanja W; Olds, Timothy; Williams, Marie T

2017-08-01

Physical activity, sedentary and sleep behaviours have strong associations with health. This systematic review aimed to identify how clinical practice guidelines (CPGs) for the management of chronic obstructive pulmonary disease (COPD) report specific recommendations and strategies for these movement behaviours. A systematic search of databases (Medline, Scopus, CiNAHL, EMbase, Clinical Guideline), reference lists and websites identified current versions of CPGs published since 2005. Specific recommendations and strategies concerning physical activity, sedentary behaviour and sleep were extracted verbatim. The proportions of CPGs providing specific recommendations and strategies were reported. From 2370 citations identified, 35 CPGs were eligible for inclusion. Of these, 21 (60%) provided specific recommendations for physical activity, while none provided specific recommendations for sedentary behaviour or sleep. The most commonly suggested strategies to improve movement behaviours were encouragement from a healthcare provider (physical activity n = 20; sedentary behaviour n = 2) and referral for a diagnostic sleep study (sleep n = 4). Since optimal physical activity, sedentary behaviour and sleep durations and patterns are likely to be associated with mitigating the effects of COPD, as well as with general health and well-being, there is a need for further COPD-specific research, consensus and incorporation of recommendations and strategies into CPGs.

2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.

PubMed

Dejaco, Christian; Singh, Yogesh P; Perel, Pablo; Hutchings, Andrew; Camellino, Dario; Mackie, Sarah; Abril, Andy; Bachta, Artur; Balint, Peter; Barraclough, Kevin; Bianconi, Lina; Buttgereit, Frank; Carsons, Steven; Ching, Daniel; Cid, Maria; Cimmino, Marco; Diamantopoulos, Andreas; Docken, William; Duftner, Christina; Fashanu, Billy; Gilbert, Kate; Hildreth, Pamela; Hollywood, Jane; Jayne, David; Lima, Manuella; Maharaj, Ajesh; Mallen, Christian; Martinez-Taboada, Victor; Maz, Mehrdad; Merry, Steven; Miller, Jean; Mori, Shunsuke; Neill, Lorna; Nordborg, Elisabeth; Nott, Jennifer; Padbury, Hannah; Pease, Colin; Salvarani, Carlo; Schirmer, Michael; Schmidt, Wolfgang; Spiera, Robert; Tronnier, David; Wagner, Alexandre; Whitlock, Madeline; Matteson, Eric L; Dasgupta, Bhaskar

2015-10-01

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

User-Centered Design for Developing Interventions to Improve Clinician Recommendation of Human Papillomavirus Vaccination

PubMed Central

Henninger, Michelle L; McMullen, Carmit K; Firemark, Alison J; Naleway, Allison L; Henrikson, Nora B; Turcotte, Joseph A

2017-01-01

Introduction Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and is associated with multiple types of cancer. Although effective HPV vaccines have been available since 2006, coverage rates in the US remain much lower than with other adolescent vaccinations. Prior research has shown that a strong recommendation from a clinician is a critical determinant in HPV vaccine uptake and coverage. However, few published studies to date have specifically addressed the issue of helping clinicians communicate more effectively with their patients about the HPV vaccine. Objective To develop one or more novel interventions for helping clinicians make strong and effective recommendations for HPV vaccination. Methods Using principles of user-centered design, we conducted qualitative interviews, interviews with persons from analogous industries, and a data synthesis workshop with multiple stakeholders. Results Five potential intervention strategies targeted at health care clinicians, youth, and their parents were developed. The two most popular choices to pursue were a values-based communication strategy and a puberty education workbook. Conclusion User-centered design is a useful strategy for developing potential interventions to improve the rate and success of clinicians recommending the HPV vaccine. Further research is needed to test the effectiveness and acceptability of these interventions in clinical settings. PMID:28898195

User-Centered Design for Developing Interventions to Improve Clinician Recommendation of Human Papillomavirus Vaccination.

PubMed

Henninger, Michelle L; Mcmullen, Carmit K; Firemark, Alison J; Naleway, Allison L; Henrikson, Nora B; Turcotte, Joseph A

2017-01-01

Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and is associated with multiple types of cancer. Although effective HPV vaccines have been available since 2006, coverage rates in the US remain much lower than with other adolescent vaccinations. Prior research has shown that a strong recommendation from a clinician is a critical determinant in HPV vaccine uptake and coverage. However, few published studies to date have specifically addressed the issue of helping clinicians communicate more effectively with their patients about the HPV vaccine. To develop one or more novel interventions for helping clinicians make strong and effective recommendations for HPV vaccination. Using principles of user-centered design, we conducted qualitative interviews, interviews with persons from analogous industries, and a data synthesis workshop with multiple stakeholders. Five potential intervention strategies targeted at health care clinicians, youth, and their parents were developed. The two most popular choices to pursue were a values-based communication strategy and a puberty education workbook. User-centered design is a useful strategy for developing potential interventions to improve the rate and success of clinicians recommending the HPV vaccine. Further research is needed to test the effectiveness and acceptability of these interventions in clinical settings.

Development of an evidence-informed leisure time physical activity resource for adults with spinal cord injury: the SCI Get Fit Toolkit.

PubMed

Arbour-Nicitopoulos, K P; Martin Ginis, K A; Latimer-Cheung, A E; Bourne, C; Campbell, D; Cappe, S; Ginis, S; Hicks, A L; Pomerleau, P; Smith, K

2013-06-01

To systematically develop an evidence-informed leisure time physical activity (LTPA) resource for adults with spinal cord injury (SCI). Canada. The Appraisal of Guidelines, Research and Evaluation (AGREE) II protocol was used to develop a toolkit to teach and encourage adults with SCI how to make smart and informed choices about being physically active. A multidisciplinary expert panel appraised the evidence and generated specific recommendations for the content of the toolkit. Pilot testing was conducted to refine the toolkit's presentation. Recommendations emanating from the consultation process were that the toolkit be a brief, evidence-based resource that contains images of adults with tetraplegia and paraplegia, and links to more detailed online information. The content of the toolkit should include the physical activity guidelines (PAGs) for adults with SCI, activities tailored to manual and power chair users, the benefits of LTPA, and strategies to overcome common LTPA barriers for adults with SCI. The inclusion of action plans and safety tips was also recommended. These recommendations have resulted in the development of an evidence-informed LTPA resource to assist adults with SCI in meeting the PAGs. This toolkit will have important implications for consumers, health care professionals and policy makers for encouraging LTPA in the SCI community.

Cancer screening guidelines.

PubMed

Zoorob, R; Anderson, R; Cefalu, C; Sidani, M

2001-03-15

Numerous medical organizations have developed cancer screening guidelines. Faced with the broad, and sometimes conflicting, range of recommendations for cancer screening, family physicians must determine the most reasonable and up-to-date method of screening. Major medical organizations have generally achieved consensus on screening guidelines for breast, cervical and colorectal cancer. For breast cancer screening in women ages 50 to 70, clinical breast examination and mammography are generally recommended every one or two years, depending on the medical organization. For cervical cancer screening, most organizations recommend a Papanicolaou test and pelvic examination at least every three years in patients between 20 and 65 years of age. Annual fecal occult blood testing along with flexible sigmoidoscopy at five-year to 10-year intervals is the standard recommendation for colorectal cancer screening in patients older than 50 years. Screening for prostate cancer remains a matter of debate. Some organizations recommend digital rectal examination and a serum prostate-specific antigen test for men older than 50 years, while others do not. In the absence of compelling evidence to indicate a high risk of endometrial cancer, lung cancer, oral cancer and ovarian cancer, almost no medical organizations have developed cancer screening guidelines for these types of cancer.

Ethical practice in Telehealth and Telemedicine.

PubMed

Chaet, Danielle; Clearfield, Ron; Sabin, James E; Skimming, Kathryn

2017-10-01

This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).

A survey of tobacco dependence treatment guidelines in 121 countries

PubMed Central

Piné-Abata, Hembadoon; McNeill, Ann; Raw, Martin; Bitton, Asaf; Rigotti, Nancy; Murray, Rachael

2013-01-01

Aims To report progress among Parties to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in developing national tobacco treatment guidelines in accordance with FCTC Article 14 guideline recommendations. Design Cross-sectional study. Setting Electronic survey from December 2011 to August 2012; participants were asked to complete either an online or attached Microsoft Word questionnaire. Participants One hundred and sixty-three of the 173 Parties to the FCTC at the time of our survey. Measurements The 51-item questionnaire contained 30 items specifically on guidelines. Questions covered the areas of guidelines writing process, content, key recommendations and other characteristics. Findings One hundred and twenty-one countries (73%) responded. Fifty-three countries (44%) had guidelines, ranging from 75% among high-income countries to 11% among low-income countries. Nearly all guidelines recommended brief advice (93%), intensive specialist support (93%) and medications (96%), while 66% recommended quitlines. Fifty-seven percent had a dissemination strategy, 76% stated funding source and 68% had professional endorsement. Conclusion Fewer than half of the Parties to the WHO FCTC have developed national tobacco treatment guidelines, but, where guidelines exist, they broadly follow FCTC Article 14 guideline recommendations. PMID:23437892

"We get them up, moving, and out the door. How do we get them to do what is recommended?" Using behaviour change theory to put exercise evidence into action for rehabilitation professionals.

PubMed

McArthur, Caitlin; Ziebart, Christina; Papaioannou, Alexandra; Cheung, Angela M; Laprade, Judi; Lee, Linda; Jain, Ravi; Giangregorio, Lora M

2018-01-25

Recommendations suggest a multicomponent exercise for people with osteoporosis. We identified rehabilitation professionals' barriers and facilitators to implementing exercise recommendations with people with osteoporosis, and used those to make suggestions for targeted knowledge translation interventions. Future work will report on development and evaluation of the interventions informed by our study. Rehabilitation professionals can help people with osteoporosis to engage in a multicomponent exercise program and perform activities of daily living safely. However, rehabilitation professional face barriers to implementing exercise evidence, especially for specific disease conditions like osteoporosis. We performed a behavioural analysis and identified rehabilitation professionals' barriers to and facilitators of implementing disease-specific physical activity and exercise recommendations (Too Fit to Fracture recommendations), and used the Behaviour Change Wheel to select interventions. Semi-structured interviews and focus groups were conducted with rehabilitation professionals, including physical therapists, kinesiologists, and occupational therapists, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the Behaviour Change Wheel framework, themes were categorized into capability, opportunity, and motivation, and relevant interventions were identified. Ninety-four rehabilitation professionals (mean age 40.5 years, 88.3% female) participated. Identified barriers were as follows: capability-lack of training in behaviour change, how to modify recommendations for physical and cognitive impairments; opportunity-lack of resources, time, and team work; motivation-lack of trust between providers, fear in providing interventions that may cause harm. Interventions selected were as follows: education, training, enablement, modelling and persuasion. Policy categories are communication/marketing, guidelines, service provision and environmental/social planning. Key barriers to implementing the recommendations are rehabilitation professionals' ability to use behaviour change techniques, to modify the recommendations for physical and cognitive limitations and to feel comfortable with delivering challenging but safe interventions for people with osteoporosis, and lacking trust and team work across sectors. Future work will report on development and evaluation of knowledge translation interventions informed by our study.

Considering health equity when moving from evidence-based guideline recommendations to implementation: a case study from an upper-middle income country on the GRADE approach

PubMed Central

Mosquera, Paola; Alzate, Juan Pablo; Pottie, Kevin; Welch, Vivian; Akl, Elie A; Jull, Janet; Lang, Eddy; Katikireddi, Srinivasa Vittal; Morton, Rachel; Thabane, Lehana; Shea, Bev; Stein, Airton T; Singh, Jasvinder; Florez, Ivan D; Guyatt, Gordon; Schünemann, Holger; Tugwell, Peter

2017-01-01

Abstract The availability of evidence-based guidelines does not ensure their implementation and use in clinical practice or policy making. Inequities in health have been defined as those inequalities within or between populations that are avoidable, unnecessary and also unjust and unfair. Evidence-based clinical practice and public health guidelines (‘guidelines’) can be used to target health inequities experienced by disadvantaged populations, although guidelines may unintentionally increase health inequities. For this reason, there is a need for evidence-based clinical practice and public health guidelines to intentionally target health inequities experienced by disadvantaged populations. Current guideline development processes do not include steps for planned implementation of equity-focused guidelines. This article describes nine steps that provide guidance for consideration of equity during guideline implementation. A critical appraisal of the literature followed by a process to build expert consensus was undertaken to define how to include consideration of equity issues during the specific GRADE guideline development process. Using a case study from Colombia we describe nine steps that were used to implement equity-focused GRADE recommendations: (1) identification of disadvantaged groups, (2) quantification of current health inequities, (3) development of equity-sensitive recommendations, (4) identification of key actors for implementation of equity-focused recommendations, (5) identification of barriers and facilitators to the implementation of equity-focused recommendations, (6) development of an equity strategy to be included in the implementation plan, (7) assessment of resources and incentives, (8) development of a communication strategy to support an equity focus and (9) development of monitoring and evaluation strategies. This case study can be used as model for implementing clinical practice guidelines, taking into account equity issues during guideline development and implementation. PMID:29029068

Developing an evidence-based Guide to Community Preventive Services--methods. The Task Force on Community Preventive Services.

PubMed

Briss, P A; Zaza, S; Pappaioanou, M; Fielding, J; Wright-De Agüero, L; Truman, B I; Hopkins, D P; Mullen, P D; Thompson, R S; Woolf, S H; Carande-Kulis, V G; Anderson, L; Hinman, A R; McQueen, D V; Teutsch, S M; Harris, J R

2000-01-01

Systematic reviews and evidence-based recommendations are increasingly important for decision making in health and medicine. Over the past 20 years, information on the science of synthesizing research results has exploded. However, some approaches to systematic reviews of the effectiveness of clinical preventive services and medical care may be less appropriate for evaluating population-based interventions. Furthermore, methods for linking evidence to recommendations are less well developed than methods for synthesizing evidence. The Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) will evaluate and make recommendations on population-based and public health interventions. This paper provides an overview of the Guide's process to systematically review evidence and translate that evidence into recommendations. The Guide reviews evidence on effectiveness, the applicability of effectiveness data, (i.e., the extent to which available effectiveness data is thought to apply to additional populations and settings), the intervention's other effects (i.e., important side effects), economic impact, and barriers to implementation of interventions. The steps for obtaining and evaluating evidence into recommendations involve: (1) forming multidisciplinary chapter development teams, (2) developing a conceptual approach to organizing, grouping, selecting and evaluating the interventions in each chapter; (3) selecting interventions to be evaluated; (4) searching for and retrieving evidence; (5) assessing the quality of and summarizing the body of evidence of effectiveness; (6) translating the body of evidence of effectiveness into recommendations; (7) considering information on evidence other than effectiveness; and (8) identifying and summarizing research gaps. Systematic reviews of and evidence-based recommendations for population-health interventions are challenging and methods will continue to evolve. However, using an evidence-based approach to identify and recommend effective interventions directed at specific public health goals may reduce errors in how information is collected and interpreted, identify important gaps in current knowledge thus guiding further research, and enhance the Guide users' ability to assess whether recommendations are valid and prudent from their own perspectives. Over time, all of these advantages could help to increase agreement regarding appropriate community health strategies and help to increase their implementation.

A service brokering and recommendation mechanism for better selecting cloud services.

PubMed

Gui, Zhipeng; Yang, Chaowei; Xia, Jizhe; Huang, Qunying; Liu, Kai; Li, Zhenlong; Yu, Manzhu; Sun, Min; Zhou, Nanyin; Jin, Baoxuan

2014-01-01

Cloud computing is becoming the new generation computing infrastructure, and many cloud vendors provide different types of cloud services. How to choose the best cloud services for specific applications is very challenging. Addressing this challenge requires balancing multiple factors, such as business demands, technologies, policies and preferences in addition to the computing requirements. This paper recommends a mechanism for selecting the best public cloud service at the levels of Infrastructure as a Service (IaaS) and Platform as a Service (PaaS). A systematic framework and associated workflow include cloud service filtration, solution generation, evaluation, and selection of public cloud services. Specifically, we propose the following: a hierarchical information model for integrating heterogeneous cloud information from different providers and a corresponding cloud information collecting mechanism; a cloud service classification model for categorizing and filtering cloud services and an application requirement schema for providing rules for creating application-specific configuration solutions; and a preference-aware solution evaluation mode for evaluating and recommending solutions according to the preferences of application providers. To test the proposed framework and methodologies, a cloud service advisory tool prototype was developed after which relevant experiments were conducted. The results show that the proposed system collects/updates/records the cloud information from multiple mainstream public cloud services in real-time, generates feasible cloud configuration solutions according to user specifications and acceptable cost predication, assesses solutions from multiple aspects (e.g., computing capability, potential cost and Service Level Agreement, SLA) and offers rational recommendations based on user preferences and practical cloud provisioning; and visually presents and compares solutions through an interactive web Graphical User Interface (GUI).

Deep Vein Thrombosis Prophylaxis: State of the Art.

PubMed

Lieberman, Jay R

2018-03-21

The selection of a prophylaxis regimen to prevent symptomatic pulmonary embolism and deep vein thrombosis is a balance between efficacy and safety. The latest American Academy of Orthopaedic Surgeons guideline recommended that either chemoprophylaxis or mechanical prophylaxis be used after total joint arthroplasty but did not recommend specific agents. However, the latest evidence-based American College of Chest Physicians guideline recommended a variety of chemoprophylaxis and mechanical agents for a minimum of 10 to 14 days after total joint arthroplasty. Risk stratification is the key to the selection of the appropriate prophylaxis regimen for the individual patient, but the optimal risk stratification protocol still needs to be developed. Copyright © 2018. Published by Elsevier Inc.

Recommendations for kidney disease guideline updating: a report by the KDIGO Methods Committee

PubMed Central

Uhlig, Katrin; Berns, Jeffrey S.; Carville, Serena; Chan, Wiley; Cheung, Michael; Guyatt, Gordon H.; Hart, Allyson; Lewis, Sandra Zelman; Tonelli, Marcello; Webster, Angela C.; Wilt, Timothy J.; Kasiske, Bertram L.

2017-01-01

Updating rather than de novo guideline development now accounts for the majority of guideline activities for many guideline development organizations, including Kidney Disease: Improving Global Outcomes (KDIGO), an international kidney disease guideline development entity that has produced guidelines on kidney diseases since 2008. Increasingly, guideline developers are moving away from updating at fixed intervals in favor of more flexible approaches that use periodic expert assessment of guideline currency (with or without an updated systematic review) to determine the need for updating. Determining the need for guideline updating in an efficient, transparent, and timely manner is challenging, and updating of systematic reviews and guidelines is labor intensive. Ideally, guidelines should be updated dynamically when new evidence indicates a need for a substantive change in the guideline based on a priori criteria. This dynamic updating (sometimes referred to as a living guideline model) can be facilitated with the use of integrated electronic platforms that allow updating of specific recommendations. This report summarizes consensus-based recommendations from a panel of guideline methodology professionals on how to keep KDIGO guidelines up to date. PMID:26994574

Seismology software: state of the practice

NASA Astrophysics Data System (ADS)

Smith, W. Spencer; Zeng, Zheng; Carette, Jacques

2018-05-01

We analyzed the state of practice for software development in the seismology domain by comparing 30 software packages on four aspects: product, implementation, design, and process. We found room for improvement in most seismology software packages. The principal areas of concern include a lack of adequate requirements and design specification documents, a lack of test data to assess reliability, a lack of examples to get new users started, and a lack of technological tools to assist with managing the development process. To assist going forward, we provide recommendations for a document-driven development process that includes a problem statement, development plan, requirement specification, verification and validation (V&V) plan, design specification, code, V&V report, and a user manual. We also provide advice on tool use, including issue tracking, version control, code documentation, and testing tools.

Seismology software: state of the practice

NASA Astrophysics Data System (ADS)

Smith, W. Spencer; Zeng, Zheng; Carette, Jacques

2018-02-01

We analyzed the state of practice for software development in the seismology domain by comparing 30 software packages on four aspects: product, implementation, design, and process. We found room for improvement in most seismology software packages. The principal areas of concern include a lack of adequate requirements and design specification documents, a lack of test data to assess reliability, a lack of examples to get new users started, and a lack of technological tools to assist with managing the development process. To assist going forward, we provide recommendations for a document-driven development process that includes a problem statement, development plan, requirement specification, verification and validation (V&V) plan, design specification, code, V&V report, and a user manual. We also provide advice on tool use, including issue tracking, version control, code documentation, and testing tools.

The engineering of construction specifications for externally bonded FRP composites

NASA Astrophysics Data System (ADS)

Yang, Xinbao

This dissertation, consisting of six technical papers, presents the results of research on the theme of developing engineering and the construction specifications for externally bonded FRP composites. For particular, the work focuses on three critical aspects of the performance of FRP systems: fiber misalignment, corner radius, and lap splice length. Based on both experimental and theoretical investigations, the main contribution of this work is the development of recommendations on fiber misalignment limit, minimum corner radius, lap splice length to be used as guidance in the construction practice of FRP strengthening of concrete structures. The first three papers focus on the strength and stiffness degradation of CFRP laminates from fiber misalignment. It was concluded that misalignment affects strength more than stiffness. In practice, when all fibers in a laminate can be regarded as through fibers, it is recommended to use a reduction factor for strength and no reduction factor for stiffness to account for fiber misalignment. Findings from concrete beams strengthened with misaligned CFRP laminates verified these recommendations. The fourth and fifth papers investigate the effect of corner radius on the mechanical properties of CFRP laminates wrapped around a rectangular cross section. A unique reusable test device was fabricated to determine fiber stress and radial stress of CFRP laminates with different corner radii. Comparison performed with finite element analyses shows that the test method and the reusable device were viable and the stress concentration needs to be considered in FRP laminate wrapped corners. A minimum of 1.0 in. corner radius was recommended for practice. The sixth paper summarizes the research on the lap splice length of FRP laminates under static and repeated loads. Although a lap splice length of 1.5 in. is sufficient for CFRP laminates to develop the ultimate static tensile strength, a minimum of 4.0 in. is recommended in order to account for repeated loads.

Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines

PubMed Central

Norris, Susan L.; Schulman, Sam; Hirsh, Jack; Eckman, Mark H.; Akl, Elie A.; Crowther, Mark; Vandvik, Per Olav; Eikelboom, John W.; McDonagh, Marian S.; Lewis, Sandra Zelman; Gutterman, David D.; Cook, Deborah J.; Schünemann, Holger J.

2012-01-01

Background: To develop the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Evidence-Based Clinical Practice Guidelines (AT9), the American College of Chest Physicians (ACCP) assembled a panel of clinical experts, information scientists, decision scientists, and systematic review and guideline methodologists. Methods: Clinical areas were designated as articles, and a methodologist without important intellectual or financial conflicts of interest led a panel for each article. Only panel members without significant conflicts of interest participated in making recommendations. Panelists specified the population, intervention and alternative, and outcomes for each clinical question and defined criteria for eligible studies. Panelists and an independent evidence-based practice center executed systematic searches for relevant studies and evaluated the evidence, and where resources and evidence permitted, they created standardized tables that present the quality of the evidence and key results in a transparent fashion. Results: One or more recommendations relate to each specific clinical question, and each recommendation is clearly linked to the underlying body of evidence. Judgments regarding the quality of evidence and strength of recommendations were based on approaches developed by the Grades of Recommendations, Assessment, Development, and Evaluation Working Group. Panel members constructed scenarios describing relevant health states and rated the disutility associated with these states based on an additional systematic review of evidence regarding patient values and preferences for antithrombotic therapy. These ratings guided value and preference decisions underlying the recommendations. Each topic panel identified questions in which resource allocation issues were particularly important and, for these issues, experts in economic analysis provided additional searches and guidance. Conclusions: AT9 methodology reflects the current science of evidence-based clinical practice guideline development, with reliance on high-quality systematic reviews, a standardized process for quality assessment of individual studies and the body of evidence, an explicit process for translating the evidence into recommendations, disclosure of financial as well as intellectual conflicts of interest followed by management of disclosed conflicts, and extensive peer review. PMID:22315256

Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).

PubMed

Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael

2016-12-01

Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.

Recommendations for the use of medications with continuous enteral nutrition.

PubMed

Wohlt, Paul D; Zheng, Lan; Gunderson, Shelly; Balzar, Sarah A; Johnson, Benjamin D; Fish, Jeffrey T

2009-08-15

Recommendations for the use of medications with continuous enteral nutrition are provided. A literature review was conducted to identify primary literature reporting medication interactions with continuous enteral nutrition. For medications without supporting literature, manufacturers were contacted for information. Package inserts for specific medications were also investigated for any information to help guide recommendations. If no specific recommendations were made by the pharmaceutical manufacturer or the package insert concerning administration of products with continuous enteral nutrition, a tertiary database was consulted. Recommendations were generated by a consensus of clinicians for those medications that lacked specific recommendations in the primary literature or from the pharmaceutical manufacturer. Documentation of medication interactions with continuous enteral nutrition and food was then collated along with specific recommendations on how to administer the medication with regard to continuous enteral nutrition. Recommendations were classified as strong (grade 1) or weak (grade 2). The quality of evidence was classified as high (grade A), moderate (grade B), or low (grade C). Forty-six medications commonly given to hospitalized patients were evaluated. Twenty-four medications had recommendations based on available data, and the remaining 22 medications had recommendations based on a consensus of clinicians. There was a lack of published data regarding drug-nutrient interactions for a majority of the drugs commonly administered to patients receiving continuous enteral nutrition. Clinicians should recognize potential drug-nutrient interactions and use available evidence to optimize patients' drug therapy.

National physical activity recommendations: systematic overview and analysis of the situation in European countries.

PubMed

Kahlmeier, Sonja; Wijnhoven, Trudy M A; Alpiger, Patrick; Schweizer, Christian; Breda, João; Martin, Brian W

2015-02-12

Developing national physical activity (PA) recommendations is an essential element of an effective national approach to promote PA. Systematic overview and analysis of national PA recommendations across the European Region of the World Health Organization (WHO). The WHO European national information focal points provided information which was complemented through online searches and input from other experts. Information received until summer 2012 from 37 countries was analyzed. Sixteen countries did not have national recommendations while 21 countries did. For 17 countries, the source document was accessible. Seventeen recommendations referred to adults, 14 to young people and 6 to older adults. Most national recommendations for children and young people are quite similar: 12 countries recommend at least 60 minutes of moderate- to vigorous-intensity PA each day, in line with the WHO global recommendation. Three countries recommend longer durations and one a lower one. In some countries, slight variations were found regarding the recommended intensity and minimum bouts. Only one country was fully in line with the WHO recommendations. Two countries have issued separate recommendations for pre-school children. For adults, most countries still follow the 1995 United States recommendations of "at least 30 minutes on 5 days a week". Three countries were fully in line with the WHO recommendations. Four countries give specific recommendations on reducing weight, avoiding weight gain or continuing weight maintenance. The six identified national PA recommendations for older adults are mainly similar to those for adults but underline that particularly for this age group also less activity has important health benefits; four countries also recommend balance training. About half of the countries for which information was available and likely less than 40% of all 53 countries in the WHO European Region have developed national PA recommendations. Further investment is needed to address this important step towards a comprehensive PA promotion approach. Much remains to be done for the 2010 WHO recommendations to be fully reflected in national documents across all parts of the Region and all age groups. In addition, avoiding extended periods of inactivity and overweight are only addressed by a minority of countries yet.

Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols: The SPIRIT-PRO Extension.

PubMed

Calvert, Melanie; Kyte, Derek; Mercieca-Bebber, Rebecca; Slade, Anita; Chan, An-Wen; King, Madeleine T; Hunn, Amanda; Bottomley, Andrew; Regnault, Antoine; Chan, An-Wen; Ells, Carolyn; O'Connor, Daniel; Revicki, Dennis; Patrick, Donald; Altman, Doug; Basch, Ethan; Velikova, Galina; Price, Gary; Draper, Heather; Blazeby, Jane; Scott, Jane; Coast, Joanna; Norquist, Josephine; Brown, Julia; Haywood, Kirstie; Johnson, Laura Lee; Campbell, Lisa; Frank, Lori; von Hildebrand, Maria; Brundage, Michael; Palmer, Michael; Kluetz, Paul; Stephens, Richard; Golub, Robert M; Mitchell, Sandra; Groves, Trish

2018-02-06

Patient-reported outcome (PRO) data from clinical trials can provide valuable evidence to inform shared decision making, labeling claims, clinical guidelines, and health policy; however, the PRO content of clinical trial protocols is often suboptimal. The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement was published in 2013 and aims to improve the completeness of trial protocols by providing evidence-based recommendations for the minimum set of items to be addressed, but it does not provide PRO-specific guidance. To develop international, consensus-based, PRO-specific protocol guidance (the SPIRIT-PRO Extension). The SPIRIT-PRO Extension was developed following the Enhancing Quality and Transparency of Health Research (EQUATOR) Network's methodological framework for guideline development. This included (1) a systematic review of existing PRO-specific protocol guidance to generate a list of potential PRO-specific protocol items (published in 2014); (2) refinements to the list and removal of duplicate items by the International Society for Quality of Life Research (ISOQOL) Protocol Checklist Taskforce; (3) an international stakeholder survey of clinical trial research personnel, PRO methodologists, health economists, psychometricians, patient advocates, funders, industry representatives, journal editors, policy makers, ethicists, and researchers responsible for evidence synthesis (distributed by 38 international partner organizations in October 2016); (4) an international Delphi exercise (n = 137 invited; October 2016 to February 2017); and (5) consensus meeting (n = 30 invited; May 2017). Prior to voting, consensus meeting participants were informed of the results of the Delphi exercise and given data from structured reviews evaluating the PRO protocol content of 3 defined samples of trial protocols. The systematic review identified 162 PRO-specific protocol recommendations from 54 sources. The ISOQOL Taskforce (n = 21) reduced this to 56 items, which were considered by 138 international stakeholder survey participants and 99 Delphi panelists. The final wording of the SPIRIT-PRO Extension was agreed on at a consensus meeting (n = 29 participants) and reviewed by external group of experts during a consultation period. Eleven extensions and 5 elaborations to the SPIRIT 2013 checklist were recommended for inclusion in clinical trial protocols in which PROs are a primary or key secondary outcome. Extension items focused on PRO-specific issues relating to the trial rationale, objectives, eligibility criteria, concepts used to evaluate the intervention, time points for assessment, PRO instrument selection and measurement properties, data collection plan, translation to other languages, proxy completion, strategies to minimize missing data, and whether PRO data will be monitored during the study to inform clinical care. The SPIRIT-PRO guidelines provide recommendations for items that should be addressed and included in clinical trial protocols in which PROs are a primary or key secondary outcome. Improved design of clinical trials including PROs could help ensure high-quality data that may inform patient-centered care.

National workshop on core competencies for success in the veterinary profession.

PubMed

Lloyd, James W; King, Lonnie J; Klausner, Jeffrey S; Harris, Donna

2003-01-01

A workshop was designed to (1) present results of the Core Competencies for Veterinary Medicine project conducted by Personnel Decisions International (PDI); (2) discuss and analyze the implications of the PDI study results for academia, private practice, and industry; (3) identify actionable items-discuss opportunities and barriers; and (4) develop appropriate recommendations-devise specific actions for implementation as next steps. In total, 25 veterinary colleges were represented at the workshop and a total of 110 attendees participated, a broad cross-section of the veterinary profession (both academic and non-academic). Through an orchestrated combination of general sessions and facilitated, small group discussions, prioritized recommendations for implementation and initial action plans for next steps were developed. Recommendations included publicizing results of the PDI study, reconsidering current admissions policies and processes, evaluating the applicant pool and current recruitment programs, developing structured mentoring programs, enhancing DVM/VMD training programs, coordinating the development of continuing education programs, and overcoming existing barriers to change. Next steps should involve collaborative efforts across all sectors of the veterinary profession to develop plans for implementing the workshop's recommendations. Leadership for follow-up might reasonably come from the Association of American Veterinary Medical Colleges (AAVMC), the American Veterinary Medical Association (AVMA), and the American Animal Hospital Association (AAHA), either individually or collectively, through the National Commission on Veterinary Economic Issues (NCVEI). Partnerships with industry are also possible and should be strongly considered.

The Ontario Psychosocial Oncology Framework: a quality improvement tool.

PubMed

Li, Madeline; Green, Esther

2013-05-01

To overview the newly developed Psychosocial Health Care for Cancer Patients and Their Families: A Framework to Guide Practice in Ontario and Guideline Recommendations in the context of Canadian psychosocial oncology care and propose strategies for guideline uptake and implementation. Recommendations from the 2008 Institute of Medicine standard Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs were adapted into the Ontario Psychosocial Oncology (PSO) Framework. Existing practice guidelines developed by the Canadian Partnership against Cancer and Cancer Care Ontario and standards developed by the Canadian Association of Psychosocial Oncology are supporting resources for adopting a quality improvement (QI) approach to the implementation of the framework in Ontario. The developed PSO Framework, including 31 specific actionable recommendations, is intended to improve the quality of comprehensive cancer care at both the provider and system levels. Important QI change management processes are described as Educate - raising awareness among medical teams of the significance of psychosocial needs of patients, Evidence - developing a research evidence base for patient care benefits from psychosocial interventions, and Electronics - using technology to collect patient reported outcomes of both physical and emotional symptoms. The Ontario PSO Framework is unique and valuable in providing actionable recommendations that can be implemented through QI processes. Overall, the result will be improved psychosocial health care for the cancer population. Copyright © 2012 John Wiley & Sons, Ltd.

Improvement for determining the axial capacity of drilled shafts in shale in Illinois.

DOT National Transportation Integrated Search

2013-05-01

In this project, Illinois-specific design procedures were developed for drilled shafts founded in weak shale. In addition, : recommendations for field and laboratory testing to characterize the in situ condition of weak shales in Illinois were : deve...

Design and construction recommendations for thin overlays in Texas.

DOT National Transportation Integrated Search

2012-10-01

Thin HMA overlays, laid at 1.0 inch or thinner, are cost-effective surface maintenance options. The primary focus of this research was : to develop specifications for three such mixes: fine dense-graded mix (fine DGM), fine-graded stone matrix asphal...

RECOVERY AND ASSAY OF VIRUSES FROM BIOSOLIDS

EPA Science Inventory

In a review of EPA's rule on sewage sludges, the National Research Council recommended that EPA develop improved methods for pathogens using modern technologies. They specifically mentioned viral pathogens that cannot be cultured and those that are difficult to culture. As a re...

Current capabilities and future directions in computational fluid dynamics

NASA Technical Reports Server (NTRS)

1986-01-01

A summary of significant findings is given, followed by specific recommendations for future directions of emphasis for computational fluid dynamics development. The discussion is organized into three application areas: external aerodynamics, hypersonics, and propulsion - and followed by a turbulence modeling synopsis.

Review of modern biometric user authentication and their development prospects

NASA Astrophysics Data System (ADS)

Boriev, Z. V.; Sokolov, S. S.; Nyrkov, A. P.

2015-09-01

This article discusses the possibility of using biometric information technologies in management. Made a brief overview of access control and time attendance. Analyzed biometrics and identification system user. Recommendations on the use of various systems depending on the specific tasks.

The outcomes of children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference.

