77 FR 73654 - Eau Galle Renewable Energy Company, Eau Galle Hydro, LLC; Notice of Transfer of Exemption

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-11

... Renewable Energy Company, Eau Galle Hydro, LLC; Notice of Transfer of Exemption 1. By letter filed October 12, 2012, Eau Galle Renewable Energy Company informed the Commission that its exemption from... transferred to Eau Galle Renewable Energy Company by letter.\\2\\ The project is located on the Eau Galle River...

Comparative Proteomic Analysis of Two Uveitis Models in Lewis Rats.

PubMed

Pepple, Kathryn L; Rotkis, Lauren; Wilson, Leslie; Sandt, Angela; Van Gelder, Russell N

2015-12-01

Inflammation generates changes in the protein constituents of the aqueous humor. Proteins that change in multiple models of uveitis may be good biomarkers of disease or targets for therapeutic intervention. The present study was conducted to identify differentially-expressed proteins in the inflamed aqueous humor. Two models of uveitis were induced in Lewis rats: experimental autoimmune uveitis (EAU) and primed mycobacterial uveitis (PMU). Differential gel electrophoresis was used to compare naïve and inflamed aqueous humor. Differentially-expressed proteins were separated by using 2-D gel electrophoresis and excised for identification with matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF). Expression of select proteins was verified by Western blot analysis in both the aqueous and vitreous. The inflamed aqueous from both models demonstrated an increase in total protein concentration when compared to naïve aqueous. Calprotectin, a heterodimer of S100A8 and S100A9, was increased in the aqueous in both PMU and EAU. In the vitreous, S100A8 and S100A9 were preferentially elevated in PMU. Apolipoprotein E was elevated in the aqueous of both uveitis models but was preferentially elevated in EAU. Beta-B2-crystallin levels decreased in the aqueous and vitreous of EAU but not PMU. The proinflammatory molecules S100A8 and S100A9 were elevated in both models of uveitis but may play a more significant role in PMU than EAU. The neuroprotective protein β-B2-crystallin was found to decline in EAU. Therapies to modulate these proteins in vivo may be good targets in the treatment of ocular inflammation.

Comparative Proteomic Analysis of Two Uveitis Models in Lewis Rats

PubMed Central

Pepple, Kathryn L.; Rotkis, Lauren; Wilson, Leslie; Sandt, Angela; Van Gelder, Russell N.

2015-01-01

Purpose Inflammation generates changes in the protein constituents of the aqueous humor. Proteins that change in multiple models of uveitis may be good biomarkers of disease or targets for therapeutic intervention. The present study was conducted to identify differentially-expressed proteins in the inflamed aqueous humor. Methods Two models of uveitis were induced in Lewis rats: experimental autoimmune uveitis (EAU) and primed mycobacterial uveitis (PMU). Differential gel electrophoresis was used to compare naïve and inflamed aqueous humor. Differentially-expressed proteins were separated by using 2-D gel electrophoresis and excised for identification with matrix-assisted laser desorption/ionization–time of flight (MALDI-TOF). Expression of select proteins was verified by Western blot analysis in both the aqueous and vitreous. Results The inflamed aqueous from both models demonstrated an increase in total protein concentration when compared to naïve aqueous. Calprotectin, a heterodimer of S100A8 and S100A9, was increased in the aqueous in both PMU and EAU. In the vitreous, S100A8 and S100A9 were preferentially elevated in PMU. Apolipoprotein E was elevated in the aqueous of both uveitis models but was preferentially elevated in EAU. Beta-B2–crystallin levels decreased in the aqueous and vitreous of EAU but not PMU. Conclusions The proinflammatory molecules S100A8 and S100A9 were elevated in both models of uveitis but may play a more significant role in PMU than EAU. The neuroprotective protein β-B2–crystallin was found to decline in EAU. Therapies to modulate these proteins in vivo may be good targets in the treatment of ocular inflammation. PMID:26747776

Acquisition of T regulatory function in cathepsin L-inhibited T cells by eye-derived CTLA-2alpha during inflammatory conditions.

PubMed

Sugita, Sunao; Horie, Shintaro; Nakamura, Orie; Maruyama, Kazuichi; Takase, Hiroshi; Usui, Yoshihiko; Takeuchi, Masaru; Ishidoh, Kazumi; Koike, Masato; Uchiyama, Yasuo; Peters, Christoph; Yamamoto, Yoshimi; Mochizuki, Manabu

2009-10-15

Pigment epithelium isolated from the eye possesses immunosuppressive properties such as regulatory T (Treg) cell induction; e.g., cultured retinal pigment epithelium (RPE) converts CD4(+) T cells into Treg cells in vitro. RPE constitutively expresses a novel immunosuppressive factor, CTLA-2alpha, which is a cathepsin L (CathL) inhibitor, and this molecule acts via RPE to induce Treg cells. To clarify CTLA-2alpha's role in the T cell response to RPE in ocular inflammation, we used the experimental autoimmune uveitis (EAU) animal model to examine this new immunosuppressive property of RPE. In EAU models, TGF-beta, but not IFN-gamma inflammatory cytokines, promotes the up-regulation of the expression of CTLA-2alpha in RPE. Similarly, CTLA-2alpha via RPE was able to promote TGF-beta production by the CD4(+) T cells. The RPE-exposed T cells (RPE-induced Treg cells) greatly produced TGF-beta and suppressed bystander effector T cells. There was less expression of CathL by the RPE-exposed T cells, and CathL-inhibited T cells were able to acquire the Treg phenotype. Moreover, CathL-deficient mice spontaneously produced Treg cells, with the increase in T cells potentially providing protection against ocular inflammation. More importantly, CD4(+) T cells from EAU in CathL knockout mice or rCTLA-2alpha from EAU animals were found to contain a high population of forkhead box p3(+) T cells. In both EAU models, there was significant suppression of the ocular inflammation. These results indicate that RPE secretes CTLA-2alpha, thereby enabling the bystander T cells to be converted into Treg cells via TGF-beta promotion.

Websites on Bladder Cancer: an Appropriate Source of Patient Information?

PubMed

Salem, Johannes; Paffenholz, Pia; Bolenz, Christian; von Brandenstein, Melanie; Cebulla, Angelika; Haferkamp, Axel; Kuru, Timur; Lee, Cheryl T; Pfister, David; Tsaur, Igor; Borgmann, Hendrik; Heidenreich, Axel

2018-01-08

A growing number of patients search for health information online. An early investigation of websites about bladder cancer (BCa) revealed mostly incomplete and particularly inaccurate information. We analyzed the quality, readability, and popularity of the most frequented websites on BCa. An Internet search on www.google.com was performed for the term "bladder cancer." After selecting the most frequented websites for patient information, HONcode quality certification, Alexa popularity rank, and readability scores (according to US grade levels) were investigated. A 36-point checklist was used to assess the content according to the EAU guidelines on BCa, which was categorized into seven topics. The popularity of the 49 websites analyzed was average, with a median Alexa popularity rank of 41,698 (interquartile range [IQR] 7-4,671,246). The readability was rated difficult with 11 years of school education needed to understand the information. Thirteen (27%) websites were HONcode certified. Out of 343 topics (seven EAU guideline topics each on 49 websites), 79% were mentioned on the websites. Of these, 10% contained incorrect information, mostly outdated or biased, and 34% contained incomplete information. Publically provided websites mentioned more topics per website (median [IQR] 7 [5.5-7] vs. 5.5 [3.3-7]; p = 0.022) and showed less incorrect information (median [IQR] 0 [0-1] vs. 1 [0-1]; p = 0.039) than physician-provided websites. Our study revealed mostly correct but partially incomplete information on BCa websites for patients. Physicians and public organizations should strive to keep their website information up-to-date and unbiased to optimize patients' health literacy.

Water resources management. World Bank policy paper; Gestion des ressources en eau

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

NONE

1993-12-31

The management framework presented in this study addresses the demand for water in Asia caused by rapid population growth and economic development. It focuses on three key actions to meet the challenge: evaluate how the region manages water resources; identify guidelines for the Bank`s water resource programs; and develop country-specific strategies and promote joint programs. Reforms built into the framework seek to modernize institutions that affect water sources. The authors suggest ways to improve planning and long-term management, streamline economic and financial policy, and upgrade `real-time` management, operation, and maintenance.

Evaluation of educational content of YouTube videos relating to neurogenic bladder and intermittent catheterization.

PubMed

Ho, Matthew; Stothers, Lynn; Lazare, Darren; Tsang, Brian; Macnab, Andrew

2015-01-01

Many patients conduct internet searches to manage their own health problems, to decide if they need professional help, and to corroborate information given in a clinical encounter. Good information can improve patients' understanding of their condition and their self-efficacy. Patients with spinal cord injury (SCI) featuring neurogenic bladder (NB) require knowledge and skills related to their condition and need for intermittent catheterization (IC). Information quality was evaluated in videos accessed via YouTube relating to NB and IC using search terms "neurogenic bladder intermittent catheter" and "spinal cord injury intermittent catheter." Video content was independently rated by 3 investigators using criteria based on European Urological Association (EAU) guidelines and established clinical practice. In total, 71 videos met the inclusion criteria. Of these, 12 (17%) addressed IC and 50 (70%) contained information on NB. The remaining videos met inclusion criteria, but did not contain information relevant to either IC or NB. Analysis indicated poor overall quality of information, with some videos with information contradictory to EAU guidelines for IC. High-quality videos were randomly distributed by YouTube. IC videos featuring a healthcare narrator scored significantly higher than patient-narrated videos, but not higher than videos with a merchant narrator. About half of the videos contained commercial content. Some good-quality educational videos about NB and IC are available on YouTube, but most are poor. The videos deemed good quality were not prominently ranked by the YouTube search algorithm, consequently user access is less likely. Study limitations include the limit of 50 videos per category and the use of a de novo rating tool. Information quality in videos with healthcare narrators was not higher than in those featuring merchant narrators. Better material is required to improve patients' understanding of their condition.

Targeting CD6 for the treatment of experimental autoimmune uveitis.