PubMed

Quasney, Michael W; López-Fernández, Yolanda M; Santschi, Miriam; Watson, R Scott

2015-06-01

To provide additional details and evidence behind the recommendations for outcomes assessment of patients with pediatric acute respiratory distress syndrome from the Pediatric Acute Lung Injury Consensus Conference. Consensus conference of experts in pediatric acute lung injury. A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute respiratory distress syndrome and to make recommendations regarding treatment and research priorities. The outcomes subgroup comprised four experts. When published data were lacking, a modified Delphi approach emphasizing strong professional agreement was used. The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 151 recommendations addressing the topics related to pediatric acute respiratory distress syndrome, seven of which related to outcomes after pediatric acute respiratory distress syndrome. All seven recommendations had strong agreement. Children with acute respiratory distress syndrome continue to have a high mortality, specifically, in relation to certain comorbidities and etiologies related to pediatric acute respiratory distress syndrome. Comorbid conditions, such as an immunocompromised state, increase the risk of mortality even further. Likewise, certain etiologies, such as non-pulmonary sepsis, also place children at a higher risk of mortality. Significant long-term effects were reported in adult survivors of acute respiratory distress syndrome: diminished lung function and exercise tolerance, reduced quality of life, and diminished neurocognitive function. Little knowledge of long-term outcomes exists in children who survive pediatric acute respiratory distress syndrome. Characterization of the longer term consequences of pediatric acute respiratory distress syndrome in children is vital to help identify opportunities for improved therapeutic and rehabilitative strategies that will lessen the long-term burden of pediatric acute respiratory distress syndrome and improve the quality of life in children. The Consensus Conference developed pediatric-specific recommendations for pediatric acute respiratory distress syndrome regarding outcome measures and future research priorities. These recommendations are intended to promote optimization and consistency of care for children with pediatric acute respiratory distress syndrome and identify areas of uncertainty requiring further investigation.

Genotoxicity assessment of nanomaterials: recommendations on best practices, assays and methods.

PubMed

Elespuru, Rosalie; Pfuhler, Stefan; Aardema, Marilyn; Chen, Tao; Doak, Shareen H; Doherty, Ann; Farabaugh, Christopher S; Kenny, Julia; Manjanatha, Mugimane; Mahadevan, Brinda; Moore, Martha M; Ouédraogo, Gladys; Stankowski, Leon F; Tanir, Jennifer Y

2018-04-26

Nanomaterials (NMs) present unique challenges in safety evaluation. An international working group, the Genetic Toxicology Technical Committee of the International Life Sciences Institute's Health and Environmental Sciences Institute, has addressed issues related to the genotoxicity assessment of NMs. A critical review of published data has been followed by recommendations on methods alterations and best practices for the standard genotoxicity assays: bacterial reverse mutation (Ames); in vitro mammalian assays for mutations, chromosomal aberrations, micronucleus induction, or DNA strand breaks (comet); and in vivo assays for genetic damage (micronucleus, comet and transgenic mutation assays). The analysis found a great diversity of tests and systems used for in vitro assays; many did not meet criteria for a valid test, and/or did not use validated cells and methods in the Organization for Economic Co-operation and Development Test Guidelines, and so these results could not be interpreted. In vivo assays were less common but better performed. It was not possible to develop conclusions on test system agreement, NM activity, or mechanism of action. However, the limited responses observed for most NMs were consistent with indirect genotoxic effects, rather than direct interaction of NMs with DNA. We propose a revised genotoxicity test battery for NMs that includes in vitro mammalian cell mutagenicity and clastogenicity assessments; in vivo assessments would be added only if warranted by information on specific organ exposure or sequestration of NMs. The bacterial assays are generally uninformative for NMs due to limited particle uptake and possible lack of mechanistic relevance, and are thus omitted in our recommended test battery for NM assessment. Recommendations include NM characterization in the test medium, verification of uptake into target cells, and limited assay-specific methods alterations to avoid interference with uptake or endpoint analysis. These recommendations are summarized in a Roadmap guideline for testing.

Barriers and Solutions to Fieldwork Education in Hand Therapy.

PubMed

Short, Nathan; Sample, Shelby; Murphy, Malachi; Austin, Brittany; Glass, Jillian

2017-08-09

Survey. Fieldwork education is a vital component of training the next generation of CHTs. Barriers and solutions to fieldwork rotations in hand therapy are examined, as well as proposed solutions, including recommendations for student preparation. This descriptive study examined barriers for certified hand therapist clinicians to accept students for clinical rotations and clinicians' preferences for student preparation before a rotation in a hand setting. A survey was developed, peer reviewed, and distributed using the electronic mailing list of the Hand Therapy Certification Commission via SurveyMonkey. Aggregate responses were analyzed to identify trends including barriers to student clinical rotations and recommendations for students to prepare for hand rotations. A total of 2080 participants responded to the survey, representing a 37% response rate. Common logistical barriers were identified for accepting students such as limited clinical time and space. Many clinicians (32% agree and 8% strongly agree) also felt that the students lack the clinical knowledge to be successful. Areas of knowledge, skill set, and experience were surveyed for development before a clinical rotation in a hand setting. Most respondents (74%) reported increased likelihood of accepting a student with the recommended preparation. Novel qualitative responses to improve clinical experiences are presented as well. Student preparation before a clinical rotation in a hand setting appears to be a significant barrier based on the survey results. Areas of recommended knowledge, skill set, and experience may serve to guide both formal and informal methods of student preparation before a hand-specific clinical rotation to facilitate knowledge translation from experienced certified hand therapists to the next generation. Although logistical barriers may be difficult to overcome, hand-specific preparation based on clinician' recommendations may facilitate student acceptance and success in hand specialty clinical rotations. N/A. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Equine disease events resulting from international horse movements: Systematic review and lessons learned.

PubMed

Dominguez, M; Münstermann, S; de Guindos, I; Timoney, P

2016-09-01

An analysis of the factors leading to equine disease events was used to support the development of international recommendations for mitigating the risk of disease dissemination through sport horse movements (high health, high performance - 'HHP' horses). A review was undertaken to identify the factors resulting in equine disease events following international movement of horses to draw lessons in support of the development of international recommendations for the safe movements of a specific subpopulation of horses: the HHP sport horses. Systematic review carried out in accordance with the PRISMA statement. The review covered disease events that occurred from 1995 to 2014, identified from the databases of the World Organisation for Animal Health (OIE) and international surveillance reports. Overall, 54 disease events were identified, of which 7 were contained in post arrival quarantine and the others resulted in the introduction of pathogens into importing countries. For 81% of the introductions, the OIE recommendations applicable to the diseases involved had not been complied with. Subclinical infections are a challenge for international trade: 88% of the regulated movements that resulted in introductions involved infected horses that showed no clinical signs at the time of import. Biosecurity and management practices in resident equine populations were identified as important mitigating factors in preventing disease spread to the local horse population. The global increase in international horse movements, if not appropriately regulated and supervised by competent veterinary authorities and respective equine industry partners, could potentially lead to increased global spread of infectious equine diseases. Appropriate mitigation measures and compliance with OIE import recommendations for specific diseases can significantly reduce this risk. The recommendations proposed under the HHP approach take into account the mitigation measures identified by this review as important factors in preventing pathogen introduction and spread. © 2015 EVJ Ltd.

Preparing for Euro 2012: developing a hazard risk assessment.

PubMed

Wong, Evan G; Razek, Tarek; Luhovy, Artem; Mogilevkina, Irina; Prudnikov, Yuriy; Klimovitskiy, Fedor; Yutovets, Yuriy; Khwaja, Kosar A; Deckelbaum, Dan L

2015-04-01

Risk assessment is a vital step in the disaster-preparedness continuum as it is the foundation of subsequent phases, including mitigation, response, and recovery. To develop a risk assessment tool geared specifically towards the Union of European Football Associations (UEFA) Euro 2012. In partnership with the Donetsk National Medical University, Donetsk Research and Development Institute of Traumatology and Orthopedics, Donetsk Regional Public Health Administration, and the Ministry of Emergency of Ukraine, a table-based tool was created, which, based on historical evidence, identifies relevant potential threats, evaluates their impacts and likelihoods on graded scales based on previous available data, identifies potential mitigating shortcomings, and recommends further mitigation measures. This risk assessment tool has been applied in the vulnerability-assessment-phase of the UEFA Euro 2012. Twenty-three sub-types of potential hazards were identified and analyzed. Ten specific hazards were recognized as likely to very likely to occur, including natural disasters, bombing and blast events, road traffic collisions, and disorderly conduct. Preventative measures, such as increased stadium security and zero tolerance for impaired driving, were recommended. Mitigating factors were suggested, including clear, incident-specific preparedness plans and enhanced inter-agency communication. This hazard risk assessment tool is a simple aid in vulnerability assessment, essential for disaster preparedness and response, and may be applied broadly to future international events.

Shifting public health practice to advance health equity: recommendations from experts and community leaders.

PubMed

Knight, Erin K

2014-01-01

While the evidence base regarding the social determinants of health and their relationship to health inequities grows, the field of public health is challenged to translate this knowledge into practice changes that advance health equity. Drawing on the knowledge, beliefs, and experiences of public health experts and community leaders working to advance health equity, our objective was to develop and disseminate recommendations for changing public health practice to better address this problem. We conducted semistructured, qualitative telephone interviews (n = 25) with key informants. Interviews were recorded and transcribed, and data were coded and analyzed using both inductive and deductive methods. Member checks were used to enhance quality. A purposeful sample of key informants was selected from content experts and community leaders involved with the development of the Unnatural Causes public impact campaign. Participants represented state and local health departments, community-based organizations, national research/advocacy organizations, and academic institutions across the country. Participants distinguished between social determinants of health and their structural precursors in social and political institutions. They believed that the field of public health has an obligation to address health inequities and shifts in practice are needed that focus more attention on societal factors that underlie such inequities. According to participants, specific practice changes are difficult to identify because actions should be community specific and community driven. Recommended approaches that may be adapted to community-based needs and assets include building nontraditional partnerships, engaging in political advocacy, promoting community leadership, collecting better data on social conditions and institutional factors, and enhancing communication for health equity. Recommended shifts in practice may be facilitated by revisiting our understanding of the 3 core functions of public health-assessment, assurance, and policy development.

Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review.

PubMed

Patel, Minal R; Vichich, Jennifer; Lang, Ian; Lin, Jessica; Zheng, Kai

2017-04-01

The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill "best" behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinical encounter, (2) weigh the evidence of each recommendation, and (3) rank evidence-based recommendations for electronic health record communication training initiatives for clinicians. We conducted a literature search of 6 databases, resulting in 52 articles included in the analysis. We extracted information such as study setting, research design, sample, findings, and implications. Recommendations were distilled based on consistent support for behavioral and communication practices across studies. Eight behavioral and communication practices received strong support of evidence in the literature and included specific aspects of using computerized systems to facilitate conversation and transparency in the exam room, such as spatial (re)organization of the exam room, maintaining nonverbal communication, and specific techniques that integrate the computerized system into the visit and engage the patient. Four practices, although patient-centered, have received insufficient evidence to date. We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Multidrug-resistant bacterial microorganisms (MDRO) in end-of-life care: development of recommendations for hospitalized patients using a mixed-methods approach.

PubMed

Heckel, Maria; Stiel, Stephanie; Herbst, Franziska A; Tiedtke, Johanna M; Sturm, Alexander; Adelhardt, Thomas; Bogdan, Christian; Sieber, Cornel; Schöffski, Oliver; Lang, Frieder R; Ostgathe, Christoph

2018-03-16

Palliative care professionals are frequently confronted with patients colonized or infected with MDRO. One major challenge is how to balance necessary isolation measures and social inclusion as one of the main principles of palliative and end-of-life care. To date, MDRO-specific policies and protocols vary widely between institutions. provide empirical recommendations on how to deal with hospitalized MDRO patients in end-of-life care. Recommendations were developed based on (i) initial results of face-to-face interviews and focus groups, (ii) impartial experts' comments and consensus on the draft via online survey and (iii) a face-to-face meeting with consortium members to finalize recommendations. Findings of 158 interviews and six focus groups (39 participants) with patients, family caregivers, staff members and institutional stakeholders contributed to the recommendations. The assessments of 17 experts were considered. In total, 21 recommendations were approved. The recommended strategy in dealing with MDRO at the end of life allows case-based application of protection and isolation measures. MDRO diagnostics and therapy involve screening at admission. The recommendations suggest consideration of required accommodation facilities, provided material as well as staff and time resources. The recommendations further highlight the importance of providing for strategies enabling the patient's social inclusion and provision of verbal and written information about MDRO for patients and family caregivers, transparent medical documentation, and staff member training. The recommendations summarize the perspectives of individuals and groups affected by MDRO at the end of life and provide practical guidance for clinical routine. Further dissemination and implementation requirements are discussed and should contain the evaluation of the knowledge, views, worries, and anxieties of the target groups.

American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

PubMed Central

Ward, Michael M.; Deodhar, Atul; Akl, Elie A.; Lui, Andrew; Ermann, Joerg; Gensler, Lianne S.; Smith, Judith A.; Borenstein, David; Hiratzka, Jayme; Weiss, Pamela F.; Inman, Robert D.; Majithia, Vikas; Haroon, Nigil; Maksymowych, Walter P.; Joyce, Janet; Clark, Bruce M.; Colbert, Robert A.; Figgie, Mark P.; Hallegua, David S.; Prete, Pamela E.; Rosenbaum, James T.; Stebulis, Judith A.; van den Bosch, Filip; Yu, David T. Y.; Miller, Amy S.; Reveille, John D.; Caplan, Liron

2016-01-01

Objective To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). Methods A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946–2014), PubMed (1966–2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework. Results In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS. Conclusion These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas. PMID:26401991

American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

PubMed Central

WARD, MICHAEL M.; DEODHAR, ATUL; AKL, ELIE A.; LUI, ANDREW; ERMANN, JOERG; GENSLER, LIANNE S.; SMITH, JUDITH A.; BORENSTEIN, DAVID; HIRATZKA, JAYME; WEISS, PAMELA F.; INMAN, ROBERT D.; MAJITHIA, VIKAS; HAROON, NIGIL; MAKSYMOWYCH, WALTER P.; JOYCE, JANET; CLARK, BRUCE M.; COLBERT, ROBERT A.; FIGGIE, MARK P.; HALLEGUA, DAVID S.; PRETE, PAMELA E.; ROSENBAUM, JAMES T.; STEBULIS, JUDITH A.; VAN DEN BOSCH, FILIP; YU, DAVID T. Y.; MILLER, AMY S.; REVEILLE, JOHN D.; CAPLAN, LIRON

2016-01-01

Objective To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). Methods A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946–2014), PubMed (1966–2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework. Results In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS. Conclusion These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas. PMID:26401907

EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis.

PubMed

Yates, M; Watts, R A; Bajema, I M; Cid, M C; Crestani, B; Hauser, T; Hellmich, B; Holle, J U; Laudien, M; Little, M A; Luqmani, R A; Mahr, A; Merkel, P A; Mills, J; Mooney, J; Segelmark, M; Tesar, V; Westman, K; Vaglio, A; Yalçındağ, N; Jayne, D R; Mukhtyar, C

2016-09-01

In this article, the 2009 European League Against Rheumatism (EULAR) recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have been updated. The 2009 recommendations were on the management of primary small and medium vessel vasculitis. The 2015 update has been developed by an international task force representing EULAR, the European Renal Association and the European Vasculitis Society (EUVAS). The recommendations are based upon evidence from systematic literature reviews, as well as expert opinion where appropriate. The evidence presented was discussed and summarised by the experts in the course of a consensus-finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) determined. In addition to the voting by the task force members, the relevance of the recommendations was assessed by an online voting survey among members of EUVAS. Fifteen recommendations were developed, covering general aspects, such as attaining remission and the need for shared decision making between clinicians and patients. More specific items relate to starting immunosuppressive therapy in combination with glucocorticoids to induce remission, followed by a period of remission maintenance; for remission induction in life-threatening or organ-threatening AAV, cyclophosphamide and rituximab are considered to have similar efficacy; plasma exchange which is recommended, where licensed, in the setting of rapidly progressive renal failure or severe diffuse pulmonary haemorrhage. These recommendations are intended for use by healthcare professionals, doctors in specialist training, medical students, pharmaceutical industries and drug regulatory organisations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Research safety vehicle program (Phase II) specification review. Volume II. Final technical report, Jul 1975--Nov 1976

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

Pugliese, S.M.

1977-02-01

In Phase I of the Research Safety Vehicle Program (RSV), preliminary design and performance specifications were developed for a mid-1980's vehicle that integrates crashworthiness and occupant safety features with material resource conservation, economy, and producibility. Phase II of the program focused on development of the total vehicle design via systems engineering and integration analyses. As part of this effort, it was necessary to continuously review the Phase I recommended performance specification in relation to ongoing design/test activities. This document contains the results of analyses of the Phase I specifications. The RSV is expected to satisfy all of the producibility andmore » safety related specifications, i.e., handling and stability systems, crashworthiness, occupant protection, pedestrian/cyclist protection, etc.« less

Towards fair health policies for migrants and ethnic minorities: the case-study of ETHEALTH in Belgium

PubMed Central

2012-01-01

Background In Europe, progress in the development of health policies that address the needs of migrants and ethnic minorities has been slow. This is partly due to the absence of a strategic commitment by the health authorities. The Ministry of Public Health commissioned the ETHEALTH (EThnicity &HEALTH) group to formulate relevant recommendations to the public authorities with a view to reducing health inequalities among ethnic minorities. This paper describes the political process and the outcomes of the ETHEALTH expert group. Results After ten meetings, the ETHEALTH group came up with 46 recommendations, which were presented at a national press conference in December 2011. Target groups concerned by these recommendations covered both irregular migrants and migrants entitled to the national insurance coverage. Recommendations were supported by the need of combining universal approaches to health care with more specific approaches. The scope of the recommendations concerned health care as well as prevention, health promotion and access to health care. When analysing the content of the recommendations, some ETHEALTH recommendations were not fully measurable, and time-related; they were, however, quite specific and realistic within the Belgian context. The weak political commitment of an executive agency was identified as a major obstacle to the implementation of the recommendations. Conclusions The ETHEALTH group was an example of scientific advice on a global health issue. It also demonstrated the feasibility of coming up with a comprehensive strategy to decrease ethnic health inequalities, even in a political context where migration issues are sensitive. Two final lessons may be highlighted at the end of the first phase of the ETHEALTH project: firstly, the combination of scientific knowledge and practical expertise makes recommendations SMART; and, secondly, the low level of commitment on the part of policymakers might jeopardise the effective implementation of the recommendations. PMID:22938597

Are nutrition messages lost in transmission? Assessing the quality and consistency of diabetes guideline recommendations on the delivery of nutrition therapy.

PubMed

Hale, Kelli; Capra, Sandra; Bauer, Judy

2016-12-01

To provide an overview of (1) the consistency of Type 2 Diabetes Clinical Practice Guidelines recommendations on the delivery of nutrition therapy and (2) Clinical Practice Guideline quality. Large international clinical practice guideline repositories, diabetes organisation websites, and electronic databases (Pubmed, Scopus), were searched to identify Clinical Practice Guidelines for adults with type 2 diabetes published 2005 to August 2014. Recommendations on the delivery of nutrition therapy were extracted and inductive content analysis was used to analyse consistency. Two researchers independently assessed guideline quality using the AGREE II tool. Nine topics were identified from the recommendations. Overall the consistency of the recommendations was related to guideline type. Compared with nutrition-specific guidelines, the broad ones had a broader focus and included more patient-focused recommendations. The ten Clinical Practice Guidelines assessed included six broad guidelines and four nutrition specific guidelines. Based on AGREE II analysis, the broad guidelines were higher quality than nutrition-specific ones. Broad Clinical Practice Guidelines were higher quality and included more patient-focused recommendations than nutrition-specific ones. Our findings suggest a need for nutrition-specific guidelines to be modified to include greater patient-focus, or for practitioners delivering nutrition therapy to adopt broad Clinical Practice Guidelines. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Diagnostic and therapeutic management of hepatocellular carcinoma

PubMed Central

Bellissimo, Francesco; Pinzone, Marilia Rita; Cacopardo, Bruno; Nunnari, Giuseppe

2015-01-01

Hepatocellular carcinoma (HCC) is an increasing health problem, representing the second cause of cancer-related mortality worldwide. The major risk factor for HCC is cirrhosis. In developing countries, viral hepatitis represent the major risk factor, whereas in developed countries, the epidemic of obesity, diabetes and nonalcoholic steatohepatitis contribute to the observed increase in HCC incidence. Cirrhotic patients are recommended to undergo HCC surveillance by abdominal ultrasounds at 6-mo intervals. The current diagnostic algorithms for HCC rely on typical radiological hallmarks in dynamic contrast-enhanced imaging, while the use of α-fetoprotein as an independent tool for HCC surveillance is not recommended by current guidelines due to its low sensitivity and specificity. Early diagnosis is crucial for curative treatments. Surgical resection, radiofrequency ablation and liver transplantation are considered the cornerstones of curative therapy, while for patients with more advanced HCC recommended options include sorafenib and trans-arterial chemo-embolization. A multidisciplinary team, consisting of hepatologists, surgeons, radiologists, oncologists and pathologists, is fundamental for a correct management. In this paper, we review the diagnostic and therapeutic management of HCC, with a focus on the most recent evidences and recommendations from guidelines. PMID:26576088

The Challenges of Credible Thermal Protection System Reliability Quantification

NASA Technical Reports Server (NTRS)

Green, Lawrence L.

2013-01-01

The paper discusses several of the challenges associated with developing a credible reliability estimate for a human-rated crew capsule thermal protection system. The process of developing such a credible estimate is subject to the quantification, modeling and propagation of numerous uncertainties within a probabilistic analysis. The development of specific investment recommendations, to improve the reliability prediction, among various potential testing and programmatic options is then accomplished through Bayesian analysis.

Recommendations on rectal surveillance for colorectal cancer after subtotal colectomy in patients with inflammatory bowel disease.

PubMed

Derikx, Lauranne A A P; de Jong, Michiel E; Hoentjen, Frank

2018-05-17

Approximately 30% of patients with ulcerative colitis require a colectomy during their disease course. This substantially reduces colorectal cancer risk, although it is still possible to develop colorectal neoplasia in the remaining rectum. Although clear and well-accepted surveillance guidelines exist for patients with inflammatory bowel disease with an intact colon, specific surveillance recommendations following colectomy are less clear. Here, we aim to summarize the prevalence, incidence, and risk factors for developing colorectal cancer in patients with inflammatory bowel disease who underwent subtotal colectomy with a permanent end ileostomy and rectal stump, or with ileorectal anastomosis. Subsequently, gained insights are integrated into a proposed endoscopic surveillance strategy of the residual rectum.

Designing a Method with Physician Participation to Assess and Improve Quality of Healthcare in Otolaryngology.

PubMed

Arce, José M; Martín Cleary, Catalina; Cenjor, Carlos; Ramos, Ángel; Ortiz, Alberto

2017-04-01

Patient choice of healthcare centers to be treated for specific diseases is compromised by the low accessibility of understandable information. Physicians are rarely involved in healthcare quality assessment, despite their potentially valuable input. The purpose of this study was to develop a methodology for evaluating the quality of care that specifically incorporates advice from medical specialists and provides accessible information for patients in search of high-quality healthcare. A pilot Delphi study was conducted among 28 Spanish otolaryngology experts, seeking their opinion on the quality-of-care indicators and on their ability to recommend the most suitable department for the treatment of specific otolaryngologic diseases. The average acceptance rate was 91.9% for quality-of-care indicator and 96.5% for the resources needed for improving the quality of care. Furthermore, 93% experts reported that patients frequently ask for physician advice on which center provides better care for a specific disease, 92.6% experts believe they could recommend the best centers for specific otolaryngologic diseases, and 80% experts agreed that expert opinion on the quality of care offered by different centers would be a valuable addition to quality-of-care assessment. The incorporation of physician advice into healthcare quality assessment may improve the usefulness of healthcare quality indicators for patients. Assessment tools incorporating physician advice should be developed and validated.

Development of vendor evaluation criteria and post-implementation considerations for MSFC center-wide executive information system

NASA Technical Reports Server (NTRS)

Moynihan, Gary P.

1992-01-01

In June 1991, the MITRE Corporation submitted a series of recommendations as part of a Marshall Space Flight Center (MSFC) Management Information System Requirements Study, initiated by the Information Systems Office (ISO). A major recommendation of the study was to develop an Executive Information System (EIS) for MSFC executives. ISO was directed, by center management, to proceed with the development of a Center-Wide Executive Information System. Existing EIS prototypes, developed by the Space Shuttle Projects Office and the Payload Projects Office, were reviewed. These existing MSFC prototypes were considered not to encompass the required functionality needed on a center-wide basis. A follow-up study by MITRE provided top-level system requirements. These were later incorporated into a final requirements specification document by Boeing Computer Support Services.

Recommended observational skills training for IAEA safeguards inspections. Final report: Recommended observational skills training for IAEA safeguards inspections

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

Toquam, J.L.; Morris, F.A.

This is the second of two reports prepared to assist the International Atomic Energy Agency (IAEA or Agency) in enhancing the effectiveness of its international safeguards inspections through inspector training in {open_quotes}Observational Skills{close_quotes}. The first (Phase 1) report was essentially exploratory. It defined Observational Skills broadly to include all appropriate cognitive, communications, and interpersonal techniques that have the potential to help IAEA safeguards inspectors function more effectively. It identified 10 specific Observational Skills components, analyzed their relevance to IAEA safeguards inspections, and reviewed a variety of inspection programs in the public and private sectors that provide training in one ormore » more of these components. The report concluded that while it should be possible to draw upon these other programs in developing Observational Skills training for IAEA inspectors, the approaches utilized in these programs will likely require significant adaption to support the specific job requirements, policies, and practices that define the IAEA inspector`s job. The overall objective of this second (Phase 2) report is to provide a basis for the actual design and delivery of Observational Skills training to IAEA inspectors. The more specific purposes of this report are to convey a fuller understanding of the potential application of Observational Skills to the inspector`s job, describe inspector perspectives on the relevance and importance of particular Observational Skills, identify the specific Observational Skill components that are most important and relevant to enhancing safeguards inspections, and make recommendations as to Observational Skills training for the IAEA`s consideration in further developing its Safeguards training program.« less

Physical activity, sedentary behaviour and sleep in COPD guidelines: A systematic review

PubMed Central

Effing, Tanja W; Olds, Timothy; Williams, Marie T

2017-01-01

Objectives: Physical activity, sedentary and sleep behaviours have strong associations with health. This systematic review aimed to identify how clinical practice guidelines (CPGs) for the management of chronic obstructive pulmonary disease (COPD) report specific recommendations and strategies for these movement behaviours. Methods: A systematic search of databases (Medline, Scopus, CiNAHL, EMbase, Clinical Guideline), reference lists and websites identified current versions of CPGs published since 2005. Specific recommendations and strategies concerning physical activity, sedentary behaviour and sleep were extracted verbatim. The proportions of CPGs providing specific recommendations and strategies were reported. Results: From 2370 citations identified, 35 CPGs were eligible for inclusion. Of these, 21 (60%) provided specific recommendations for physical activity, while none provided specific recommendations for sedentary behaviour or sleep. The most commonly suggested strategies to improve movement behaviours were encouragement from a healthcare provider (physical activity n = 20; sedentary behaviour n = 2) and referral for a diagnostic sleep study (sleep n = 4). Conclusion: Since optimal physical activity, sedentary behaviour and sleep durations and patterns are likely to be associated with mitigating the effects of COPD, as well as with general health and well-being, there is a need for further COPD-specific research, consensus and incorporation of recommendations and strategies into CPGs. PMID:28774202

The advantages and limitations of guideline adaptation frameworks.

PubMed

Wang, Zhicheng; Norris, Susan L; Bero, Lisa

2018-05-29

The implementation of evidence-based guidelines can improve clinical and public health outcomes by helping health professionals practice in the most effective manner, as well as assisting policy-makers in designing optimal programs. Adaptation of a guideline to suit the context in which it is intended to be applied can be a key step in the implementation process. Without taking the local context into account, certain interventions recommended in evidence-based guidelines may be infeasible under local conditions. Guideline adaptation frameworks provide a systematic way of approaching adaptation, and their use may increase transparency, methodological rigor, and the quality of the adapted guideline. This paper presents a number of adaptation frameworks that are currently available. We aim to compare the advantages and limitations of their processes, methods, and resource implications. These insights into adaptation frameworks can inform the future development of guidelines and systematic methods to optimize their adaptation. Recent adaptation frameworks show an evolution from adapting entire existing guidelines, to adapting specific recommendations extracted from an existing guideline, to constructing evidence tables for each recommendation that needs to be adapted. This is a move towards more recommendation-focused, context-specific processes and considerations. There are still many gaps in knowledge about guideline adaptation. Most of the frameworks reviewed lack any evaluation of the adaptation process and outcomes, including user satisfaction and resources expended. The validity, usability, and health impact of guidelines developed via an adaptation process have not been studied. Lastly, adaptation frameworks have not been evaluated for use in low-income countries. Despite the limitations in frameworks, a more systematic approach to adaptation based on a framework is valuable, as it helps to ensure that the recommendations stay true to the evidence while taking local needs into account. The utilization of frameworks in the guideline implementation process can be optimized by increasing the understanding and upfront estimation of resource and time needed, capacity building in adaptation methods, and increasing the adaptability of the source recommendation document.

Chapel branch creek TMDL development: integrating TMDL development with implementation

Treesearch

T.M. Williams; D.M. Amatya; D.R. Hitchcock; N. Levine; E.N. Mihalik

2007-01-01

South Carolina assured the USEPA "The State intends to achieve waste load and load allocation reductions in 303(d) listed waters in order to achieve the water quality goals of the Clean Water Act. This includes waters impaired solely or primarily by NPS sources. For each such water, a TMDL will be established that includes specific recommendations for reducing...

Defining Mathematics Competency in the Service of Cognitively Based Assessment for Grades 6 through 8. Research Report. ETS RR-09-42

ERIC Educational Resources Information Center

Graf, Edith Aurora

2009-01-01

This report makes recommendations for the development of middle-school assessment in mathematics, based on a synthesis of scientific findings in cognitive psychology and mathematics education. The focus is on background research, rather than test specifications or example tasks. Readers interested in early development and pilot efforts associated…

Cost and benefits design optimization model for fault tolerant flight control systems

NASA Technical Reports Server (NTRS)

Rose, J.

1982-01-01

Requirements and specifications for a method of optimizing the design of fault-tolerant flight control systems are provided. Algorithms that could be used for developing new and modifying existing computer programs are also provided, with recommendations for follow-on work.

An International Aerospace Information System: A Cooperative Opportunity.

ERIC Educational Resources Information Center

Blados, Walter R.; Cotter, Gladys A.

1992-01-01

Introduces and discusses ideas and issues relevant to the international unification of scientific and technical information (STI) through development of an international aerospace database (IAD). Specific recommendations for improving the National Aeronautics and Space Administration Aerospace Database (NAD) and for implementing IAD are given.…

Michelin Tire Company Workplace Literacy Curriculum.

ERIC Educational Resources Information Center

Alabama State Dept. of Education, Montgomery.

This packet provides generic versions of curriculum developed for the Michelin Tire Corporation workplace literacy program, specifically the mathematics portion. Altered material included in the packet protects proprietary information; some lessons include lines that take the place of deleted information. Other companies are recommended to use…

The Screening and Diagnosis of Autistic Spectrum Disorders.

ERIC Educational Resources Information Center

Filipek, Pauline A.; Accardo, Pasquale J.; Baranek, Grace T.; Cook, Edwin H., Jr.; Dawson, Geraldine; Gordon, Barry; Gravel, Judith S.; Johnson, Chris P.; Kallen, Ronald J.; Levy, Susan E.; Minshew, Nancy J.; Prizant, Barry M.; Rapin, Isabelle; Rogers, Sally J.; Stone, Wendy L.; Teplin, Stuart; Tuchman, Roberto F.; Volkmar, Fred R.

1999-01-01

This paper presents detailed recommendations for diagnosis of autism established by a multidisciplinary panel of the Child Neurology Society and the American Academy of Neurology. The paper offers dual-level (general development and specific symptoms) guidelines for diagnosis of autistic disorder, Asperger disorder, childhood disintegrative…

Methods of assessing structural integrity for space shuttle vehicles

NASA Technical Reports Server (NTRS)

Anderson, R. E.; Stuckenberg, F. H.

1971-01-01

A detailed description and evaluation of nondestructive evaluation (NDE) methods are given which have application to space shuttle vehicles. Appropriate NDE design data is presented in twelve specifications in an appendix. Recommendations for NDE development work for the space shuttle program are presented.

Student Assessment in Portugal: Academic Practice and Bologna Policy

ERIC Educational Resources Information Center

Sin, Cristina; Manatos, Maria

2014-01-01

This paper investigates institutional policies and academic practices of student assessment in four Portuguese higher education institutions (HEIs) in the wake of European policy developments driven by the Bologna Process. Specifically, it examines the correspondence between European policy recommendations related to student assessment (promotion…

Treatment of Sexual Offenders: Research, Best Practices, and Emerging Models

ERIC Educational Resources Information Center

Yates, Pamela M.

2013-01-01

Treatment of sexual offenders has evolved substantially over the years; various theoretical and practice models of treatment been developed, modified, refined, and proposed over time. The predominant current recommended approach, supported by research, adheres to specific principles of effective correctional intervention, follows a…

Liquid rocket engine turbines

NASA Technical Reports Server (NTRS)

1974-01-01

Criteria for the design and development of turbines for rocket engines to meet specific performance, and installation requirements are summarized. The total design problem, and design elements are identified, and the current technology pertaining to these elements is described. Recommended practices for achieving a successful design are included.

The New Biotechnology and Biological Science-Related Instruction in Colleges of Pharmacy.

ERIC Educational Resources Information Center

Hudson, Richard A.; And Others

1990-01-01

A discussion of the impact of modern biotechnological developments on pharmaceutical education looks at undergraduate and graduate curricula separately, and focuses on the impact on needs for new faculty and faculty retraining. Specific faculty and curriculum recommendations are made. (MSE)

Racket sports.

PubMed

Jayanthi, Neeru; Esser, Stephen

2013-01-01

Tennis may be considered a static and dynamic form of exercise with many well-demonstrated health benefits. Tennis has similar rates of injury to other individual recreational sports and junior competitive sports, without the catastrophic risk of contact/collision sports. Classifying tennis players into junior and elite categories versus adult recreational players may help in outlining volume of play recommendations, exposure risk, and types of injuries. Junior and elite players tend to tolerate higher volumes, have more acute and lower extremity injuries, and have more serious overuse stress injuries. Adult recreational players tend to tolerate lower volumes, have more overuse and upper extremity injuries, and more conditions that are degenerative. Many tennis players also develop asymmetric musculoskeletal adaptations, which may increase risk of specific injury. Tennis-specific evaluations may identify these at-risk segments, help guide preventive strategies including technical errors, and assist in developing return-to-play recommendations. Other racket sports such as squash, badminton, and racquetball have less data available but report both acute and traumatic injuries less commonly seen in tennis.

ACR Appropriateness Criteria® Chronic Ankle Pain.

PubMed

Chang, Eric Y; Tadros, Anthony S; Amini, Behrang; Bell, Angela M; Bernard, Stephanie A; Fox, Michael G; Gorbachova, Tetyana; Ha, Alice S; Lee, Kenneth S; Metter, Darlene F; Mooar, Pekka A; Shah, Nehal A; Singer, Adam D; Smith, Stacy E; Taljanovic, Mihra S; Thiele, Ralf; Kransdorf, Mark J

2018-05-01

Chronic ankle pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic ankle pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

ACR Appropriateness Criteria® Chronic Hip Pain.

PubMed

Mintz, Douglas N; Roberts, Catherine C; Bencardino, Jenny T; Baccei, Steven J; Caird, Michelle S; Cassidy, R Carter; Chang, Eric Y; Fox, Michael G; Gyftopoulos, Soterios; Kransdorf, Mark J; Metter, Darlene F; Morrison, William B; Rosenberg, Zehava S; Shah, Nehal A; Small, Kirstin M; Subhas, Naveen; Tambar, Siddharth; Towers, Jeffrey D; Yu, Joseph S; Weissman, Barbara N

2017-05-01

Chronic hip pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic hip pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Principles and Recommendations for Standardizing the Use of the Next-Generation Sequencing Variant File in Clinical Settings.