PubMed

Zhang, Lingjun; Li, Yan; Qiu, Wen; Bell, Brent A; Dvorina, Nina; Baldwin, William M; Singer, Nora; Kern, Timothy; Caspi, Rachel R; Fox, David A; Lin, Feng

2018-06-01

CD6 is emerging as a new target for treating many pathological conditions in which T cells are integrally involved, but even the latest data from studies of CD6 gene engineered mice were still contradictory. To address this issue, we studied experimental autoimmune uveitis (EAU), a model of autoimmune uveitis, in wild-type (WT) and CD6 knockout (KO) mice. After EAU induction in WT and CD6 KO mice, we evaluated ocular inflammation and compared retinal antigen-specific T-cell responses using scanning laser ophthalmoscopy, spectral-domain optical coherence tomography, histopathology, and T cell recall assays. Uveitogenic T cells from WT and CD6 KO mice were adoptively transferred into WT naïve mice to confirm the impact of CD6 on T cells. In addition, we immunized CD6 KO mice with recombinant CD6 protein to develop mouse anti-mouse CD6 monoclonal antibodies (mAbs) in which functional antibodies exhibiting cross-reactivity with human CD6 were screened and identified for treatment studies. In CD6 KO mice with EAU, we found significantly decreased retinal inflammation and reduced autoreactive T-cell responses, and confirmed the impaired uveitogenic capacity of T cells from these mice in an adoptive transfer experiment. Notably, one of these cross-reactive mAbs significantly ameliorated retinal inflammation in EAU induced by the adoptive transfer of uveitogenic T cells. Together, these data strongly suggest that CD6 plays a previously unknown, but pivotal role in autoimmune uveitis, and may be a promising new treatment target for this blinding disease. In addition, the newly developed mouse anti-mouse/human CD6 mAbs could be valuable tools for testing CD6-targeted therapies in other mouse models of human diseases. Copyright © 2018 Elsevier Ltd. All rights reserved.

Urinary tract infection in children: Diagnosis, treatment, imaging - Comparison of current guidelines.

PubMed

Okarska-Napierała, M; Wasilewska, A; Kuchar, E

2017-12-01

Urinary tract infection (UTI) is a frequent disorder of childhood, yet the proper approach for a child with UTI is still a matter of controversy. The objective of this study was to critically compare current guidelines for the diagnosis and management of UTI in children, in light of new scientific data. An analysis was performed of the guidelines from: American Academy of Pediatrics (AAP), National Institute for Health and Care Excellence (NICE), Italian Society of Pediatric Nephrology, Canadian Paediatric Society (CPS), Polish Society of Pediatric Nephrology, and European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU). Separate aspects of the approach for a child with UTI, including diagnosis, treatment and further imaging studies, were compared, with allowance for recent research in each field. The analyzed guidelines tried to reconcile recent reports about diagnosis, treatment, and further diagnostics in pediatric UTI with prior practices and opinions, and economic capabilities. There was still a lack of sufficient data to formulate coherent, unequivocal guidelines on UTI management in children, with imaging tests remaining the main area of controversy. As a result, the authors formulated their own proposal for UTI management in children. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

A systematic review of clinical practice guidelines and best practice statements for the diagnosis and management of varicocele in children and adolescents.

PubMed

Roque, Matheus; Esteves, Sandro C

2016-01-01

A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines (CPG) and Best Practice Statements (BPS) concerning varicocele in the pediatric and adolescent population. An electronic search was performed with the MEDLINE, EMBASE, Science Direct, and Scielo databases, as well as guidelines' Web sites until September 2015. Four guidelines were included in the qualitative synthesis. In general, the recommendations provided by the CPG/BPS were consistent despite the existence of some gaps across the studies. The guidelines issued by the American Urological Association (AUA) and American Society for Reproductive Medicine (ASRM) did not provide evidence-based levels for the recommendations given. Most of the recommendations given by the European Association of Urology (EAU) and European Society of Pediatric Urology (ESPU) were derived from nonrandomized clinical trials, retrospective studies, and expert opinion. Among all CPG/BPS, only one was specifically designed for the pediatric population. The studied guidelines did not undertake independent cost-effectiveness and risk-benefit analysis. The main objectives of these guidelines were to translate the best evidence into practice and provide a framework of standardized care while maintaining clinical autonomy and physician judgment. However, the limitations identified in the CPG/BPS for the diagnosis and management of varicocele in children and adolescents indicate ample opportunities for research and future incorporation of higher quality standards in patient care.

Regulation of adenosine deaminase (ADA) on induced mouse experimental autoimmune uveitis (EAU) ‡

PubMed Central

Liang, Dongchun; Zuo, Aijun; Zhao, Ronglan; Shao, Hui; Kaplan, Henry J.; Sun, Deming

2016-01-01

Adenosine is an important regulator of the immune response and adenosine deaminase (ADA) inhibits this regulatory effect by converting adenosine into functionally inactive molecules. Studies have shown that adenosine receptor (AR) agonists can be either anti- or pro-inflammatory. Clarification of the mechanisms that cause these opposing effects should provide a better guide for therapeutic intervention. In this study, we investigated the effect of ADA on the development of experimental autoimmune uveitis (EAU) induced by immunizing EAU-prone mice with a known uveitogenic peptide, IRBP1–20. Our results showed that the effective time to administer a single dose of ADA to suppress induction of EAU was 8–14 days post-immunization, shortly before EAU expression, but ADA treatment at other time points exacerbated disease. ADA preferentially inhibited Th17 responses and this effect was γδ T cell-dependent. Our results demonstrated that the existing immune status strongly influences the anti- or proinflammatory effects of ADA. Our observations should help improve the design of ADA- and AR-targeted therapies. PMID:26856700

EAU guidelines on laser technologies.

PubMed

Herrmann, Thomas R W; Liatsikos, Evangelos N; Nagele, Udo; Traxer, Olivier; Merseburger, Axel S

2012-04-01

The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction.

PubMed

Gratzke, Christian; Bachmann, Alexander; Descazeaud, Aurelien; Drake, Marcus J; Madersbacher, Stephan; Mamoulakis, Charalampos; Oelke, Matthias; Tikkinen, Kari A O; Gravas, Stavros

2015-06-01

Lower urinary tract symptoms (LUTS) represent one of the most common clinical complaints in adult men and have multifactorial aetiology. To develop European Association of Urology (EAU) guidelines on the assessment of men with non-neurogenic LUTS. A structured literature search on the assessment of non-neurogenic male LUTS was conducted. Articles with the highest available level of evidence were selected. The Delphi technique consensus approach was used to develop the recommendations. As a routine part of the initial assessment of male LUTS, a medical history must be taken, a validated symptom score questionnaire with quality-of-life question(s) should be completed, a physical examination including digital rectal examination should be performed, urinalysis must be ordered, post-void residual urine (PVR) should be measured, and uroflowmetry may be performed. Micturition frequency-volume charts or bladder diaries should be used to assess male LUTS with a prominent storage component or nocturia. Prostate-specific antigen (PSA) should be measured only if a diagnosis of prostate cancer will change the management or if PSA can assist in decision-making for patients at risk of symptom progression and complications. Renal function must be assessed if renal impairment is suspected from the history and clinical examination, if the patient has hydronephrosis, or when considering surgical treatment for male LUTS. Uroflowmetry should be performed before any treatment. Imaging of the upper urinary tract in men with LUTS should be performed in patients with large PVR, haematuria, or a history of urolithiasis. Imaging of the prostate should be performed if this assists in choosing the appropriate drug and when considering surgical treatment. Urethrocystoscopy should only be performed in men with LUTS to exclude suspected bladder or urethral pathology and/or before minimally invasive/surgical therapies if the findings may change treatment. Pressure-flow studies should be performed only in individual patients for specific indications before surgery or when evaluation of the pathophysiology underlying LUTS is warranted. These guidelines provide evidence-based practical guidance for assessment of non-neurogenic male LUTS. An extended version is available online (www.uroweb.org/guidelines). This article presents a short version of European Association of Urology guidelines for non-neurogenic male lower urinary tract symptoms (LUTS). The recommended tests should be able to distinguish between uncomplicated male LUTS and possible differential diagnoses and to evaluate baseline parameters for treatment. The guidelines also define the clinical profile of patients to provide the best evidence-based care. An algorithm was developed to guide physicians in using appropriate diagnostic tests. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

The role of the Spanish Committee of the International Association of Hydrogeologists in the management and protection of Spain's groundwater resources

NASA Astrophysics Data System (ADS)

Custodio, Emilio; Llamas, M.-Ramón; Villarroya, Fermín

Spain is a relatively large European country (ca. 500,000km2) with extensive semiarid areas in which there exists a large number of good aquifers. In some areas, these aquifers are intensively developed and are the most important sources of fresh water. Nevertheless, groundwater development and protection has rarely been duly considered by the Spanish Water Administration, despite the pressure to remedy this situation by various groups of experts, some of them members of the Water Administration. The Spanish Committee of the International Association of Hydrogeologists (IAH) has been very active during the last decade in promoting activities to spread groundwater science, technology, and management in Spain and outside, mostly in Latin America, and in trying to orient water policy toward issues of groundwater. These activities include mainly the organization of technical and scientific meetings on current topics such as groundwater in the new Water Act, overexploitation, groundwater in water-resources planning, groundwater pollution, natural-recharge estimation and others. The impact of these activities on the recent water policy of Spain seems significant, and the experience gained may be applicable to other countries. Résumé L'Espagne est un pays européen assez étendu (500,000km2 environ), où existent des zones semi-arides possédant de nombreux aquifères intéressants. Dans certaines régions, ces aquifères sont intensivement exploités et constituent les sources essentielles d'eau douce. Cependant, l'exploitation et la protection des eaux souterraines ont rarement été prises en compte de façon correcte par l'Administration Espagnole de l'Eau, malgré les pressions exercées pour remédier à la situation par différents groupes d'experts, dont certains sont membres de l'Administration de l'Eau. Le Comité Espagnol de l'Association Internationale des Hydrogéologues (AIH) a été particulièrement actif au cours de ces dix dernières années pour promouvoir des activités de diffusion des sciences, de la technologie et de la gestion de l'eau en Espagne et à l'étranger, surtout en Amérique latine, et pour tenter d'orienter la politique de l'eau à l'égard des eaux souterraines. Ces activités incluent principalement l'organisation de réunions techniques et scientifiques sur des sujets classiques tels que l'eau souterraine dans la nouvelle Loi sur l'Eau, la surexploitation, l'eau souterraine dans la gestion des ressources en eau, la pollution de l'eau souterraine, l'estimation des écoulements naturels, entre autres. Les retombées de ces activités sur la récente politique de l'eau en Espagne paraissent significatives et l'expérience acquise peut être appliquée à d'autres pays. Resumen España es un país relativamente grande (unos 500,000km2) con áreas extensas en las que existe un elevado número de buenos acuíferos. En algunas zonas estos acuíferos son intensamente aprovechados y constituyen el recurso más importante de agua dulce. Sin embargo, el aprovechamiento y la protección de las aguas subterráneas pocas veces han sido debidamente considerados por la Administración hidráulica española, a pesar de la presión ejercida por distintos grupos y por algunos miembros responsables de la propia Administración hidráulica para corregir esta situación. Durante el último decenio el Comité Español de la Asociación Internacional de Hidrogeólogos (AIH) ha sido muy activo en promover reuniones para difundir la ciencia, la tecnología y la adecuada gestión del agua subterránea en España y en el extranjero, especialmente en Ibero-América. También ha intentado que los temas referentes al agua subterránea tuviesen la oportuna consideración en la política hidrológica general. Estas actividades han consistido principalmente en la organización de reuniones científicas y técnicas sobre temas actuales tales como el agua subterránea en la planificación hidrológica, contaminación del agua subterránea, estimación de la recarga natural y otros. El impacto de estas actividades en la reciente política hidráulica española parece significativo. La experiencia general puede ser aplicable a otros países.