PubMed

Lubin, Ira M; Aziz, Nazneen; Babb, Lawrence J; Ballinger, Dennis; Bisht, Himani; Church, Deanna M; Cordes, Shaun; Eilbeck, Karen; Hyland, Fiona; Kalman, Lisa; Landrum, Melissa; Lockhart, Edward R; Maglott, Donna; Marth, Gabor; Pfeifer, John D; Rehm, Heidi L; Roy, Somak; Tezak, Zivana; Truty, Rebecca; Ullman-Cullere, Mollie; Voelkerding, Karl V; Worthey, Elizabeth A; Zaranek, Alexander W; Zook, Justin M

2017-05-01

A national workgroup convened by the Centers for Disease Control and Prevention identified principles and made recommendations for standardizing the description of sequence data contained within the variant file generated during the course of clinical next-generation sequence analysis for diagnosing human heritable conditions. The specifications for variant files were initially developed to be flexible with regard to content representation to support a variety of research applications. This flexibility permits variation with regard to how sequence findings are described and this depends, in part, on the conventions used. For clinical laboratory testing, this poses a problem because these differences can compromise the capability to compare sequence findings among laboratories to confirm results and to query databases to identify clinically relevant variants. To provide for a more consistent representation of sequence findings described within variant files, the workgroup made several recommendations that considered alignment to a common reference sequence, variant caller settings, use of genomic coordinates, and gene and variant naming conventions. These recommendations were considered with regard to the existing variant file specifications presently used in the clinical setting. Adoption of these recommendations is anticipated to reduce the potential for ambiguity in describing sequence findings and facilitate the sharing of genomic data among clinical laboratories and other entities. Copyright © 2017 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

Clinical Recommendation: Vulvovaginitis.

PubMed

Zuckerman, Andrea; Romano, Mary

2016-12-01

Vulvovaginitis is a commonly encountered condition among prepubertal and adolescent females. The objective of this report is to provide the latest evidence regarding the diagnosis and management of vulvovaginitis in prepubertal and adolescent females. In this systematic review we used the Grading of Recommendations Assessment, Development and Evaluation evidence system. Vulvovaginal complaints are common in the pediatric and adolescent age group. The patient's age in conjunction with history and associated complaints will guide evaluation, diagnosis, and treatment. Treatment should include counseling on hygiene and voiding techniques as well as therapy for any specific pathogens identified. Copyright © 2016.

Development of a laboratory prototype water quality monitoring system suitable for use in zero gravity

NASA Technical Reports Server (NTRS)

Misselhorn, J. E.; Witz, S.; Hartung, W. H.

1973-01-01

The development of a laboratory prototype water quality monitoring system for use in the evaluation of candidate water recovery systems and for study of techniques for measuring potability parameters is reported. Sensing techniques for monitoring of the most desirable parameters are reviewed in terms of their sensitivities and complexities, and their recommendations for sensing techniques are presented. Rationale for selection of those parameters to be monitored (pH, specific conductivity, Cr(+6), I2, total carbon, and bacteria) in a next generation water monitor is presented along with an estimate of flight system specifications. A master water monitor development schedule is included.

Approaches for Establishing Clinically Relevant Dissolution Specifications for Immediate Release Solid Oral Dosage Forms.

PubMed

Hermans, Andre; Abend, Andreas M; Kesisoglou, Filippos; Flanagan, Talia; Cohen, Michael J; Diaz, Dorys A; Mao, Y; Zhang, Limin; Webster, Gregory K; Lin, Yiqing; Hahn, David A; Coutant, Carrie A; Grady, Haiyan

2017-11-01

This manuscript represents the perspective of the Dissolution Analytical Working Group of the IQ Consortium. The intent of this manuscript is to highlight the challenges of, and to provide a recommendation on, the development of clinically relevant dissolution specifications (CRS) for immediate release (IR) solid oral dosage forms. A roadmap toward the development of CRS for IR products containing active ingredients with a non-narrow therapeutic window is discussed, within the context of mechanistic dissolution understanding, supported by in-human pharmacokinetic (PK) data. Two case studies present potential outcomes of following the CRS roadmap and setting dissolution specifications. These cases reveal some benefits and challenges of pursuing CRS with additional PK data, in light of current regulatory positions, including that of the US Food and Drug Administration (FDA), who generally favor this approach, but with the understanding that both industry and regulatory agency perspectives are still evolving in this relatively new field. The CRS roadmap discussed in this manuscript also describes a way to develop clinically relevant dissolution specifications based primarily on dissolution data for batches used in pivotal clinical studies, acknowledging that not all IR product development efforts need to be supported by additional PK studies, albeit with the associated risk of potentially unnecessarily tight manufacturing controls. Recommendations are provided on what stages during the life cycle investment into in vivo studies may be valuable. Finally, the opportunities for CRS within the context of post-approval changes, Modeling and Simulation (M&S), and the application of biowaivers, are briefly discussed.

Laboratory Medicine Best Practice Guideline: Vitamins A, E and the Carotenoids in Blood

PubMed Central

Greaves, Ronda F; Woollard, Gerald A; Hoad, Kirsten E; Walmsley, Trevor A; Johnson, Lambro A; Briscoe, Scott; Koetsier, Sabrina; Harrower, Tamantha; Gill, Janice P

2014-01-01

Despite apparent method similarities between laboratories there appear to be confounding factors inhibiting uniform reporting and standardisation of vitamin assays. The Australasian Association of Clinical Biochemists (AACB) Vitamins Working Party, in conjunction with The Royal College of Pathologists of Australasia Quality Assurance Programs, has formulated a guideline to improve performance, reproducibility and accuracy of fat-soluble vitamin results. The aim of the guideline is to identify critical pre-analytical, analytical and post-analytical components of the analysis of vitamins A, E and carotenoids in blood to promote best practice and harmonisation. This best practice guideline has been developed with reference to the Centers for Disease Control and Prevention (CDC) “Laboratory Medicine Best Practices: Developing an Evidence-Based Review and Evaluation Process”. The CDC document cites an evaluation framework for generating best practice recommendations that are specific to laboratory medicine. These 50 recommendations proposed herein, were generated from a comprehensive literature search and the extensive combined experience of the AACB Vitamins Working Party members. They were formulated based on comparison between an impact assessment rating and strength of evidence and were classified as either: (1) strongly recommend, (2) recommend, (3) no recommendation for or against, or (4) recommend against. These best practice recommendations represent the consensus views, in association with peer reviewed evidence of the AACB Vitamins Working Party, towards best practice for the collection, analysis and interpretation of vitamins A, E and carotenoids in blood. PMID:25210208

OARSI Clinical Trials Recommendations: Design, conduct, and reporting of clinical trials for knee osteoarthritis.

PubMed

McAlindon, T E; Driban, J B; Henrotin, Y; Hunter, D J; Jiang, G-L; Skou, S T; Wang, S; Schnitzer, T

2015-05-01

The goal of this document is to update the original OARSI recommendations specifically for the design, conduct, and reporting of clinical trials that target symptom or structure modification among individuals with knee osteoarthritis (OA). To develop recommendations for the design, conduct, and reporting of clinical trials for knee OA we initially drafted recommendations through an iterative process. Members of the working group included representatives from industry and academia. After the working group members reviewed a final draft, they scored the appropriateness for recommendations. After the members voted we calculated the median score among the nine members of the working group who completed the score. The document includes 25 recommendations regarding randomization, blocking and stratification, blinding, enhancing accuracy of patient-reported outcomes (PRO), selecting a study population and index knee, describing interventions, patient-reported and physical performance measures, structural outcome measures, biochemical biomarkers, and reporting recommendations. In summary, the working group identified 25 recommendations that represent the current best practices regarding clinical trials that target symptom or structure modification among individuals with knee OA. These updated recommendations incorporate novel technologies (e.g., magnetic resonance imaging (MRI)) and strategies to address the heterogeneity of knee OA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Developing the Tools for Geologic Repository Monitoring - Andra's Monitoring R and D Program - 12045

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

Buschaert, S.; Lesoille, S.; Bertrand, J.

2012-07-01

The French Safety Guide recommends that Andra develop a monitoring program to be implemented during repository construction and conducted until (and possibly after) closure, in order to confirm expected behavior and enhance knowledge of relevant processes. To achieve this, Andra has developed an overall monitoring strategy and identified specific technical objectives to inform disposal process management on evolutions relevant to both the long term safety and reversible, pre-closure management of the repository. Andra has launched an ambitious R and D program to ensure that reliable, durable, metrologically qualified and tested monitoring systems will be available at the time of repositorymore » construction in order to respond to monitoring objectives. After four years of a specific R and D program, first observations are described and recommendations are proposed. The results derived from 4 years of Andra's R and D program allow three main observations to be shared. First, while other industries also invest in monitoring equipment, their obvious emphasis will always be on their specific requirements and needs, thus often only providing a partial match with repository requirements. Examples can be found for all available sensors, which are generally not resistant to radiation. Second, the very close scrutiny anticipated for the geologic disposal process is likely to place an unprecedented emphasis on the quality of monitoring results. It therefore seems important to emphasize specific developments with an aim at providing metrologically qualified systems. Third, adapting existing technology to specific repository needs, and providing adequate proof of their worth, is a lengthy process. In conclusion, it therefore seems prudent to plan ahead and to invest wisely in the adequate development of those monitoring tools that will likely be needed in the repository to respond to the implementers' and regulators' requirements, including those agreed and developed to respond to potential stakeholder expectations. (authors)« less

EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases.

PubMed

Foster, Helen E; Minden, Kirsten; Clemente, Daniel; Leon, Leticia; McDonagh, Janet E; Kamphuis, Sylvia; Berggren, Karin; van Pelt, Philomine; Wouters, Carine; Waite-Jones, Jennifer; Tattersall, Rachel; Wyllie, Ruth; Stones, Simon R; Martini, Alberto; Constantin, Tamas; Schalm, Susanne; Fidanci, Berna; Erer, Burak; Demirkaya, Erkan; Ozen, Seza; Carmona, Loreto

2017-04-01

To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: (1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Integrating Genomics Into Clinical Pediatric Oncology Using the Molecular Tumor Board at the Memorial Sloan Kettering Cancer Center.

PubMed

Ortiz, Michael V; Kobos, Rachel; Walsh, Michael; Slotkin, Emily K; Roberts, Stephen; Berger, Michael F; Hameed, Meera; Solit, David; Ladanyi, Marc; Shukla, Neerav; Kentsis, Alex

2016-08-01

Pediatric oncologists have begun to leverage tumor genetic profiling to match patients with targeted therapies. At the Memorial Sloan Kettering Cancer Center (MSKCC), we developed the Pediatric Molecular Tumor Board (PMTB) to track, integrate, and interpret clinical genomic profiling and potential targeted therapeutic recommendations. This retrospective case series includes all patients reviewed by the MSKCC PMTB from July 2014 to June 2015. Cases were submitted by treating oncologists and potential treatment recommendations were based upon the modified guidelines of the Oxford Centre for Evidence-Based Medicine. There were 41 presentations of 39 individual patients during the study period. Gliomas, acute myeloid leukemia, and neuroblastoma were the most commonly reviewed cases. Thirty nine (87%) of the 45 molecular sequencing profiles utilized hybrid-capture targeted genome sequencing. In 30 (73%) of the 41 presentations, the PMTB provided therapeutic recommendations, of which 19 (46%) were implemented. Twenty-one (70%) of the recommendations involved targeted therapies. Three (14%) targeted therapy recommendations had published evidence to support the proposed recommendations (evidence levels 1-2), eight (36%) recommendations had preclinical evidence (level 3), and 11 (50%) recommendations were based upon hypothetical biological rationales (level 4). The MSKCC PMTB enabled a clinically relevant interpretation of genomic profiling. Effective use of clinical genomics is anticipated to require new and improved tools to ascribe pathogenic significance and therapeutic actionability. The development of specific rule-driven clinical protocols will be needed for the incorporation and evaluation of genomic and molecular profiling in interventional prospective clinical trials. © 2016 Wiley Periodicals, Inc.

Evidence-based decision-making as a practice-based learning skill: a pilot study.

PubMed

Falzer, Paul R; Garman, D Melissa

2012-03-01

As physicians are being trained to adapt their practices to the needs and experience of patients, initiatives to standardize care have been gaining momentum. The resulting conflict can be addressed through a practice-based learning and improvement (PBL) program that develops competency in using treatment guidelines as decision aids and incorporating patient-specific information into treatment recommendations. This article describes and tests a program that is consistent with the ACGME's multilevel competency-based approach, targets students at four levels of training, and features progressive learning objectives and assessments. The program was pilot-tested with 22 paid volunteer psychiatric residents and fellows. They were introduced to a schizophrenia treatment guideline and reviewed six case vignettes of varying complexity. PBL assessments were based on how treatment recommendations were influenced by clinical and patient-specific factors. The task permitted separate assessments of learning objectives all four training levels. Among the key findings at each level, most participants found the treatment guideline helpful in making treatment decisions. Recommendations were influenced by guideline-based assessment criteria and other clinical features. They were also influenced by patients' perceptions of their illness, patient-based progress assessments, and complications such as stressors and coping patterns. Recommendations were strongly influenced by incongruence between clinical facts and patient experience. Practical understanding of how patient experience joins with clinical knowledge can enhance the use of treatment guidelines as decision tools and enable clinicians to appreciate more fully how and why patients' perceptions of their illness should influence treatment recommendations. This PBL program can assist training facilities in preparing students to cope with contradictory demands to both standardize and adapt their practice. The program can be modified to accommodate various disorders and a range of clinical factors and patient-specific complications.

Healthcare provider compliance with the 2013 ACC/AHA Adult Cholesterol Guideline recommendation for high-intensity dose statins for patients with coronary artery disease.

PubMed

Housholder-Hughes, Susan D; Martin, Melanie M; McFarland, Marilyn R; Creech, Constance J; Shea, Michael J

Atherosclerotic cardiovascular disease is the foremost cause of death for U.S. adults. The 2013 ACC/AHA Adult Cholesterol Guidelines recommend high-intensity dose statins for individuals with coronary artery disease (CAD). To determine healthcare provider compliance with the Cholesterol Guideline recommendation specific to high-intensity dose statins for patients with CAD. A retrospective chart review was conducted to determine compliance rate. A questionnaire was developed to evaluate healthcare provider beliefs, attitudes, and self-confidence toward this recommendation. Of the 473 patients with CAD, 67% were prescribed a high-intensity dose statin. Patients with non-ST segment myocardial infarction and ST segment myocardial infarction were more likely to be prescribed a high-intensity dose statin versus a moderate or low-intensity dose. Healthcare providers strongly agreed with this guideline recommendation. There exists a dichotomy between intention to prescribe and actual prescribing behaviors of high-intensity dose statin for patients with CAD. Copyright © 2017 Elsevier Inc. All rights reserved.

Optimising the Inflammatory Bowel Disease Unit to Improve Quality of Care: Expert Recommendations.

PubMed

Louis, Edouard; Dotan, Iris; Ghosh, Subrata; Mlynarsky, Liat; Reenaers, Catherine; Schreiber, Stefan

2015-08-01

The best care setting for patients with inflammatory bowel disease [IBD] may be in a dedicated unit. Whereas not all gastroenterology units have the same resources to develop dedicated IBD facilities and services, there are steps that can be taken by any unit to optimise patients' access to interdisciplinary expert care. A series of pragmatic recommendations relating to IBD unit optimisation have been developed through discussion among a large panel of international experts. Suggested recommendations were extracted through systematic search of published evidence and structured requests for expert opinion. Physicians [n = 238] identified as IBD specialists by publications or clinical focus on IBD were invited for discussion and recommendation modification [Barcelona, Spain; 2014]. Final recommendations were voted on by the group. Participants also completed an online survey to evaluate their own experience related to IBD units. A total of 60% of attendees completed the survey, with 15% self-classifying their centre as a dedicated IBD unit. Only half of respondents indicated that they had a defined IBD treatment algorithm in place. Key recommendations included the need to develop a multidisciplinary team covering specifically-defined specialist expertise in IBD, to instil processes that facilitate cross-functional communication and to invest in shared care models of IBD management. Optimising the setup of IBD units will require progressive leadership and willingness to challenge the status quo in order to provide better quality of care for our patients. IBD units are an important step towards harmonising care for IBD across Europe and for establishing standards for disease management programmes. © European Crohn’s and Colitis Organisation 2015.

Optimising the Inflammatory Bowel Disease Unit to Improve Quality of Care: Expert Recommendations

PubMed Central

Dotan, Iris; Ghosh, Subrata; Mlynarsky, Liat; Reenaers, Catherine; Schreiber, Stefan

2015-01-01

Introduction: The best care setting for patients with inflammatory bowel disease [IBD] may be in a dedicated unit. Whereas not all gastroenterology units have the same resources to develop dedicated IBD facilities and services, there are steps that can be taken by any unit to optimise patients’ access to interdisciplinary expert care. A series of pragmatic recommendations relating to IBD unit optimisation have been developed through discussion among a large panel of international experts. Methods: Suggested recommendations were extracted through systematic search of published evidence and structured requests for expert opinion. Physicians [n = 238] identified as IBD specialists by publications or clinical focus on IBD were invited for discussion and recommendation modification [Barcelona, Spain; 2014]. Final recommendations were voted on by the group. Participants also completed an online survey to evaluate their own experience related to IBD units. Results: A total of 60% of attendees completed the survey, with 15% self-classifying their centre as a dedicated IBD unit. Only half of respondents indicated that they had a defined IBD treatment algorithm in place. Key recommendations included the need to develop a multidisciplinary team covering specifically-defined specialist expertise in IBD, to instil processes that facilitate cross-functional communication and to invest in shared care models of IBD management. Conclusions: Optimising the setup of IBD units will require progressive leadership and willingness to challenge the status quo in order to provide better quality of care for our patients. IBD units are an important step towards harmonising care for IBD across Europe and for establishing standards for disease management programmes. PMID:25987349

Automated detection using natural language processing of radiologists recommendations for additional imaging of incidental findings.

PubMed

Dutta, Sayon; Long, William J; Brown, David F M; Reisner, Andrew T

2013-08-01

As use of radiology studies increases, there is a concurrent increase in incidental findings (eg, lung nodules) for which the radiologist issues recommendations for additional imaging for follow-up. Busy emergency physicians may be challenged to carefully communicate recommendations for additional imaging not relevant to the patient's primary evaluation. The emergence of electronic health records and natural language processing algorithms may help address this quality gap. We seek to describe recommendations for additional imaging from our institution and develop and validate an automated natural language processing algorithm to reliably identify recommendations for additional imaging. We developed a natural language processing algorithm to detect recommendations for additional imaging, using 3 iterative cycles of training and validation. The third cycle used 3,235 radiology reports (1,600 for algorithm training and 1,635 for validation) of discharged emergency department (ED) patients from which we determined the incidence of discharge-relevant recommendations for additional imaging and the frequency of appropriate discharge documentation. The test characteristics of the 3 natural language processing algorithm iterations were compared, using blinded chart review as the criterion standard. Discharge-relevant recommendations for additional imaging were found in 4.5% (95% confidence interval [CI] 3.5% to 5.5%) of ED radiology reports, but 51% (95% CI 43% to 59%) of discharge instructions failed to note those findings. The final natural language processing algorithm had 89% (95% CI 82% to 94%) sensitivity and 98% (95% CI 97% to 98%) specificity for detecting recommendations for additional imaging. For discharge-relevant recommendations for additional imaging, sensitivity improved to 97% (95% CI 89% to 100%). Recommendations for additional imaging are common, and failure to document relevant recommendations for additional imaging in ED discharge instructions occurs frequently. The natural language processing algorithm's performance improved with each iteration and offers a promising error-prevention tool. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

The GRADE approach for assessing new technologies as applied to apheresis devices in ulcerative colitis

PubMed Central

2010-01-01

Background In the last few years, a new non-pharmacological treatment, termed apheresis, has been developed to lessen the burden of ulcerative colitis (UC). Several methods can be used to establish treatment recommendations, but over the last decade an informal collaboration group of guideline developers, methodologists, and clinicians has developed a more sensible and transparent approach known as the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). GRADE has mainly been used in clinical practice guidelines and systematic reviews. The aim of the present study is to describe the use of this approach in the development of recommendations for a new health technology, and to analyse the strengths, weaknesses, opportunities, and threats found when doing so. Methods A systematic review of the use of apheresis for UC treatment was performed in June 2004 and updated in May 2008. Two related clinical questions were selected, the outcomes of interest defined, and the quality of the evidence assessed. Finally, the overall quality of each question was taken into account to formulate recommendations following the GRADE approach. To evaluate this experience, a SWOT (strengths, weaknesses, opportunities and threats) analysis was performed to enable a comparison with our previous experience with the SIGN (Scottish Intercollegiate Guidelines Network) method. Results Application of the GRADE approach allowed recommendations to be formulated and the method to be clarified and made more explicit and transparent. Two weak recommendations were proposed to answer to the formulated questions. Some challenges, such as the limited number of studies found for the new technology and the difficulties encountered when searching for the results for the selected outcomes, none of which are specific to GRADE, were identified. GRADE was considered to be a more time-consuming method, although it has the advantage of taking into account patient values when defining and grading the relevant outcomes, thereby avoiding any influence from literature precedents, which could be considered to be a strength of this method. Conclusions The GRADE approach could be appropriate for making the recommendation development process for Health Technology Assessment (HTA) reports more explicit, especially with regard to new technologies. PMID:20553616

Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia.

PubMed

Zafren, Ken; Giesbrecht, Gordon G; Danzl, Daniel F; Brugger, Hermann; Sagalyn, Emily B; Walpoth, Beat; Weiss, Eric A; Auerbach, Paul S; McIntosh, Scott E; Némethy, Mária; McDevitt, Marion; Dow, Jennifer; Schoene, Robert B; Rodway, George W; Hackett, Peter H; Bennett, Brad L; Grissom, Colin K

2014-12-01

To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. Copyright © 2014 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

77 FR 55192 - New England Fishery Management Council (NEFMC); Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-07

... 25-27, 2012 to consider actions affecting New England fisheries in the exclusive economic zone (EEZ... findings and recommendations concerning the use of socio-cultural information in the NEFMC process. Three... will cover initial development of Atlantic herring fishery specifications for the upcoming fishing...

Cognitive Requirements for Small Unit Leaders in Military Operations in Urban Terrain

DTIC Science & Technology

1998-09-01

operations specifically. A cognitive task analysis , based on in depth interviews with subject matter experts (n=7), was conducted to expose the...process. The findings of the cognitive task analysis guided the development of training recommendations, particularly the need for a scenario based

76 FR 5365 - Environmental Management Site-Specific Advisory Board, Nevada

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-31

... related activities. Tentative Agenda: 1. Recommendation Development--Industrial Sites, CAU 566 Rail Cars 2... presentations pertaining to agenda items should contact Denise Rupp at the telephone number listed above. The... the presentation in the agenda. The Deputy Designated Federal Officer is empowered to conduct the...

Guiding Students to Answers: Query Recommendation

ERIC Educational Resources Information Center

Yilmazel, Ozgur

2011-01-01

This paper reports on a guided navigation system built on the textbook search engine developed at Anadolu University to support distance education students. The search engine uses Turkish Language specific language processing modules to enable searches over course material presented in Open Education Faculty textbooks. We implemented a guided…

Defense Logistics Agency 1995 Defense Base Realignment and Closure Data Collection Process for the Evaluation Phase.

DTIC Science & Technology

1995-05-04

Commission. The specific objective for the audit was to determine whether the evaluation process that the DLA used to develop recommendations reported to the...1995 Commission was consistently applied and adequately supported. The audit also reviewed applicable management controls.

The Teacher/Scientist: From Trainer to Educator.

ERIC Educational Resources Information Center

Ellerbrock, Michael J.

Problems and issues in U.S. undergraduate education are identified, and 10 recommendations for improvement are offered. Specific reference is made to agriculture faculty. Problems and issues include: current emphasis on academic specialization rather than the development of integrated, holistic students; the purpose of a liberal education versus…

METHODOLOGICAL NOTES: Computer viruses and methods of combatting them

NASA Astrophysics Data System (ADS)

Landsberg, G. L.

1991-02-01

This article examines the current virus situation for personal computers and time-sharing computers. Basic methods of combatting viruses are presented. Specific recommendations are given to eliminate the most widespread viruses. A short description is given of a universal antiviral system, PHENIX, which has been developed.

77 FR 793 - National Environmental Justice Advisory Council; Request for Nominations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-06

... or serve on Work Groups to develop recommendations, advice letters, and reports to address specific... above. In addition, EPA is seeking nominees with knowledge in community sustainability, public health... sustainability issues at the national, state, or local level; Excellent interpersonal and consensus-building...

Integrating Science and Technology into a Policy of Lifelong Education in Nigeria.

ERIC Educational Resources Information Center

Urevbu, Andrew O.

1985-01-01

Examines Nigeria's National Policy on Education guidelines, specifically focusing on science and technological education. Discusses the development of vocational and technical schools, transfer of technology, and the role of research institutes. Recommendations are made concerning academic survival skills, respect for manual skills, improved…

40 CFR 798.4100 - Dermal sensitization.

Code of Federal Regulations, 2014 CFR

2014-07-01

... system selected is recommended; (ii) Animals may act as their own controls or groups of induced animals... CONTROL ACT (CONTINUED) HEALTH EFFECTS TESTING GUIDELINES Specific Organ/Tissue Toxicity § 798.4100 Dermal... hypersensitive state is developed. (3) Induction exposure is an experimental exposure of a subject to a test...

40 CFR 798.4100 - Dermal sensitization.

Code of Federal Regulations, 2012 CFR

2012-07-01

... system selected is recommended; (ii) Animals may act as their own controls or groups of induced animals... CONTROL ACT (CONTINUED) HEALTH EFFECTS TESTING GUIDELINES Specific Organ/Tissue Toxicity § 798.4100 Dermal... hypersensitive state is developed. (3) Induction exposure is an experimental exposure of a subject to a test...

40 CFR 798.4100 - Dermal sensitization.

Code of Federal Regulations, 2013 CFR

2013-07-01

... system selected is recommended; (ii) Animals may act as their own controls or groups of induced animals... CONTROL ACT (CONTINUED) HEALTH EFFECTS TESTING GUIDELINES Specific Organ/Tissue Toxicity § 798.4100 Dermal... hypersensitive state is developed. (3) Induction exposure is an experimental exposure of a subject to a test...

40 CFR 798.4100 - Dermal sensitization.

Code of Federal Regulations, 2011 CFR

2011-07-01

... system selected is recommended; (ii) Animals may act as their own controls or groups of induced animals... CONTROL ACT (CONTINUED) HEALTH EFFECTS TESTING GUIDELINES Specific Organ/Tissue Toxicity § 798.4100 Dermal... hypersensitive state is developed. (3) Induction exposure is an experimental exposure of a subject to a test...

A Service Brokering and Recommendation Mechanism for Better Selecting Cloud Services

PubMed Central

Gui, Zhipeng; Yang, Chaowei; Xia, Jizhe; Huang, Qunying; Liu, Kai; Li, Zhenlong; Yu, Manzhu; Sun, Min; Zhou, Nanyin; Jin, Baoxuan

2014-01-01

Cloud computing is becoming the new generation computing infrastructure, and many cloud vendors provide different types of cloud services. How to choose the best cloud services for specific applications is very challenging. Addressing this challenge requires balancing multiple factors, such as business demands, technologies, policies and preferences in addition to the computing requirements. This paper recommends a mechanism for selecting the best public cloud service at the levels of Infrastructure as a Service (IaaS) and Platform as a Service (PaaS). A systematic framework and associated workflow include cloud service filtration, solution generation, evaluation, and selection of public cloud services. Specifically, we propose the following: a hierarchical information model for integrating heterogeneous cloud information from different providers and a corresponding cloud information collecting mechanism; a cloud service classification model for categorizing and filtering cloud services and an application requirement schema for providing rules for creating application-specific configuration solutions; and a preference-aware solution evaluation mode for evaluating and recommending solutions according to the preferences of application providers. To test the proposed framework and methodologies, a cloud service advisory tool prototype was developed after which relevant experiments were conducted. The results show that the proposed system collects/updates/records the cloud information from multiple mainstream public cloud services in real-time, generates feasible cloud configuration solutions according to user specifications and acceptable cost predication, assesses solutions from multiple aspects (e.g., computing capability, potential cost and Service Level Agreement, SLA) and offers rational recommendations based on user preferences and practical cloud provisioning; and visually presents and compares solutions through an interactive web Graphical User Interface (GUI). PMID:25170937

Alberta CancerBridges development of a care plan evaluation measure

PubMed Central

Giese-Davis, J.; Sisler, J.; Zhong, L.; Brandelli, Y.; McCormick, J.L.; Railton, C.; Shirt, L.; Lau, H.; Hao, D.; Chobanuk, J.; Walley, B.; Joy, A.A.; Taylor, A.; Carlson, L.

2018-01-01

Background No standardized measures specifically assess cancer survivors’ and healthcare providers’ experience of Survivor Care Plans (scps). We sought to develop two care plan evaluation (cpe) measures, one for survivors (cpe-s) and one for healthcare providers (cpe-p), examine initial psychometric qualities in Alberta, and assess generalizability in Manitoba, Canada. Methods We developed the initial measures using convenience samples of breast (n = 35) and head and neck (n = 18) survivors who received scps at the end of active cancer-centre treatment. After assessing Alberta’s scp concordance with Institute of Medicine (iom) recommendations using a published coding scheme, we examined psychometric qualities for the cpe-s and cpe-p. We examined generalizability in Manitoba, Canada, with colorectal survivors discharged to primary care providers for follow-up (n = 75). Results We demonstrated acceptable internal consistency for the cpe-s and cpe-p subscales and total score after eliminating one item per subscale for cpe-s, two for cpe-p, resulting in revised scales with four 7-item and 6-item subscales, respectively. Subscale scores correlated highly indicating that for each measure the total score may be the most reliable and valid. We provide initial cpe-s discriminant, convergent, and predictive validity using the total score. Using the Manitoba sample, initial psychometrics similarly indicated good generalizability across differences in tumour groups, scp, and location. Conclusions We recommend the revised cpe-s and cpe-p for further use and development. Studies documenting the creation and standardization of scp evaluations are few, and we recommend further development of patient experience measures to improve both clinical practice and the specificity of research questions. PMID:29507497

Central station market development strategies for photovoltaics

NASA Technical Reports Server (NTRS)

1980-01-01

Federal market development strategies designed to accelerate the market penetration of central station applications of photovoltaic energy system are analyzed. Since no specific goals were set for the commercialization of central station applications, strategic principles are explored which, when coupled with specific objectives for central stations, can produce a market development implementation plan. The study includes (1) background information on the National Photovoltaic Program, photovoltaic technology, and central stations; (2) a brief market assessment; (3) a discussion of the viewpoints of the electric utility industry with respect to solar energy; (4) a discussion of commercialization issues; and (5) strategy principles. It is recommended that a set of specific goals and objectives be defined for the photovoltaic central station program, and that these goals and objectives evolve into an implementation plan that identifies the appropriate federal role.

Central station market development strategies for photovoltaics

NASA Astrophysics Data System (ADS)

1980-11-01

Federal market development strategies designed to accelerate the market penetration of central station applications of photovoltaic energy system are analyzed. Since no specific goals were set for the commercialization of central station applications, strategic principles are explored which, when coupled with specific objectives for central stations, can produce a market development implementation plan. The study includes (1) background information on the National Photovoltaic Program, photovoltaic technology, and central stations; (2) a brief market assessment; (3) a discussion of the viewpoints of the electric utility industry with respect to solar energy; (4) a discussion of commercialization issues; and (5) strategy principles. It is recommended that a set of specific goals and objectives be defined for the photovoltaic central station program, and that these goals and objectives evolve into an implementation plan that identifies the appropriate federal role.

Nutrition for healthy term infants, six to 24 months: An overview

PubMed Central

Critch, Jeffrey N

2014-01-01

Nutrition for Healthy Term Infants is a joint statement by Health Canada, the Canadian Paediatric Society, Dietitians of Canada and the Breastfeeding Committee for Canada. It was republished in September 2012, with recommendations on infant feeding from birth to six months of age. The statement was most recently updated in April 2014, with recommendations for feeding older infants and young children from six to 24 months of age. The present practice point outlines the statement development process and principles of feeding, with specific recommendations for clinicians. Health professionals who counsel families on nutrition in infants and young children are advised to read the statement in its entirety because discussion in the longer document expands on and clarifies advice summarized in the principles and recommendations given here. The complete statement is available on Health Canada’s website: www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-eng.php. PMID:25587235

Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists.

PubMed

Bahn Chair, Rebecca S; Burch, Henry B; Cooper, David S; Garber, Jeffrey R; Greenlee, M Carol; Klein, Irwin; Laurberg, Peter; McDougall, I Ross; Montori, Victor M; Rivkees, Scott A; Ross, Douglas S; Sosa, Julie Ann; Stan, Marius N

2011-06-01

Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.

Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists.

PubMed

Bahn, Rebecca S; Burch, Henry B; Cooper, David S; Garber, Jeffrey R; Greenlee, M Carol; Klein, Irwin; Laurberg, Peter; McDougall, I Ross; Montori, Victor M; Rivkees, Scott A; Ross, Douglas S; Sosa, Julie Ann; Stan, Marius N

2011-01-01

Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.

Competency, Programming, and Emerging Innovation in Graduate Education within Schools of Pharmacy: The Report of the 2016-2017 Research and Graduate Affairs Committee.

PubMed

Poloyac, Samuel M; Block, Kirsten F; Cavanaugh, Jane E; Dwoskin, Linda P; Melchert, Russell B; Nemire, Ruth E; O'Donnell, James M; Priefer, Ronny; Touchette, Daniel R

2017-10-01

Graduate education in the pharmaceutical sciences is a cornerstone of research within pharmacy schools. Pharmaceutical scientists are critical contributors to addressing the challenges of new drug discovery, delivery, and optimal care in order to ensure improved therapeutic outcomes in populations of patients. The American Association of Colleges of Pharmacy (AACP) charged the 2016-2017 Research and Graduate Affairs Committee (RGAC) to define the competencies necessary for graduate education in the pharmaceutical sciences (Charge 1), recommend collaborative curricular development across schools of pharmacy (Charge 2), recommend AACP programing for graduate education (Charge 3), and provide guidance on emerging areas for innovation in graduate education (Charge 4). With respect to Charges 1 and 2, the RGAC committee developed six domains of core competencies for graduate education in the pharmaceutical sciences as well as recommendations for shared programming. For Charge 3, the committee made 3 specific programming recommendations that include AACP sponsored regional research symposia, a professional development forum at the AACP INterim Meeting, and the addition of a graduate research and education poster session at the AACP Annual Meeting. For Charge 4, the committee recommended that AACP develop a standing committee of graduate program deans and directors to provide guidance to member schools in support of graduate program representation at AACP meetings, develop skills for interprofessional teamwork and augment research through integration of Pharm.D., Ph.D., postdoctoral associates, resident, and fellow experiences. Two proposed policy statements by the committee are that AACP believes core competencies are essential components of graduate education and AACP supports the inclusion of research and graduate education focuses in its portfolio of meetings and programs.

Competency, Programming, and Emerging Innovation in Graduate Education within Schools of Pharmacy: The Report of the 2016-2017 Research and Graduate Affairs Committee

PubMed Central

Poloyac, Samuel M.; Block, Kirsten F.; Cavanaugh, Jane E.; Dwoskin, Linda P.; Melchert, Russell B.; Nemire, Ruth E.; O’Donnell, James M.; Priefer, Ronny; Touchette, Daniel R.