Investigation experimentale de l'ecoulement et des performances thermiques du nanofluide eau-oxyde de cuivre dans un Micro-Canal Chauffe

NASA Astrophysics Data System (ADS)

Rimbault, Benjamin

Cette these de maitrise presentee par articles visait a etudier le comportement hydraulique et thermique d'un ecoulement de nanofluides en micro-canal chauffe. Nous avons etudie premierement de l'eau distillee, ensuite des melanges de particules d'oxyde de cuivre (taille 29nm) avec de l'eau distillee en concentrations particulaires volumiques 4.5%, 1.03%, et 0.24% (CuO-H2O). L'ecoulement force des differents fluides a ete realise au moyen de pompes a engrenages au sein d'un circuit ferme, comprenant un micro-canal a section rectangulaire (e=1.116mm,1=25.229mm) chauffe sur deux faces paralleles via des cartouches electriques, deux echangeurs de chaleurs en serie, ainsi qu'un debitmetre magnetique. A notre connaissance peu d'etudes sur l'ecoulement de nanofluides d'oxyde de cuivre-eau en micro-canal rectangulaire chauffe sont disponibles dans la litterature, cette recherche sert de contribution. Premierement, une validation avec la litterature a ete effectuee pour le cas d'un ecoulement d'eau entre plaques planes paralleles chauffees. Des essais hydrauliques ont ete realises pour une gamme du nombre de Reynolds allant jusqu'a Re=5000 a temperature constante. Par la suite des essais thermiques jusqu'a Re=2500 ont consiste en une elevation de temperature fixe (20.5°C a 30.5°C) a travers la longueur du micro-canal sous un regime stationnaire. Les resultats ont demontre une augmentation de la perte de pression et du coefficient de frottement des nanofluides sur l'eau pour un meme debit. Une telle augmentation de perte de pression etait de +70%, +25%, et +0 a 30% respectivement pour les concentrations 4.50%, 1.03%, et 0.24%. Concernant la transition laminaire a turbulent les comportements semblaient indiquer une valeur critique semblable entre l'eau et les differentes concentrations avec et sans chauffage a un nombre de Reynolds critique Rem 1000. Nous avons observe une legere augmentation du coefficient de convection thermique avec le debit massique pour les faibles concentrations (1.03% et 0.24%), alors que la concentration 4.5% demontre une nette diminution. En general la performance energetique globale definie par la chaleur transferee sur la puissance de pompage, reste inferieure compare a l'eau pour un meme Reynolds et un meme debit massique egalement. L'eau semble etre la meilleure solution en termes de performance energetique globale.

Primed Mycobacterial Uveitis (PMU): Histologic and Cytokine Characterization of a Model of Uveitis in Rats

PubMed Central

Pepple, Kathryn L.; Rotkis, Lauren; Van Grol, Jennifer; Wilson, Leslie; Sandt, Angela; Lam, Deborah L.; Carlson, Eric; Van Gelder, Russell N.

2015-01-01

Purpose The purpose of this study was to compare the histologic features and cytokine profiles of experimental autoimmune uveitis (EAU) and a primed mycobacterial uveitis (PMU) model in rats. Methods In Lewis rats, EAU was induced by immunization with interphotoreceptor binding protein peptide, and PMU was induced by immunization with a killed mycobacterial extract followed by intravitreal injection of the same extract. Clinical course, histology, and the cytokine profiles of the aqueous and vitreous were compared using multiplex bead fluorescence immunoassays. Results Primed mycobacterial uveitis generates inflammation 2 days after intravitreal injection and resolves spontaneously 14 days later. CD68+ lymphocytes are the predominant infiltrating cells and are found in the anterior chamber, surrounding the ciliary body and in the vitreous. In contrast to EAU, no choroidal infiltration or retinal destruction is noted. At the day of peak inflammation, C-X-C motif ligand 10 (CXCL10), IL-1β, IL-18, and leptin were induced in the aqueous of both models. Interleukin-6 was induced 2-fold in the aqueous of PMU but not EAU. Cytokines elevated in the aqueous of EAU exclusively include regulated on activation, normal T cell expressed and secreted (RANTES), lipopolysaccharide-induced CXC chemokine (LIX), growth-related oncogene/keratinocyte chemokine (GRO/KC), VEGF, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), and IL-17A. In the vitreous, CXCL10, GRO/KC, RANTES, and MIP-1α were elevated in both models. Interleukin-17A and IL-18 were elevated exclusively in EAU. Conclusions Primed mycobacterial uveitis generates an acute anterior and intermediate uveitis without retinal involvement. Primed mycobacterial uveitis has a distinct proinflammatory cytokine profile compared with EAU, suggesting PMU is a good complementary model for study of immune-mediated uveitis. CXCL10, a proinflammatory cytokine, was increased in the aqueous and vitreous of both models and may be a viable therapeutic target. PMID:26747775

Primed Mycobacterial Uveitis (PMU): Histologic and Cytokine Characterization of a Model of Uveitis in Rats.

PubMed

Pepple, Kathryn L; Rotkis, Lauren; Van Grol, Jennifer; Wilson, Leslie; Sandt, Angela; Lam, Deborah L; Carlson, Eric; Van Gelder, Russell N

2015-12-01

The purpose of this study was to compare the histologic features and cytokine profiles of experimental autoimmune uveitis (EAU) and a primed mycobacterial uveitis (PMU) model in rats. In Lewis rats, EAU was induced by immunization with interphotoreceptor binding protein peptide, and PMU was induced by immunization with a killed mycobacterial extract followed by intravitreal injection of the same extract. Clinical course, histology, and the cytokine profiles of the aqueous and vitreous were compared using multiplex bead fluorescence immunoassays. Primed mycobacterial uveitis generates inflammation 2 days after intravitreal injection and resolves spontaneously 14 days later. CD68+ lymphocytes are the predominant infiltrating cells and are found in the anterior chamber, surrounding the ciliary body and in the vitreous. In contrast to EAU, no choroidal infiltration or retinal destruction is noted. At the day of peak inflammation, C-X-C motif ligand 10 (CXCL10), IL-1β, IL-18, and leptin were induced in the aqueous of both models. Interleukin-6 was induced 2-fold in the aqueous of PMU but not EAU. Cytokines elevated in the aqueous of EAU exclusively include regulated on activation, normal T cell expressed and secreted (RANTES), lipopolysaccharide-induced CXC chemokine (LIX), growth-related oncogene/keratinocyte chemokine (GRO/KC), VEGF, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), and IL-17A. In the vitreous, CXCL10, GRO/KC, RANTES, and MIP-1α were elevated in both models. Interleukin-17A and IL-18 were elevated exclusively in EAU. Primed mycobacterial uveitis generates an acute anterior and intermediate uveitis without retinal involvement. Primed mycobacterial uveitis has a distinct proinflammatory cytokine profile compared with EAU, suggesting PMU is a good complementary model for study of immune-mediated uveitis. CXCL10, a proinflammatory cytokine, was increased in the aqueous and vitreous of both models and may be a viable therapeutic target.

ITE, a novel endogenous nontoxic aryl hydrocarbon receptor ligand, efficiently suppresses EAU and T-cell-mediated immunity.

PubMed

Nugent, Lindsey F; Shi, Guangpu; Vistica, Barbara P; Ogbeifun, Osato; Hinshaw, Samuel J H; Gery, Igal

2013-11-13

Ligands for aryl hydrocarbon receptor (AHR), such as dioxins, are highly toxic. One such ligand, TCDD, was found to exert potent immunosuppressive capacities in mice developing pathogenic autoimmune processes, including EAU, but its toxicity makes it unusable for humans. A recently identified endogenous AHR ligand, ITE, is also immunosuppressive, but is nontoxic and could therefore be useful for therapy in humans. Here, we tested ITE for its capacity to inhibit EAU and related immune responses. EAU was induced in B10.A mice by immunization with interphotoreceptor retinoid-binding protein (IRBP; 40 μg) in CFA. Treatment with ITE was by daily intraperitoneal injection of 0.2 mg. Disease severity was assessed by both fundoscopy and histological examination. Draining lymph node cells were tested for proliferation by thymidine uptake and for cytokine production and release by ELISA. In addition, the intracellular expression of cytokines and Foxp3 was determined by flow cytometry. Serum antibodies were measured by ELISA. Treatment with ITE efficiently inhibited the development of EAU in mice, as well as the cellular immune responses against IRBP and PPD. ITE treatment inhibited the expansion of both Th1 and Th17 subpopulations, as well as their release of the signature cytokines, IFN-gamma and IL-17. The treatment moderately increased, however, the proportion of Foxp3 expressing T-regulatory cells. Antibody production was not affected by the treatment. ITE, an endogenous AHR ligand, efficiently inhibits EAU development and related cellular immune responses. Being nontoxic, ITE may be considered for treatment of pathogenic immunity in humans.