2017-01-01

EXECUTIVE SUMMARY Graduate education in the pharmaceutical sciences is a cornerstone of research within pharmacy schools. Pharmaceutical scientists are critical contributors to addressing the challenges of new drug discovery, delivery, and optimal care in order to ensure improved therapeutic outcomes in populations of patients. The American Association of Colleges of Pharmacy (AACP) charged the 2016-2017 Research and Graduate Affairs Committee (RGAC) to define the competencies necessary for graduate education in the pharmaceutical sciences (Charge 1), recommend collaborative curricular development across schools of pharmacy (Charge 2), recommend AACP programing for graduate education (Charge 3), and provide guidance on emerging areas for innovation in graduate education (Charge 4). With respect to Charges 1 and 2, the RGAC committee developed six domains of core competencies for graduate education in the pharmaceutical sciences as well as recommendations for shared programming. For Charge 3, the committee made 3 specific programming recommendations that include AACP sponsored regional research symposia, a professional development forum at the AACP INterim Meeting, and the addition of a graduate research and education poster session at the AACP Annual Meeting. For Charge 4, the committee recommended that AACP develop a standing committee of graduate program deans and directors to provide guidance to member schools in support of graduate program representation at AACP meetings, develop skills for interprofessional teamwork and augment research through integration of Pharm.D., Ph.D., postdoctoral associates, resident, and fellow experiences. Two proposed policy statements by the committee are that AACP believes core competencies are essential components of graduate education and AACP supports the inclusion of research and graduate education focuses in its portfolio of meetings and programs. PMID:29200459

Reporting Standards for Research in Psychology

PubMed Central

2010-01-01

In anticipation of the impending revision of the Publication Manual of the American Psychological Association, APA’s Publications and Communications Board formed the Working Group on Journal Article Reporting Standards (JARS) and charged it to provide the board with background and recommendations on information that should be included in manuscripts submitted to APA journals that report (a) new data collections and (b) meta-analyses. The JARS Group reviewed efforts in related fields to develop standards and sought input from other knowledgeable groups. The resulting recommendations contain (a) standards for all journal articles, (b) more specific standards for reports of studies with experimental manipulations or evaluations of interventions using research designs involving random or nonrandom assignment, and (c) standards for articles reporting meta-analyses. The JARS Group anticipated that standards for reporting other research designs (e.g., observational studies, longitudinal studies) would emerge over time. This report also (a) examines societal developments that have encouraged researchers to provide more details when reporting their studies, (b) notes important differences between requirements, standards, and recommendations for reporting, and (c) examines benefits and obstacles to the development and implementation of reporting standards. PMID:19086746

Bone Marrow Synoptic Reporting for Hematologic Neoplasms: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center.

PubMed

Sever, Cordelia; Abbott, Charles L; de Baca, Monica E; Khoury, Joseph D; Perkins, Sherrie L; Reichard, Kaaren Kemp; Taylor, Ann; Terebelo, Howard R; Colasacco, Carol; Rumble, R Bryan; Thomas, Nicole E

2016-09-01

-There is ample evidence from the solid tumor literature that synoptic reporting improves accuracy and completeness of relevant data. No evidence-based guidelines currently exist for synoptic reporting for bone marrow samples. -To develop evidence-based recommendations to standardize the basic components of a synoptic report template for bone marrow samples. -The College of American Pathologists Pathology and Laboratory Quality Center convened a panel of experts in hematopathology to develop recommendations. A systematic evidence review was conducted to address 5 key questions. Recommendations were derived from strength of evidence, open comment feedback, and expert panel consensus. -Nine guideline statements were established to provide pathology laboratories with a framework by which to develop synoptic reporting templates for bone marrow samples. The guideline calls for specific data groups in the synoptic section of the pathology report; provides a list of evidence-based parameters for key, pertinent elements; and addresses ancillary testing. -A framework for bone marrow synoptic reporting will improve completeness of the final report in a manner that is clear, succinct, and consistent among institutions.

Executive Self-Assessment and Development in the United States Air Force

DTIC Science & Technology

1989-05-01

34 (Harvard Business Review, January-February 1988, pp.45-53) 056 Drucker , P. " Management and the World’s Work." (Harvard Business Review, September...professional military factors, general leadership and management factors, and functional/technical factors. The study also includes a critical review and...maintaining a comprehensive executive self-assessment and development system. The study concludes with specific recommendations for management action

Using multicriteria decision analysis during drug development to predict reimbursement decisions.

PubMed

Williams, Paul; Mauskopf, Josephine; Lebiecki, Jake; Kilburg, Anne

2014-01-01

Pharmaceutical companies design clinical development programs to generate the data that they believe will support reimbursement for the experimental compound. The objective of the study was to present a process for using multicriteria decision analysis (MCDA) by a pharmaceutical company to estimate the probability of a positive recommendation for reimbursement for a new drug given drug and environmental attributes. The MCDA process included 1) selection of decisions makers who were representative of those making reimbursement decisions in a specific country; 2) two pre-workshop questionnaires to identify the most important attributes and their relative importance for a positive recommendation for a new drug; 3) a 1-day workshop during which participants undertook three tasks: i) they agreed on a final list of decision attributes and their importance weights, ii) they developed level descriptions for these attributes and mapped each attribute level to a value function, and iii) they developed profiles for hypothetical products 'just likely to be reimbursed'; and 4) use of the data from the workshop to develop a prediction algorithm based on a logistic regression analysis. The MCDA process is illustrated using case studies for three countries, the United Kingdom, Germany, and Spain. The extent to which the prediction algorithms for each country captured the decision processes for the workshop participants in our case studies was tested using a post-meeting questionnaire that asked the participants to make recommendations for a set of hypothetical products. The data collected in the case study workshops resulted in a prediction algorithm: 1) for the United Kingdom, the probability of a positive recommendation for different ranges of cost-effectiveness ratios; 2) for Spain, the probability of a positive recommendation at the national and regional levels; and 3) for Germany, the probability of a determination of clinical benefit. The results from the post-meeting questionnaire revealed a high predictive value for the algorithm developed using MCDA. Prediction algorithms developed using MCDA could be used by pharmaceutical companies when designing their clinical development programs to estimate the likelihood of a favourable reimbursement recommendation for different product profiles and for different positions in the treatment pathway.

Using multicriteria decision analysis during drug development to predict reimbursement decisions

PubMed Central

Williams, Paul; Mauskopf, Josephine; Lebiecki, Jake; Kilburg, Anne

2014-01-01

Background Pharmaceutical companies design clinical development programs to generate the data that they believe will support reimbursement for the experimental compound. Objective The objective of the study was to present a process for using multicriteria decision analysis (MCDA) by a pharmaceutical company to estimate the probability of a positive recommendation for reimbursement for a new drug given drug and environmental attributes. Methods The MCDA process included 1) selection of decisions makers who were representative of those making reimbursement decisions in a specific country; 2) two pre-workshop questionnaires to identify the most important attributes and their relative importance for a positive recommendation for a new drug; 3) a 1-day workshop during which participants undertook three tasks: i) they agreed on a final list of decision attributes and their importance weights, ii) they developed level descriptions for these attributes and mapped each attribute level to a value function, and iii) they developed profiles for hypothetical products ‘just likely to be reimbursed’; and 4) use of the data from the workshop to develop a prediction algorithm based on a logistic regression analysis. The MCDA process is illustrated using case studies for three countries, the United Kingdom, Germany, and Spain. The extent to which the prediction algorithms for each country captured the decision processes for the workshop participants in our case studies was tested using a post-meeting questionnaire that asked the participants to make recommendations for a set of hypothetical products. Results The data collected in the case study workshops resulted in a prediction algorithm: 1) for the United Kingdom, the probability of a positive recommendation for different ranges of cost-effectiveness ratios; 2) for Spain, the probability of a positive recommendation at the national and regional levels; and 3) for Germany, the probability of a determination of clinical benefit. The results from the post-meeting questionnaire revealed a high predictive value for the algorithm developed using MCDA. Conclusions Prediction algorithms developed using MCDA could be used by pharmaceutical companies when designing their clinical development programs to estimate the likelihood of a favourable reimbursement recommendation for different product profiles and for different positions in the treatment pathway.

Developing and validating a perinatal depression screening tool in Kenya blending Western criteria with local idioms: A mixed methods study.

PubMed

Green, Eric P; Tuli, Hawa; Kwobah, Edith; Menya, D; Chesire, Irene; Schmidt, Christina

2018-03-01

Routine screening for perinatal depression is not common in most primary health care settings. The U.S. Preventive Services Task Force only recently updated their recommendation on depression screening to specifically recommend screening during the pre- and postpartum periods. While practitioners in high-income countries can respond to this new recommendation by implementing one of several existing depression screening tools developed in Western contexts, such as the Edinburgh Postnatal Depression Scale (EPDS) or the Patient Health Questionnaire-9 (PHQ-9), these tools lack strong evidence of cross-cultural equivalence, validity for case finding, and precision in measuring response to treatment in developing countries. Thus, there is a critical need to develop and validate new screening tools for perinatal depression that can be used by lay health workers, primary health care personnel, and patients. Working in rural Kenya, we used free listing, card sorting, and item analysis methods to develop a locally-relevant screening tool that blended Western psychiatric concepts with local idioms of distress. We conducted a validation study with a random sample of 193 pregnant women and new mothers to test the diagnostic accuracy of this scale along with the EPDS and PHQ-9. The sensitivity/specificity of the EPDS and PHQ-9 was estimated to be 0.70/0.72 and 0.70/0.73, respectively. This compared to sensitivity/specificity of 0.90/0.90 for a new 9-item locally-developed tool called the Perinatal Depression Screening (PDEPS). Across these three tools, internal consistency reliability ranged from 0.77 to 0.81 and test-retest reliability ranged from 0.57 to 0.67. The prevalence of depression ranges from 5.2% to 6.2% depending on the clinical reference standard. The EPDS and PHQ-9 are valid and reliable screening tools for perinatal depression in rural Western Kenya, the PDEPS may be a more useful alternative. At less than 10%, the prevalence of depression in this region appears to be lower than other published estimates for African and other low-income countries. Copyright © 2017 Elsevier B.V. All rights reserved.

Application of Recommended Design Practices for Conceptual Nuclear Fusion Space Propulsion Systems

NASA Technical Reports Server (NTRS)

Williams, Craig H.

2004-01-01

An AIAA Special Project Report was recently produced by AIAA's Nuclear and Future Flight Propulsion Technical Committee and is currently in peer review. The Report provides recommended design practices for conceptual engineering studies of nuclear fusion space propulsion systems. Discussion and recommendations are made on key topics including design reference missions, degree of technological extrapolation and concomitant risk, thoroughness in calculating mass properties (nominal mass properties, weight-growth contingency and propellant margins, and specific impulse), and thoroughness in calculating power generation and usage (power-flow, power contingencies, specific power). The report represents a general consensus of the nuclear fusion space propulsion system conceptual design community and proposes 15 recommendations. This paper expands on the Report by providing specific examples illustrating how to apply each of the recommendations.

Expert Recommender: Designing for a Network Organization

NASA Astrophysics Data System (ADS)

Reichling, Tim; Veith, Michael; Wulf, Volker

Recent knowledge management initiatives focus on expertise sharing within formal organizational units and informal communities of practice. Expert recommender systems seem to be a promising tool in support of these initiatives. This paper presents experiences in designing an expert recommender system for a knowledge- intensive organization, namely the National Industry Association (NIA). Field study results provide a set of specific design requirements. Based on these requirements, we have designed an expert recommender system which is integrated into the specific software infrastructure of the organizational setting. The organizational setting is, as we will show, specific for historical, political, and economic reasons. These particularities influence the employees’ organizational and (inter-)personal needs within this setting. The paper connects empirical findings of a long-term case study with design experiences of an expertise recommender system.

Developing primary care in Hong Kong: evidence into practice and the development of reference frameworks.

PubMed

Griffiths, Sian M; Lee, Jeff P M

2012-10-01

Enhancing primary care is one of the proposals put forward in the Healthcare Reform Consultation Document "Your Health, Your Life" issued in March 2008. In 2009, the Working Group on Primary Care, chaired by the Secretary for Food and Health, recommended the development of age-group and disease-specific primary care conceptual models and reference frameworks. Drawing on international experience and best evidence, the Task Force on Conceptual Model and Preventive Protocols of the Working Group on Primary Care has developed two reference frameworks for the management of two common chronic diseases in Hong Kong, namely diabetes and hypertension, in primary care settings. Adopting a population approach for the prevention and control of diabetes and hypertension across the life course, the reference frameworks aim to provide evidence-based and appropriate recommendations for the provision of continuing and comprehensive care for patients with chronic diseases in the community.

Development, validation and utilisation of food-frequency questionnaires - a review.

PubMed

Cade, Janet; Thompson, Rachel; Burley, Victoria; Warm, Daniel

2002-08-01

The purpose of this review is to provide guidance on the development, validation and use of food-frequency questionnaires (FFQs) for different study designs. It does not include any recommendations about the most appropriate method for dietary assessment (e.g. food-frequency questionnaire versus weighed record). A comprehensive search of electronic databases was carried out for publications from 1980 to 1999. Findings from the review were then commented upon and added to by a group of international experts. Recommendations have been developed to aid in the design, validation and use of FFQs. Specific details of each of these areas are discussed in the text. FFQs are being used in a variety of ways and different study designs. There is no gold standard for directly assessing the validity of FFQs. Nevertheless, the outcome of this review should help those wishing to develop or adapt an FFQ to validate it for its intended use.

Automated personnel data base system specifications, Task V. Final report

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

Bartley, H.J.; Bocast, A.K.; Deppner, F.O.

1978-11-01

The full title of this study is 'Development of Qualification Requirements, Training Programs, Career Plans, and Methodologies for Effective Management and Training of Inspection and Enforcement Personnel.' Task V required the development of an automated personnel data base system for NRC/IE. This system is identified as the NRC/IE Personnel, Assignment, Qualifications, and Training System (PAQTS). This Task V report provides the documentation for PAQTS including the Functional Requirements Document (FRD), the Data Requirements Document (DRD), the Hardware and Software Capabilities Assessment, and the Detailed Implementation Schedule. Specific recommendations to facilitate implementation of PAQTS are also included.

Patient Satisfaction Measurement in Occupational and Environmental Medicine Practice.

PubMed

Drury, David L; Adamo, Philip; Cloeren, Marianne; Hegmann, Kurt T; Martin, Douglas W; Levine, Michael J; Olson, Shawn M; Pransky, Glenn S; Tacci, James A; Thiese, Matthew

2018-05-01

: High patient satisfaction is a desirable goal in medical care. Patient satisfaction measures are increasingly used to evaluate and improve quality in all types of medical practices. However, the unique aspects of occupational and environmental medicine (OEM) practice require development of OEM-specific measures and thoughtful interpretation of results. The American College of Occupational and Environmental Medicine has developed and recommends a set of specific questions to measure patient satisfaction in OEM, designed to meet anticipated regulatory requirements, facilitate quality improvement of participating OEM practices, facilitate case-management review, and offer fair and accurate assessment of OEM physicians.

Exercise Training and Parkinson's Disease: Placebo or Essential Treatment?

ERIC Educational Resources Information Center

Reuter, Iris; Engelhardt, Martin

2002-01-01

Exercise training is often recommended for people with Parkinson's disease, though there is debate about the pathophysiologic cause of impaired movement in Parkinsonism which makes it difficult to develop a specific exercise treatment for symptoms that include hypokinesia, tremor, and muscular rigidity. Most published studies show a benefit of…

78 FR 29134 - HIT Standards Committee; Schedule for the Assessment of HIT Policy Committee Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-17

... quality, clinical operations, implementation, consumer technology, nationwide health information networks and privacy and security. Other groups will be convened to address specific issues as needed. HIT...) Direct the appropriate workgroup or other special group to develop a report for the HIT Standards...

Using Positive Behavior Support to Design Effective Classrooms

ERIC Educational Resources Information Center

Anderson, Cynthia M.; Spaulding, Scott A.

2007-01-01

A number of evidence-based classroom management approaches, procedures, and programs have been developed and presented over the years. In this article the authors synthesize recommendations from various sources, focusing on evidence-based strategies that can be implemented in a systematic manner. They focus specifically on universal strategies,…

Development of a species-specific PCR assay for differentiation of Heterodera filipjevi and H. avenae

USDA-ARS?s Scientific Manuscript database

Heterodera avenae and H. filipjevi are economically important cyst nematodes that restrict production of cereal crops in the Pacific Northwest (PNW) USA and elsewhere in the world. Identification of these two species is critical for recommending and implementing effective management practices. Prime...

Sources for Selecting School Library Resource Materials.

ERIC Educational Resources Information Center

Friderichsen, Blanche

A Department of Education publication on an integrated program for Alberta school libraries, this document recommends the use of specific material selection sources designed to aid schools in developing their library collections. Materials are listed in the following sections: (1) Sources for Selecting School Library Resource Materials; (2)…

Evaluating the Effectiveness of Student Assistance Programs in Pennsylvania.

ERIC Educational Resources Information Center

Fertman, Carl I.; Fichter, Cele; Schlesinger, Jo; Tarasevich, Susan; Wald, Holly; Zhang, Xiaoyan

2001-01-01

This evaluation of the Pennsylvania Student Assistance Program (SAP) was conducted to determine overall efficacy of SAPs and, more specifically, how SAP is currently implemented. Findings indicate that SAP is being implemented as designed. Recommended is the development of benchmarks and indicators focusing on best SAP practices and effectiveness.…

MANUAL OF PLANNING STANDARDS FOR SCHOOL BUILDINGS.

ERIC Educational Resources Information Center

New York State Education Dept., Albany.

THIS MANUAL CONTAINS THE REQUIREMENTS AND RECOMMENDATIONS FOR DEVELOPMENT AND DESIGN IN ERECTION, REPAIR, ENLARGEMENT, AND REMODELING OF SCHOOL BUILDINGS, IN TERMS OF HEALTH, COMFORT, AND SAFETY OF PUPILS ATTENDING THE PUBLIC SCHOOLS. SPECIFIC AREAS COVERED BY THIS MANUAL INCLUDE--(1) STRUCTURE AND SAFETY PLANNING, (2) MATERIALS, (3) VISUAL…

True Stem Education

ERIC Educational Resources Information Center

Gomez, Alan; Albrecht, Bryan

2014-01-01

The authors argue that the ongoing research by the National Academies, the National Research Council, and the National Science Foundation are imperative. The findings and recommendations on what the school systems of America must do to develop specific educational programming will position the U.S. at the forefront of the world's economies if…

77 FR 22286 - Western Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-13

... Team (PPT) in Honolulu, HI to discuss fishery issues and develop recommendations for future management... and Central Pacific Fishery Commission 8. Other business 9. Public comment 10. Pelagic Plan Team... meetings. Plan Team action will be restricted to those issues specifically listed in this document and any...

Digital and multimedia forensics justified: An appraisal on professional policy and legislation

NASA Astrophysics Data System (ADS)

Popejoy, Amy Lynnette

Recent progress in professional policy and legislation at the federal level in the field of forensic science constructs a transformation of new outcomes for future experts. An exploratory and descriptive qualitative methodology was used to critique and examine Digital and Multimedia Science (DMS) as a justified forensic discipline. Chapter I summarizes Recommendations 1, 2, and 10 of the National Academy of Sciences (NAS) Report 2009 regarding disparities and challenges facing the forensic science community. Chapter I also delivers the overall foundation and framework of this thesis, specifically how it relates to DMS. Chapter II expands on Recommendation 1: "The Promotion and Development of Forensic Science," and focuses chronologically on professional policy and legislative advances through 2014. Chapter III addresses Recommendation 2: "The Standardization of Terminology in Reporting and Testimony," and the issues of legal language and terminology, model laboratory reports, and expert testimony concerning DMS case law. Chapter IV analyzes Recommendation 10: "Insufficient Education and Training," identifying legal awareness for the digital and multimedia examiner to understand the role of the expert witness, the attorney, the judge and the admission of forensic science evidence in litigation in our criminal justice system. Finally, Chapter V studies three DME specific laboratories at the Texas state, county, and city level, concentrating on current practice and procedure.

ASCCP Colposcopy Standards: How Do We Perform Colposcopy? Implications for Establishing Standards.

PubMed

Waxman, Alan G; Conageski, Christine; Silver, Michelle I; Tedeschi, Candice; Stier, Elizabeth A; Apgar, Barbara; Huh, Warner K; Wentzensen, Nicolas; Massad, L Stewart; Khan, Michelle J; Mayeaux, Edward J; Einstein, Mark H; Schiffman, Mark H; Guido, Richard S

2017-10-01

The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to colposcopy and biopsy for cervical cancer prevention in the United States. The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. Working group 3 defined colposcopy procedure guidelines for minimum and comprehensive colposcopy practice and evaluated the use of colposcopy adjuncts. The working group performed a systematic literature review to identify best practices in colposcopy methodology and to evaluate the use of available colposcopy adjuncts. The literature provided little evidence to support specific elements of the procedure. The working group, therefore, implemented a national survey of current and recent ASCCP members to evaluate common elements of the colposcopy examination. The findings of this survey were modified by expert consensus from the ASCCP Colposcopy Standards Committee members to create guidelines for performing colposcopy. The draft recommendations were posted online for public comment and presented at an open session of the International Federation for Cervical Pathology and Colposcopy 2017 World Congress for further comment. All comments were considered in the development of final recommendations. Minimum and comprehensive colposcopy practice guidelines were developed. These guidelines represent recommended practice in all parts of the examination including the following: precolposcopy evaluation, performing the procedure, documentation of findings, biopsy practice, and postprocedure follow-up. These guidelines are intended to serve as a guide to standardize colposcopy across the United States.

Patient-Reported Outcomes in Cancer Drug Development and US Regulatory Review: Perspectives From Industry, the Food and Drug Administration, and the Patient.

PubMed

Basch, Ethan; Geoghegan, Cindy; Coons, Stephen Joel; Gnanasakthy, Ari; Slagle, Ashley F; Papadopoulos, Elektra J; Kluetz, Paul G

2015-06-01

Data reported directly by patients about how they feel and function are rarely included in oncology drug labeling in the United States, in contrast to Europe and to nononcology labeling in the United States, where this practice is more common. Multiple barriers exist, including challenges unique to oncology trials, and industry's concerns regarding cost, logistical complexities, and the Food and Drug Administration's (FDA's) rigorous application of its 2009 guidance on the use of patient-reported outcome (PRO) measures. A panel consisting of representatives of industry, FDA, the PRO Consortium, clinicians, and patients was assembled at a 2014 workshop cosponsored by FDA to identify practical recommendations for overcoming these barriers. Key recommendations included increasing proactive encouragement by FDA to clinical trial sponsors for including PROs in drug development programs; provision of comprehensive PRO plans by sponsors to FDA early in drug development; promotion of an oncology-specific PRO research agenda; development of an approach to existing ("legacy") PRO measures, when appropriate (focused initially on symptoms and functional status); and increased FDA and industry training in PRO methodology. FDA has begun implementing several of these recommendations.

Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: the best alternative? Case report and review of literature.

PubMed

Sebastian, Raul; Ghanem, Omar; Diroma, Frank; Milner, Stephen M; Gerold, Kevin B; Price, Leigh A

2015-05-01

Multiple factors place burn patients at a high risk of pneumothorax development. Currently, no specific recommendations for the management of pneumothorax in large total body surface area (TBSA) burn patients exist. We present a case of a major burn patient who developed pneumothorax after central line insertion. After the traditional large bore (24 Fr) chest tube failed to resolve the pneumothorax, the pneumothorax was ultimately managed by a percutaneous placed pigtail catheter thoracostomy placement and resulted in its complete resolution. We will review the current recommendations of pneumothorax treatment and will highlight on the use of pigtail catheters in pneumothorax management in burn patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Definitional-mission report: Clean-coal-technology assistance project in Poland (final report). Export trade information

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

Shrivastava, V.K.

1992-01-01

The new impending environmental law in Poland provides for strict environmental guidelines for coal preparation, washing, mine desalination, and application of commercially viable and economical clean coal technologies for utilization of coal. The government of Poland requested the U.S. Trade and Development Program (TDP) carry out a Definitional Mission to Poland to define the requirements of the Polish authorities and to prepare specific recommendations for follow on actions by TDP. The technical assistance package proposed to be funded by TDP includes two specific activities. These are (i) an orientation visit to review selected clean coal technology projects in the U.S.,more » and (ii) preparation of a compendium of the main coal sector requirements in Poland and the types of technologies needed. The Definitional Mission has prepared a Scope of Work which recommends that TDP allocate a fund to finance the cost of the above technical assistance activities. It is further recommended that TDP enlist the assistance of a non-profit trade organization to provide this assistance to the Polish government.« less

Diagnosis and management of newly diagnosed childhood autoimmune haemolytic anaemia. Recommendations from the Red Cell Study Group of the Paediatric Haemato-Oncology Italian Association

PubMed Central

Ladogana, Saverio; Maruzzi, Matteo; Samperi, Piera; Perrotta, Silverio; Del Vecchio, Giovanni C.; Notarangelo, Lucia D.; Farruggia, Piero; Verzegnassi, Federico; Masera, Nicoletta; Saracco, Paola; Fasoli, Silvia; Miano, Maurizio; Girelli, Gabriella; Barcellini, Wilma; Zanella, Alberto; Russo, Giovanna

2017-01-01

Autoimmune haemolytic anaemia is an uncommon disorder to which paediatric haematology centres take a variety of diagnostic and therapeutic approaches. The Red Cell Working Group of the Italian Association of Paediatric Onco-haematology (Associazione Italiana di Ematologia ed Oncologia Pediatrica, AIEOP) developed this document in order to collate expert opinions on the management of newly diagnosed childhood autoimmune haemolytic anaemia. The diagnostic process includes the direct and indirect antiglobulin tests; recommendations are given regarding further diagnostic tests, specifically in the cases that the direct and indirect antiglobulin tests are negative. Clear-cut definitions of clinical response are stated. Specific recommendations for treatment include: dosage of steroid therapy and tapering modality for warm autoimmune haemolytic anaemia; the choice of rituximab as first-line therapy for the rare primary transfusion-dependent cold autoimmune haemolytic anaemia; the indications for supportive therapy; the need for switching to second-line therapy. Each statement is provided with a score expressing the level of appropriateness and the agreement among participants. PMID:28151390

Food parenting: a selective review of current measurement and an empirical examination to inform future measurement.

PubMed

Musher-Eizenman, Dara R; Kiefner, Allison

2013-08-01

Interactions between parents and children in regard to food are an important part of the development of food preferences and intake patterns for children. The measurement of this complex and multidimensional construct is very challenging. This article examines the current status of measurement in this domain in a selective review, considers qualitative input from parents and adolescents in an empirical examination of the topic, and makes concrete recommendations for the future. Qualitatively, there were important differences between what the adolescents reported that their parents did to impact their eating habits, what parents of younger children report they currently do, and what researchers typically measure in research on parental feeding practices. On the basis of these empirical findings and our review of the literature, we recommend that food parenting be measured on three levels: Feeding styles (e.g., authoritative), food parenting practices (e.g., restriction), and specific feeding behaviors (e.g., putting food out of the child's reach). Specific recommendations for future study are given for each level of measurement.

Food Parenting: A Selective Review of Current Measurement and an Empirical Examination To Inform Future Measurement

PubMed Central

Kiefner, Allison

2013-01-01

Abstract Background Interactions between parents and children in regard to food are an important part of the development of food preferences and intake patterns for children. The measurement of this complex and multidimensional construct is very challenging. Methods This article examines the current status of measurement in this domain in a selective review, considers qualitative input from parents and adolescents in an empirical examination of the topic, and makes concrete recommendations for the future. Results Qualitatively, there were important differences between what the adolescents reported that their parents did to impact their eating habits, what parents of younger children report they currently do, and what researchers typically measure in research on parental feeding practices. Conclusions On the basis of these empirical findings and our review of the literature, we recommend that food parenting be measured on three levels: Feeding styles (e.g., authoritative), food parenting practices (e.g., restriction), and specific feeding behaviors (e.g., putting food out of the child's reach). Specific recommendations for future study are given for each level of measurement. PMID:23944922

Recommended Standards: Common to All Programs; Specific to Production Agriculture, Secondary; Specific to Adult Education for Quality Agriculture/Agribusiness Programs in Kansas.

ERIC Educational Resources Information Center

Kansas State Univ., Manhattan. Dept. of Adult and Occupational Education.

This document contains recommended standards for quality vocational programs in agricultural/agribusiness education which are divided into (1) standards common to all programs, (2) standards specific to adult education in agriculture/agribusiness, and (3) standards specific to production agriculture, secondary. The sixty common standards are…

Evaluation and optimization of a commercial blocking ELISA for detecting antibodies to influenza A virus for research and surveillance of mallards.

PubMed

Shriner, Susan A; VanDalen, Kaci K; Root, J Jeffrey; Sullivan, Heather J

2016-02-01

The availability of a validated commercial assay is an asset for any wildlife investigation. However, commercial products are often developed for use in livestock and are not optimized for wildlife. Consequently, it is incumbent upon researchers and managers to apply commercial products appropriately to optimize program outcomes. We tested more than 800 serum samples from mallards for antibodies to influenza A virus with the IDEXX AI MultiS-Screen Ab test to evaluate assay performance. Applying the test per manufacturer's recommendations resulted in good performance with 84% sensitivity and 100% specificity. However, performance was improved to 98% sensitivity and 98% specificity by increasing the recommended cut-off. Using this alternative threshold for identifying positive and negative samples would greatly improve sample classification, especially for field samples collected months after infection when antibody titers have waned from the initial primary immune response. Furthermore, a threshold that balances sensitivity and specificity reduces estimation bias in seroprevalence estimates. Published by Elsevier B.V.

Special Session 4: Astronomy Education between Past and Future

NASA Astrophysics Data System (ADS)

de Greve, Jean-Pierre

2010-11-01

The special session aims at discussing an integrated approach of the different efforts to increase and promote the teaching and learning of astronomy in the world, with emphasis on developing countries. To this end, attention will be given to research on education, specifically in the field of physics, to best practices of the use of astronomy in educational systems (specifically in developing countries), and to innovative learning initiatives other than formal education. The Special Session aims also at creating a universal perspective wherein modern (post-Copernican) astronomy will presented as an intellectual cumulus. The objective of the session is to disseminate best practices in teaching and learning activities of astronomy and to give an opportunity to learn about initiatives in different cultural and socio-economic settings. The special session also wants to give food-for-thought and proposals for reflection for an integrative approach, and for optimization processes, to enhance the interest in astronomy and its role as a trigger towards science education in the educational systems, with emphasis on the developing countries. The outcome should be a sensitization of teachers and students alike to the concept of a universal history of astronomy and creation of some reliable source material which can be used as a teaching aid in a culture-specific context. The outcome could be a set of recommendations for future integrated actions, and eventually recommendations on new initiatives, framed into the new decadal policy plan.

Representation of cardiovascular magnetic resonance in the AHA / ACC guidelines.

PubMed

von Knobelsdorff-Brenkenhoff, Florian; Pilz, Guenter; Schulz-Menger, Jeanette

2017-09-25

Whereas evidence supporting the diagnostic value of cardiovascular magnetic resonance (CMR) has increased, there exists significant worldwide variability in the clinical utilization of CMR. A recent study demonstrated that CMR is represented in the majority of European Society for Cardiology (ESC) guidelines, with a large number of specific recommendations in particular regarding coronary artery disease. To further investigate the gap between the evidence and clinical use of CMR, this study analyzed the role of CMR in the guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA). Twenty-four AHA/ACC original guidelines, updates and new editions, published between 2006 and 2017, were screened for the terms "magnetic", "MRI", "CMR", "MR" and "imaging". Non-cardiovascular MR examinations were excluded. All CMR-related paragraphs and specific recommendations for CMR including the level of evidence (A, B, C) and the class of recommendation (I, IIa, IIb, III) were extracted. Twelve of the 24 guidelines (50.0%) contain specific recommendations regarding CMR. Four guidelines (16.7%) mention CMR in the text only, and 8 (33.3%) do not mention CMR. The 12 guidelines with recommendations for CMR contain in total 65 specific recommendations (31 class-I, 23 class-IIa, 6 class-IIb, 5 class-III). Most recommendations have evidence level C (44/65; 67.7%), followed by level B (21/65; 32.3%). There are no level A recommendations. 22/65 recommendations refer to vascular imaging, 17 to congenital heart disease, 8 to cardiomyopathies, 8 to myocardial stress testing, 5 to left and right ventricular function, 3 to viability, and 2 to valvular heart disease. CMR is represented in two thirds of the AHA/ACC guidelines, which contain a number of specific recommendations for the use of CMR. In a simplified comparison with the ESC guidelines, CMR is less represented in the AHA/ACC guidelines in particular in the field of coronary artery disease.

S3-guideline "helicobacter pylori and gastroduodenal ulcer disease" of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e. V., German society for rheumatology, AWMF-registration-no. 021 / 001.

PubMed

Fischbach, W; Malfertheiner, P; Hoffmann, J C; Bolten, W; Bornschein, J; Götze, O; Höhne, W; Kist, M; Koletzko, S; Labenz, J; Layer, P; Miehlke, St; Morgner, A; Peitz, U; Preiss, J; Prinz, C; Rosien, U; Schmidt, W; Schwarzer, A; Suerbaum, St; Timmer, A; Treiber, G; Vieth, M

2009-12-01

This guideline updates a prior consensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Hygiene and Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE), and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based S 3 level consensus guideline and has also implemented grading criteria according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) process. Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics, and therapy were taken into account.

Developing a Web-Based Mechanism for Assessing Teacher Science Content Knowledge

NASA Astrophysics Data System (ADS)

Byers, Al; Koba, Susan; Sherman, Greg; Scheppke, Joan; Bolus, Roger

2011-04-01

The National Science Teachers Association (NSTA) recently launched a comprehensive electronic professional development (e-PD) online portal, the NSTA Learning Center. This support site for educators currently includes over 6,000 e-PD resources and opportunities available on-demand, as well as various tools designed to help educators maximize the effectiveness of using NSTA resources. One tool, the PD Indexer, helps teachers identify their own areas of content strengths and weaknesses by selecting content-specific assessments. Individual NSTA resources are recommended based on assessment outcomes. This paper presents a detailed description of the procedures employed by NSTA to develop valid and reliable PD Indexer content-specific multiple-choice assessment items.

Development of tuberculosis infection control guidelines in a pediatric HIV clinic in sub-Saharan Africa.

PubMed

Carlucci, J G; Jin, L; Sanders, J E; Mohapi, E Q; Mandalakas, A M

2015-03-21

A well-established pediatric human immunodeficiency virus (HIV) clinic in Lesotho with initial infection control (IC) measures prioritizing blood-borne disease. In line with international recommendations, services have been expanded to include the management of patients with tuberculosis (TB). The creation of comprehensive IC guidelines with an emphasis on TB has become a priority. To provide a model for developing and implementing IC guidelines in ambulatory care facilities in limited-resource settings with high HIV and TB prevalence. Activities: An IC plan that includes guidance covering both general IC measures and TB-specific guidelines was created by integrating local and international recommendations and emphasizing the importance of administrative measures, environmental controls, and disease-specific precautions. An interdisciplinary committee was established to oversee its implementation, monitoring, and evaluation. Development and implementation of IC guidelines in resource-limited settings are feasible and should be a priority in high HIV and TB prevalence areas. Education should be the cornerstone of such endeavors. Many interventions can be implemented with minimal expertise and material resources. Administrative support and institutional investment are essential to the sustainability of an effective IC program.

Developing Effective Communications about Extreme Weather Risks.

NASA Astrophysics Data System (ADS)

Bruine de Bruin, W.

2014-12-01

Members of the general public often face complex decisions about the risks that they face, including those associated with extreme weather and climate change adaptation. Scientific experts may be asked to develop communications with the goal of improving people's understanding of weather and climate risks, and informing people's decisions about how to protect against these risks. Unfortunately, scientific experts' communication efforts may fail if they lack information about what people need or want to know to make more informed decisions or what wording people prefer use to describe relevant concepts. This presentation provides general principles for developing effective risk communication materials that aim for widespread dissemination, such as brochures and websites. After a brief review of the social science evidence on how to design effective risk communication materials, examples will focus on communications about extreme weather events and climate change. Specifically, data will be presented from ongoing projects on flood risk perception, public preparedness for heat waves, and public perceptions of climate change. The presentation will end with specific recommendations about how to improve recipients' understanding about risks and inform decisions. These recommendations should be useful to scientific experts who aim to communicate about extreme weather, climate change, or other risks.

Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

PubMed Central

Visser, K; Katchamart, W; Loza, E; Martinez-Lopez, J A; Salliot, C; Trudeau, J; Bombardier, C; Carmona, L; van der Heijde, D; Bijlsma, J W J; Boumpas, D T; Canhao, H; Edwards, C J; Hamuryudan, V; Kvien, T K; Leeb, B F; Martín-Mola, E M; Mielants, H; Müller-Ladner, U; Murphy, G; Østergaard, M; Pereira, I A; Ramos-Remus, C; Valentini, G; Zochling, J; Dougados, M

2009-01-01

Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007–8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005–7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroid-sparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use. PMID:19033291

Evaluating and Evolving Metadata in Multiple Dialects

NASA Technical Reports Server (NTRS)

Kozimore, John; Habermann, Ted; Gordon, Sean; Powers, Lindsay

2016-01-01

Despite many long-term homogenization efforts, communities continue to develop focused metadata standards along with related recommendations and (typically) XML representations (aka dialects) for sharing metadata content. Different representations easily become obstacles to sharing information because each representation generally requires a set of tools and skills that are designed, built, and maintained specifically for that representation. In contrast, community recommendations are generally described, at least initially, at a more conceptual level and are more easily shared. For example, most communities agree that dataset titles should be included in metadata records although they write the titles in different ways.

Do we need personalized recommendations for infants at risk of developing disease?

PubMed

Hernell, Olle; West, Christina

2008-01-01

Current nutrition recommendations, directed towards populations, are based on estimated average nutrient requirements for a target population and intend to meet the needs of most individuals within that population. They also aim at preventing common diseases such as obesity, diabetes and cardiovascular disease. For infants with specific genetic polymorphisms, e.g. some inborn errors of metabolism, adherence to current recommendations will cause disease symptoms and they need personalized nutrition recommendations. Some other monogenic polymorphisms, e.g. adult hypolactasia, are common but with varying prevalence between ethnic groups and within populations. Ages at onset as well as the degree of the resulting lactose intolerance also vary, making population-based as well as personalized recommendations difficult. The tolerable intake is best set by each individual based on symptoms. For polygenetic diseases such as celiac disease, type-1 diabetes and allergic disease, current knowledge is insufficient to suggest personalized recommendations aiming at primary prevention for all high-risk infants, although it may be justified to provide such recommendations on an individual level should the parents ask for them. New technologies such as nutrigenetics and nutrigenomics are promising tools with which current nutrition recommendations can possibly be refined and the potential of individualized nutrition be explored. It seems likely that in the future it will be possible to offer more subgroups within a population personalized recommendations.

Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

PubMed Central

Reinhart, K.; Brunkhorst, F. M.; Bone, H.-G.; Bardutzky, J.; Dempfle, C.-E.; Forst, H.; Gastmeier, P.; Gerlach, H.; Gründling, M.; John, S.; Kern, W.; Kreymann, G.; Krüger, W.; Kujath, P.; Marggraf, G.; Martin, J.; Mayer, K.; Meier-Hellmann, A.; Oppert, M.; Putensen, C.; Quintel, M.; Ragaller, M.; Rossaint, R.; Seifert, H.; Spies, C.; Stüber, F.; Weiler, N.; Weimann, A.; Werdan, K.; Welte, T.

2010-01-01

Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1st revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the “German Instrument for Methodological Guideline Appraisal” of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources. PMID:20628653

TU-E-BRB-00: Deformable Image Registration: Is It Right for Your Clinic

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

NONE

2015-06-15

Deformable image registration (DIR) is developing rapidly and is poised to substantially improve dose fusion accuracy for adaptive and retreatment planning and motion management and PET fusion to enhance contour delineation for treatment planning. However, DIR dose warping accuracy is difficult to quantify, in general, and particularly difficult to do so on a patient-specific basis. As clinical DIR options become more widely available, there is an increased need to understand the implications of incorporating DIR into clinical workflow. Several groups have assessed DIR accuracy in clinically relevant scenarios, but no comprehensive review material is yet available. This session will alsomore » discuss aspects of the AAPM Task Group 132 on the Use of Image Registration and Data Fusion Algorithms and Techniques in Radiotherapy Treatment Planning official report, which provides recommendations for DIR clinical use. We will summarize and compare various commercial DIR software options, outline successful clinical techniques, show specific examples with discussion of appropriate and inappropriate applications of DIR, discuss the clinical implications of DIR, provide an overview of current DIR error analysis research, review QA options and research phantom development and present TG-132 recommendations. Learning Objectives: Compare/contrast commercial DIR software and QA options Overview clinical DIR workflow for retreatment To understand uncertainties introduced by DIR Review TG-132 proposed recommendations.« less

Pieces of the Puzzle: Tracking the Chemical Component of the ...

EPA Pesticide Factsheets

This presentation provides an overview of the risk assessment conducted at the U.S. EPA, as well as some research examples related to the exposome concept. This presentation also provides the recommendation of using two organizational and predictive frameworks for tracking chemical components in the exposome. The National Exposure Research Laboratory (NERL) Computational Exposure Division (CED) develops and evaluates data, decision-support tools, and models to be applied to media-specific or receptor-specific problem areas. CED uses modeling-based approaches to characterize exposures, evaluate fate and transport, and support environmental diagnostics/forensics with input from multiple data sources. It also develops media- and receptor-specific models, process models, and decision support tools for use both within and outside of EPA.

Summary of recommendations for the diagnosis and treatment of malaria by the Committee to Advise on Tropical Medicine and Travel (CATMAT)

PubMed Central

Boggild, A; Brophy, J; Charlebois, P; Crockett, M; Geduld, J; Ghesquiere, W; McDonald, P; Plourde, P; Teitelbaum, P; Tepper, M; Schofield, S; McCarthy, A

2014-01-01

Background On behalf of the Public Health Agency of Canada, the Committee to Advise on Tropical Medicine and Travel (CATMAT) developed the Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers for Canadian health care providers who are preparing patients for travel to malaria-endemic areas and treating travellers who have returned ill. These recommendations aim to achieve appropriate diagnosis and management of malaria, a disease that is still uncommon in Canada. Objective To provide recommendations on the appropriate diagnosis and treatment of malaria. Methods CATMAT reviewed all major sources of information on malaria diagnosis and treatment, as well as recent research and national and international epidemiological data, to tailor guidelines to the Canadian context. The evidence-based medicine recommendations were developed with associated rating scales for the strength and quality of the evidence. Recommendations Malarial management depends on rapid identification of the disease, as well as identification of the malaria species and level of parasitemia. Microscopic identification of blood samples is both rapid and accurate but can be done only by trained laboratory technicians. Rapid diagnostic tests are widely available, are simple to use and do not require specialized laboratory equipment or training; however, they do not provide the level of parasitemia and do require verification. Polymerase chain reaction (PCR), although still limited in availability, is emerging as the gold standard for high sensitivity and specificity in identifying the species. PMID:29769894

Recommendations to enhance constructivist-based learning in Interprofessional Education using video-based self-assessment

PubMed Central

Dahmen, Uta; Schulze, Christine; Schindler, Claudia; Wick, Katharina; Schwartze, Dominique; Veit, Andrea; Smolenski, Ulrich

2016-01-01

Introduction: Interprofessional collaboration is crucial to the optimization of patient care. Aim: This paper aims to provide recommendations for implementing an innovative constructivist educational concept with the core element of video-based self-assessment. Methodology: A course for students in medicine, physiotherapy, and nursing was developed through interprofessional, cross-institutional collaboration. The course consisted of drawing on prior knowledge about the work done by each professional group in regard to a specific clinical scenario and an interprofessional treatment situation, filming a role play of this treatment situation, and a structured self-assessment of the role play. We evaluated the preparation and implementation of the three courses conducted thus far. Concrete recommendations for implementation were made based on evaluation sheets (students), open discussions (tutors, instructors, institutions) and recorded meeting minutes (project managers, project participants). Results: Basic recommendations for implementation include: selecting appropriate criteria for self-assessment and a simulated situation that offers members of each professional group an equal opportunity to act in the role play. In terms of administrative implementation we recommend early coordination among the professions and educational institutions regarding the target groups, scheduling and attendance policy to ensure participant recruitment across all professions. Procedural planning should include developing teaching materials, such as the case vignette and treatment scenario, and providing technical equipment that can be operated intuitively in order to ensure efficient recording. Conclusion: These recommendations serve as an aid for implementing an innovative constructivist educational concept with video-based self-assessment at its core. PMID:27280144

Dystonia rating scales: critique and recommendations

PubMed Central

Albanese, Alberto; Sorbo, Francesca Del; Comella, Cynthia; Jinnah, H.A.; Mink, Jonathan W.; Post, Bart; Vidailhet, Marie; Volkmann, Jens; Warner, Thomas T.; Leentjens, Albert F.G.; Martinez-Martin, Pablo; Stebbins, Glenn T.; Goetz, Christopher G.; Schrag, Anette

2014-01-01

Background Many rating scales have been applied to the evaluation of dystonia, but only few have been assessed for clinimetric properties. The Movement Disorders Society commissioned this task force to critique existing dystonia rating scales and place them in the clinical and clinimetric context. Methods A systematic literature review was conducted to identify rating scales that have either been validated or used in dystonia. Results Thirty six potential scales were identified. Eight were excluded because they did not meet review criteria, leaving twenty-eight scales that were critiqued and rated by the task force. Seven scales were found to meet criteria to be “recommended”: the Blepharospasm Disability Index is recommended for rating blepharospasm; the Cervical Dystonia Impact Scale and the Toronto Western Spasmodic Torticollis Rating Scale for rating cervical dystonia; the Craniocervical Dystonia Questionnaire for blepharospasm and cervical dystonia; the Voice Handicap Index (VHI) and the Vocal Performance Questionnaire (VPQ) for laryngeal dystonia; and the Fahn-Marsden Dystonia Rating Scale for rating generalized dystonia. Two “recommended” scales (VHI and VPQ) are generic scales validated on few patients with laryngeal dystonia, whereas the others are disease-specific scales. Twelve scales met criteria for “suggested” and seven scales met criteria for “listed”. All the scales are individually reviewed in the online appendix. Conclusion The task force recommends five specific dystonia scales and suggests to further validate in dystonia two recommended generic voice-disorder scales. Existing scales for oromandibular, arm and task-specific dystonia should be refined and fully assessed. Scales should be developed for body regions where no scales are available, such as lower limbs and trunk. PMID:23893443

Travel vaccination recommendations and endemic infection risks in solid organ transplantation recipients.

PubMed

Trubiano, Jason A; Johnson, Douglas; Sohail, Asma; Torresi, Joseph

2016-06-01

Solid organ transplant (SOT) recipients are often heavily immunosuppressed and consequently at risk of serious illness from vaccine preventable viral and bacterial infections or with endemic fungal and parasitic infections. We review the literature to provide guidance regarding the timing and appropriateness of vaccination and pathogen avoidance related to the immunological status of SOT recipients. A PUBMED search ([Vaccination OR vaccine] AND/OR ["specific vaccine"] AND/OR [immunology OR immune response OR cytokine OR T lymphocyte] AND transplant was performed. A review of the literature was performed in order to develop recommendations on vaccination for SOT recipients travelling to high-risk destinations. Whilst immunological failure of vaccination in SOT is primarily the result of impaired B-cell responses, the role of T-cells in vaccine failure and success remains unknown. Vaccination should be initiated at least 4 weeks prior to SOT or more than 6 months post-SOT. Avoidance of live vaccination is generally recommended, although some live vaccines may be considered in the specific situations (e.g. yellow fever). The practicing physician requires a detailed understanding of region-specific endemic pathogen risks. We provide a vaccination and endemic pathogen guide for physicians and travel clinics involved in the care of SOT recipients. In addition, recommendations based on timing of anticipated immunological recovery and available evidence regarding vaccine immunogenicity in SOT recipients are provided to help guide pre-travel consultations. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline

PubMed Central

Harris, Lyndsay N.; McShane, Lisa M.; Andre, Fabrice; Collyar, Deborah E.; Gonzalez-Angulo, Ana M.; Hammond, Elizabeth H.; Kuderer, Nicole M.; Liu, Minetta C.; Mennel, Robert G.; Van Poznak, Catherine; Bast, Robert C.; Hayes, Daniel F.

2016-01-01

Purpose To provide recommendations on appropriate use of breast tumor biomarker assay results to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer. Methods A literature search and prospectively defined study selection sought systematic reviews, meta-analyses, randomized controlled trials, prospective-retrospective studies, and prospective comparative observational studies published from 2006 through 2014. Outcomes of interest included overall survival and disease-free or recurrence-free survival. Expert panel members used informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 50 relevant studies. One randomized clinical trial and 18 prospective-retrospective studies were found to have evaluated the clinical utility, as defined by the guideline, of specific biomarkers for guiding decisions on the need for adjuvant systemic therapy. No studies that met guideline criteria for clinical utility were found to guide choice of specific treatments or regimens. Recommendations In addition to estrogen and progesterone receptors and human epidermal growth factor receptor 2, the panel found sufficient evidence of clinical utility for the biomarker assays Oncotype DX, EndoPredict, PAM50, Breast Cancer Index, and urokinase plasminogen activator and plasminogen activator inhibitor type 1 in specific subgroups of breast cancer. No biomarker except for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was found to guide choices of specific treatment regimens. Treatment decisions should also consider disease stage, comorbidities, and patient preferences. PMID:26858339

Decision Analysis and Policy Formulation for Technology-Specific Renewable Energy Targets

NASA Astrophysics Data System (ADS)

Okioga, Irene Teshamulwa

This study establishes a decision making procedure using Analytic Hierarchy Process (AHP) for a U.S. national renewable portfolio standard, and proposes technology-specific targets for renewable electricity generation for the country. The study prioritizes renewable energy alternatives based on a multi-perspective view: from the public, policy makers, and investors' points-of-view, and uses multiple criteria for ranking the alternatives to generate a unified prioritization scheme. During this process, it considers a 'quadruple bottom-line' approach (4P), i.e. reflecting technical "progress", social "people", economic 'profits", and environmental "planet" factors. The AHP results indicated that electricity generation from solar PV ranked highest, and biomass energy ranked lowest. A "Benefits/Cost Incentives/Mandates" (BCIM) model was developed to identify where mandates are needed, and where incentives would instead be required to bring down costs for technologies that have potential for profitable deployment. The BCIM model balances the development of less mature renewable energy technologies, without the potential for rising near-term electricity rates for consumers. It also ensures that recommended policies do not lead to growth of just one type of technology--the "highest-benefit, least-cost" technology. The model indicated that mandates would be suited for solar PV, and incentives generally for geothermal and concentrated solar power. Development for biomass energy, as a "low-cost, low-benefits" alternative was recommended at a local rather than national level, mainly due to its low resource potential values. Further, biomass energy generated from wastewater treatment plants (WWTPs) had the least resource potential compared to other biomass sources. The research developed methodologies and recommendations for biogas electricity targets at WWTPs, to take advantage of the waste-to-energy opportunities.

Parameters of care for craniosynostosis.

PubMed

McCarthy, Joseph G; Warren, Stephen M; Bernstein, Joseph; Burnett, Whitney; Cunningham, Michael L; Edmond, Jane C; Figueroa, Alvaro A; Kapp-Simon, Kathleen A; Labow, Brian I; Peterson-Falzone, Sally J; Proctor, Mark R; Rubin, Marcie S; Sze, Raymond W; Yemen, Terrance A

2012-01-01

A multidisciplinary meeting was held from March 4 to 6, 2010, in Atlanta, Georgia, entitled "Craniosynostosis: Developing Parameters for Diagnosis, Treatment, and Management." The goal of this meeting was to create parameters of care for individuals with craniosynostosis. Fifty-two conference attendees represented a broad range of expertise, including anesthesiology, craniofacial surgery, dentistry, genetics, hand surgery, neurosurgery, nursing, ophthalmology, oral and maxillofacial surgery, orthodontics, otolaryngology, pediatrics, psychology, public health, radiology, and speech-language pathology. These attendees also represented 16 professional societies and peer-reviewed journals. The current state of knowledge related to each discipline was reviewed. Based on areas of expertise, four breakout groups were created to reach a consensus and draft specialty-specific parameters of care based on the literature or, in the absence of literature, broad clinical experience. In an iterative manner, the specialty-specific draft recommendations were presented to all conference attendees. Participants discussed the recommendations in multidisciplinary groups to facilitate exchange and consensus across disciplines. After the conference, a pediatric intensivist and social worker reviewed the recommendations. Consensus was reached among the 52 conference attendees and two post hoc reviewers. Longitudinal parameters of care were developed for the diagnosis, treatment, and management of craniosynostosis in each of the 18 specialty areas of care from prenatal evaluation to adulthood. To our knowledge, this is the first multidisciplinary effort to develop parameters of care for craniosynostosis. These parameters were designed to help facilitate the development of educational programs for the patient, families, and health-care professionals; stimulate the creation of a national database and registry to promote research, especially in the area of outcome studies; improve credentialing of interdisciplinary craniofacial clinical teams; and improve the availability of health insurance coverage for all individuals with craniosynostosis.

Latin American Consensus for Pediatric Cardiopulmonary Resuscitation 2017: Latin American Pediatric Critical Care Society Pediatric Cardiopulmonary Resuscitation Committee.

PubMed

López-Herce, Jesús; Almonte, Enma; Alvarado, Manuel; Bogado, Norma Beatriz; Cyunel, Mariana; Escalante, Raffo; Finardi, Christiane; Guzmán, Gustavo; Jaramillo-Bustamante, Juan C; Madrid, Claudia C; Matamoros, Martha; Moya, Luis Augusto; Obando, Grania; Reboredo, Gaspar; López, Lissette R; Scheu, Christian; Valenzuela, Alejandro; Yerovi, Rocío; Yock-Corrales, Adriana

2018-03-01

To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. Expert consensus recommendations with Delphi methodology. Latin American countries. Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. Delphi methodology for expert consensus. The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

An Evidence-based Guideline for the air medical transportation of prehospital trauma patients.

PubMed

Thomas, Stephen H; Brown, Kathleen M; Oliver, Zoë J; Spaite, Daniel W; Lawner, Benjamin J; Sahni, Ritu; Weik, Tasmeen S; Falck-Ytter, Yngve; Wright, Joseph L; Lang, Eddy S

2014-01-01

Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport. The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation. A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on EMS and the National EMS Advisory Council. Two strong and three weak recommendations emerged from the process, all supported only by low or very low quality evidence. The panel strongly recommended that the 2011 CDC Guideline for the Field Triage of Injured Patients be used as the initial step in the triage process, and that ground emergency medical services (GEMS) be used for patients not meeting CDC anatomic, physiologic, and situational high-acuity criteria. The panel issued a weak recommendation to use helicopter emergency medical services (HEMS) for higher-acuity patients if there is a time-savings versus GEMS, or if an appropriate hospital is not accessible by GEMS due to systemic/logistical factors. The panel strongly recommended that online medical direction should not be required for activating HEMS. Special consideration was given to the potential need for local adaptation. Systematic and transparent methodology was used to develop an evidence-based guideline for the transportation of prehospital trauma patients. The recommendations provide specific guidance regarding the activation of GEMS and HEMS for patients of varying acuity. Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost.

Developing guidelines in low-income and middle-income countries: lessons from Kenya

PubMed Central

English, Mike; Irimu, Grace; Nyamai, Rachel; Were, Fred; Garner, Paul; Opiyo, Newton

2017-01-01

There are few examples of sustained nationally organised, evidence-informed clinical guidelines development processes in Sub-Saharan Africa. We describe the evolution of efforts from 2005 to 2015 to support evidence-informed decision making to guide admission hospital care practices in Kenya. The approach to conduct reviews, present evidence, and structure and promote transparency of consensus-based procedures for making recommendations improved over four distinct rounds of policy making. Efforts to engage important voices extended from government and academia initially to include multiple professional associations, regulators and practitioners. More than 100 people have been engaged in the decision-making process; an increasing number outside the research team has contributed to the conduct of systematic reviews, and 31 clinical policy recommendations has been developed. Recommendations were incorporated into clinical guideline booklets that have been widely disseminated with a popular knowledge and skills training course. Both helped translate evidence into practice. We contend that these efforts have helped improve the use of evidence to inform policy. The systematic reviews, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approaches and evidence to decision-making process are well understood by clinicians, and the process has helped create a broad community engaged in evidence translation together with a social or professional norm to use evidence in paediatric care in Kenya. Specific sustained efforts should be made to support capacity and evidence-based decision making in other African settings and clinical disciplines. PMID:28584069

Charles Darwin and Evolution: Illustrating Human Aspects of Science

ERIC Educational Resources Information Center

Kampourakis, Kostas; McComas, William F.

2010-01-01

Recently, the nature of science (NOS) has become recognized as an important element within the K-12 science curriculum. Despite differences in the ultimate lists of recommended aspects, a consensus is emerging on what specific NOS elements should be the focus of science instruction and inform textbook writers and curriculum developers. In this…

Recommendations for designing and conducting cold-fill hold challenge studies for acidified food products

USDA-ARS?s Scientific Manuscript database

A scheduled process developed for manufacture of acidified foods must be validated with data from existing literature or from a product-specific challenge study, either of which can establish both safety and shelf stability. The challenge study would evaluate the ability of a particular food product...

Measuring Student Success from a Developmental Mathematics Course at an Elite Public Institution

ERIC Educational Resources Information Center

Hsu, Julian; Gehring, William J.

2016-01-01

This paper asks whether placement recommendations for a developmental math course at an elite public institution impact students' future academic performance, course-taking, and college outcomes. Researchers use these specific outcomes to measure whether developmental courses help students develop the skills necessary to succeed in college,…

77 FR 23250 - HIT Standards Committee; Schedule for the Assessment of HIT Policy Committee Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

... quality, clinical operations, implementation, and privacy and security. Other groups are convened to address specific issues as needed, such as the Nationwide Health Information Network Power Team, the... appropriate workgroup or other special group to develop a report for the HIT Standards Committee, to the...

War-Related Stress: Addressing the Stress of War and Other Traumatic Events.

ERIC Educational Resources Information Center

Hobfoll, Stevan E.; And Others

1991-01-01

Reports the findings of a task force convened to develop strategies for prevention and treatment of psychological, psychosocial, and psychosomatic disorders associated with the Persian Gulf War. Discusses who is at risk, stress reactions to look for, and guidelines for successful coping. Recommends specific interventions at the institutional,…

Photovoice as Participatory Action Research Tool for Engaging People with Intellectual Disabilities in Research and Program Development

ERIC Educational Resources Information Center

Jurkowski, Janine M.

2008-01-01

People with intellectual disabilities have few opportunities to actively participate in research affecting programs and policies. Employment of participatory action research has been recommended. Although use of this approach with people who have intellectual disabilities is growing, articles on specific participatory research methods are rare.…

Effective Classroom Management: Teacher Preparation and Professional Development. TQ Connection Issue Paper

ERIC Educational Resources Information Center

Oliver, Regina M.; Reschly, Daniel J.

2007-01-01

The purpose of this paper is to provide research and recommendations related to teacher quality and effectiveness, specifically addressing the area of classroom management to improve outcomes in general and special education. Focusing on classroom organization and behavior management is necessary as a preventive approach for students who are…

Improving Mathematical Problem Solving in Grades 4 through 8. IES Practice Guide. NCEE 2012-4055

ERIC Educational Resources Information Center

Woodward, John; Beckmann, Sybilla; Driscoll, Mark; Franke, Megan; Herzig, Patricia; Jitendra, Asha; Koedinger, Kenneth R.; Ogbuehi, Philip

2012-01-01

The Institute of Education Sciences (IES) publishes practice guides in education to bring the best available evidence and expertise to bear on current challenges in education. Authors of practice guides combine their expertise with the findings of rigorous research, when available, to develop specific recommendations for addressing these…

Energy Industry

DTIC Science & Technology

2007-01-01

Coal Power Plant , Dickerson, MD Consol Corporation, Morgantown and Wanna, WV Chevron Corporation, San Ramon, CA Valero Refinery , Benicia, CA Pacific...important petrochemical industry Cons: Reliance on imports from volatile regions Greenhouse gas emissions Policy Recommendations: Limit number...nuclear power, and reduce hazardous emissions through the development of cleaner burning technologies and use of alternative fuels. Specifically, the

New Horizons in Civic Education. Our Democracy: How America Works.

ERIC Educational Resources Information Center

Banaszak, Ronald A.; Hartoonian, H. Michael; Leming, James S.

This book grew from a working conference on "Citizenship for the 21st Century." The purpose of the conference was to develop specific recommendations to guide the Foundation for Teaching Economics (FTE) and the Constitutional Rights Foundation (CRF) in their efforts to improve civic education for young adolescents. The conferees reached consensus…

D-Fussion: A Semantic Selective Disssemination of Information Service for the Research Community in Digital Libraries

ERIC Educational Resources Information Center

Morales-del-Castillo, Jose Manuel; Peis, Eduardo; Moreno, Juan Manuel; Herrera-Viedma, Enrique

2009-01-01

Introduction: In this paper we propose a multi-agent Selective Dissemination of Information service to improve the research community's access to digital library resources. The service also provides a new recommendation approach to satisfy researchers' specific information requirements. Method: The service model is developed by jointly applying…

Applying Social Learning Theory of Career Decision Making to Gay, Lesbian, Bisexual, Transgender, and Questioning Young Adults

ERIC Educational Resources Information Center

Datti, Paul A.

2009-01-01

Incorporating J. D. Krumboltz's (1979) social learning theory of career decision making, the author explores career development issues for gay, lesbian, bisexual, transgender, and questioning (GLBTQ) adolescents and young adults. Unique challenges for the GLBTQ population are discussed, specific recommendations for effective career counseling with…

MANAGING TROUBLED WATERS: THE EVOLUTION OF THE EMAP COASTAL MONITORING PROGRAM 2001 EMAP SYMPOSIUM, APRIL 24-27, PENSACOLA BEACH, FL

EPA Science Inventory

In 1990, Managing Troubled Waters concluded by stating three primary conclusions and then developing specific recommendations regarding their execution. Using the decade of the 90s, we examine the evolution of the U.S. EPA's Environmental Monitoring and Assessment Program's Coast...

Requirements for Programming Languages in Computer-Based Instructional Systems.

ERIC Educational Resources Information Center

Zinn, Karl

The author reviews the instructional programing languages which already exist and describes their methods of presentation, organization, and preparation. He recommends that all research and development projects remain flexible in their choice of programing language for a time yet. He suggests ways to adapt to specific uses and users, to exploit…

REPORT AND RECOMMENDATION FOR LEARNING MATERIALS CENTER.

ERIC Educational Resources Information Center

KEIM, WILLIAM A.; AND OTHERS

THIS REPORT IS A HISTORY OF THE DEVELOPMENT OF A SET OF EDUCATIONAL SPECIFICATIONS FOR THE EXPANSION OF AN EXISTING LIBRARY AND THE ADDITION OF AN INSTRUCTIONAL MATERIALS CENTER. PRELIMINARY CONSIDERATION WAS GIVEN TO THE METHODS OF INSTRUCTION AT THE COLLEGE, THE STUDENTS, THE FACULTY, AND THE AVAILABLE FINANCIAL RESOURCES. A GENERAL STUDY…

Induction Programs for the Support and Development of Beginning Teachers of Science. National Science Teachers Association Position Statement

ERIC Educational Resources Information Center

National Science Teachers Association (NJ1), 2007

2007-01-01

The National Science Teachers Association (NSTA) recommends that schools and teacher preparation programs provide new teachers of science with comprehensive induction programs. Research suggests these programs should address specifics for teachers of science, involve trained mentors, provide adequate time to support continual learning of new…

WHO Expert Committee on Specifications for Pharmaceutical Preparations. Forty-ninth report.

PubMed

2015-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use. Revised procedure for the development of monographs and other texts for The International Pharmacopoeia; Revised updating mechanism for the section on radiopharmaceuticals in The International Pharmacopoeia; Revision of the supplementary guidelines on good manufacturing practices: validation, Appendix 7: non-sterile process validation; General guidance for inspectors on hold-time studies; 16 technical supplements to Model guidance for the storage and transport of time- and temperature-sensitive pharmaceutical products; Recommendations for quality requirements when plant-derived artemisinin is used as a starting material in the production of antimalarial active pharmaceutical ingredients; Multisource (generic) pharmaceutical products: guidelines on registration requirements to establish interchangeability: revision; Guidance on the selection of comparator pharmaceutical products for equivalence assessment of interchangeable multisource (generic) products: revision; and Good review practices: guidelines for national and regional regulatory authorities.

From Observation to Information: Data-Driven Understanding of on Farm Yield Variation

PubMed Central

Jiménez, Daniel; Dorado, Hugo; Cock, James; Prager, Steven D.; Delerce, Sylvain; Grillon, Alexandre; Andrade Bejarano, Mercedes; Benavides, Hector; Jarvis, Andy

2016-01-01

Agriculture research uses “recommendation domains” to develop and transfer crop management practices adapted to specific contexts. The scale of recommendation domains is large when compared to individual production sites and often encompasses less environmental variation than farmers manage. Farmers constantly observe crop response to management practices at a field scale. These observations are of little use for other farms if the site and the weather are not described. The value of information obtained from farmers’ experiences and controlled experiments is enhanced when the circumstances under which it was generated are characterized within the conceptual framework of a recommendation domain, this latter defined by Non-Controllable Factors (NCFs). Controllable Factors (CFs) refer to those which farmers manage. Using a combination of expert guidance and a multi-stage analytic process, we evaluated the interplay of CFs and NCFs on plantain productivity in farmers’ fields. Data were obtained from multiple sources, including farmers. Experts identified candidate variables likely to influence yields. The influence of the candidate variables on yields was tested through conditional forests analysis. Factor analysis then clustered harvests produced under similar NCFs, into Homologous Events (HEs). The relationship between NCFs, CFs and productivity in intercropped plantain were analyzed with mixed models. Inclusion of HEs increased the explanatory power of models. Low median yields in monocropping coupled with the occasional high yields within most HEs indicated that most of these farmers were not using practices that exploited the yield potential of those HEs. Varieties grown by farmers were associated with particular HEs. This indicates that farmers do adapt their management to the particular conditions of their HEs. Our observations confirm that the definition of HEs as recommendation domains at a small-scale is valid, and that the effectiveness of distinct management practices for specific micro-recommendation domains can be identified with the methodologies developed. PMID:26930552

Development of a meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology.

PubMed

Muche-Borowski, Cathleen; Lühmann, Dagmar; Schäfer, Ingmar; Mundt, Rebekka; Wagner, Hans-Otto; Scherer, Martin

2017-06-22

The study aimed to develop a comprehensive algorithm (meta-algorithm) for primary care encounters of patients with multimorbidity. We used a novel, case-based and evidence-based procedure to overcome methodological difficulties in guideline development for patients with complex care needs. Systematic guideline development methodology including systematic evidence retrieval (guideline synopses), expert opinions and informal and formal consensus procedures. Primary care. The meta-algorithm was developed in six steps:1. Designing 10 case vignettes of patients with multimorbidity (common, epidemiologically confirmed disease patterns and/or particularly challenging health care needs) in a multidisciplinary workshop.2. Based on the main diagnoses, a systematic guideline synopsis of evidence-based and consensus-based clinical practice guidelines was prepared. The recommendations were prioritised according to the clinical and psychosocial characteristics of the case vignettes.3. Case vignettes along with the respective guideline recommendations were validated and specifically commented on by an external panel of practicing general practitioners (GPs).4. Guideline recommendations and experts' opinions were summarised as case specific management recommendations (N-of-one guidelines).5. Healthcare preferences of patients with multimorbidity were elicited from a systematic literature review and supplemented with information from qualitative interviews.6. All N-of-one guidelines were analysed using pattern recognition to identify common decision nodes and care elements. These elements were put together to form a generic meta-algorithm. The resulting meta-algorithm reflects the logic of a GP's encounter of a patient with multimorbidity regarding decision-making situations, communication needs and priorities. It can be filled with the complex problems of individual patients and hereby offer guidance to the practitioner. Contrary to simple, symptom-oriented algorithms, the meta-algorithm illustrates a superordinate process that permanently keeps the entire patient in view. The meta-algorithm represents the back bone of the multimorbidity guideline of the German College of General Practitioners and Family Physicians. This article presents solely the development phase; the meta-algorithm needs to be piloted before it can be implemented. © 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.

GRADE guidelines: 10. Considering resource use and rating the quality of economic evidence.

PubMed

Brunetti, Massimo; Shemilt, Ian; Pregno, Silvia; Vale, Luke; Oxman, Andrew D; Lord, Joanne; Sisk, Jane; Ruiz, Francis; Hill, Suzanne; Guyatt, Gordon H; Jaeschke, Roman; Helfand, Mark; Harbour, Robin; Davoli, Marina; Amato, Laura; Liberati, Alessandro; Schünemann, Holger J

2013-02-01

In this article, we describe how to include considerations about resource utilization when making recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. We focus on challenges with rating the confidence in effect estimates (quality of evidence) and incorporating resource use into evidence profiles and Summary of Findings (SoF) tables. GRADE recommends that important differences in resource use between alternative management strategies should be included along with other important outcomes in the evidence profile and SoF table. Key steps in considering resources in making recommendations with GRADE are the identification of items of resource use that may differ between alternative management strategies and that are potentially important to decision makers, finding evidence for the differences in resource use, making judgments regarding confidence in effect estimates using the same criteria used for health outcomes, and valuing the resource use in terms of costs for the specific setting for which recommendations are being made. With our framework, decision makers will have access to concise summaries of recommendations, including ratings of the quality of economic evidence, and better understand the implications for clinical decision making. Copyright © 2013 Elsevier Inc. All rights reserved.

Systems biology of personalized nutrition

PubMed Central

van Ommen, Ben; van den Broek, Tim; de Hoogh, Iris; van Erk, Marjan; van Someren, Eugene; Rouhani-Rankouhi, Tanja; Anthony, Joshua C; Hogenelst, Koen; Pasman, Wilrike; Boorsma, André; Wopereis, Suzan

2017-01-01

Abstract Personalized nutrition is fast becoming a reality due to a number of technological, scientific, and societal developments that complement and extend current public health nutrition recommendations. Personalized nutrition tailors dietary recommendations to specific biological requirements on the basis of a person’s health status and goals. The biology underpinning these recommendations is complex, and thus any recommendations must account for multiple biological processes and subprocesses occurring in various tissues and must be formed with an appreciation for how these processes interact with dietary nutrients and environmental factors. Therefore, a systems biology–based approach that considers the most relevant interacting biological mechanisms is necessary to formulate the best recommendations to help people meet their wellness goals. Here, the concept of “systems flexibility” is introduced to personalized nutrition biology. Systems flexibility allows the real-time evaluation of metabolism and other processes that maintain homeostasis following an environmental challenge, thereby enabling the formulation of personalized recommendations. Examples in the area of macro- and micronutrients are reviewed. Genetic variations and performance goals are integrated into this systems approach to provide a strategy for a balanced evaluation and an introduction to personalized nutrition. Finally, modeling approaches that combine personalized diagnosis and nutritional intervention into practice are reviewed. PMID:28969366

Recommendations by the Spanish Society of Rheumatology for the management of patients diagnosed with rheumatoid arthritis who cannot be treated with methotrexate.

PubMed

García-Vicuña, Rosario; Martín-Martínez, María Auxiliadora; Gonzalez-Crespo, María Rosa; Tornero-Molina, Jesús; Fernández-Nebro, Antonio; Blanco-García, Francisco Javier; Blanco-Alonso, Ricardo; Marsal-Barril, Sara

To establish a set of recommendations for the management of patients diagnosed with rheumatoid arthritis (RA) who cannot be treated with methotrexate (MTX) due to contraindications, drug toxicity or lack of adherence, and to establish therapeutic strategies more effective and safer in these RA patients. A qualitative analysis of the scientific evidence available to June 2015. The 2-round Delphi technique of consensus was used to collect and establish expert opinion based on the participants' clinical experience when only low quality evidence was available. A total of eighteen recommendations were developed for the management of this patient profile. Fourteen of these recommendations were related to drug safety aspects. Recommendations on contraindication and toxicity of MTX have been updated. The experts recommend the use of biological monotherapy, a preferred treatment option, in patients whose profiles reveal a contraindication, intolerance or circumstances that prevent us against the use of MTX. There is some high-quality scientific evidence that supports contraindication and establishes certain conditions of MTX use in RA patients with specific clinical profiles. Copyright © 2016. Publicado por Elsevier España, S.L.U.