ITE, A Novel Endogenous Nontoxic Aryl Hydrocarbon Receptor Ligand, Efficiently Suppresses EAU and T-Cell–Mediated Immunity

PubMed Central

Nugent, Lindsey F.; Shi, Guangpu; Vistica, Barbara P.; Ogbeifun, Osato; Hinshaw, Samuel J. H.; Gery, Igal

2013-01-01

Purpose. Ligands for aryl hydrocarbon receptor (AHR), such as dioxins, are highly toxic. One such ligand, TCDD, was found to exert potent immunosuppressive capacities in mice developing pathogenic autoimmune processes, including EAU, but its toxicity makes it unusable for humans. A recently identified endogenous AHR ligand, ITE, is also immunosuppressive, but is nontoxic and could therefore be useful for therapy in humans. Here, we tested ITE for its capacity to inhibit EAU and related immune responses. Methods. EAU was induced in B10.A mice by immunization with interphotoreceptor retinoid-binding protein (IRBP; 40 μg) in CFA. Treatment with ITE was by daily intraperitoneal injection of 0.2 mg. Disease severity was assessed by both fundoscopy and histological examination. Draining lymph node cells were tested for proliferation by thymidine uptake and for cytokine production and release by ELISA. In addition, the intracellular expression of cytokines and Foxp3 was determined by flow cytometry. Serum antibodies were measured by ELISA. Results. Treatment with ITE efficiently inhibited the development of EAU in mice, as well as the cellular immune responses against IRBP and PPD. ITE treatment inhibited the expansion of both Th1 and Th17 subpopulations, as well as their release of the signature cytokines, IFN-gamma and IL-17. The treatment moderately increased, however, the proportion of Foxp3 expressing T-regulatory cells. Antibody production was not affected by the treatment. Conclusions. ITE, an endogenous AHR ligand, efficiently inhibits EAU development and related cellular immune responses. Being nontoxic, ITE may be considered for treatment of pathogenic immunity in humans. PMID:24150760

Etude de la qualité bactériologique de l’eau utilisée dans l’industrie agroalimentaire dans le Nord du Maroc

PubMed Central

Haijoubi, El Houcine; Benyahya, Fatiha; Bendahou, Abdrezzak; Essadqui, Faima Zahra; Behhari, Mohammed El; El Mamoune, Ahmed Fouad; Ghailani, Naima Nourouti; Mechita, Mohcine Bennani; Barakat, Amina

2017-01-01

Introduction L'eau est utilisée d'une façon primordiale dans tout le processus de la fabrication des produits alimentaires. Les industries agroalimentaires du Nord du Maroc utilisent différentes sources d'eaux mais l'eau de réseau public et l'eau de puits sont les principales sources d'eau utilisée. Cette eau peut s'avérer la source principale des éventuelles contaminations et altérations des aliments. Notre but est d'évaluer la qualité bactériologique de l'eau utilisée par les industries agroalimentaires dans la région du Nord du Maroc, d'identifier les différents germes responsables de la pollution de ces eaux et de définir les principales causes de cette pollution. Méthodes Des échantillons d'eau prélevés aux robinets ou des puits ont été analysés pour la recherche des germes indicateurs de la pollution (coliformes totaux (CT), coliformes fécaux (CF), entérocoques intestinaux (E), microorganismes revivifiables (MOR), anaérobies sulfitoréducteurs) et les germes pathogènes (Salmonelles, Staphylocoques, Pseudomonas aeruginosa). Le dénombrement des bactéries a été fait par la technique de filtration et par incorporation en milieu solide en surfusion. Résultats Les résultats ont montré que les eaux du réseau public ont été de qualité bactériologique satisfaisante tandis que 40% des eaux des puits ont été non conformes aux normes à cause de la présence des indicateurs de pollution CT, CF, E et MOR. En revanche, les germes pathogènes, en particulier les Salmonelles, ont été absents dans les eaux de tous les puits analysés. Conclusion La pollution de ces puits a été généralement liée au non-respect des conditions de puisage hygiéniques. La qualité bactériologique des eaux de ces puits peut être améliorée par une protection adéquate. PMID:28450992

Evaluation of educational content of YouTube videos relating to neurogenic bladder and intermittent catheterization

PubMed Central

Ho, Matthew; Stothers, Lynn; Lazare, Darren; Tsang, Brian; Macnab, Andrew

2015-01-01

Introduction: Many patients conduct internet searches to manage their own health problems, to decide if they need professional help, and to corroborate information given in a clinical encounter. Good information can improve patients’ understanding of their condition and their self-efficacy. Patients with spinal cord injury (SCI) featuring neurogenic bladder (NB) require knowledge and skills related to their condition and need for intermittent catheterization (IC). Methods: Information quality was evaluated in videos accessed via YouTube relating to NB and IC using search terms “neurogenic bladder intermittent catheter” and “spinal cord injury intermittent catheter.” Video content was independently rated by 3 investigators using criteria based on European Urological Association (EAU) guidelines and established clinical practice. Results: In total, 71 videos met the inclusion criteria. Of these, 12 (17%) addressed IC and 50 (70%) contained information on NB. The remaining videos met inclusion criteria, but did not contain information relevant to either IC or NB. Analysis indicated poor overall quality of information, with some videos with information contradictory to EAU guidelines for IC. High-quality videos were randomly distributed by YouTube. IC videos featuring a healthcare narrator scored significantly higher than patient-narrated videos, but not higher than videos with a merchant narrator. About half of the videos contained commercial content. Conclusions: Some good-quality educational videos about NB and IC are available on YouTube, but most are poor. The videos deemed good quality were not prominently ranked by the YouTube search algorithm, consequently user access is less likely. Study limitations include the limit of 50 videos per category and the use of a de novo rating tool. Information quality in videos with healthcare narrators was not higher than in those featuring merchant narrators. Better material is required to improve patients’ understanding of their condition. PMID:26644803

Ambient Noise Statistics for Sonar Modelling - Final Report

DTIC Science & Technology

2005-05-01

traitement des données de bouées acoustiques EC-SWAN (bruit ambiant en eau peu profonde dans l’Est canadien) collectées mensuellement sur une période de 12...déplacé son champ d’intérêt de l’océan profond vers les eaux des zones littorales. L’acoustique en eau peu profonde présente un grand défi, car...l’expérience EC-SWAN (bruit ambiant en eau peu profonde dans l’Est canadien), ont été entreprises pour étudier les variations dans le temps et dans

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients.

PubMed

John, Axel; Baumgart, André; Worst, Thomas; Heinzelbecker, Julia

2018-01-01

The study aimed to calculate direct medical costs (DMC) during the first year of diagnosis and to evaluate the impact of guideline changes on treatment costs in clinical stage (CS) I testicular germ cell tumor (TGCT) patients in a German healthcare system. Healthcare expenditures as DMC during the first year of diagnosis for 307 TGCT patients in CS I treated at our institution from 1987 to 2013 were calculated from the statutory health insurance perspective using patient level data. Three periods were defined referring to the first European Association of Urology (EAU) guideline in 2001 as well as to subsequent major guideline changes in 2005 and 2010. Data source for cost calculations were the German Diagnosis Related Groups system for inpatient stays (version 2014) and the German system for reimbursement of outpatient care (EBM - Einheitlicher Bewertungsmaßstab, edition 2014). During our 25 years of study period, mean DMC in the first year after diagnosis for the entire cohort of TGCT patients in CS I almost halved from EUR 13.000 to EUR 6.900 (p < 0.001). From 1987 to 2001, DMC for CS I seminomatous germ cell tumor (SGCT) patients were EUR 13.790 ± 4.700. From 2002 to 2010, mean costs were EUR 10.900 ± 5.990, and from 2011 to 2013, mean costs were EUR 5.190 ± 3.700. For CS I non-seminomatous germ cell tumor (NSGCT) patients, from 1987 to 2001, mean DMC were EUR 11.650 ± 5.690. From 2002 to 2010, mean costs were EUR 11.230 ± 5.990, and from 2011 to 2013, mean costs were EUR 11.170 ± 7.390. Follow-up examinations became less frequent over time, which caused a significant cost reduction for NSGCT (p = 0.042) while costs remained stable for SGCT. When adding costs of relapse treatment, active surveillance (AS) was the most cost-effective adjuvant treatment option in CS I NSGCT whereas one course carboplatin or AS caused similar expenditures in SGCT patients. The introduction of the EAU guidelines in 2001 caused a decrease in DMC in CS I seminoma patients. This cost reduction mainly took place due to the declining importance of radiation therapy. No substantial changes were seen in patients with CS I NSGCT. Costs for follow-up care also diminished, but to a lesser degree. Even when considering expenditures for relapse treatment, AS remained cost-effective in CS I TCGT patients. Our data show that evidence-based medicine in TGCT can reduce DMC in the first year after diagnosis. © 2018 S. Karger AG, Basel.

Diagnosis and treatment for clinically localized prostate cancer. Adherence to the European Association of Urology clinical guidelines in a nationwide population-based study - GESCAP group.

PubMed

Gómez-Veiga, F; Rodríguez-Antolín, A; Miñana, B; Hernández, C; Suárez, J F; Fernández-Gómez, J M; Unda, M; Burgos, J; Alcaraz, A; Rodríguez, P; Medina, R; Castiñeiras, J; Moreno, C; Pedrosa, E; Cózar, J M

To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain. Epidemiological, population-based, study including a national representative sample of 3,918 incident patients with histopathological confirmation during 2010; 95% of the patient's sample was followed up for at least one year. Diagnosis along with treatment related variables (for localized PCa -low, intermediate, high and locally-advanced by D'Amico risk stratification) was recorded. Differences between groups were tested with Chi-squared and Kruskal-Wallis tests. Mean (SD) age of PCa patients was 68.48 (8.18). Regarding diagnostic by biopsy procedures, 64.56% of all patients had 8-12 cores in first biopsy and 46.5% of the patients over 75 years, with PSA<10ng/mL were biopsied. Staging by Computer Tomography (CT) or Bone Scan (BS) was used for determining tumor extension in 60.09% of high-risk cases and was applied differentially depending on patients' age; 3,293 (84.05%) patients received a treatment for localized PCa. Radical prostatectomy was done in 1,277 patients and 206 out of these patients also had a lymphadenectomy, being 4.64% low-risk, 22.81% intermediate-risk and 36.00% high-risk patients; 86.08% of 1,082 patients who had radiotherapy were treated with 3D or IMRT and 35.77% received a dose ≥75Gy; 419 patients were treated with brachytherapy (BT): 54.81% were low-risk patients, 22.84% intermediate-risk and 12.98% high-risk. Hormonotherapy (HT, n=521) was applied as single therapy in 9.46% of low-risk and 17.92% of intermediate-risk patients. Additionally, HT was combined with RT in 14.34% of lower-risk patients and 58.26% of high-risk patients, and 67.19% low-intermediate risk with RT and/or BT received neoadjuvant/concomitant/adjuvant HT. Finally, 83.75% of high-risk patients undergoing RT and/or BT also received HT. Although EAU guidelines for PCa management are easily available in Europe, the adherence to their recommendations is low, finding the highest discrepancies in the need for a prostate biopsy and the diagnostic methods. Improve information and educational programs could allow a higher adherence to the guidelines and reduce the variability in daily practice. (Controlled-trials.com: ISRCTN19893319). Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Aldose reductase deficiency protects from autoimmune- and endotoxin-induced uveitis in mice.

PubMed

Yadav, Umesh C S; Shoeb, Mohammed; Srivastava, Satish K; Ramana, Kota V

2011-10-17

To investigate the effect of aldose reductase (AR) deficiency in protecting the chronic experimental autoimmune (EAU) and acute endotoxin-induced uveitis (EIU) in c57BL/6 mice. The WT and AR-null (ARKO) mice were immunized with human interphotoreceptor retinoid-binding peptide (hIRPB-1-20), to induce EAU, or were injected subcutaneously with lipopolysaccharide (LPS; 100 μg) to induce EIU. The mice were killed on day 21 for EAU and at 24 hours for EIU, when the disease was at its peak, and the eyes were immediately enucleated for histologic and biochemical studies. Spleen-derived T-lymphocytes were used to study the antigen-specific immune response in vitro and in vivo. In WT-EAU mice, severe damage to the retinal wall, especially to the photoreceptor layer was observed, corresponding to a pathologic score of ∼2, which was significantly prevented in the ARKO or AR inhibitor-treated mice. The levels of cytokines and chemokines increased markedly in the whole-eye homogenates of WT-EAU mice, but not in ARKO-EAU mice. Further, expression of inflammatory marker proteins such as inducible nitric oxide synthase (iNOS), cyclooxygenase (COX)-2, tumor necrosis factor (TNF)-α, and vascular cell adhesion molecule (VCAM)-1 was increased in the WT-EIU mouse eyes but not in the ARKO-EIU eyes. The T cells proliferated vigorously when exposed to the hIRPB antigen in vitro and secreted various cytokines and chemokines, which were significantly inhibited in the T cells isolated from the ARKO mice. These findings suggest that AR-deficiency/inhibition protects against acute as well as chronic forms of ocular inflammatory complications such as uveitis.

Intravitreal injection of anti-Interleukin (IL)-6 antibody attenuates experimental autoimmune uveitis in mice.

PubMed

Tode, Jan; Richert, Elisabeth; Koinzer, Stefan; Klettner, Alexa; Pickhinke, Ute; Garbers, Christoph; Rose-John, Stefan; Nölle, Bernhard; Roider, Johann

2017-08-01

To evaluate the effect of an intravitreally applied anti-IL-6 antibody for the treatment of experimental autoimmune uveitis (EAU). EAU was induced in female B10.RIII mice by Inter-Photoreceptor-Binding-Protein (IRBP) in complete Freund's adjuvant, boosted by Pertussis toxin. Single blinded intravitreal injections of anti-IL-6 antibody were applied 5-7days as well as 8-10days (3day interval) after EAU induction into the randomized treatment eye and phosphate buffered saline (PBS) into the fellow control eye. Clinical and fluorescein angiography scoring (6 EAU grades) was done at each injection day and at enucleation day 14. Enucleated eyes were either scored histologically (6 EAU grades) or examined by ELISA for levels of IL-6, IL-17 and IL-6 soluble Receptor (sIL-6R). Uveitis developed in all 12 mice. Clinical uveitis score was significantly reduced (p=0.035) in treated eyes (median 2.0, range 0-4.0, n=12) compared to the fellow control eyes (median 3.0, range 1.0-4.0, n=12). Angiography scores were reduced in 9/12 treated eyes and histological scores in 3/4 treated eyes compared to the fellow control eyes. Cytokine levels were determined in 8 mice, of which 4 responded to anti-IL-6 treatment and 4 did not respond. All mice responding to treatment had a significant reduction of IL-6 (p<0.01) and IL-17 (p=0.01) levels in treated eyes compared to the fellow control eyes. This difference was not seen in non-responding mice. Intravitreal anti-IL-6 treatment significantly attenuates experimental autoimmune uveitis in mice. EAU activity correlates with ocular IL-6 and IL-17 levels. Copyright © 2017 Elsevier Ltd. All rights reserved.

76 FR 35831 - Television Broadcasting Services; Eau Claire, WI

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 73 [MB Docket No. 11-100, RM-11632; DA 11-1034] Television Broadcasting Services; Eau Claire, WI AGENCY: Federal Communications Commission. ACTION: Proposed.... ADDRESSES: Federal Communications Commission, Office of the Secretary, 445 12th Street, SW., Washington, DC...

Immunomodulatory effects of Longdan Xiegan Tang on CD4+/CD8+ T cells and associated inflammatory cytokines in rats with experimental autoimmune uveitis.

PubMed

Tang, Kai; Guo, Dadong; Zhang, Lian; Guo, Junguo; Zheng, Fengming; Si, Junkang; Bi, Hongsheng

2016-09-01

Longdan Xiegan Tang (LXT) is a mixture of herbal extracts commonly used in traditional Chinese medicine that may exert immunomodulatory effects for the treatment of autoimmune diseases. However, the detailed mechanisms that mediate the actions of LXT are unclear. The present study induced an experimental autoimmune uveitis (EAU) model in Lewis rats via injection of IRBP1177‑1191 emulsion. The model was used to investigate the effects of LXT on EAU rats and assess the efficacy of LXT by measuring clinical manifestations and histopathological changes caused by EAU. Additionally, alterations in the ratio of CD4+/CD8+‑T cells were determined by flow cytometry, and the expression of interferon (IFN)‑γ, interleukin (IL)‑17, IL‑10 and tumor necrosis factor (TNF)‑α were measured using reverse transcription‑quantitative polymerase chain reaction and enzyme‑linked immunosorbent assay analysis. The results of the present study demonstrate that LXT can efficiently alleviate the symptoms of EAU, inhibit the differentiation of uveitogenic CD4+ T cells and reduce the expression of proinflammatory cytokines, including IFN‑γ, IL‑17 and TNF‑α. Furthermore, LXT promotes the production of IL‑10 and accelerates the recovery of EAU, indicating that the immunomodulatory effects of LXT may potentially be used for the treatment of uveitis.

Blockade of the interaction of leukotriene b4 with its receptor prevents development of autoimmune uveitis.

PubMed

Liao, Tianjiang; Ke, Yan; Shao, Wen-Hai; Haribabu, Bodduluri; Kaplan, Henry J; Sun, Deming; Shao, Hui

2006-04-01

To investigate the role of leukotriene B4 (LTB4) and its receptor BLT1 in the pathogenesis of mouse uveitis. Experimental autoimmune uveitis (EAU) was induced in B10RIII mice by immunization of interphotoreceptor retinoid binding protein (IRBP; peptide sequence 161-180) or in C57BL/6 (B6) mice by transfer of activated T cells specific for IRBP1-20. The animals were then treated with and without the BLT1 receptor antagonist, CP105696, at the disease onset after immunization or at day 0 or day 6 after T-cell transfer. EAU was also induced in wild-type B6 (WT) and BLT1-deficient (BLT1-/-) mice by reciprocal transfer of the T cells from B6 to BLT1-deficient mice and vise versa. Clinical signs of inflammation and ocular histology were compared. The chemotactic activity of LTB4 on naïve and IRBP-specific autoreactive T cells as well as effector leukocytes was examined. The treatment of CP105696, greatly reduced the intensity of ongoing disease. IRBP1-20-specific T cells derived from wild-type B6 mice induced only mild uveitis in syngeneic BLT1-deficient mice and that IRBP1-20-specific T cells derived from BLT1-/- mice induced milder disease in wild-type B6 mice than those derived from wild-type B6 mice, suggesting that expression of the LTB4 receptor on both activated autoreactive T cells and effector leukocytes was necessary for ocular inflammation to occur. Consistent with these data, transfer of autoreactive T cells from B6 mice to 5-lipoxygenase-deficient (5-LO-/-) mice, which have a functional defect in LTB4 expression, also failed to induce uveitis in the recipient mice. The results demonstrate a critical role for LTB4 in ocular inflammation and in the development and progression of EAU and suggest a new potential target for therapeutic intervention in this disease.

Cyclosporine: A Historical Perspective on Its Role in the Treatment of Noninfectious Uveitis.

PubMed

Smith, Wendy M

2017-05-01

The history of cyclosporine and uveitis is intertwined with the development of experimental autoimmune uveitis (EAU) animal models and the understanding that T lymphocytes play a major role in the pathogenesis of uveitis. The early studies of CsA in uveitis also demonstrated the power of collaborative efforts in translational research. Dr. Robert Nussenblatt and his colleagues were the first to show that CsA can inhibit EAU. Over many years after the initial CsA experiments, Dr. Nussenblatt's group as well as others continued to study CsA under experimental conditions as well as in clinical trials with human patients. The data and observations from these studies significantly advanced our knowledge of uveitis pathophysiology and demonstrated the value of well-designed masked, controlled treatment trials in uveitis. Dr. Nussenblatt and his collaborators delved into the most significant adverse effect of CsA, renal toxicity, and helped elucidate the pathophysiology of renal injury. They explored adjunctive treatments to improve the efficacy and decrease the toxicity of CsA and also studied other members of the cyclosporine family. Among the immunosuppressives used to treat ocular inflammation, CsA was the first, and remains the only medication comprehensively studied under both experimental and clinical conditions.

Novel survey disseminated through Twitter supports its utility for networking, disseminating research, advocacy, clinical practice and other professional goals.

PubMed

Borgmann, Hendrik; DeWitt, Sasha; Tsaur, Igor; Haferkamp, Axel; Loeb, Stacy

2015-01-01

Twitter use has grown exponentially within the urological community. We aimed to determine the perceptions of the impact of Twitter on users' clinical practice, research, and other professional activities. We performed an 11-item online survey of Twitter contributors during two major urological meetings: the European Association of Urology (EAU) and the American Urological Association (AUA) annual meetings. During the EAU 2014 meeting, we distributed the survey via the meeting official Twitter feed. During the AUA 2014 meeting, we applied a new method by directly sending the survey to Twitter contributors. We performed a subset analysis for assessing the perceived impact of Twitter on the clinical practice of physicians. Among 312 total respondents, the greatest perceived benefits of Twitter among users were for networking (97%) and disseminating information (96%), followed by research (75%), advocacy (74%) and career development (62%). In total, 65% of Twitter users have dealt with guidelines on online medical professionalism and 71% of physician users found that Twitter had an impact on their clinical practice, and 33% had made a clinical decision based on an online case discussion. Our results suggest that Twitter users in the urological community perceive important benefits. These benefits extend to multiple professional domains, particularly networking, disseminating information, remote conference participation, research, and advocacy. This is the first study that has been disseminated to targeted individuals from the urological community directly through tweets, providing a proof of principle for this research method.

Immunomodulatory effects of linomide in animals immunized with immunopathogenic retinal antigens: dissociation between different immune functions.

PubMed

Shirkey, B L; Slavin, S; Vistica, B P; Podgor, M J; Gery, I

1997-06-01

Linomide (LS-2616, quinoline-3-carboxamide) has been reported to exert a diverse range of effects on the immune system. On one hand, this drug was found to stimulate the immune system and to enhance activities such as DTH or allograft rejection. On the other hand, linomide was shown to inhibit the induction of experimental autoimmune encephalomyelitis and myasthenia gravis, as well as the development of diabetes in non-obese diabetic (NOD) mice. Here we report the effects of linomide in animals immunized with uveitogenic retinal antigens. Treatment with linomide completely inhibited the development of experimental autoimmune uveoretinitis (EAU) in mice immunized with interphotoreceptor retinoid-binding protein and markedly suppressed EAU in rats immunized with S-antigen (S-Ag). In addition, linomide-treated rats exhibited reduced antibody production and lymphocyte proliferative response to S-Ag. In contrast to these suppressive activities, linomide treatment did not affect the development of adoptively transferred EAU in rats and moderately enhanced the DTH reactions to S-Ag in immunized rats in which EAU and other immune responses to this antigen were suppressed.