Formalising multidisciplinary peer review: developing a haematological malignancy-specific electronic proforma and standard operating procedure to facilitate procedural efficiency and evidence-based clinical practice.

PubMed

Trotman, Judith; Trinh, Jimmy; Kwan, Yiu Lam; Estell, Jane A; Fletcher, Julie; Archer, Kate; Lee, Kenneth; Foo, Kerwin; Curnow, Jennifer; Bianchi, Alessandra; Wignall, Lynda; Verner, Emma; Gasiorowski, Robin; Siedlecka, Elizabeth; Cunningham, Ilona

2017-05-01

Multidisciplinary team (MDT) meetings aimed at facilitating peer review have become standard practice in oncology. However, there is scant literature on the optimal structure and conduct of such meetings. To develop a process for formal peer review of patients with haematological malignancies and to audit any resulting changes made to the management recommendations of the treating physician. A standard operating procedure (SOP) for MDT meetings was developed essentially to integrate clinical peer review with weekly pathology and radiology meetings. The centrepiece is the electronic submission of a patient-specific proforma (Microsoft InfoPath) prior to the meeting. It serves as the template for presentation, discussion and recording of recommendations and conclusions. The final verified document is stored in the electronic patient record, and a copy is sent to the general practitioner. The proposed management plans were compared to the consensus recommendations of the meeting for the first 4 years since inception. Both SOP and proforma underwent continual improvements. These provided the framework for the conduct of a robust weekly MDT meeting for peer review of the management of patients with haematological malignancies. On 20% of occasions, patient management plans were altered to optimise patient care as a direct consequence on peer review at the MDT. Our streamlined process, in its ultimate format, has provided a mature and efficient forum for formal peer review in a genuine multidisciplinary environment. Both initial data and informal feedback support its ongoing activity as an integral component of delivering quality patient care. © 2016 Royal Australasian College of Physicians.

Recommended Implementation of Arterial Spin Labeled Perfusion MRI for Clinical Applications: A consensus of the ISMRM Perfusion Study Group and the European Consortium for ASL in Dementia

PubMed Central

Alsop, David C.; Detre, John A.; Golay, Xavier; Günther, Matthias; Hendrikse, Jeroen; Hernandez-Garcia, Luis; Lu, Hanzhang; MacIntosh, Bradley J.; Parkes, Laura M.; Smits, Marion; van Osch, Matthias J. P.; Wang, Danny JJ; Wong, Eric C.; Zaharchuk, Greg

2014-01-01

This article provides a summary statement of recommended implementations of arterial spin labeling (ASL) for clinical applications. It is a consensus of the ISMRM Perfusion Study Group and the European ‘ASL in Dementia’ consortium, both of whom met to reach this consensus in October 2012 in Amsterdam. Although ASL continues to undergo rapid technical development, we believe that current ASL methods are robust and ready to provide useful clinical information, and that a consensus statement on recommended implementations will help the clinical community to adopt a standardized approach. In this article we describe the major considerations and tradeoffs in implementing an ASL protocol, and provide specific recommendations for a standard approach. Our conclusions are that, as an optimal default implementation we recommend: pseudo-continuous labeling, background suppression, a segmented 3D readout without vascular crushing gradients, and calculation and presentation of both label/control difference images and cerebral blood flow in absolute units using a simplified model. PMID:24715426

Sports Dietitians Australia position statement: sports nutrition for the adolescent athlete.

PubMed

Desbrow, Ben; McCormack, Joanna; Burke, Louise M; Cox, Gregory R; Fallon, Kieran; Hislop, Matthew; Logan, Ruth; Marino, Nello; Sawyer, Susan M; Shaw, Greg; Star, Anita; Vidgen, Helen; Leveritt, Michael

2014-10-01

It is the position of Sports Dietitians Australia (SDA) that adolescent athletes have unique nutritional requirements as a consequence of undertaking daily training and competition in addition to the demands of growth and development. As such, SDA established an expert multidisciplinary panel to undertake an independent review of the relevant scientific evidence and consulted with its professional members to develop sports nutrition recommendations for active and competitive adolescent athletes. The position of SDA is that dietary education and recommendations for these adolescent athletes should reinforce eating for long term health. More specifically, the adolescent athlete should be encouraged to moderate eating patterns to reflect daily exercise demands and provide a regular spread of high quality carbohydrate and protein sources over the day, especially in the period immediately after training. SDA recommends that consideration also be given to the dietary calcium, Vitamin D and iron intake of adolescent athletes due to the elevated risk of deficiency of these nutrients. To maintain optimal hydration, adolescent athletes should have access to fluids that are clean, cool and supplied in sufficient quantities before, during and after participation in sport. Finally, it is the position of SDA that nutrient needs should be met by core foods rather than supplements, as the recommendation of dietary supplements to developing athletes over-emphasizes their ability to manipulate performance in comparison with other training and dietary strategies.

Assisting Consumer Health Information Retrieval with Query Recommendations

PubMed Central

Zeng, Qing T.; Crowell, Jonathan; Plovnick, Robert M.; Kim, Eunjung; Ngo, Long; Dibble, Emily

2006-01-01

Objective: Health information retrieval (HIR) on the Internet has become an important practice for millions of people, many of whom have problems forming effective queries. We have developed and evaluated a tool to assist people in health-related query formation. Design: We developed the Health Information Query Assistant (HIQuA) system. The system suggests alternative/additional query terms related to the user's initial query that can be used as building blocks to construct a better, more specific query. The recommended terms are selected according to their semantic distance from the original query, which is calculated on the basis of concept co-occurrences in medical literature and log data as well as semantic relations in medical vocabularies. Measurements: An evaluation of the HIQuA system was conducted and a total of 213 subjects participated in the study. The subjects were randomized into 2 groups. One group was given query recommendations and the other was not. Each subject performed HIR for both a predefined and a self-defined task. Results: The study showed that providing HIQuA recommendations resulted in statistically significantly higher rates of successful queries (odds ratio = 1.66, 95% confidence interval = 1.16–2.38), although no statistically significant impact on user satisfaction or the users' ability to accomplish the predefined retrieval task was found. Conclusion: Providing semantic-distance-based query recommendations can help consumers with query formation during HIR. PMID:16221944

The effectiveness of scoliosis screening programs: methods for systematic review and expert panel recommendations formulation

PubMed Central

2013-01-01

Background Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. Methods To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. Conclusions In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields. PMID:23883346

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

Gaffney, David K., E-mail: david.gaffney@hci.utah.edu; King, Bronwyn; Viswanathan, Akila N.

Purpose: The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma. Methods and Materials: An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The levelmore » of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours. Results: Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer. Conclusions: These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.« less

Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion.

PubMed

Heffernan, Kayla Joanne; Chang, Shanton; Maclean, Skye Tamara; Callegari, Emma Teresa; Garland, Suzanne Marie; Reavley, Nicola Jane; Varigos, George Andrew; Wark, John Dennis

2016-02-09

The now ubiquitous catchphrase, "There's an app for that," rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of "do no harm." There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). This research has provided principles for developing interactive eHealth apps for complex messaging as guidelines by aggregating existing design concepts and expanding these concepts and new learnings from our development process. A set of guidelines to develop interactive eHealth apps generally, and specifically those for complex messaging, was previously missing from the literature; this research has contributed these principles. Safe-D delivers complex messaging simply, to aid education, and explicitly, considering user safety.

Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion

PubMed Central

Heffernan, Kayla Joanne; Maclean, Skye Tamara; Callegari, Emma Teresa; Garland, Suzanne Marie; Reavley, Nicola Jane; Varigos, George Andrew; Wark, John Dennis

2016-01-01

Background The now ubiquitous catchphrase, “There’s an app for that,” rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of “do no harm.” There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. Objective This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. Methods For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. Results By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). Conclusions This research has provided principles for developing interactive eHealth apps for complex messaging as guidelines by aggregating existing design concepts and expanding these concepts and new learnings from our development process. A set of guidelines to develop interactive eHealth apps generally, and specifically those for complex messaging, was previously missing from the literature; this research has contributed these principles. Safe-D delivers complex messaging simply, to aid education, and explicitly, considering user safety. PMID:26860623

Tailoring implementation strategies for evidence-based recommendations using computerised clinical decision support systems: protocol for the development of the GUIDES tools.

PubMed

Van de Velde, Stijn; Roshanov, Pavel; Kortteisto, Tiina; Kunnamo, Ilkka; Aertgeerts, Bert; Vandvik, Per Olav; Flottorp, Signe

2016-03-05

A computerised clinical decision support system (CCDSS) is a technology that uses patient-specific data to provide relevant medical knowledge at the point of care. It is considered to be an important quality improvement intervention, and the implementation of CCDSS is growing substantially. However, the significant investments do not consistently result in value for money due to content, context, system and implementation issues. The Guideline Implementation with Decision Support (GUIDES) project aims to improve the impact of CCDSS through optimised implementation based on high-quality evidence-based recommendations. To achieve this, we will develop tools that address the factors that determine successful CCDSS implementation. We will develop the GUIDES tools in four steps, using the methods and results of the Tailored Implementation for Chronic Diseases (TICD) project as a starting point: (1) a review of research evidence and frameworks on the determinants of implementing recommendations using CCDSS; (2) a synthesis of a comprehensive framework for the identified determinants; (3) the development of tools for use of the framework and (4) pilot testing the utility of the tools through the development of a tailored CCDSS intervention in Norway, Belgium and Finland. We selected the conservative management of knee osteoarthritis as a prototype condition for the pilot. During the process, the authors will collaborate with an international expert group to provide input and feedback on the tools. This project will provide guidance and tools on methods of identifying implementation determinants and selecting strategies to implement evidence-based recommendations through CCDSS. We will make the GUIDES tools available to CCDSS developers, implementers, researchers, funders, clinicians, managers, educators, and policymakers internationally. The tools and recommendations will be generic, which makes them scalable to a large spectrum of conditions. Ultimately, the better implementation of CCDSS may lead to better-informed decisions and improved care and patient outcomes for a wide range of conditions. PROSPERO, CRD42016033738.

Report of the IAU Commission 4 Working Group on Standardizing Access to Ephemerides and File Format Specification

DTIC Science & Technology

2014-12-01

format for the orientation of a body. It further recommends support- ing data be stored in a text PCK. These formats are used by the SPICE system...INTRODUCTION These file formats were developed for and are used by the SPICE system, developed by the Navigation and Ancillary Information Facility (NAIF...of NASA’s Jet Propulsion Laboratory (JPL). Most users will want to use either the SPICE libraries or CALCEPH, developed by the Institut de mécanique

A Critical Appraisal of and Recommendations for Faculty Development

PubMed Central

Guglielmo, B. Joseph; Edwards, David J.; Franks, Andrea S.; Naughton, Cynthia A.; Schonder, Kristine S.; Stamm, Pamela L.; Thornton, Phillip; Popovich, Nicholas G.

2011-01-01

The 2009-2010 American Association of Colleges of Pharmacy (AACP) Council of Faculties Faculty Affairs Committee reviewed published literature assessing the scope and outcomes of faculty development for tenure and promotion. Relevant articles were identified via a PubMed search, review of pharmacy education journals, and identification of position papers from major healthcare professions academic organizations. While programs intended to enhance faculty development were described by some healthcare professions, relatively little specific to pharmacy has been published and none of the healthcare professions have adequately evaluated the impact of various faculty-development programs on associated outcomes. The paucity of published information strongly suggests a lack of outcomes-oriented faculty-development programs in colleges and schools of pharmacy. Substantial steps are required toward the development and scholarly evaluation of faculty-development programs. As these programs are developed and assessed, evaluations must encompass all faculty subgroups, including tenure- and nontenure track faculty members, volunteer faculty members, women, and underrepresented minorities. This paper proposes AACP, college and school, and department-level recommendations intended to ensure faculty success in achieving tenure and promotion. PMID:21931460

Best practices in incident investigation in the chemical process industries with examples from the industry sector and specifically from Nova Chemicals.

PubMed

Morrison, Lisa M

2004-07-26

This paper will summarize best practices in incident investigation in the chemical process industries and will provide examples from both the industry sector and specifically from NOVA Chemicals. As a sponsor of the Center for Chemical Process Safety (CCPS), an industry technology alliance of the American Institute of Chemical Engineers, NOVA Chemicals participates in a number of working groups to help develop best practices and tools for the chemical process and associated industries in order to advance chemical process safety. A recent project was to develop an update on guidelines for investigating chemical process incidents. A successful incident investigation management system must ensure that all incidents and near misses are reported, that root causes are identified, that recommendations from incident investigations identify appropriate preventive measures, and that these recommendations are resolved in a timely manner. The key elements of an effective management system for incident investigation will be described. Accepted definitions of such terms as near miss, incident, and root cause will be reviewed. An explanation of the types of incident classification systems in use, along with expected levels of follow-up, will be provided. There are several incident investigation methodologies in use today by members of the CCPS; most of these methodologies incorporate the use of several tools. These tools include: timelines, sequence diagrams, causal factor identification, brainstorming, checklists, pre-defined trees, and team-defined logic trees. Developing appropriate recommendations and then ensuring their resolution is the key to prevention of similar events from recurring, along with the sharing of lessons learned from incidents. There are several sources of information on previous incidents and lessons learned available to companies. In addition, many companies in the chemical process industries use their own internal databases to track recommendations from incidents and to share learnings internally.

Energy Efficiency Opportunities in Highway Lodging Buildings: Development of 50% Energy Savings Design Technology Packages

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

Jiang, Wei; Gowri, Krishnan; Thornton, Brian A.

2010-06-30

This paper presents the process, methodology, and assumptions for development of the 50% Energy Savings Design Technology Packages for Highway Lodging Buildings, a design guidance document that provides specific recommendations for achieving 50% energy savings in roadside motels (highway lodging) above the requirements of ANSI/ASHRAE/IESNA Standard 90.1-2004. This 50% solution represents a further step toward realization of the U.S. Department of Energy’s net-zero energy building goal, and go beyond the 30% savings in the Advanced Energy Design Guide series (upon which this work was built). This work can serve as the technical feasibility study for the development of a 50%more » saving Advanced Energy Design Guide for highway lodging, and thus should greatly expedite the development process. The purpose of this design package is to provide user-friendly design assistance to designers, developers, and owners of highway lodging properties. It is intended to encourage energy-efficient design by providing prescriptive energy-efficiency recommendations for each climate zone that attains the 50% the energy savings target. This paper describes the steps that were taken to demonstrate the technical feasibility of achieving a 50% reduction in whole-building energy use with practical and commercially available technologies. The energy analysis results are presented, indicating the recommended energy-efficient measures achieved a national-weighted average energy savings of 55%, relative to Standard 90.1-2004. The cost-effectiveness of the recommended technology package is evaluated and the result shows an average simple payback of 11.3 years.« less

The skills and experience of GRADE methodologists can be assessed with a simple tool.

PubMed

Norris, Susan L; Meerpohl, Joerg J; Akl, Elie A; Schünemann, Holger J; Gartlehner, Gerald; Chen, Yaolong; Whittington, Craig

2016-11-01

To suggest approaches for guideline developers on how to assess a methodologist's expertise with Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods and tasks and to provide a set of minimum skills and experience required to perform specific tasks related to guideline development using GRADE. We used an iterative and consensus-based process involving individuals with in-depth experience with GRADE. We considered four main tasks: (1) development of key questions; (2) assessment of the certainty of effect estimates; (3) development of recommendations; and (4) teaching GRADE. There are three basic approaches to determine a methodologist's skill set. First, self-report of knowledge, skills, and experience with a standardized "GRADE curriculum vitae (CV)" focused on each of the GRADE-related tasks; second, demonstration of skills using worked examples; third, a formal evaluation using a written or oral test. We suggest that the GRADE CV is likely to be useful and feasible to implement. We also suggest minimum training including attendance at one or more full-day workshops and familiarity with the main GRADE publications and the GRADE handbook. The selection of a GRADE methodologist must be a thoughtful, reasoned decision, informed by the criteria suggested in this article and tailored to the specific project. Our suggested approaches need further pilot testing and validation. Copyright © 2016 Elsevier Inc. All rights reserved.

Screening youth for suicide risk in medical settings: time to ask questions.

PubMed

Horowitz, Lisa M; Bridge, Jeffrey A; Pao, Maryland; Boudreaux, Edwin D

2014-09-01

This paper focuses on the National Action Alliance for Suicide Prevention's Research Prioritization Task Force's Aspirational Goal 2 (screening for suicide risk) as it pertains specifically to children, adolescents, and young adults. Two assumptions are forwarded: (1) strategies for screening youth for suicide risk need to be tailored developmentally; and (2) we must use instruments that were created and tested specifically for suicide risk detection and developed specifically for youth. Recommendations for shifting the current paradigm include universal suicide screening for youth in medical settings with validated instruments. Published by Elsevier Inc.

A development of logistics management models for the Space Transportation System

NASA Technical Reports Server (NTRS)

Carrillo, M. J.; Jacobsen, S. E.; Abell, J. B.; Lippiatt, T. F.

1983-01-01

A new analytic queueing approach was described which relates stockage levels, repair level decisions, and the project network schedule of prelaunch operations directly to the probability distribution of the space transportation system launch delay. Finite source population and limited repair capability were additional factors included in this logistics management model developed specifically for STS maintenance requirements. Data presently available to support logistics decisions were based on a comparability study of heavy aircraft components. A two-phase program is recommended by which NASA would implement an integrated data collection system, assemble logistics data from previous STS flights, revise extant logistics planning and resource requirement parameters using Bayes-Lin techniques, and adjust for uncertainty surrounding logistics systems performance parameters. The implementation of these recommendations can be expected to deliver more cost-effective logistics support.

Standard for Models and Simulations

NASA Technical Reports Server (NTRS)

Steele, Martin J.

2016-01-01

This NASA Technical Standard establishes uniform practices in modeling and simulation to ensure essential requirements are applied to the design, development, and use of models and simulations (MS), while ensuring acceptance criteria are defined by the program project and approved by the responsible Technical Authority. It also provides an approved set of requirements, recommendations, and criteria with which MS may be developed, accepted, and used in support of NASA activities. As the MS disciplines employed and application areas involved are broad, the common aspects of MS across all NASA activities are addressed. The discipline-specific details of a given MS should be obtained from relevant recommended practices. The primary purpose is to reduce the risks associated with MS-influenced decisions by ensuring the complete communication of the credibility of MS results.

The Development of a Mindfulness-Based Music Therapy (MBMT) Program for Women Receiving Adjuvant Chemotherapy for Breast Cancer

PubMed Central

Lesiuk, Teresa

2016-01-01

Problems with attention and symptom distress are common clinical features reported by women who receive adjuvant chemotherapy for breast cancer. Mindfulness practice significantly improves attention and mindfulness programs significantly reduce symptom distress in patients with cancer, and, more specifically, in women with breast cancer. Recently, a pilot investigation of a music therapy program, built on core attitudes of mindfulness practice, reported significant benefits of enhanced attention and decreased negative mood and fatigue in women with breast cancer. This paper delineates the design and development of the mindfulness-based music therapy (MBMT) program implemented in that pilot study and includes clients’ narrative journal responses. Conclusions and recommendations, including recommendation for further exploration of the function of music in mindfulness practice are provided. PMID:27517966

[Chronic Pancreatitis and Pancreatic Cancer - Tumor Risk and Screening].

PubMed

Beyer, Georg; D'Haese, Jan G; Ormanns, Steffen; Mayerle, Julia

2018-06-01

Chronic pancreatitis is a fibroinflammatory syndrome of the exocrine pancreas, which is characterized by an increasing incidence, high morbidity and lethality. Common etiologies besides alcohol and nicotine consumption include genetic causes and risk factors. The life time risk for the development of pancreatic cancer is elevated 13- to 45-fold depending on the underlying etiology. In patients with chronic pancreatitis clinical, laboratory and imaging surveillance for early detection of complications, including pancreatic cancer, is recommended, although the available methods lack the desired sensitivity and specificity. In this article we review the epidemiology, etiologies and risk factors for chronic pancreatitis and pancreatic cancer and discuss current recommendations for screening and management of patients at risk for tumor development. © Georg Thieme Verlag KG Stuttgart · New York.

Monopropellant hydrazine resistojet: Flight application design

NASA Technical Reports Server (NTRS)

Kurch, C. K.

1973-01-01

The design, development, and testing of an engineering model nominal 20-millipound thrust monopropellant hydrazine resistojet program is directed toward the advanced development of an electrothermal hydrazine thruster (EHT). The EHT decomposes hydrazine thermally and expands the decomposition products through a nozzle to provide the impulse necessary to fulfill spacecraft propulsive requirements. The thruster is capable of operation at pulse widths from 0.050 second to steady state and delivers specific impulse values up to about 230 seconds depending on the duty cycle. The program is comprised of six tasks including analyses, the generation of specifications and other documentation, design, fabrication and test, data correlation, and recommendations for the design of flight units.

The influence of evaluation recommendations on instrumental and conceptual uses: A preliminary analysis.

PubMed

Bourgeois, Isabelle; Whynot, Jane

2018-06-01

Evaluation recommendations are sometimes included in evaluation reports to highlight specific actions to be taken to improve a program or to make other changes to its operational context. This preliminary study sought to examine evaluation recommendations drawn from 25 evaluation reports published by Canadian federal government departments and agencies, in order to examine the evaluation issues covered and the focus of the recommendations. Our results show that in keeping with policy requirements, the evaluation recommendations focused on program relevance, effectiveness and efficiency and economy. Furthermore, a significant number of recommendations also focused on the implementation of more rigorous performance measurement strategies. The focus of the recommendations did not vary by publication date, recommendation type, and organizational sector. The findings also show that for the most part, the management responses produced as part of the broader evaluation process support the recommendations included in the report and identify specific timelines for implementation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Data compression for near Earth and deep space to Earth transmission

NASA Technical Reports Server (NTRS)

Erickson, Daniel E.

1991-01-01

Key issues of data compression for near Earth and deep space to Earth transmission discussion group are briefly presented. Specific recommendations as made by the group are as follows: (1) since data compression is a cost effective way to improve communications and storage capacity, NASA should use lossless data compression wherever possible; (2) NASA should conduct experiments and studies on the value and effectiveness of lossy data compression; (3) NASA should develop and select approaches to high ratio compression of operational data such as voice and video; (4) NASA should develop data compression integrated circuits for a few key approaches identified in the preceding recommendation; (5) NASA should examine new data compression approaches such as combining source and channel encoding, where high payoff gaps are identified in currently available schemes; and (6) users and developers of data compression technologies should be in closer communication within NASA and with academia, industry, and other government agencies.

How Qualitative Methods Can be Used to Inform Model Development.

PubMed

Husbands, Samantha; Jowett, Susan; Barton, Pelham; Coast, Joanna

2017-06-01

Decision-analytic models play a key role in informing healthcare resource allocation decisions. However, there are ongoing concerns with the credibility of models. Modelling methods guidance can encourage good practice within model development, but its value is dependent on its ability to address the areas that modellers find most challenging. Further, it is important that modelling methods and related guidance are continually updated in light of any new approaches that could potentially enhance model credibility. The objective of this article was to highlight the ways in which qualitative methods have been used and recommended to inform decision-analytic model development and enhance modelling practices. With reference to the literature, the article discusses two key ways in which qualitative methods can be, and have been, applied. The first approach involves using qualitative methods to understand and inform general and future processes of model development, and the second, using qualitative techniques to directly inform the development of individual models. The literature suggests that qualitative methods can improve the validity and credibility of modelling processes by providing a means to understand existing modelling approaches that identifies where problems are occurring and further guidance is needed. It can also be applied within model development to facilitate the input of experts to structural development. We recommend that current and future model development would benefit from the greater integration of qualitative methods, specifically by studying 'real' modelling processes, and by developing recommendations around how qualitative methods can be adopted within everyday modelling practice.

Strategies for increasing adolescent immunizations in diverse ethnic communities.

PubMed

Greenfield, Lauren S; Page, Libby C; Kay, Meagan; Li-Vollmer, Meredith; Breuner, Cora C; Duchin, Jeffrey S

2015-05-01

We sought to identify attitudes and knowledge of adolescent vaccination recommendations for tetanus, diphtheria, and acellular pertussis (Tdap); quadrivalent meningococcal conjugate (MCV4); and human papillomavirus (HPV) vaccines among Hispanic, Somali, and Ethiopian/Eritrean communities in King County, Washington. In-person surveys of Hispanic, Somali, and Ethiopian/Eritrean adolescents (n = 45) and parents of adolescents (n = 157), and three focus groups with mothers of 11- to 18-year-olds were conducted to assess knowledge, attitudes, and barriers related to recommended adolescent vaccines. Bivariate analyses of parent survey responses were performed to evaluate possible differences between ethnic groups (chi-square test and Fisher exact test where possible). Findings were used to develop (1) culture-specific written brochures for community members, which addressed misperceptions about adolescent immunizations and related diseases, and (2) a presentation highlighting specific messages for health care providers (HCPs) in the target communities. HCPs were surveyed after delivery of the presentation (n = 20). We identified barriers to adolescent immunization including: parents' and adolescents' limited awareness of, and misperceptions regarding, recommended adolescent vaccines and vaccine preventable diseases; lack of HCP recommendations for vaccination; and inability to access health information in native languages. Awareness of tetanus, diphtheria, and acellular pertussis, quadrivalent meningococcal conjugate, and human papillomavirus vaccines varied by vaccine and ethnic group. Lack of knowledge of adolescent vaccination recommendations was the main reason given by parents that their adolescents had not been vaccinated. Most parents in the focus groups identified doctors as a trusted source of health information and reported that they would vaccinate their teens if their doctor recommended it. All the surveyed HCPs routinely recommend adolescent vaccines at well-child visits, 55% at acute visits, and 35% at injury visits. Eighty percent reported that they would be more likely to recommend HPV vaccine after our on-site presentation. A strong recommendation from the physician is a critical factor influencing parents' decision to vaccinate, even when hesitancy exists. Other factors (such as personal experiences with these diseases and religious and cultural beliefs) also influence parents' decisions regarding vaccination. Knowledge of beliefs, misperceptions, and concerns can help inform strategies to improve adolescent vaccine uptake among specific ethnic populations, including the availability of culturally tailored, translated information. Additionally, HCPs may benefit from guidance on communicating with ethnic populations to support meaningful dialogue with families about the risks and benefits of adolescent vaccines. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation

PubMed Central

Collaco, Joseph M.; Baker, Christopher D.; Carroll, John L.; Sharma, Girish D.; Brozek, Jan L.; Finder, Jonathan D.; Ackerman, Veda L.; Arens, Raanan; Boroughs, Deborah S.; Carter, Jodi; Daigle, Karen L.; Dougherty, Joan; Gozal, David; Kevill, Katharine; Kravitz, Richard M.; Kriseman, Tony; MacLusky, Ian; Rivera-Spoljaric, Katherine; Tori, Alvaro J.; Ferkol, Thomas; Halbower, Ann C.

2016-01-01

Background: Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children. Purpose: To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation. Methods: The Pediatric Assembly of the American Thoracic Society assembled an interdisciplinary workgroup with expertise in the care of children requiring chronic invasive ventilation. The experts developed four questions of clinical importance and used an evidence-based strategy to identify relevant medical evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to formulate and grade recommendations. Results: Clinical practice recommendations for the management of children with chronic ventilator dependence at home are provided, and the evidence supporting each recommendation is discussed. Conclusions: Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. Standardized hospital discharge criteria are suggested. An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child’s care. Standardized equipment for monitoring, emergency preparedness, and airway clearance are outlined. The recommendations presented are based on the current evidence and expert opinion and will require an update as new evidence and/or technologies become available. PMID:27082538

NALDA (Naval Aviation Logistics Data Analysis) CAI (computer aided instruction)

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

Handler, B.H.; France, P.A.; Frey, S.C.

Data Systems Engineering Organization (DSEO) personnel developed a prototype computer aided instruction CAI system for the Naval Aviation Logistics Data Analysis (NALDA) system. The objective of this project was to provide a CAI prototype that could be used as an enhancement to existing NALDA training. The CAI prototype project was performed in phases. The task undertaken in Phase I was to analyze the problem and the alternative solutions and to develop a set of recommendations on how best to proceed. The findings from Phase I are documented in Recommended CAI Approach for the NALDA System (Duncan et al., 1987). Inmore » Phase II, a structured design and specifications were developed, and a prototype CAI system was created. A report, NALDA CAI Prototype: Phase II Final Report, was written to record the findings and results of Phase II. NALDA CAI: Recommendations for an Advanced Instructional Model, is comprised of related papers encompassing research on computer aided instruction CAI, newly developing training technologies, instructional systems development, and an Advanced Instructional Model. These topics were selected because of their relevancy to the CAI needs of NALDA. These papers provide general background information on various aspects of CAI and give a broad overview of new technologies and their impact on the future design and development of training programs. The paper within have been index separately elsewhere.« less

78 FR 55263 - Draft Guidance for Industry on Bioequivalence Recommendations for Fluticasone Propionate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-10

...] Draft Guidance for Industry on Bioequivalence Recommendations for Fluticasone Propionate; Salmeterol... ``Bioequivalence Recommendations for Fluticasone Propionate; Salmeterol Xinafoate.'' The recommendations provide specific guidance on the design of bioequivalence (BE) studies to support abbreviated new drug applications...

Coronary heart disease in women: highlights of the past 2 years--stepping stones, milestones and obstructing boulders.

PubMed

Wenger, Nanette K

2006-04-01

Emerging data continue to highlight important sex-based differences in coronary heart disease (CHD) prevention and diagnostic testing, in the management of acute coronary syndromes and in the outcomes of CHD therapies. Evidence-based guidelines have been developed that offer specific recommendations for clinicians and information for women. These guidelines are buttressed by results that have become available from randomized, controlled clinical trials in women, and data from CHD registries and clinical trials involving both sexes but including adequate numbers of women to enable the reporting of sex-specific results. Underuse of guideline-based preventive and therapeutic strategies for women probably contributes to their less favorable CHD outcomes. Adherence to recommendations offers the promise of improving the heart health of women. In this article, I summarize new information to guide the preventive, diagnostic and therapeutic management of CHD in women.

Drug offence sentencing practices in the United States of America.

PubMed

Weissman, J C

1984-01-01

The United States criminal justice system, in response to a variety of risks, makes available a range of options to help control drug offenders. Pre-arrest diversion, pre-trial diversion, pre-trial release, probation, split sentencing, warn release, incarceration and parole release are alternative dispositions involving a graduated scale of punishment, incarceration, specific deterrence and rehabilitation. New drug offence sentencing policies are emerging within the criminal justice system. Traditional values of rehabilitation are currently less favoured and contemporary doctrines advocate sentencing based on principles of uniformity and retribution. Drug law sentencing practices are a principal concern of this article and the major policy themes are systematically reviewed. Diversion, criminal responsibility, selective incapacitation, trafficking, and cocaine abuse are examined. Guidelines for policy development are recommended and the analysis covers the related concepts of sentencing ideology, decriminalization, and determinate sentencing models. Specific recommendations are offered for revision of drug offence sentencing policies to incorporate the emerging penal values.

Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations.

PubMed

von Bültzingslöwen, Inger; Sollecito, Thomas P; Fox, Philip C; Daniels, Troy; Jonsson, Roland; Lockhart, Peter B; Wray, David; Brennan, Michael T; Carrozzo, Marco; Gandera, Beatrice; Fujibayashi, Takashi; Navazesh, Mahvash; Rhodus, Nelson L; Schiødt, Morten

2007-03-01

The objective of this study was to identify systemic diseases associated with hyposalivation and xerostomia and develop evidence-based management recommendations for hyposalivation/xerostomia. Literature searches covered the English language medical literature from 1966 to 2005. An evidence-based review process was applied to management studies published from 2002 to 2005. Several systemic diseases were identified. From studies published 2002 to 2005, 15 were identified as high-quality studies and were used to support management recommendations: pilocarpine and cevimeline are recommended for treating hyposalivation and xerostomia in primary and secondary Sjögren's syndrome (SS). IFN-alpha lozenges may enhance saliva flow in primary SS patients. Anti-TNF-alpha agents, such as infliximab or etanercept, are not recommended to treat hyposalivation in SS. Dehydroepiandrosterone is not recommended to relieve hyposalivation or xerostomia in primary SS. There was not enough evidence to support any recommendations for the use of local stimulants, lubricants, and protectants for hyposalivation/xerostomia. However, professional judgment and patient preferences may support the use of a specific product for an individual patient. These evidence-based management recommendations should guide the clinician's management decisions for patients with salivary dysfunction related to systemic disease. Future treatment strategies may include new formulations of existing drugs, e.g., local application of pilocarpine. Recent discoveries on gene expression and a better understanding of the etiopathogenesis of SS may open new treatment options in the future.

Final Report on the Development of a Model Education and Training System for Inmates in Federal Correctional Institutions, to Federal Prison Industries, Incorporated, U.S. Department of Justice.

ERIC Educational Resources Information Center

Hitt, William D.; Agostino, Norman R.

This study to develop an education and training (E&T) system for inmates in Federal correctional institutions described and evaluated existing E&T systems and needs at Milan, Michigan, and Terre Haute, Indiana; formulated an E&T model; and made specific recommendations for implementation of each point in the model. A systems analysis approach was…

Guidelines for the diagnosis, prevention and management of osteoporosis.

PubMed

Rossini, M; Adami, S; Bertoldo, F; Diacinti, D; Gatti, D; Giannini, S; Giusti, A; Malavolta, N; Minisola, S; Osella, G; Pedrazzoni, M; Sinigaglia, L; Viapiana, O; Isaia, G C

2016-06-23

Osteoporosis poses a significant public health issue. National Societies have developed Guidelines for the diagnosis and treatment of this disorder with an effort of adapting specific tools for risk assessment on the peculiar characteristics of a given population. The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has recently revised the previously published Guidelines on the diagnosis, riskassessment, prevention and management of primary and secondary osteoporosis. The guidelines were first drafted by a working group and then approved by the board of SIOMMMS. Subsequently they received also the endorsement of other major Scientific Societies that deal with bone metabolic disease. These recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on leading experts' experience and opinion, and on good clinical practice. The osteoporosis prevention should be based on the elimination of specific risk factors. The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk, and this is the case only when the risk of fracture is rather high as measured with variables susceptible to pharmacological effect. DeFRA (FRAX® derived fracture risk assessment) is recognized as a useful tool for easily estimate the long-term fracture risk. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management.

Identifying important life stages for monitoring and assessing risks from exposures to environmental contaminants: results of a World Health Organization review.

PubMed

Cohen Hubal, Elaine A; de Wet, Thea; Du Toit, Lilo; Firestone, Michael P; Ruchirawat, Mathuros; van Engelen, Jacqueline; Vickers, Carolyn

2014-06-01

In this paper, we summarize exposure-related issues to consider in determining the most appropriate age ranges and life stages for risk assessment. We then propose a harmonized set of age bins for monitoring and assessing risks from exposures to chemicals for global use. The focus is on preconception through adolescence, though the approach should be applicable to additional life stages. A two-tiered set of early life age groups is recommended. The first tier involves the adoption of guidance similar to the childhood age groups recommended by the U.S. Environmental Protection Agency, whereas the second tier consolidates some of those age groups to reduce the burden of developing age-specific exposure factors for different regions. While there is no single "correct" means of choosing a common set of age groups to use internationally in assessing early life exposure and risk, use of a set of defined age groups is recommended to facilitate comparisons of potential exposures and risks around the globe, the collection of data and analyses of aggregate exposure and cumulative risk. Application of these age groups for robust assessment of exposure and risk for specific populations will require region-specific exposure factors as well as local environmental monitoring data. Copyright © 2013 World Health Organization. Published by Elsevier Inc. All rights reserved.