Human Embryonic Stem Cell-Derived Mesenchymal Stromal Cells Decrease the Development of Severe Experimental Autoimmune Uveitis in B10.RIII Mice.

PubMed

Qin, Yu; Chan, Ann M; Chang, Yu-Ling; Matynia, Anna; Kouris, Nicholas A; Kimbrel, Erin A; Ashki, Negin; Parikh, Sachin; Gorin, Michael B; Lanza, Robert; Levinson, Ralph D; Gordon, Lynn K

2017-09-15

We investigated the effect of exogenously administered human embryonic stem cell-derived mesenchymal stromal cells (hESC-MSCs) in experimental autoimmune uveitis (EAU) in B10.RIII mice, a murine model of severe uveitis. B10.RIII mice were immunized with an uveitogenic peptide, and intraperitoneal injections of 5 million hESC-MSCs per animal were given on the same day. Behavioral light sensitivity assays, histological evaluation, cytokine production, and regulatory T cells were analyzed at the peak of the disease. Histological and behavioral evidence demonstrated that early systemic treatment with hESC-MSCs decreases the development of severe EAU in B10.RIII mice. hESC-MSCs suppress Th17 and upregulate Th1 and Th2 responses as well as IL-2 and GM-CSF in splenocytes from hESC-MSC-treated mice. MSCs that originate from hESC decrease the development of severe EAU in B10.RIII mice, likely through systemic immune modulation. Further investigation is needed to determine any potential effect on active EAU.

Developing a Nonsexist/Nongendered Language Policy at the University of Wisconsin-Eau Claire

ERIC Educational Resources Information Center

Benson, Erica J.; Kemp, Theresa D.; Pirlott, Angela; Coughlin, Casey; Forss, Quinn; Becherer, Laura

2013-01-01

This article describes a project initiated in 2011 at the University of Wisconsin-Eau Claire (UWEC) to develop a research-based action plan to justify the need for, and consequently the creation and adoption of, gender-inclusive language policies that aligned with UWEC's equity, diversity, and inclusivity goals and mission. By 2013, six…

Annual Summary Report for ONR Contract Number N00014-76-C-0430.

DTIC Science & Technology

1985-07-17

University of Paris VII, 4-7 Dec. 1984 (to appear in the Proceedings, published as a special issue of Traitement du Signal): * (a) L’acoustique des...Mathematics, University of Deraen, Norv~ae). "R~fflexion et rdfraction d’un faiL- eau acoustique sur une interface eau -stdiment". IWO - 15h50 A. FLORI

Novel survey disseminated through Twitter supports its utility for networking, disseminating research, advocacy, clinical practice and other professional goals

PubMed Central

Borgmann, Hendrik; DeWitt, Sasha; Tsaur, Igor; Haferkamp, Axel; Loeb, Stacy

2015-01-01

Introduction: Twitter use has grown exponentially within the urological community. We aimed to determine the perceptions of the impact of Twitter on users’ clinical practice, research, and other professional activities. Methods: We performed an 11-item online survey of Twitter contributors during two major urological meetings: the European Association of Urology (EAU) and the American Urological Association (AUA) annual meetings. During the EAU 2014 meeting, we distributed the survey via the meeting official Twitter feed. During the AUA 2014 meeting, we applied a new method by directly sending the survey to Twitter contributors. We performed a subset analysis for assessing the perceived impact of Twitter on the clinical practice of physicians. Results: Among 312 total respondents, the greatest perceived benefits of Twitter among users were for networking (97%) and disseminating information (96%), followed by research (75%), advocacy (74%) and career development (62%). In total, 65% of Twitter users have dealt with guidelines on online medical professionalism and 71% of physician users found that Twitter had an impact on their clinical practice, and 33% had made a clinical decision based on an online case discussion. Conclusions: Our results suggest that Twitter users in the urological community perceive important benefits. These benefits extend to multiple professional domains, particularly networking, disseminating information, remote conference participation, research, and advocacy. This is the first study that has been disseminated to targeted individuals from the urological community directly through tweets, providing a proof of principle for this research method. PMID:26664662

Validation de modeles d'eclairement incident a la surface de l'eau en Arctique

NASA Astrophysics Data System (ADS)

Julien, Laliberte

Dans ce memoire, deux methodes d'estimation d'eclairement incident a la surface de l'Arctique sont evaluees. Une base de donnees in situ a ete constituee a partir de 16 campagnes oceanographiques en Arctique. Pour les dates ou l'eclairement est mesure, les estimations d'eclairement journalier incident a la surface obtenues a partir des satellites de la couleur de l'eau (Frouin et al. 2003) et a partir des satellites meteorologiques (Belanger et al. 2013) sont produites. De meme, un exercise de comparaison entre les estimations satellitaires est produit pour l'annee 2004 sur tout le territoire Arctique. La comparaison entre les donnees observees et les donnees estimees a partir des satellites meteorologiques donnent un biais de 6% et une quadratique moyenne 33%. La comparaison entre les observations et les satellites de la couleur de l'eau donnent un biais de 2% et 20%. Finalement, la difference moyenne entre les estimations des 2 methodes d'estimation satellitaires pour tout l'Arctique pour l'annee 2004 est de 0,29 Einstein/m2/jour avec un ecart-type de 6,78 Einstein/m2/jour. Les resultats montrent entre autres que la methode qui utilise les satellites de la couleur de l'eau est plus precise pour estimer l'eclairement sur une petite superficie puisqu'elle rend mieux les variations locales dans l'eclairement. La methode qui utilise les satellites meteorologique est plus precise pour estimer l'eclairement sur une grande superficie, puisqu'elle est moins restreinte dans les conditions qui permettent de fournir une estimation. Ainsi, la methode qui utilise les satellites meteorologiques montre qu'un eclairement annuel de l'Arctique de 38% n'est pas prise en compte par les satellites de la couleur de l'eau.

Small heat shock protein αA-crystallin prevents photoreceptor degeneration in experimental autoimmune uveitis.

PubMed

Rao, Narsing A; Saraswathy, Sindhu; Pararajasegaram, Geeta; Bhat, Suraj P

2012-01-01

The small heat shock protein, αA-crystallin null (αA-/-) mice are known to be more prone to retinal degeneration than the wild type mice in Experimental Autoimmune Uveoretinitis (EAU). In this report we demonstrate that intravenous administration of αA preserves retinal architecture and prevents photoreceptor damage in EAU. Interestingly, only αA and not αB-crystallin (αB), a closely related small heat shock protein works, pointing to molecular specificity in the observed retinal protection. The possible involvement of αA in retinal protection through immune modulation is corroborated by adaptive transfer experiments, (employing αA-/- and wild type mice with EAU as donors and Rag2-/- as the recipient mice), which indicate that αA protects against the autoimmune challenge by modulating the systemic B and T cell immunity. We show that αA administration causes marked reduction in Th1 cytokines (TNF-α, IL-12 and IFN-γ), both in the retina and in the spleen; notably, IL-17 was only reduced in the retina suggesting local intervention. Importantly, expression of Toll-like receptors and their associated adaptors is also inhibited suggesting that αA protection, against photoreceptor loss in EAU, is associated with systemic suppression of both the adaptive and innate immune responses.

Numerical modelling and hydrochemical characterisation of a fresh-water lens in the Belgian coastal plain

NASA Astrophysics Data System (ADS)

Vandenbohede, A.; Lebbe, L.

2002-05-01

The distribution of fresh and salt water in coastal aquifers is influenced by many processes. The influence of aquifer heterogeneity and human interference such as land reclamation is illustrated in the Belgian coastal plain where, around A.D. 1200, the reclamation of a tidally influenced environment was completed. The aquifer, which was filled with salt water, was thereafter freshened. The areal distribution of peat, clay, silt and sand influences the general flow and distribution of fresh and salt water along with the drainage pattern and results in the development of fresh-water lenses. The water quality in and around the fresh-water lenses below an inverted tidal channel ridge is surveyed. The hydrochemical evolution of the fresh water lens is reconstructed, pointing to cation exchange, solution of calcite and the oxidation of organic material as the major chemical reactions. The formation and evolution of the fresh water lens is modelled using a two-dimensional density-dependent solute transport model and the sensitivity of drainage and conductivities are studied. Drainage level mainly influences the depth of the fresh-water lens, whereas the time of formation is mainly influenced by conductivity. Résumé. La répartition de l'eau douce et de l'eau salée dans les aquifères littoraux est influencée par de nombreux mécanismes. L'influence de l'hétérogénéité de l'aquifère et des interférences anthropiques telles que la mise en valeur des terres est illustrée par la plaine côtière belge où, depuis l'an 1200, on a mis en valeur un environnement soumis aux marées. L'aquifère, qui contenait de l'eau salée, contient maintenant de l'eau douce. La distribution spatiale de tourbe, d'argile, de silt et de sable joue un rôle dans l'écoulement général et dans la répartition de l'eau douce et de l'eau salée le long du réseau de drainage et produit des lentilles d'eau douce. La qualité de l'eau dans et autour des lentilles d'eau douce sous une levée de canal de marée est étudiée. L'évolution hydrochimique de la lentille d'eau douce est reconstituée, révélant que les principales réactions chimiques sont l'échange de cations, la dissolution de calcite et l'oxydation de matières organiques. La formation et l'évolution de la lentille d'eau douce sont modélisées en recourant à un modèle en deux dimensions de transport de soluté dépendant de la densité la sensibilité au drainage et les conductivités sont étudiées. Le niveau du drainage influence surtout la profondeur de la lentille d'eau douce, alors que le temps de formation de la lentille est surtout influencé par la conductivité. Resumen. La distribución de las aguas dulces y salinas en acuíferos costeros está influenciada por muchos procesos. Se ilustra la influencia de la heterogeneidad del medio y de la interferencia humana mediante acciones tales como la recuperación de terrenos en la llanura costera belga, donde, hacia el año 1200 D.C., se aprovechó un medio sometido a fluctuaciones mareales. La salinidad del acuífero, que fue invadido por agua salada, está siendo rebajada desde entonces. La distribución espacial de turba, arcilla, limo y arena influencia el flujo general y la distribución de agua dulce y salina, además de afectar el esquema de drenaje, y origina el desarrollo de lentejones de agua dulce. Se inspecciona la calidad del agua en y en torno a los lentejones de agua dulce bajo la cresta de un canal mareal invertido. Se reconstruye la evolución hidroquímica de los lentejones de agua dulce, proponiendo como reacciones principales el intercambio catiónico, la disolución de calcita y la oxidación de materia orgánica. Se modela la formación y evolución de los lentejones mediante un modelo bidimensional de transporte con densidad variable, y se estudia la sensibilidad del drenaje y de las conductividades. El nivel de drenaje influencia sobretodo la profundidad de los lentejones de agua dulce, mientras el tiempo de formación está esencialmente condicionado por la conductividad.

Urbanization and the groundwater budget, metropolitan Seoul area, Korea

NASA Astrophysics Data System (ADS)

Kim, Yoon-Young; Lee, Kang-Kun; Sung, Ig Hwan

2001-07-01

The city of Seoul is home to more than 10 million people in an area of 605 km2. Groundwater is ed for public water supply and industrial use, and to drain underground facilities and construction sites. Though most tap water is supplied from the Han River, the quantity and quality of groundwater is of great concern to Seoul's citizens, because the use of groundwater for drinking water is continuously increasing. This study identifies the major factors affecting the urban water budget and quality of groundwater in the Seoul area and estimates the urban water budget. These factors include leakage from the municipal water-supply system and sewer systems, precipitation infiltration, water-level fluctuations of the Han River, the subway pumping system, and domestic pumping. The balance between groundwater recharge and discharge is near equilibrium. However, the quality of groundwater and ability to control contaminant fluxes are impeded by sewage infiltration, abandoned landfills, waste dumps, and abandoned wells. Résumé. La ville de Séoul possède une population de plus de 10 millions d'habitants, pour une superficie de 605 km2. Les eaux souterraines sont pompées pour l'eau potable et pour les usages industriels, ainsi que pour drainer les équipements souterrains et les sites en construction. Bien que l'essentiel de l'eau potable provienne de la rivière Han, la quantité et la qualité de l'eau souterraine présentent un grand intérêt pour les habitants de Séoul, parce qu'on utilise de plus en plus l'eau souterraine pour l'eau potable. Cette étude identifie les facteurs principaux qui affectent la qualité de l'eau souterraine dans la région de Séoul et fait l'estimation du bilan d'eau urbaine. Les principaux facteurs affectant le bilan d'eau urbaine et la qualité de l'eau souterraine sont les fuites du réseau d'adduction et du réseau d'égouts, l'infiltration des eaux de précipitation, les fluctuations du niveau de la rivière Han, le réseau de pompage du métro et les pompages privés. Le bilan entre la recharge de la nappe et sa décharge est proche de l'équilibre. Cependant, les infiltrations d'eaux usées, les décharges abandonnées, les décharges d'ordures et les puits abandonnés portent atteinte à la qualité de l'eau souterraine et à la capacité de contrôler les flux de contaminants. Resumen. La ciudad de Seúl tiene más de 10 millones de habitantes en un área de 605 km2. Se bombea aguas subterráneas para abastecimiento urbano y para usos industriales, así como para el drenaje de instalaciones subterráneas y de solares en construcción. Aunque la mayor parte del agua de boca procede del río Han, los ciudadanos de Seúl están muy concienciados por la cantidad y calidad de las aguas subterráneas, ya que su explotación para uso de boca está experimentando un continuo incremento. El presente estudio identifica los factores que más afectan a la calidad de las aguas subterráneas en el área de Seúl y hace una estimación del balance de agua en el territorio urbano. Entre los factores principales que afectan al balance y a la calidad de las aguas subterráneas, se incluye el lixiviado de la red municipal de suministro y de la red de alcantarillado, la infiltración de agua de lluvia, las fluctuaciones del nivel del río Han, el sistema de bombeo del metro y los bombeos domésticos. El balance entre la recarga y la descarga en el acuífero está próximo al equilibrio. Sin embargo, la calidad de las aguas subterráneas y la capacidad de controlar los flujos de contaminación están amenazadas por la infiltración de aguas residuales, vertederos abandonados, depósitos de residuos y pozos abanadonados.

Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence.

PubMed

Chapple, Christopher R; Cruz, Francisco; Deffieux, Xavier; Milani, Alfredo L; Arlandis, Salvador; Artibani, Walter; Bauer, Ricarda M; Burkhard, Fiona; Cardozo, Linda; Castro-Diaz, David; Cornu, Jean Nicolas; Deprest, Jan; Gunnemann, Alfons; Gyhagen, Maria; Heesakkers, John; Koelbl, Heinz; MacNeil, Sheila; Naumann, Gert; Roovers, Jan-Paul W R; Salvatore, Stefano; Sievert, Karl-Dietrich; Tarcan, Tufan; Van der Aa, Frank; Montorsi, Francesco; Wirth, Manfred; Abdel-Fattah, Mohamed

2017-09-01

Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). A consensus review of existing data based on published meta-analyses and reviews. This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations. Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae. When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres. Synthetic slings can be safely used in the surgical treatment of stress incontinence in both male and female patients. Patients need to be aware of the alternative therapy and potential risks and complications of this therapy. Synthetic mesh for treating prolapse should be used only in complex cases with recurrent prolapse in specialist referral centres. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Groundwater for urban water supplies in northern China - An overview

NASA Astrophysics Data System (ADS)

Zaisheng, Han

Groundwater plays an important role for urban and industrial water supply in northern China. More than 1000 groundwater wellfields have been explored and installed. Groundwater provides about half the total quantity of the urban water supply. Complete regulations and methods for the exploration of groundwater have been established in the P.R. China. Substantial over-exploitation of groundwater has created environmental problems in some cities. Some safeguarding measures for groundwater-resource protection have been undertaken. Résumé Les eaux souterraines jouent un rôle important dans l'approvisionnement en eau des agglomérations et des industries du nord de la Chine. Les explorations ont conduit à mettre en place plus de 1000 champs de puits captant des eaux souterraines. Les eaux souterraines satisfont environ la moitié des besoins en eau des villes. Une réglementation complète et des méthodes d'exploration des eaux souterraines ont étéétablies en République Populaire de Chine. Une surexploitation très nette est à l'origine de problèmes environnementaux dans certaines villes. Des mesures ont été prises pour protéger la ressource en eau souterraine. Resumen El agua subterránea desempeña un papel importante en el suministro de agua para uso doméstico e industrial en la China septentrional. Se han explorado y puesto en marcha más de 1000 campos de explotación de aguas subterráneas, que proporcionan cerca de la mitad del total del suministro urbano. En la República Popular de China se han definido totalmente la legislación y la metodología para realizar estas explotaciones. La gran sobreexplotación en algunas ciudades ha creado algunos problemas medioambientales. Como consecuencia, se han llevado a cabo algunas medidas de protección de los recursos de aguas subterráneas.

The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study.

PubMed

Roos, A-M; Abdool, Z; Sultan, A H; Thakar, R

2011-07-01

To determine the accuracy and predictive value of transperineal (TPU) and endovaginal ultrasound (EVU) in the detection of anal sphincter defects in women with obstetric anal sphincter injuries and/or postpartum symptoms of faecal incontinence. One hundred and sixty-five women were recruited, four women were excluded as they were seen years after their last delivery. TPU and EVU, followed by endonanal ultrasound (EAU), were performed using the B&K Viking 2400 scanner. Sensitivity and specificity, as well as predictive values with 95% confidence intervals, for detecting anal sphincter defects were calculated for EVU and TPU, using EAU as the reference standard. On EAU a defect was found in 42 (26%) women: 39 (93%) had an external (EAS) and 23 (55%) an internal anal sphincter (IAS) defect. Analysable images of one level of the EAS combined with an analysable IAS were available in 140 (87%) women for EVU and in 131 (81%) for TPU. The sensitivity and specificity for the detection of any defect was 48% (30-67%) and 85% (77-91%) for EVU and 64% (44-81%) and 85% (77-91%) for TPU, respectively. Although EAU using a rotating endoprobe is the validated reference standard in the identification of anal sphincter defects, it is not universally available. However while TPU and/or EVU with conventional ultrasound probes can be useful in identifying normality, for clinical purposes they are not sensitive enough to identify an underlying sphincter defect. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Soldiers in Cold Environments (Soldats en environnements froids)

DTIC Science & Technology

2009-04-01

survie par temps froid et en eau froide pour l’essai de divers ensembles d’habillement ; d) envisager l’adoption du procédé d’Ulm pour le traitement des...vêtements d’hiver ; • Les expériences de laboratoire en air froid et sur la morsure du gel; • La modélisation de la survie en eau froide et en air froid...normalisés au sein des pays de l’OTAN ; b) développer un protocole commun pour le traitement de l’hypothermie; c) développer un modèle de prévision de

Botulinum toxin A for the Treatment of Overactive Bladder.

PubMed

Hsieh, Po-Fan; Chiu, Hung-Chieh; Chen, Kuan-Chieh; Chang, Chao-Hsiang; Chou, Eric Chieh-Lung

2016-02-29

The standard treatment for overactive bladder starts with patient education and behavior therapies, followed by antimuscarinic agents. For patients with urgency urinary incontinence refractory to antimuscarinic therapy, currently both American Urological Association (AUA) and European Association of Urology (EAU) guidelines suggested that intravesical injection of botulinum toxin A should be offered. The mechanism of botulinum toxin A includes inhibition of vesicular release of neurotransmitters and the axonal expression of capsaicin and purinergic receptors in the suburothelium, as well as attenuation of central sensitization. Multiple randomized, placebo-controlled trials demonstrated that botulinum toxin A to be an effective treatment for patients with refractory idiopathic or neurogenic detrusor overactivity. The urinary incontinence episodes, maximum cystometric capacity, and maximum detrusor pressure were improved greater by botulinum toxin A compared to placebo. The adverse effects of botulinum toxin A, such as urinary retention and urinary tract infection, were primarily localized to the lower urinary tract. Therefore, botulinum toxin A offers an effective treatment option for patients with refractory overactive bladder.

Microscopie par rayons X dans la fenêtre de l'eau : faisabilité et intérêt pour la biologie d'un instrument de laboratoire

NASA Astrophysics Data System (ADS)

Adam, J. F.; Moy, J. P.