Reporting standards for research in psychology: why do we need them? What might they be?

PubMed

2008-12-01

In anticipation of the impending revision of the Publication Manual of the American Psychological Association, APA's Publications and Communications Board formed the Working Group on Journal Article Reporting Standards (JARS) and charged it to provide the board with background and recommendations on information that should be included in manuscripts submitted to APA journals that report (a) new data collections and (b) meta-analyses. The JARS Group reviewed efforts in related fields to develop standards and sought input from other knowledgeable groups. The resulting recommendations contain (a) standards for all journal articles, (b) more specific standards for reports of studies with experimental manipulations or evaluations of interventions using research designs involving random or nonrandom assignment, and (c) standards for articles reporting meta-analyses. The JARS Group anticipated that standards for reporting other research designs (e.g., observational studies, longitudinal studies) would emerge over time. This report also (a) examines societal developments that have encouraged researchers to provide more details when reporting their studies, (b) notes important differences between requirements, standards, and recommendations for reporting, and (c) examines benefits and obstacles to the development and implementation of reporting standards.

Appropriate Use Criteria in Dermatopathology: Initial Recommendations from the American Society of Dermatopathology.

PubMed

Vidal, Claudia I; Armbrect, Eric A; Andea, Aleodor A; Bohlke, Angela K; Comfere, Nneka I; Hughes, Sarah R; Kim, Jinah; Kozel, Jessica A; Lee, Jason B; Linos, Konstantinos; Litzner, Brandon R; Missall, Tricia A; Novoa, Roberto A; Sundram, Uma; Swick, Brian L; Hurley, M Yadira; Alam, Murad; Argenyi, Zsolt; Duncan, Lyn M; Elston, Dirk M; Emanuel, Patrick O; Ferringer, Tammie; Fung, Maxwell A; Hosler, Gregory A; Lazar, Alexander J; Lowe, Lori; Plaza, Jose A; Prieto, Victor G; Robinson, June K; Schaffer, Andras; Subtil, Antonio; Wang, Wei-Lien

2018-04-21

Appropriate use criteria (AUC) provide physicians guidance in test selection, can affect health care delivery, reimbursement policy, and physician decision-making. The American Society of Dermatopathology (ASDP), with input from the American Academy of Dermatology (AAD) and the College of American Pathologists (CAP), sought to develop AUC in dermatopathology. The RAND/UCLA appropriateness methodology, which combines evidence-based medicine, clinical experience and expert judgment, was used to develop AUC in dermatopathology. With the number of ratings predetermined at 3, AUC were developed for 211 clinical scenarios (CS) involving 12 ancillary studies (AS). Consensus was reached for 188 (89%) CS, with 93 (44%) considered "usually appropriate", 52 (25%) "rarely appropriate", and 43 (20%) "uncertain appropriateness". The methodology requires a focus on appropriateness without comparison between tests and irrespective of cost. The ultimate decision of when to order specific test rests with the physician and is one where the expected benefit exceeds the negative consequences. This publication outlines the recommendation of appropriateness - AUC for 12 tests used in dermatopathology. Importantly, these recommendations may change considering new evidence. Results deemed "uncertain appropriateness" and where consensus was not reached may benefit from further research. Copyright © 2018. Published by Elsevier Inc.

The WHO evidence-informed guideline development process and implications for vitamin and mineral research priorities: symposium rationale and summary.

PubMed

Neufeld, Lynnette M; Jalal, Chowdhury S B; Peña-Rosas, Juan Pablo; Tovey, David; Lutter, Chessa K; Stoltzfus, Rebecca J; Habicht, Jean-Pierre

2013-09-01

The WHO evidence-informed guidelines provide recommendations to Member States and their partners on interventions with vitamins and minerals. Evidence gathered and synthesized through systematic reviews contributes to the development of these guidelines, a process that is dependent on the availability and quality of evidence. Although the guideline development process is stringently governed and supervised to maintain clarity and transparency, the lack of adequacy and specificity of available evidence poses limitations to the formulation of recommendations that can be easily applied for policy and program decision making in diverse contexts. The symposium created a space for dialogue among scientists and public health practitioners to improve the understanding of how evidence fulfills the needs and reflect on mechanisms by which policy and program guidance and priorities for research could be better informed by policy and program needs. Ultimately, programmatic success depends not only on identifying efficacious agents but ensuring effective delivery to those with the potential to respond. To do this, we must understand the rationale for recommending interventions, the biological pathways by which interventions work, delivery systems required to make efficacious interventions work, and other contextual factors that might limit or facilitate successful implementation.

Wind energy Computerized Maintenance Management System (CMMS) : data collection recommendations for reliability analysis.

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

Peters, Valerie A.; Ogilvie, Alistair B.

2012-01-01

This report addresses the general data requirements for reliability analysis of fielded wind turbines and other wind plant equipment. The report provides a rationale for why this data should be collected, a list of the data needed to support reliability and availability analysis, and specific data recommendations for a Computerized Maintenance Management System (CMMS) to support automated analysis. This data collection recommendations report was written by Sandia National Laboratories to address the general data requirements for reliability analysis of operating wind turbines. This report is intended to help develop a basic understanding of the data needed for reliability analysis frommore » a Computerized Maintenance Management System (CMMS) and other data systems. The report provides a rationale for why this data should be collected, a list of the data needed to support reliability and availability analysis, and specific recommendations for a CMMS to support automated analysis. Though written for reliability analysis of wind turbines, much of the information is applicable to a wider variety of equipment and analysis and reporting needs. The 'Motivation' section of this report provides a rationale for collecting and analyzing field data for reliability analysis. The benefits of this type of effort can include increased energy delivered, decreased operating costs, enhanced preventive maintenance schedules, solutions to issues with the largest payback, and identification of early failure indicators.« less

[The Balance of Care approach for the development of custom-fit health care services for people with dementia on the margins of care between home and nursing home: experiences with its application in Germany].

PubMed

Stephan, Astrid; Renom Guiteras, Anna; Juchems, Stefan; Meyer, Gabriele

2013-01-01

In Germany as in other countries of the European Union (EU), the majority of people with dementia are cared for by their informal caregivers at home. Across countries, however, there are considerable differences in the time to nursing home admission. The European research project RightTimePlaceCare intends to establish good practice recommendations for how to sustain the preferred living situation as long as possible. The Balance of Care approach was used to develop these recommendations, which combines empirical data, cost estimates and expert consensus, and thus implemented in a multinational context for the first time. In eight EU countries a survey was conducted among 2,014 people with dementia and their informal caregivers in nursing homes (n=1,223) or at home (n=791). Selected descriptive characteristics of the study participants were used for case type development. The case types were translated into 14 case vignettes, which were discussed by five to six expert panels (each consisting of three to four participants) per country. The experts (n=161) recommended the most suitable living place (at home or in a nursing home) and customised care packages for home care situations. Across all countries, the experts predominantly recommended care at home for four of the case types whose reference group of study participants actually lived in a nursing home. These case types represent a relevant part of the study population. In Germany, the experts judged the case vignettes as realistic but criticised that information relevant for proper decision making was missing. Expert group discussions always ended in consensus, and care at home was predominately recommended. The proposed care packages most often comprised standard care services, and hence appeared to be realistic and feasible. The development of country-specific recommendations is still ongoing. In order to assess economic feasibility, estimated costs of home care packages will be compared with costs of nursing home care. Further outcomes like the quality of life will be considered for good practice recommendation finding. Balance of Care supports the development of empirically based expert recommendations. The approach is widely applicable but seems to be particularly useful for the development of local custom-fit healthcare services. The clinical effectiveness, safety, and cost implications of the Balance of Care approach remain to be investigated in future studies. Copyright © 2013. Published by Elsevier GmbH.

Expert panel consensus recommendations for home blood pressure monitoring in Asia: the Hope Asia Network.

PubMed

Park, Sungha; Buranakitjaroen, Peera; Chen, Chen-Huan; Chia, Yook-Chin; Divinagracia, Romeo; Hoshide, Satoshi; Shin, Jinho; Siddique, Saulat; Sison, Jorge; Soenarta, Arieska Ann; Sogunuru, Guru Prasad; Tay, Jam Chin; Turana, Yuda; Wang, Ji-Guang; Zhang, Yuqing; Kario, Kazuomi

2018-04-01

Hypertension is the leading cause of mortality throughout Asia. Home blood pressure monitoring has the potential to improve hypertension control and is a useful adjunct to conventional office blood pressure measurements due to its diagnostic accuracy and prognostic value in predicting cardiovascular outcomes. At present, there are no region-specific guidelines addressing the use of home blood pressure monitoring in Asia. Therefore, an expert panel was convened to address the use of home blood pressure monitoring and develop key recommendations to help guide clinical practice throughout the Asia region. The resulting recommendations support the use of home blood pressure monitoring with a validated device as an accurate adjunct for diagnosing hypertension and predicting cardiovascular outcome. Diagnosis and treatment of hypertension should still be guided by conventional office/clinic blood pressure measurements. The expert panel encourages the incorporation of home blood pressure monitoring into local clinical guidelines and offers practical recommendations to ensure continuity of care where a validated home blood pressure device is not available.

Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report

PubMed Central

Clavien, Pierre-Alain; Lesurtel, Mickael; Bossuyt, Patrick M M; Gores, Gregory J; Langer, Bernard; Perrier, Arnaud

2012-01-01

Although liver transplantation is a widely accepted treatment for hepatocellular carcinoma (HCC), much controversy remains and there is no generally accepted set of guidelines. An international consensus conference was held on Dec 2–4, 2010, in Zurich, Switzerland, with the aim of reviewing current practice regarding liver transplantation in patients with HCC and to develop internationally accepted statements and guidelines. The format of the conference was based on the Danish model. 19 working groups of experts prepared evidence-based reviews according to the Oxford classification, and drafted recommendations answering 19 specific questions. An independent jury of nine members was appointed to review these submissions and make final recommendations, after debates with the experts and audience at the conference. This report presents the final 37 statements and recommendations, covering assessment of candidates for liver transplantation, criteria for listing in cirrhotic and non-cirrhotic patients, role of tumour downstaging, management of patients on the waiting list, role of living donation, and post-transplant management. PMID:22047762

Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years).

PubMed

Tremblay, Mark S; Leblanc, Allana G; Carson, Valerie; Choquette, Louise; Connor Gorber, Sarah; Dillman, Carrie; Duggan, Mary; Gordon, Mary Jane; Hicks, Audrey; Janssen, Ian; Kho, Michelle E; Latimer-Cheung, Amy E; Leblanc, Claire; Murumets, Kelly; Okely, Anthony D; Reilly, John J; Stearns, Jodie A; Timmons, Brian W; Spence, John C

2012-04-01

The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years). These national guidelines are in response to a call from health and health care professionals, child care providers, and fitness practitioners for guidance on sedentary behaviour in the early years. The guideline development process followed the Appraisal of Guidelines for Research Evaluation (AGREE) II framework. The recommendations are informed by evidence from a systematic review that examined the relationships between sedentary behaviour (predominantly screen time) and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged <1 year; toddlers aged 1-2 years; preschoolers aged 3-4 years). Evidence from the review was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from extensive on-line consultations with input from >900 domestic and international stakeholders, end-users, and key informants. The final guidelines state: for healthy growth and development, caregivers should minimize the time infants (aged <1 year), toddlers (aged 1-2 years), and preschoolers (aged 3-4 years) spend being sedentary during waking hours. This includes prolonged sitting or being restrained (e.g., stroller, high chair) for more than 1 h at a time. For those under 2 years, screen time (e.g., TV, computer, electronic games) is not recommended. For children 2-4 years, screen time should be limited to under 1 h per day; less is better.

Apollo experience report: Television system

NASA Technical Reports Server (NTRS)

Coan, P. P.

1973-01-01

The progress of the Apollo television systems from the early definition of requirements through the development and inflight use of color television hardware is presented. Television systems that have been used during the Apollo Program are discussed, beginning with a description of the specifications for each system. The document describes the technical approach taken for the development of each system and discusses the prototype and engineering hardware built to test the system itself and to perform the testing to verify compatibility with the spacecraft systems. Problems that occurred during the design and development phase are described. Finally, the flight hardware, operational characteristics, and performance during several Apollo missions are described, and specific recommendations for the remaining Apollo flights and future space missions are made.

Consensus recommendations for cancer rehabilitation: research and education priorities

PubMed Central

McEwen, S.; Egan, M.; Chasen, M.; Fitch, M.

2013-01-01

As cancer survivorship increases, there is a need for additional and more complex rehabilitation services. The Partners in Cancer Rehabilitation Research group held a 3-day invitational working meeting aimed at defining the state of the science in cancer rehabilitation research and identifying key areas for development of research and education. In May 2012, 29 participants gathered to present their current work, review a synthesis of the current literature, generate ideas about research and education gaps, and develop consensus on priority areas. The conclusion of the meeting was that a main research priority is to develop and test personalized rehabilitation interventions and brief measures to identify the presence and severity of disabling sequelae. The education consensus statement concluded that a clear description of cancer rehabilitation and its mandate should be developed as a precursor to education activities, including both a conceptualization of complex interdisciplinary rehabilitation and the roles of individual professions, and further, that there is a great need to increase awareness among health professionals, patients, and families of the need for and general effectiveness of cancer rehabilitation. Numerous specific recommendations were also put forward, and it is hoped that those recommendations will provide the foundation for a new and productive era of research and will play a role in the improvement of functional health and participation outcomes for cancer survivors.

Surveying Cystic Fibrosis Care Centers to Assess Adoption of Infection Prevention and Control Recommendations.

PubMed

Saiman, Lisa; Zhou, Juyan J; Jiang, Xiaotong; Kosorok, Michael R; Muhlebach, Marianne S

2018-04-15

OBJECTIVEIn 2013, the Cystic Fibrosis (CF) Foundation developed an updated guideline for infection prevention and control (IP&C) practices for CF. We sought to assess the adoption of specific recommendations by CF care centers.METHODSDirectors of the 277 CF care centers in the United States were asked to complete a confidential online survey regarding the adoption of selected IP&C recommendations. Selected recommendations were those we considered less likely to be incorporated into a center's written IP&C policies.RESULTSCenter directors from 198 of 277 CF centers (71%) completed the survey between December 2015 and June 2016; pediatric and larger centers were more likely to do so. Overall, 70% have adopted ≥75% of the selected recommendations. As recommended, almost all provided education to CF center staff (98%) and patients and families (97%); fewer developed educational materials in collaboration with local IP&C teams (59%) and/or patients and families (37%). Among 108 centers with non-English-speaking patients, 65 (60%) provided educational materials in relevant languages. Most (74%) held group education events; of the 138 centers with in-person meetings, 45% allowed 1 individual with CF to attend, and 51% allowed no individuals with CF to attend. Most centers (93%) held outdoor events, and 84% allowed >1 individual with CF to attend. Audits of exam-room cleaning were performed by 49% of CF centers.CONCLUSIONSCystic fibrosis centers in the United States have adopted many of the recommendations addressed in this survey. Nonetheless, these findings suggest opportunities for improvement. More CF centers should provide education to non-English-speaking patients and families, and CF centers should perform audits of room cleaning.Infect Control Hosp Epidemiol. 2018:1-5.

Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm.

PubMed

Friedli, Natalie; Stanga, Zeno; Culkin, Alison; Crook, Martin; Laviano, Alessandro; Sobotka, Lubos; Kressig, Reto W; Kondrup, Jens; Mueller, Beat; Schuetz, Philipp

2018-03-01

Refeeding syndrome (RFS) can be a life-threatening metabolic condition after nutritional replenishment if not recognized early and treated adequately. There is a lack of evidence-based treatment and monitoring algorithm for daily clinical practice. The aim of the study was to propose an expert consensus guideline for RFS for the medical inpatient (not including anorexic patients) regarding risk factors, diagnostic criteria, and preventive and therapeutic measures based on a previous systematic literature search. Based on a recent qualitative systematic review on the topic, we developed clinically relevant recommendations as well as a treatment and monitoring algorithm for the clinical management of inpatients regarding RFS. With international experts, these recommendations were discussed and agreement with the recommendation was rated. Upon hospital admission, we recommend the use of specific screening criteria (i.e., low body mass index, large unintentional weight loss, little or no nutritional intake, history of alcohol or drug abuse) for risk assessment regarding the occurrence of RFS. According to the patient's individual risk for RFS, a careful start of nutritional therapy with a stepwise increase in energy and fluids goals and supplementation of electrolyte and vitamins, as well as close clinical monitoring, is recommended. We also propose criteria for the diagnosis of imminent and manifest RFS with practical treatment recommendations with adoption of the nutritional therapy. Based on the available evidence, we developed a practical algorithm for risk assessment, treatment, and monitoring of RFS in medical inpatients. In daily routine clinical care, this may help to optimize and standardize the management of this vulnerable patient population. We encourage future quality studies to further refine these recommendations. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparing the Information and Support Needs of Different Population Groups in Preparation for 2015 Government Approval for HIV Self-testing in France

PubMed Central

Greacen, Tim; Kersaudy-Rahib, Delphine; Le Gall, Jean-Marie; Lydié, Nathalie; Ghosn, Jade; Champenois, Karen

2016-01-01

Context HIV self-tests are currently being introduced in France with the aim of promoting screening both for the general population and for high-risk populations. Objective The current study aimed to identify and compare the information and support needs of the different target population groups. Methods The Delphi process was used to synthesize expert opinions for each population group. Experts were chosen for their experience and expertise in the area of HIV and HIV screening for each population. Each group developed recommendations for a specific population: six high HIV prevalence populations (men who have sex with men; transgender people; substance users; migrants from sub-Saharan Africa; French West Indies; French Guiana) and two low prevalence populations (the general population; people under 25). Each group included expertise from four areas: research, screening and care, policy-making, and community groups. Results A final total of 263 recommendations were grouped into eight main themes: Communicating at both national and community levels about self-test arrival (24% of all recommendations); Providing information adapted to the different community groups’ needs (23%); Providing counselling on self-test use and access to care (15%); Making self-tests available to all in terms of accessibility and cost (13%); Preparing community healthcare and screening systems for the arrival of the self-test (11%); Approving only high quality self-tests (6%); Defending self-test users’ legal rights (5%); Evaluating self-test use (3%). Although a large number of recommendations were common to several groups of experts, the study highlighted a certain number of recommendations specific to each different population group, particularly with regard to information content and access both to information and to the self-tests themselves. Conclusion Results from the current study should make a significant contribution to policy decisions concerning catering for the specific access, information and support needs of different potential HIV self-test user groups in France. PMID:27031234

Comparing the Information and Support Needs of Different Population Groups in Preparation for 2015 Government Approval for HIV Self-testing in France.

PubMed

Greacen, Tim; Kersaudy-Rahib, Delphine; Le Gall, Jean-Marie; Lydié, Nathalie; Ghosn, Jade; Champenois, Karen

2016-01-01

HIV self-tests are currently being introduced in France with the aim of promoting screening both for the general population and for high-risk populations. The current study aimed to identify and compare the information and support needs of the different target population groups. The Delphi process was used to synthesize expert opinions for each population group. Experts were chosen for their experience and expertise in the area of HIV and HIV screening for each population. Each group developed recommendations for a specific population: six high HIV prevalence populations (men who have sex with men; transgender people; substance users; migrants from sub-Saharan Africa; French West Indies; French Guiana) and two low prevalence populations (the general population; people under 25). Each group included expertise from four areas: research, screening and care, policy-making, and community groups. A final total of 263 recommendations were grouped into eight main themes: Communicating at both national and community levels about self-test arrival (24% of all recommendations); Providing information adapted to the different community groups' needs (23%); Providing counselling on self-test use and access to care (15%); Making self-tests available to all in terms of accessibility and cost (13%); Preparing community healthcare and screening systems for the arrival of the self-test (11%); Approving only high quality self-tests (6%); Defending self-test users' legal rights (5%); Evaluating self-test use (3%). Although a large number of recommendations were common to several groups of experts, the study highlighted a certain number of recommendations specific to each different population group, particularly with regard to information content and access both to information and to the self-tests themselves. Results from the current study should make a significant contribution to policy decisions concerning catering for the specific access, information and support needs of different potential HIV self-test user groups in France.

Advanced technology for America's future in space

NASA Technical Reports Server (NTRS)

1990-01-01

In response to Recommendation 8 of the Augustine Committee Report, NASA's Office of Aeronautics, Exploration and Technology (OAET) developed a proposed 'Integrated Technology Plan for the Civil Space Program' that entails substantial changes in the processes, structure and the content of NASA's space research and technology program. The Space Systems and Technology Advisory Committee (SSTAC, a subcommittee of the NASA Advisory Committee) and several other senior, expert, informed advisory groups conducted a review of NASA's proposed Integrated Technology Plan (ITP). This review was in response to the specific request in Recommendation 8 that 'NASA utilize an expert, outside review process, managed from headquarters, to assist in the allocation of technology funds'. This document, the final report from that review, addresses: (1) summary recommendations; (2) mission needs; (3) the integrated technology plan; (4) summary reports of the technical panels; and (5) conclusions and observations.

Virtually impossible: limiting Australian children and adolescents daily screen based media use.

PubMed

Houghton, Stephen; Hunter, Simon C; Rosenberg, Michael; Wood, Lisa; Zadow, Corinne; Martin, Karen; Shilton, Trevor

2015-01-22

Paediatric recommendations to limit children's and adolescents' screen based media use (SBMU) to less than two hours per day appear to have gone unheeded. Given the associated adverse physical and mental health outcomes of SBMU it is understandable that concern is growing worldwide. However, because the majority of studies measuring SBMU have focused on TV viewing, computer use, video game playing, or a combination of these the true extent of total SBMU (including non-sedentary hand held devices) and time spent on specific screen activities remains relatively unknown. This study assesses the amount of time Australian children and adolescents spend on all types of screens and specific screen activities. We administered an online instrument specifically developed to gather data on all types of SBMU and SBMU activities to 2,620 (1373 males and 1247 females) 8 to 16 year olds from 25 Australian government and non-government primary and secondary schools. We found that 45% of 8 year olds to 80% of 16 year olds exceeded the recommended < 2 hours per day for SBMU. A series of hierarchical linear models demonstrated different relationships between the degree to which total SBMU and SBMU on specific activities (TV viewing, Gaming, Social Networking, and Web Use) exceeded the < 2 hours recommendation in relation to sex and age. Current paediatric recommendations pertaining to SBMU may no longer be tenable because screen based media are central in the everyday lives of children and adolescents. In any reappraisal of SBMU exposure times, researchers, educators and health professionals need to take cognizance of the extent to which SBMU differs across specific screen activity, sex, and age.

Mathematics and online learning experiences: a gateway site for engineering students

NASA Astrophysics Data System (ADS)

Masouros, Spyridon D.; Alpay, Esat

2010-03-01

This paper focuses on the preliminary design of a multifaceted computer-based mathematics resource for undergraduate and pre-entry engineering students. Online maths resources, while attractive in their flexibility of delivery, have seen variable interest from students and teachers alike. Through student surveys and wide consultations, guidelines have been developed for effectively collating and integrating learning, support, application and diagnostic tools to produce an Engineer's Mathematics Gateway. Specific recommendations include: the development of a shared database of engineering discipline-specific problems and examples; the identification of, and resource development for, troublesome mathematics topics which encompass ideas of threshold concepts and mastery components; the use of motivational and promotional material to raise student interest in learning mathematics in an engineering context; the use of general and lecture-specific concept maps and matrices to identify the needs and relevance of mathematics to engineering topics; and further exploration of the facilitation of peer-based learning through online resources.

Variation in adult vaccination policies across Europe: an overview from VENICE network on vaccine recommendations, funding and coverage.

PubMed

Kanitz, Elisabeth E; Wu, Lauren A; Giambi, Cristina; Strikas, Raymond A; Levy-Bruhl, Daniel; Stefanoff, Pawel; Mereckiene, Jolita; Appelgren, Eva; D'Ancona, Fortunato

2012-07-27

In 2010-2011, in the framework of the VENICE project, we surveyed European Union (EU) and Economic Area (EEA) countries to fill the gap of information regarding vaccination policies in adults. This project was carried out in collaboration with the United States National Vaccine Program Office, who conducted a similar survey in all developed countries. VENICE representatives of all 29 EU/EEA-countries received an online questionnaire including vaccination schedule, recommendations, funding and coverage in adults for 17 vaccine-preventable diseases. The response rate was 100%. The definition of age threshold for adulthood for the purpose of vaccination ranged from 15 to 19 years (median=18 years). EU/EEA-countries recommend between 4 and 16 vaccines for adults (median=11 vaccines). Tetanus and diphtheria vaccines are recommended to all adults in 22 and 21 countries respectively. The other vaccines are mostly recommended to specific risk groups; recommendations for seasonal influenza and hepatitis B exist in all surveyed countries. Six countries have a comprehensive summary document or schedule describing all vaccines which are recommended for adults. None of the surveyed countries was able to provide coverage estimates for all the recommended adult vaccines. Vaccination policies for adults are not consistent across Europe, including the meaning of "recommended vaccine" which is not comparable among countries. Coverage data for adults should be collected routinely like for children vaccination. Copyright © 2012 Elsevier Ltd. All rights reserved.

A Machine Learning Recommender System to Tailor Preference Assessments to Enhance Person-Centered Care Among Nursing Home Residents.

PubMed

Gannod, Gerald C; Abbott, Katherine M; Van Haitsma, Kimberly; Martindale, Nathan; Heppner, Alexandra

2018-05-21

Nursing homes (NHs) using the Preferences for Everyday Living Inventory (PELI-NH) to assess important preferences and provide person-centered care find the number of items (72) to be a barrier to using the assessment. Using a sample of n = 255 NH resident responses to the PELI-NH, we used the 16 preference items from the MDS 3.0 Section F to develop a machine learning recommender system to identify additional PELI-NH items that may be important to specific residents. Much like the Netflix recommender system, our system is based on the concept of collaborative filtering whereby insights and predictions (e.g., filters) are created using the interests and preferences of many users. The algorithm identifies multiple sets of "you might also like" patterns called association rules, based upon responses to the 16 MDS preferences that recommends an additional set of preferences with a high likelihood of being important to a specific resident. In the evaluation of the combined apriori and logistic regression approach, we obtained a high recall performance (i.e., the ratio of correctly predicted preferences compared with all predicted preferences and nonpreferences) and high precision (i.e., the ratio of correctly predicted rules with respect to the rules predicted to be true) of 80.2% and 79.2%, respectively. The recommender system successfully provides guidance on how to best tailor the preference items asked of residents and can support preference capture in busy clinical environments, contributing to the feasibility of delivering person-centered care.

The evolution of standards for naturally occurring fluorides: an example of scientific due process.

PubMed Central

Clark, N; Corbin, S

1983-01-01

In three quarters of a century of observation and research, the effects of fluoride on dental caries and on general bodily health have been well documented. An expanding data base has allowed a firming up of the guidance and standards for appropriate and safe levels of naturally occurring fluorides for human consumption. Over time, through specific recommendations, the maximum fluoride concentrations deemed appropriate have been altered, but by a process of considered adjustment. Although the Public Health Service has been responsible for the formalization of many of the recommended standards, those recommendations have been based on research from many fronts. In the most recent reconsideration of the standards for natural fluoride, the most exhaustive and thoroughly documented review to date was done, incorporating review by representatives from State, Federal, and private programs. Although the specific example of the development of standards for natural fluoride is used, it should be illustrative of similar processes that are constantly underway in regard to substances and factors with a potential impact on the public's health. Expansion of the data base through research and scientific inquiry will lay the foundation for future reconsideration of the standards for naturally occurring fluorides. PMID:6828638

Contemporary Atrial Fibrillation Management: A Comparison of the Current AHA/ACC/HRS, CCS, and ESC Guidelines.

PubMed

Andrade, Jason G; Macle, Laurent; Nattel, Stanley; Verma, Atul; Cairns, John

2017-08-01

In this article we compare and contrast the current recommendations, and highlight the important differences, in the American College of Cardiology/American Heart Association/Heart Rhythm Society, European Society of Cardiology, and Canadian Cardiovascular Society atrial fibrillation (AF) guidelines. Although many of the recommendations of the various societies are similar, there are important differences in the methodologies underlying their development and the specific content. Specifically, key differences can be observed in: (1) the definition of nonvalvular AF, which subsequently affects anticoagulation choices and candidacy for non-vitamin K antagonist oral anticoagulants; (2) the symptom score used to guide management decisions and longitudinal patient profiling; (3) the stroke risk stratification algorithm used to determine indications for oral anticoagulant therapy; (4) the role of acetylsalicylic acid in stroke prevention in AF; (5) the antithrombotic regimens used in the context of coronary artery disease, acute coronary syndromes, and percutaneous coronary intervention; (6) the rate control target and medications recommended to achieve the target; and (7) the role of "first-line" catheter ablation, open surgical ablation, and left atrial appendage exclusion. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Management of relapsed multiple myeloma: recommendations of the International Myeloma Working Group.

PubMed

Laubach, J; Garderet, L; Mahindra, A; Gahrton, G; Caers, J; Sezer, O; Voorhees, P; Leleu, X; Johnsen, H E; Streetly, M; Jurczyszyn, A; Ludwig, H; Mellqvist, U-H; Chng, W-J; Pilarski, L; Einsele, H; Hou, J; Turesson, I; Zamagni, E; Chim, C S; Mazumder, A; Westin, J; Lu, J; Reiman, T; Kristinsson, S; Joshua, D; Roussel, M; O'Gorman, P; Terpos, E; McCarthy, P; Dimopoulos, M; Moreau, P; Orlowski, R Z; Miguel, J S; Anderson, K C; Palumbo, A; Kumar, S; Rajkumar, V; Durie, B; Richardson, P G

2016-05-01

The prognosis for patients multiple myeloma (MM) has improved substantially over the past decade with the development of new, more effective chemotherapeutic agents and regimens that possess a high level of anti-tumor activity. In spite of this important progress, however, nearly all MM patients ultimately relapse, even those who experience a complete response to initial therapy. Management of relapsed MM thus represents a vital aspect of the overall care for patients with MM and a critical area of ongoing scientific and clinical research. This comprehensive manuscript from the International Myeloma Working Group provides detailed recommendations on management of relapsed disease, with sections dedicated to diagnostic evaluation, determinants of therapy, and general approach to patients with specific disease characteristics. In addition, the manuscript provides a summary of evidence from clinical trials that have significantly impacted the field, including those evaluating conventional dose therapies, as well as both autologous and allogeneic stem cell transplantation. Specific recommendations are offered for management of first and second relapse, relapsed and refractory disease, and both autologous and allogeneic transplant. Finally, perspective is provided regarding new agents and promising directions in management of relapsed MM.

System Data Bases In European Satellites Programs: Lessons Learned and Recommendations

NASA Astrophysics Data System (ADS)

Passot, X.; Denuault, D.; Guiral, Ph.; Kerjean, L.; Lebreton, D.; Lecrvain, C.; Valera, S.

2007-08-01

This paper is intended for European space eningeers who must design or interact with all or part of a system database, hereafter referred to as 'SDB'. The document presents the objectives of a system database (SDB), describes the development of an SDB project from the specification stage until operations, and preovides recommendations so that an effective system can be obtained. As part of return on experience, the document gives an overview of exisiting systems in the European space industry. To prepare the new systems, it presents the services to be provided, the tools available and the emerging standars towards which SDBs must converge.

New Exposure Time Calculator for NICMOS (imaging): Features, Testing and Recommendations

NASA Astrophysics Data System (ADS)

Arribas, S.; McLean, D.; Busko, I.; Sosey, M.

2004-02-01

A new NICMOS ETC for imaging mode has been developed as part of the Astronomer’s Proposal Toolkit (APT) project. This new tool fully updates the NICMOS performance for Cycles 11+, expands the funtionality of the previous ETC, providing the user more options, and homogenizes the non-instrument specific parameters (i.e. sky background, extinction laws) with other HST-ETCs. This report summarizes its main characteristics, and gives some recommendations to potential users. Details about the tool itself can be found in the documentation linked to the ETC user interface, which can be accessed from the NICMOS web site at STScI.

[Benign proliferative breast disease with and without atypia].

PubMed

Coutant, C; Canlorbe, G; Bendifallah, S; Beltjens, F

2015-12-01

In the last few years, diagnostics of high-risk breast lesions (atypical ductal hyperplasia [ADH], flat epithelial atypia [FEA], lobular neoplasia: atypical lobular hyperplasia [ALH], lobular carcinoma in situ [LCIS], radial scar [RS], usual ductal hyperplasia [UDH], adenosis, sclerosing adenosis [SA], papillary breast lesions, mucocele-like lesion [MLL]) have increased with the growing number of breast percutaneous biopsies. The management of these lesions is highly conditioned by the enlarged risk of breast cancer combined with either an increased probability of finding cancer after surgery, either a possible malignant transformation (in situ or invasive cancer), or an increased probability of developing cancer on the long range. An overview of the literature reports grade C recommendations concerning the management and follow-up of these lesions: in case of ADH, FEA, ALH, LCIS, RS, MLL with atypia, diagnosed on percutaneous biopsies: surgical excision is recommended; in case of a diagnostic based on vacuum-assisted core biopsy with complete disappearance of radiological signal for FEA or RS without atypia: surgical abstention is a valid alternative approved by multidisciplinary meeting. In case of ALH (incidental finding) associated with benign lesion responsible of radiological signal: abstention may be proposed; in case of UDH, adenosis, MLL without atypia, diagnosed on percutaneous biopsies: the concordance of radiology and histopathology findings must be ensured. No data is available to recommend surgery; in case of non-in sano resection for ADH, FEA, ALH, LCIS (except pleomorphic type), RS, MLL: surgery does not seem to be necessary; in case of previous ADH, ALH, LCIS: a specific follow-up is recommended in accordance with HAS's recommendations. In case of FEA and RS or MLL combined with atypia, little data are yet available to differ the management from others lesions with atypia; in case of UDH, usual sclerosing adenosis, RS without atypia, fibro cystic disease: no specific follow-up is recommended in agreement with HAS's recommendations. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Experiences of Trans Women and Two-Spirit Persons Accessing Women-Specific Health and Housing Services in a Downtown Neighborhood of Vancouver, Canada.

PubMed

Lyons, Tara; Krüsi, Andrea; Pierre, Leslie; Smith, Adrienne; Small, Will; Shannon, Kate

2016-10-01

Little is known about trans womens' experiences accessing gender-segregated health and housing services, particularly services for marginalized individuals living in poverty. As such, we conducted a qualitative investigation into experiences of accessing women-specific health and housing services among trans women and two-spirit persons in a downtown neighborhood of Vancouver, Canada. Between June 2012 and May 2013 interviews were conducted with 32 trans women and two-spirit individuals who had accessed women-specific health and/or housing services. Participants were recruited from four open prospective cohorts of sex workers and individuals who use drugs. Interview data were analyzed using a participatory analysis approach with two participants who were hired as research assistants. Participants were generally able to access women-specific services in the neighborhood. However, there were reports of discrimination related to gender identity, discrimination based on gender expression (e.g., requirement of a feminine gender expression), and lack of staff intervention in harassment from other service users. Trans women and two-spirit persons in our study relied upon services for their health and safety and, therefore, exclusion from women-specific services had potentially severe adverse consequences such as homelessness and sexual violence. Recommendations to improve accessibility, including policy development and procedural recommendations, are put forth.

Core Outcome Set-STAndards for Development: The COS-STAD recommendations.

PubMed

Kirkham, Jamie J; Davis, Katherine; Altman, Douglas G; Blazeby, Jane M; Clarke, Mike; Tunis, Sean; Williamson, Paula R

2017-11-01

The use of core outcome sets (COS) ensures that researchers measure and report those outcomes that are most likely to be relevant to users of their research. Several hundred COS projects have been systematically identified to date, but there has been no formal quality assessment of these studies. The Core Outcome Set-STAndards for Development (COS-STAD) project aimed to identify minimum standards for the design of a COS study agreed upon by an international group, while other specific guidance exists for the final reporting of COS development studies (Core Outcome Set-STAndards for Reporting [COS-STAR]). An international group of experienced COS developers, methodologists, journal editors, potential users of COS (clinical trialists, systematic reviewers, and clinical guideline developers), and patient representatives produced the COS-STAD recommendations to help improve the quality of COS development and support the assessment of whether a COS had been developed using a reasonable approach. An open survey of experts generated an initial list of items, which was refined by a 2-round Delphi survey involving nearly 250 participants representing key stakeholder groups. Participants assigned importance ratings for each item using a 1-9 scale. Consensus that an item should be included in the set of minimum standards was defined as at least 70% of the voting participants from each stakeholder group providing a score between 7 and 9. The Delphi survey was followed by a consensus discussion with the study management group representing multiple stakeholder groups. COS-STAD contains 11 minimum standards that are the minimum design recommendations for all COS development projects. The recommendations focus on 3 key domains: the scope, the stakeholders, and the consensus process. The COS-STAD project has established 11 minimum standards to be followed by COS developers when planning their projects and by users when deciding whether a COS has been developed using reasonable methods.

An Employment-Oriented Definition of the Information Systems Field: An Educator's View

ERIC Educational Resources Information Center

Westfall, Ralph D.

2012-01-01

Defining information systems has been a longstanding problem for the field. This paper suggests that, since it may not be possible to develop a universal definition, consideration should be given to a plurality of definitions aligned toward specific purposes. As an implementation of this approach it recommends the following shorter definition for…

Common Pitfalls in the Chief Resident Role: Impact on Effective Leadership Practices

ERIC Educational Resources Information Center

Saxena, Anurag; Garg, Avni; Desanghere, Loni

2015-01-01

Background: This paper explores the leadership and management needs of medical resident leaders, skills that contribute to the success in their role. The importance of leadership development for physicians is reflected in the specific recommendations in the FMEC-MD and FMEC-PG reports of the Association of Faculties of Medicine of Canada and…

Establish Best Practices for Supervision of Instructors

DTIC Science & Technology

2012-09-01

633. Christen, W. L., & Murphy, T. J. (1987). Inservice training and peer evaluation: An integrated program for faculty development. NASSP...describes the current state of instructional supervision in Special Operations Forces (SOF) initial acquisition training (IAT) language schools. This...leadership and Command Language Program Managers (CLPMs) related to selection, training , and resourcing. Finally, specific recommendations are provided for

Applying Web Usage Mining for Personalizing Hyperlinks in Web-Based Adaptive Educational Systems

ERIC Educational Resources Information Center

Romero, Cristobal; Ventura, Sebastian; Zafra, Amelia; de Bra, Paul

2009-01-01

Nowadays, the application of Web mining techniques in e-learning and Web-based adaptive educational systems is increasing exponentially. In this paper, we propose an advanced architecture for a personalization system to facilitate Web mining. A specific Web mining tool is developed and a recommender engine is integrated into the AHA! system in…

Manpower Development in Toxicology. EURO Reports and Studies, No. 9.

ERIC Educational Resources Information Center

World Health Organization, Copenhagen (Denmark). Regional Office for Europe.

This report addresses the widely held view that currently available literature in toxicology is inadequate in that there is a need to identify manpower deficiencies in this field and to suggest means to correct these deficiencies. It contains a list of specific recommendations including the organization of a working group, sponsored by the World…

How to Sustain Interprofessional Learning and Practice: Messages for Higher Education and Health and Social Care Management

ERIC Educational Resources Information Center

Meads, Geoffrey; Jones, Isabel; Harrison, Rachel; Forman, Dawn; Turner, Warren

2009-01-01

The principal aim of this article is to promote the more effective integration of interprofessional learning with practice developments in health and social care. Ten specific recommendations are offered for the successful management of recent central policies for collaboration at the interface of the higher education and service sectors.…

Parental Influence on Youth Propensity to Join the Military

ERIC Educational Resources Information Center

Gibson, Jennifer Lee; Griepentrog, Brian K.; Marsh, Sean M.

2007-01-01

The purpose of this research was to apply the Theory of Planned Behavior (TPB) in a model of youths' career choice intentions and parents' recommendation intentions. Specifically, a TPB model was developed for youth-parent dyads and tested with SEM to examine parental influence on youth intentions as well as behavior. Results indicated that a…

Simulation and control engineering studies of NASA-Ames 40 foot by 80 foot/80 foot by 120 foot wind tunnels

NASA Technical Reports Server (NTRS)

Bohn, J. G.; Jones, J. E.

1978-01-01

The development and use of a digital computer simulation of the proposed wind tunnel facility is described. The feasibility of automatic control of wind tunnel airspeed and other parameters was examined. Specifications and implementation recommendations for a computer based automatic control and monitoring system are presented.

Sex-specific association between infant diet and white matter integrity in 8-y-old children

USDA-ARS?s Scientific Manuscript database

Background: The American Academy of Pediatrics recommends breastfeeding, which is well known to promote cognitive and behavioral development. The evidence for why this occurs is not well understood. Methods: Fifty-six 7.5- to 8.5-y-old healthy children were breastfed (BF; n = 22, 10 males) or formul...

The Aims of Sex Education: Demoting Autonomy and Promoting Mutuality

ERIC Educational Resources Information Center

McAvoy, Paula

2013-01-01

In this essay, Paula McAvoy critiques a commonly held view that teaching young people to be good choice makers should be a central aim of sex education. Specifically, she argues against David Archard's recommendation that sex educators ought to focus on the development of autonomy and teaching young people that "choice should be accorded…

The Primary Science Project in Norway: Action Research and Curriculum Development.

ERIC Educational Resources Information Center

Jorde, Doris

This paper describes the Primary Science Project in Norway whose goals were to describe the primary (grades 1-6) science classroom and to make recommendations on improvements for primary science teaching. The purpose of this study was to study the classroom climate, specifically focusing on the social interactions between teachers and students.…

Effectively Adapting the Sport Management Curricula: Harnessing Internal and External Resources to Address Industry-Specific Needs

ERIC Educational Resources Information Center

Braunstein-Minkove, Jessica R.; DeLuca, Jaime R.

2015-01-01

Academic programs must constantly evolve in order to ensure that students are best prepared for success in internships and subsequent post-collegiate endeavors within the dynamic, rapidly changing sport industry. Based upon qualitative research, this work assesses and recommends areas of development in sport management curricula using internal and…

Improving Data Analysis in Second Language Acquisition by Utilizing Modern Developments in Applied Statistics

ERIC Educational Resources Information Center

Larson-Hall, Jenifer; Herrington, Richard

2010-01-01

In this article we introduce language acquisition researchers to two broad areas of applied statistics that can improve the way data are analyzed. First we argue that visual summaries of information are as vital as numerical ones, and suggest ways to improve them. Specifically, we recommend choosing boxplots over barplots and adding locally…

National Language Policy and Its Impacts on Second Language Reading Culture

ERIC Educational Resources Information Center

Azmi, Mohd Nazri Latiff

2013-01-01

This research concentrates on Malaysian language policy and its impacts on the development of English language (regarded as a second language in Malaysia) specifically on reading culture. The main objectives of this research are to investigate the weaknesses and strengths of the policy and also to come out with recommendations to improve the…

A Model Conceptual Framework for the Development of Humanities Programs in American Public Secondary Schools.

ERIC Educational Resources Information Center

Groden, Austin F.

The conceptual framework for a humanities program presented in this dissertation was arrived at through a literature review, which yielded many alternative recommendations, and a mail questionnaire. The replies of 117 individuals resulted in the establishment of the following priorities: (1) the humanities are defined as specific objectives to be…

Recommendations for sustainable development of non-timber forest products

Treesearch

Gina H. Mohammed

2001-01-01

Non-timber forest products--or NTFPs--are considered here to be botanical products harvested or originating from forest-based species, but excluding primary timber products, industrial boards and composites, and paper products. A recent study of non-timber forest products in Ontario, Canada, identified at least 50 types of NTFPs and hundreds of specific products used...

Building Scalable Knowledge Graphs for Earth Science

NASA Technical Reports Server (NTRS)

Ramachandran, Rahul; Maskey, Manil; Gatlin, Patrick; Zhang, Jia; Duan, Xiaoyi; Miller, J. J.; Bugbee, Kaylin; Christopher, Sundar; Freitag, Brian

2017-01-01

Knowledge Graphs link key entities in a specific domain with other entities via relationships. From these relationships, researchers can query knowledge graphs for probabilistic recommendations to infer new knowledge. Scientific papers are an untapped resource which knowledge graphs could leverage to accelerate research discovery. Goal: Develop an end-to-end (semi) automated methodology for constructing Knowledge Graphs for Earth Science.

Investigating financial incentives for maternal health: an introduction.

PubMed

Stanton, Mary Ellen; Higgs, Elizabeth S; Koblinsky, Marge

2013-12-01

Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives (e.g. performance-based financing, user fees, and various insurance mechanisms) and demand-side incentives (e.g. conditional cash transfers, vouchers, user fee exemptions, and subsidies for care-seeking). At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured feedback on recommendations which the teams included in their final papers appearing in this Supplement. Papers in this Supplement review the evidence for a specific financial incentive mechanism (e.g. pay for performance, conditional cash transfer) to improve the use and quality of maternal healthcare and makes recommendations for programmes and future research. While data on programmes using financial incentives for improved use and indications of the quality of maternal health services support specific conclusions and recommendations, including those for future research, data linking the use of financial incentives with improved health outcomes are minimal.

US DOE Perspectives on Advisory Board Effectiveness - 13539

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

Adler, David

2013-07-01

Federal missions on the Oak Ridge Reservation began with the Manhattan Project, and continues today with major facilities supporting the Nation's Science and National Security missions. While most of the land area on the Oak Ridge Reservation is free of environmental impacts from these activities, significant legacy contamination is associated with specific facilities and past waste management areas. In 1989, the Oak Ridge Reservation (ORR) was placed on National Priorities List, and DOE established its Office of Environmental Management that same year. Three years later, in 1992, the Federal Facility Agreement for the reservation was signed. Three years afterward, themore » Oak Ridge Site Specific Advisory Board was established to augment ongoing public involvement activities related to Oak Ridge Reservation cleanup activities. One of the early and most impactful decisions the board made was to organize the End Use Working Group. This broad-based group of board members, DOE representatives, and members of the public was formed in 1997 to study future uses for contaminated areas of the reservation. The group was instrumental in building consensus in the Oak Ridge community regarding the long-term end state of reservation lands. The group's recommendations were a fundamental input into Record's of Decision subsequently developed to establish cleanup requirements across the ORR, and they continue to influence decisions being made today. In developing its recommendations on end states, the End Use Working Group came to the realization that long-term stewardship of contaminated areas of the reservation would be necessary, in some cases in perpetuity. It was from this concept that the Oak Ridge SSAB's 15-year involvement in stewardship would begin. A stewardship committee formed by the End Use Working Group wrote Volume 1 of the Stakeholder Report on Stewardship. This document-and its companion Volume 2, which was written a year later-form a crucial foundation for stewardship planning in Oak Ridge and have been referenced around the DOE complex as other sites consider stewardship planning. From these two broad-based initiatives, the board's focus has evolved to increasingly hone in on more specific, project-based recommendations and initiatives. The Oak Ridge Reservation Site Specific Advisory Board has been a highly effective forum for soliciting community input on Oak Ridge Reservation cleanup. Experience in Oak Ridge indicates that the utility of Board recommendations is far higher when the Board is asked to focus on broad programmatic issues, and less useful when the Board attempts to provide advice and recommendations on matters related to technical or project management issues. In Oak Ridge the Board has helped shape the program on many levels including definition of end-state cleanup objectives, budget development, program sequencing, waste management, and decisions concerning preservation of history related to missions implemented on the Oak Ridge Reservation. (authors)« less

EULAR recommendations for terminology and research in individuals at risk of rheumatoid arthritis: report from the Study Group for Risk Factors for Rheumatoid Arthritis

PubMed Central

Gerlag, Danielle M; Raza, Karim; van Baarsen, Lisa G M; Brouwer, Elisabeth; Buckley, Christopher D; Burmester, Gerd R; Gabay, Cem; Catrina, Anca I; Cope, Andrew P; Cornelis, François; Dahlqvist, Solbritt Rantapää; Emery, Paul; Eyre, Stephen; Finckh, Axel; Gay, Steffen; Hazes, Johanna M; van der Helm-van Mil, Annette; Huizinga, Tom W J; Klareskog, Lars; Kvien, Tore K; Lewis, Cathryn; Machold, Klaus P; Rönnelid, Johan; van Schaardenburg, Dirkjan; Schett, Georg; Smolen, Josef S; Thomas, Sue; Worthington, Jane; Tak, Paul P

2012-01-01

The Study Group for Risk Factors for Rheumatoid Arthritis was established by the EULAR Standing Committee on Investigative Rheumatology to facilitate research into the preclinical and earliest clinically apparent phases of rheumatoid arthritis (RA). This report describes the recommendation for terminology to be used to define specific subgroups during different phases of disease, and defines the priorities for research in this area. Terminology was discussed by way of a three-stage structured process: A provisional list of descriptors for each of the possible phases preceding the diagnosis of RA were circulated to members of the study group for review and feedback. Anonymised comments from the members on this list were fed back to participants before a 2-day meeting. 18 participants met to discuss these data, agree terminologies and prioritise important research questions. The study group recommended that, in prospective studies, individuals without RA are described as having: genetic risk factors for RA; environmental risk factors for RA; systemic autoimmunity associated with RA; symptoms without clinical arthritis; unclassified arthritis; which may be used in a combinatorial manner. It was recommended that the prefix ‘pre-RA with:’ could be used before any/any combination of the five points above but only to describe retrospectively a phase that an individual had progressed through once it was known that they have developed RA. An approach to dating disease onset was recommended. In addition, important areas for research were proposed, including research of other tissues in which an adaptive immune response may be initiated, and the identification of additional risk factors and biomarkers for the development of RA, its progression and the development of extra-articular features. These recommendations provide guidance on approaches to describe phases before the development of RA that will facilitate communication between researchers and comparisons between studies. A number of research questions have been defined, requiring new cohorts to be established and new techniques to be developed to image and collect material from different sites. PMID:22387728

EULAR recommendations for terminology and research in individuals at risk of rheumatoid arthritis: report from the Study Group for Risk Factors for Rheumatoid Arthritis.

PubMed

Gerlag, Danielle M; Raza, Karim; van Baarsen, Lisa G M; Brouwer, Elisabeth; Buckley, Christopher D; Burmester, Gerd R; Gabay, Cem; Catrina, Anca I; Cope, Andrew P; Cornelis, François; Dahlqvist, Solbritt Rantapää; Emery, Paul; Eyre, Stephen; Finckh, Axel; Gay, Steffen; Hazes, Johanna M; van der Helm-van Mil, Annette; Huizinga, Tom W J; Klareskog, Lars; Kvien, Tore K; Lewis, Cathryn; Machold, Klaus P; Rönnelid, Johan; van Schaardenburg, Dirkjan; Schett, Georg; Smolen, Josef S; Thomas, Sue; Worthington, Jane; Tak, Paul P

2012-05-01

The Study Group for Risk Factors for Rheumatoid Arthritis was established by the EULAR Standing Committee on Investigative Rheumatology to facilitate research into the preclinical and earliest clinically apparent phases of rheumatoid arthritis (RA). This report describes the recommendation for terminology to be used to define specific subgroups during different phases of disease, and defines the priorities for research in this area. Terminology was discussed by way of a three-stage structured process: A provisional list of descriptors for each of the possible phases preceding the diagnosis of RA were circulated to members of the study group for review and feedback. Anonymised comments from the members on this list were fed back to participants before a 2-day meeting. 18 participants met to discuss these data, agree terminologies and prioritise important research questions. The study group recommended that, in prospective studies, individuals without RA are described as having: genetic risk factors for RA; environmental risk factors for RA; systemic autoimmunity associated with RA; symptoms without clinical arthritis; unclassified arthritis; which may be used in a combinatorial manner. It was recommended that the prefix 'pre-RA with:' could be used before any/any combination of the five points above but only to describe retrospectively a phase that an individual had progressed through once it was known that they have developed RA. An approach to dating disease onset was recommended. In addition, important areas for research were proposed, including research of other tissues in which an adaptive immune response may be initiated, and the identification of additional risk factors and biomarkers for the development of RA, its progression and the development of extra-articular features. These recommendations provide guidance on approaches to describe phases before the development of RA that will facilitate communication between researchers and comparisons between studies. A number of research questions have been defined, requiring new cohorts to be established and new techniques to be developed to image and collect material from different sites.

Clinical Practice Guideline: Safe Medication Use in the ICU.

PubMed

Kane-Gill, Sandra L; Dasta, Joseph F; Buckley, Mitchell S; Devabhakthuni, Sandeep; Liu, Michael; Cohen, Henry; George, Elisabeth L; Pohlman, Anne S; Agarwal, Swati; Henneman, Elizabeth A; Bejian, Sharon M; Berenholtz, Sean M; Pepin, Jodie L; Scanlon, Mathew C; Smith, Brian S

2017-09-01

To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill. PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015. Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed. Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation. The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations. This guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed considerations to an active surveillance system that includes reporting, identification, and evaluation are discussed. Also, highlighted is the need for future research for safe medication practices that is specific to critically ill patients.

Designing a carbon market that protects forests in developing countries.

PubMed

Niesten, Eduard; Frumhoff, Peter C; Manion, Michelle; Hardner, Jared J

2002-08-15

Firmly incorporated into the Kyoto Protocol, market mechanisms offer an innovative and cost-effective means of controlling atmospheric concentrations of greenhouse gases. However, as with markets for many other goods and services, a carbon market may generate negative environmental externalities. Possible interpretations and application of Kyoto provisions under COP-6bis and COP-7 raise concerns that rules governing forestry with respect to the Kyoto carbon market may increase pressure on native forests and their biodiversity in developing countries. In this paper, we assess the following two specific concerns with Kyoto provisions for forestry measures. First, whether, under the Clean Development Mechanism (CDM), by restricting allowable forestry measures to afforestation and reforestation, and explicitly excluding protection of threatened native forests, the Kyoto Protocol will enhance incentives for degradation and clearing of forests in developing countries; second, whether carbon crediting for forest management in Annex I (industrialized) regions under Article 3.4 creates a dynamic that can encourage displacement of timber harvests from Annex I countries to developing nations. Given current timber extraction patterns in developing regions, additional harvest pressure would certainly entail a considerable cost in terms of biodiversity loss. In both cases, we find that the concerns about deleterious impacts to forests and biodiversity are justified, although the scale of such impacts is difficult to predict. Both to ensure reliable progress in managing carbon concentrations and to avoid unintended consequences with respect to forest biodiversity, the further development of the Kyoto carbon market must explicitly correct these perverse incentives. We recommend several steps that climate policymakers can take to ensure that conservation and restoration of biodiversity-rich natural forests in developing countries are rewarded rather than penalized. To correct incentives to clear natural forests through CDM crediting for afforestation and reforestation, we recommend for the first commitment period that policymakers establish an early base year, such as 1990, such that lands cleared after that year would be ineligible for crediting. We further recommend an exception to this rule for CDM projects that are explicitly designed to promote natural forest restoration and that pass rigorous environmental impact review. Restoration efforts are typically most effective on lands that are adjacent to standing forests and hence likely to have been recently cleared. Thus, we recommend for these projects establishing a more recent base year, such as 2000. For the second and subsequent commitment periods, we recommend that climate policymakers act to restrain inter-annex leakage and its impacts by ensuring that crediting for forest management in industrialized countries is informed by modelling efforts to anticipate the scale of leakage associated with different Annex I 'Land use, land-use change and forestry' policy options, and coupled with effective measures to protect natural forests in developing countries. The latter should include expanding the options permitted under the CDM to carbon crediting for projects that protect threatened forests from deforestation and forest degradation. Ultimately, carbon market incentives for forest clearing can be reduced and incentives for forest conservation most effectively strengthened by fully capturing carbon emissions associated with deforestation and forest degradation in developing countries under a future emissions cap. Finally, we note that these recommendations have broader relevance to any forest-based measures to reduce greenhouse-gas emissions developed outside of the specific context of the Kyoto Protocol.

Usability Guidelines for Product Recommenders Based on Example Critiquing Research

NASA Astrophysics Data System (ADS)

Pu, Pearl; Faltings, Boi; Chen, Li; Zhang, Jiyong; Viappiani, Paolo

Over the past decade, our group has developed a suite of decision tools based on example critiquing to help users find their preferred products in e-commerce environments. In this chapter, we survey important usability research work relative to example critiquing and summarize the major results by deriving a set of usability guidelines. Our survey is focused on three key interaction activities between the user and the system: the initial preference elicitation process, the preference revision process, and the presentation of the systems recommendation results. To provide a basis for the derivation of the guidelines, we developed a multi-objective framework of three interacting criteria: accuracy, confidence, and effort (ACE). We use this framework to analyze our past work and provide a specific context for each guideline: when the system should maximize its ability to increase users' decision accuracy, when to increase user confidence, and when to minimize the interaction effort for the users. Due to the general nature of this multi-criteria model, the set of guidelines that we propose can be used to ease the usability engineering process of other recommender systems, especially those used in e-commerce environments. The ACE framework presented here is also the first in the field to evaluate the performance of preference-based recommenders from a user-centric point of view.

Recommendations for ICT use in Alzheimer's disease assessment: Monaco CTAD Expert Meeting.

PubMed

Robert, P H; Konig, A; Andrieu, S; Bremond, F; Chemin, I; Chung, P C; Dartigues, J F; Dubois, B; Feutren, G; Guillemaud, R; Kenisberg, P A; Nave, S; Vellas, B; Verhey, F; Yesavage, J; Mallea, P

2013-01-01

Alzheimer disease (AD) and other related dementia represent a major challenge for health care systems within the aging population. It is therefore important to develop better instruments for assessing disease severity and disease progression to optimize patient's care and support to care providers, and also provide better tools for clinical research. In this area, Information and Communication Technologies (ICT) are of particular interest. Such techniques enable accurate and standardized assessments of patients' performance and actions in real time and real life situations. The aim of this article is to provide basic recommendation concerning the development and the use of ICT for Alzheimer's disease and related disorders. During he ICT and Mental Health workshop (CTAD meeting held in Monaco on the 30th October 2012) an expert panel was set up to prepare the first recommendations for the use of ICT in dementia research. The expert panel included geriatrician, epidemiologist, neurologist, psychiatrist, psychologist, ICT engineers, representatives from the industry and patient association. The recommendations are divided into three sections corresponding to 1/ the clinical targets of interest for the use of ICT, 2/ the conditions, the type of sensors and the outputs (scores) that could be used and obtained, 3/ finally the last section concerns specifically the use of ICT within clinical trials.

Executive summary and recommendations from WHO/UNAIDS and AAVP consultation on: 'The inclusion of adolescents in HIV vaccine trials', 16-18 March 2006 in Gaborone, Botswana.

PubMed

Osmanov, Saladin

2007-09-12

This report summarizes the discussions and recommendations from a consultation held in Gaborone, Botswana (16-19 March 2006), organized by the joint World Health Organization (WHO)/United Nations Programme on HIV/AIDS (UNAIDS) HIV Vaccine Initiative (HVI) and the African AIDS Vaccine Programme (AAVP). The consultation considered key challenges and strategies in enrolling adolescents into HIV vaccine clinical trials, relevant to developing countries, in particular in eastern and southern Africa. Approaches were identified that might address and resolve country-specific challenges related to scientific, legal, ethical, regulatory and community aspects of the involvement of adolescents in HIV vaccine trials. This executive summary is formulated for a broader dissemination of the outcomes of the meeting to the general clinical, scientific and regulatory community involved in the review, approval and monitoring of clinical trials and potential licensing of HIV vaccine candidates. Four major topics were discussed and recommendations developed with regard to: (i) criteria for products selection and clinical trial design; (ii) ethical and legal issues; (iii) community acceptance and participation; and (iv) regulatory considerations. The recommendations of this meeting were further discussed and endorsed by the WHO/UNAIDS HIV Vaccine Advisory Committee.

Adaptation of international guidelines for metastatic colorectal cancer: an asian consensus.

PubMed

Cheng, Ann-Lii; Li, Jin; Vaid, Ashok K; Ma, Brigette Buig Yue; Teh, Catherine; Ahn, Joong B; Bello, Maximino; Charoentum, Chaiyut; Chen, Li-Tzong; de Lima Lopes, Gilberto; Ho, Gwo F; Kong, Hwai L; Lam, Ka O; Liu, Tian S; Park, Young S; Sriuranpong, Virote; Sudoyo, Aru W; Wang, Jaw-Yuan; Zhang, Jun; Zhang, Su Z; Ciardiello, Fortunato; Köhne, Clause-Henning; Shaw, Michael; Kim, Tae Won

2014-09-01

Colorectal cancer (CRC) is among the most common cancers worldwide, but marked epidemiological differences exist between Asian and non-Asian populations. Hence, a consensus meeting was held in Hong Kong in December 2012 to develop Asia-specific guidelines for the management of metastatic CRC (mCRC). A multidisciplinary expert panel, consisting of 23 participants from 10 Asian and 2 European countries, discussed current guidelines for colon or rectal cancer and developed recommendations for adapting these guidelines to Asian clinical practice. Participants agreed that mCRC management in Asia largely follows international guidelines, but they proposed a number of recommendations based on regional 'real-world' experience. In general, participants agreed that 5-fluorouracil (5-FU) infusion regimens in doublets can be substituted with UFT (capecitabine, tegafur-uracil) and S1 (tegafur, 5-chloro-2,4-dihydroxypyridine and oxonic acid), and that the monoclonal antibodies cetuximab and panitumumab are recommended for KRAS wild type tumors. For KRAS mutant tumors, bevacizumab is the preferred biological therapy. FOLFOX (folinic acid, 5-FU, and oxaliplatin) is preferred for initial therapy in Asian patients. The management of mCRC is evolving, and it must be emphasized that the recommendations presented here reflect current treatment practices and thus might change as more data become available. Copyright © 2014 Elsevier Inc. All rights reserved.

Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer: CHEST Guideline and Expert Panel Report.

PubMed

Molassiotis, Alex; Smith, Jaclyn A; Mazzone, Peter; Blackhall, Fiona; Irwin, Richard S

2017-04-01

Cough among patients with lung cancer is a common but often undertreated symptom. We used a 2015 Cochrane systematic review, among other sources of evidence, to update the recommendations and suggestions of the American College of Chest Physicians (CHEST) 2006 guideline on this topic. The CHEST methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on data from the Cochrane systematic review on the topic, uncontrolled studies, case studies, and the clinical context. Final grading was reached by consensus according to the Delphi method. The Cochrane systematic review identified 17 trials of primarily low-quality evidence. Such evidence was related to both nonpharmacologic (cough suppression) and pharmacologic (demulcents, opioids, peripherally acting antitussives, or local anesthetics) treatments, as well as endobronchial brachytherapy. Compared with the 2006 CHEST Cough Guideline, the current recommendations and suggestions are more specific and follow a step-up approach to the management of cough among patients with lung cancer, acknowledging the low-quality evidence in the field and the urgent need to develop more effective, evidence-based interventions through high-quality research. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Practical Recommendations for Robot-Assisted Treadmill Therapy (Lokomat) in Children with Cerebral Palsy: Indications, Goal Setting, and Clinical Implementation within the WHO-ICF Framework.

PubMed

Aurich-Schuler, Tabea; Warken, Birgit; Graser, Judith V; Ulrich, Thilo; Borggraefe, Ingo; Heinen, Florian; Meyer-Heim, Andreas; van Hedel, Hubertus J A; Schroeder, A Sebastian

2015-08-01

Active participation and the highest level of independence during daily living are primary goals in neurorehabilitation. Therefore, standing and walking are key factors in many rehabilitation programs. Despite inconclusive evidence considering the best application and efficacy of robotic tools in the field of pediatric neurorehabilitation, robotic technologies have been implemented to complement conventional therapies in recent years. A group of experienced therapists and physicians joined in an "expert panel." They compared their clinical application protocols, discussed recurring open questions, and developed experience-based recommendations for robot-assisted treadmill therapy (exemplified by the Lokomat, Hocoma, Volketswil, Switzerland) with a focus on children with cerebral palsy. Specific indications and therapeutic goals were defined considering the severity of motor impairments and the International Classification of Functioning, Disability and Health framework (ICF). After five meetings, consensus was found and recommendations for the implementation of robot-assisted treadmill therapy including postsurgery rehabilitation were proposed. This article aims to provide a comprehensive overview on therapeutical applications in a fast developing field of medicine, where scientific evidence is still scarce. These recommendations can help physicians and therapists to plan the child's individual therapy protocol of robot-assisted treadmill therapy. Georg Thieme Verlag KG Stuttgart · New York.

Guidelines for the selection of chemical-protective clothing. Volume 2. Technical and reference manual. (3rd Edition). Report for January 1985-March 1987

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

Schwope, A.D.; Costas, P.P.; Jackson, J.O.

1987-02-01

A variety of protective-clothing items are commercially available for emergency response and other applications where chemical hazards may be encountered. Data and information for selecting chemical-protective clothing is either not available or is inconsistant from source to source. In 1983, the U.S. Environmental Protection Agency sponsored the development of chemical-protective clothing selection guidelines to assist their own Office of Health and Safety in providing guidance to personnel, primarily EPA employees and contractors, working on hazardous-waste sites. These guidelines allowed a user to select an appropriate protective material for a specific chemical, select a clothing item (glove, suit, etc.), and thenmore » determine which manufacturers offered the clothing item in the recommended material. The U.S, Coast Guard Office of Research and Development and the EPA have supplemented these guidelines with additional data on material chemical resistance, material physical properties, clothing design features, and specific-vendor products. A chapter has been added for selecting chemical-protective suits. These guidelines contain data for over 750 chemicals and 700 clothing products. Volume I provides performance information and recommendations for selecting different types of protective clothing. Volume II contains a detailed technical discussion, and the data on which Volume I recommendations are based. The U.S. Coast Guard intends to use these guidelines for protective-clothing selection by its National Strike Force and Marine Safety Offices.« less

ACR Appropriateness Criteria® Ovarian Cancer Screening.

PubMed

Pandharipande, Pari V; Lowry, Kathryn P; Reinhold, Caroline; Atri, Mostafa; Benson, Carol B; Bhosale, Priyadarshani R; Green, Edward D; Kang, Stella K; Lakhman, Yulia; Maturen, Katherine E; Nicola, Refky; Salazar, Gloria M; Shipp, Thomas D; Simpson, Lynn; Sussman, Betsy L; Uyeda, Jennifer; Wall, Darci J; Whitcomb, Bradford; Zelop, Carolyn M; Glanc, Phyllis

2017-11-01

There has been much interest in the identification of a successful ovarian cancer screening test, in particular, one that can detect ovarian cancer at an early stage and improve survival. We reviewed the currently available data from randomized and observational trials that examine the role of imaging for ovarian cancer screening in average-risk and high-risk women. We found insufficient evidence to recommend ovarian cancer screening, when considering the imaging modality (pelvic ultrasound) and population (average-risk postmenopausal women) for which there is the greatest available published evidence; randomized controlled trials have not demonstrated a mortality benefit in this setting. Screening high-risk women using pelvic ultrasound may be appropriate in some clinical situations; however, related data are limited because large, randomized trials have not been performed in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Establishing advanced practice for medical imaging in New Zealand

PubMed Central

Yielder, Jill; Young, Adrienne; Park, Shelley; Coleman, Karen

2014-01-01

IntroductionThis article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). MethodsThe study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. ResultsFindings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. ConclusionsThe authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ. PMID:26229631

Establishing advanced practice for medical imaging in New Zealand

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

Yielder, Jill, E-mail: j.yielder@auckland.ac.nz; Young, Adrienne; Park, Shelley

Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that couldmore » be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.« less

Computational simulation of concurrent engineering for aerospace propulsion systems

NASA Technical Reports Server (NTRS)

Chamis, C. C.; Singhal, S. N.

1992-01-01

Results are summarized of an investigation to assess the infrastructure available and the technology readiness in order to develop computational simulation methods/software for concurrent engineering. These results demonstrate that development of computational simulations methods for concurrent engineering is timely. Extensive infrastructure, in terms of multi-discipline simulation, component-specific simulation, system simulators, fabrication process simulation, and simulation of uncertainties - fundamental in developing such methods, is available. An approach is recommended which can be used to develop computational simulation methods for concurrent engineering for propulsion systems and systems in general. Benefits and facets needing early attention in the development are outlined.

Computational simulation for concurrent engineering of aerospace propulsion systems

NASA Technical Reports Server (NTRS)

Chamis, C. C.; Singhal, S. N.

1993-01-01

Results are summarized for an investigation to assess the infrastructure available and the technology readiness in order to develop computational simulation methods/software for concurrent engineering. These results demonstrate that development of computational simulation methods for concurrent engineering is timely. Extensive infrastructure, in terms of multi-discipline simulation, component-specific simulation, system simulators, fabrication process simulation, and simulation of uncertainties--fundamental to develop such methods, is available. An approach is recommended which can be used to develop computational simulation methods for concurrent engineering of propulsion systems and systems in general. Benefits and issues needing early attention in the development are outlined.

Computational simulation for concurrent engineering of aerospace propulsion systems

NASA Astrophysics Data System (ADS)

Chamis, C. C.; Singhal, S. N.

1993-02-01

Results are summarized for an investigation to assess the infrastructure available and the technology readiness in order to develop computational simulation methods/software for concurrent engineering. These results demonstrate that development of computational simulation methods for concurrent engineering is timely. Extensive infrastructure, in terms of multi-discipline simulation, component-specific simulation, system simulators, fabrication process simulation, and simulation of uncertainties--fundamental to develop such methods, is available. An approach is recommended which can be used to develop computational simulation methods for concurrent engineering of propulsion systems and systems in general. Benefits and issues needing early attention in the development are outlined.

Risk communications and the Chemical Stockpile Emergency Preparedness Program

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

Vogt, B.M.

1995-12-31

One of the greater challenges the Army faces is effectively dealing with the concerns of the public, local officials and the news media on the disposal of aging chemical agents. This paper describes the method developed for the Chemical Stockpile Emergency Preparedness Program (CSEPP). The purpose was to provide a fairly comprehensive document on risk communication research and recommended practices as they related to the CSEPP. Using the communications perspective suggested by Covello and colleagues, the existing practices of communicating risk information about chemical weapons and the associated efforts in emergency planning, storage and eventual disposal are described. Risk communicationmore » problems specific to the CSEPP are then examined and described via scenarios. A framework is developed that distinguishes between the major components of risk communication, flow and intent. Within this framework, the research and recommendations are summarized as to direction of flow -- dialogue, or two-way interaction, versus monologue, or one-way communication -- and that of intent -- exchange versus persuasion. The findings and recommendations are synthesized and related to risk events for the CSEPP as posited in the scenarios.« less

14 CFR 1240.110 - Recommendation to the Administrator.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Recommendation to the Administrator. 1240... AND CONTRIBUTIONS Awards for Scientific and Technical Contributions § 1240.110 Recommendation to the... specific amount and distribution thereof for any multiple contributors. The recommendation of the Board to...

14 CFR 1240.110 - Recommendation to the Administrator.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Recommendation to the Administrator. 1240... AND CONTRIBUTIONS Awards for Scientific and Technical Contributions § 1240.110 Recommendation to the... specific amount and distribution thereof for any multiple contributors. The recommendation of the Board to...

77 FR 18827 - Draft Guidance for Industry on Bioequivalence Recommendations for Iron Sucrose Injection...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

...] Draft Guidance for Industry on Bioequivalence Recommendations for Iron Sucrose Injection; Availability... Recommendations for Iron Sucrose.'' The recommendations provide specific guidance on the design of bioequivalence (BE) studies to support abbreviated new drug applications (ANDAs) for iron sucrose injection. DATES...