2005-06-01

La biologie étudie des structures ou des phénomènes sub-cellulaires. Pour cela la microscopie est la technique d'observation privilégiée. La résolution spatiale de la microscopie optique s'avère bien souvent insuffisante pour de telles observations. Les techniques plus résolvantes, comme la microscopie électronique par transmission sont souvent destructrices et d'une complexité peu adaptée aux besoins des biologistes. La microscopie par rayons X dans la fenêtre de l'eau permet l'imagerie rapide de cellules dans leur milieu naturel, nécessite peu de préparation et offre des résolutions de quelques dizaines de nanomètres. De plus, il existe un bon contraste naturel entre les structures carbonées (protéines, lipides) et l'eau. Actuellement cette technique est limitée aux centres de rayonnement synchrotron, ce qui impose une planification et des déplacements incompatibles avec les besoins de la biologie. Un tel microscope fonctionnant avec uns source de laboratoire serait d'une grande utilité. Ce document présente un état de l'art de la microscopie par rayons X dans la fenêtre de l'eau. Un cahier des charges détaillé pour un appareil de laboratoire ayant les performances optiques requises par les biologistes est présenté et confronté aux microscopes X de laboratoire déjà existants. Des solutions concernant la source et les optiques sont également discutées.

Use of flexible ureteroscopy in the clinical practice for the treatment of renal stones: results from a large European survey conducted by the EAU Young Academic Urologists-Working Party on Endourology and Urolithiasis.

PubMed

Sanguedolce, F; Liatsikos, E; Verze, P; Hruby, S; Breda, A; Beatty, J D; Knoll, T

2014-08-01

Treatment of renal stones using flexible ureteroscopy (fURS) is increasingly common despite the poor evidence in literature supporting its use and indications. With this study, we wanted to investigate the current use and indication of fURS for the treatment of renal stones in the clinical practice across the European countries. A survey was conducted using an emailed questionnaire consisting of 21 items; 2,894 recipients were selected via the EAU membership database. The questionnaires were collected through the SurveyMonkey system and the data were processed with the SPSS statistical package. Frequencies, cross tabs and Pearson correlation coefficients were applied as appropriate. 1,168 questionnaires were collected (response rate 40.4%). fURS was performed in 72.9% of the respondents' institutions, and 54.2% of the respondents were performing the procedure. For 95% of the users, fURS was considered first-line treatment, for stone of lower pole stone (45.9%) and <1 cm (44.2%) and 2 cm (43.8%) in size. The ureteral access sheaths were used routinely by more than 70% of the respondents. Lower pole stone repositioning technique was routinely performed by 45.9% of the surgeons. After fragmentation, 47.2% of the responders preferred to retrieve only the bigger fragments. At the end of fURS, lower volume surgeons were more likely to place routinely a double-J stent (p = 0.001). Higher volume surgeons estimated a higher durability of devices, both optical and digital ones (p < 0.001), and were more prone to consider fURS cost-effective when compared to other treatment modalities (p < 0.001). fURS is widely used for the treatment of renal stones and its use and indication can vary according to the age and surgeons' case volume. Higher volume surgeons are more prompt to extend international guidelines indications and to consider the technology cost-effective.

ShipMo3D Version 3.0 User Manual for Computing Ship Motions in the Time and Frequency Domains

DTIC Science & Technology

2012-01-01

permettent de modéliser un navire en manœuvre libre et en eau calme ou dans les vagues. SM3DBuildSeaway construit des modèles de voie maritime à trajet...manœuvrant libre - ment en eau calme ou dans une voie maritime modélisée. Plusieurs applications du logiciel ShipMo3D font des prévisions des mouvements de...can be produced. For a random seaway, the range of wave frequencies should be sufficient to encompass almost all energy within the wave spectrum. For

The social media revolution is changing the conference experience: analytics and trends from eight international meetings.

PubMed

Wilkinson, Sarah E; Basto, Marnique Y; Perovic, Greta; Lawrentschuk, Nathan; Murphy, Declan G

2015-05-01

To analyse the use of Twitter at urology conferences to enhance the social media conference experience. We prospectively registered the hashtags of eight international urology conferences taking place in 2013, using the social media metrics website, Symplur.com. In addition, we prospectively registered the hashtag for the European Association of Urology (EAU) Annual Congress for 3 consecutive years (2012-2014) to analyse the trend in the use of Twitter at a particular meeting. Metrics including number of 'tweets', number of participants, tweet traffic per day, and overall digital impressions, which were captured for 5 days before each conference, the conference itself, and the following 2 days. We also measured corresponding social media activity at a very large non-urology meeting (the American Society of Clinical Oncology) for comparative purposes. Twitter activity was noted at all eight conferences in 2013. In all, 12,363 tweets were sent generating over 14 million impressions. The number of participants tweeting at each meeting varied from 80 (Congress of the Société Internationale d'Urologie, #SIU2013) to 573 (the American Urological Association, #AUA13). Overall, the AUA meeting (#AUA13) generated the most Twitter activity with >8.6 million impressions and a total of 4663 tweets over the peri-conference period. It also had the most impressions and tweets per day over this period, at 717,000 and 389, respectively. The EAU Annual Congress 2013 (#EAU13) generated 1.74 million impressions from a total of 1762 tweets from 236 participants. For trends in Twitter use, there was a very sharp rise in Twitter activity at the EAU Annual Congress between 2012 and 2014. Over this 3-year period, the number of participants increased almost 10-fold, leading to an increase in the number of tweets from 347 to almost 6000. At #EAU14, digital impressions reached 7.35 million with 5903 tweets sent by 797 participants. Urological conferences, to a varying extent, have adopted social media as a means of amplifying the conference experience to a wider audience, generating international engagement and global reach. Twitter is a very powerful tool that amplifies the content of scientific meetings, and conference organisers should put in place strategies to capitalise on this. © 2014 The Authors. BJU International © 2014 BJU International.

Maladies reliées aux loisirs aquatiques

PubMed Central

Sanborn, Margaret; Takaro, Tim

2013-01-01

Résumé Objectif Passer en revue les facteurs de risque, la prise en charge et la prévention des maladies reliées aux loisirs aquatiques en pratique familiale. Sources des données Des articles originaux et de synthèse entre janvier 1998 et février 2012 ont été identifiés à l’aide de PubMed et des expressions de recherche en anglais water-related illness, recreational water illness et swimmer illness. Message principal Il y a un risque de 3 % à 8 % de maladies gastrointestinales (MGI) après la baignade. Les groupes à risque élevé de MGI sont les enfants de moins de 5 ans, surtout s’ils n’ont pas été vaccinés contre le rotavirus, les personnes âgées et les patients immunodéficients. Les enfants sont à plus grand risque parce qu’ils avalent plus d’eau quand ils nagent, restent dans l’eau plus longtemps et jouent dans l’eau peu profonde et le sable qui sont plus contaminés. Les adeptes des sports dans lesquels le contact avec l’eau est abondant comme le triathlon et le surf cerf-volant sont aussi à risque élevé et même ceux qui s’adonnent à des activités impliquant un contact partiel avec l’eau comme la navigation de plaisance et la pêche ont un risque de 40 % à 50 % fois plus grand de MGI par rapport à ceux qui ne pratiquent pas de sports aquatiques. Il y a lieu de faire une culture des selles quand on soupçonne une maladie reliée aux loisirs aquatiques et l’échelle clinique de la déshydratation est utile pour l’évaluation des besoins de traitement chez les enfants affectés. Conclusion Les maladies reliées aux loisirs aquatiques est la principale cause de MGI durant la saison des baignades. La reconnaissance que la baignade est une source importante de maladies peut aider à prévenir les cas récurrents et secondaires. On recommande fortement le vaccin contre le rotavirus chez les enfants qui se baignent souvent.

Eco-hydrology: Groundwater flow and site factors in plant ecology

NASA Astrophysics Data System (ADS)

Klijn, Frans; Witte, Jan-Philip M.

Résumé En écologie végétale, le site est un concept central. Un site, c'est l'endroit où une espèce végétale ou une communauté de plantes se développe le site assure un ensemble de conditions dans lesquelles elles vivent. Dans un matériau homogène à l'origine, l'écoulement gravitaire d'une nappe influence les conditions du site par l'intermédiaire de la distribution spatiale des nutriments et d'autres composés chimiques associés. Les remontées d'eau peuvent tout spécialement produire et maintenir les conditions du site essentielles pour différentes espèces et communautés de plantes relativement rares. Les écologues ont porté une attention accrue à ces remontées d'eau, en sorte qu'une coopération avec les hydrologues en a résulté, avec l'émergence d'une discipline propre, l'éco-hydrologie, à la limite des deux domaines scientifiques et liée au concept de site. Aux Pays-Bas, une classification des types d'eau, basée sur l'histoire de l'eau souterraine à proximité de la surface, a été mise en oeuvre pour constituer une base nationale de données géographiques sur les remontées d'eau d'intérêt écologique. Des analyses des correspondances des données de cette base, portant sur l'existence de certaines espèces de plantes, montrent que dans les sols sableux pauvres du Pléistocène la remontée d'eau explique très bien la présence de certaines espèces et communautés, alors que, dans les plaines fluviales et les régions de polders à sols argileux riches, l'influence de la remontée d'eau est masquée par l'importance des caractéristiques des sols. En conclusion donc, certaines espèces de plantes peuvent être utilisées comme des indicateurs de la remontée d'eau dans des diagnostiques et des levés de terrain rapides, mais à condition de prendre en permanence des précautions sur les limites de l'approche. Resumen En ecología botánica un concepto de gran importancia es el de emplazamiento, definido como el lugar que proporciona unas condiciones de vida adecuadas que permiten el crecimiento de una especie o una comunidad botánica. En un material inicialmente homogéneo, el flujo subterráneo gravífico influencia las condiciones del emplazamiento variando la distribución espacial de los nutrientes y de otros agentes químicos relevantes. En especial, el flujo ascendente puede producir y mantener una serie de condiciones que son esenciales para algunas especies y comunidades de plantas relativamente raras. La especial atención hacia este fenómeno ha dado lugar a una cooperación entre ecologistas e hidrogeólogos y a la aparición de una nueva disciplina - eco-hidrología -, en la frontera de los dos campos científicos. En Holanda, se ha usado una clasificación sencilla de tipos de agua para crear una base de datos, a nivel nacional, de lugares donde la presencia de flujos ascendentes pueda ser de interés ecológico. El análisis de correspondencias entre esta base de datos y los tipos de plantas existentes muestra que en los suelos arenosos pobres del Pleistoceno los flujos ascendentes explican la presencia de algunas especies y comunidades de plantas. Por el contrario, en las llanuras fluviales y pólders, con suelos más arcillosos, la influencia de estos flujos es despreciable frente a la relativa a las propias características de los suelos. Se concluye que las especies botánicas se pueden usar como indicadores de la presencia de flujo ascendente sólo en campañas preliminares, pero que el método presenta grandes limitaciones para su extensión a casos generales.

Evaluation of Underwater Contamination by Explosives and Metals at Point Amour Labrador and in the Halifax Harbour Area

DTIC Science & Technology

2004-06-01

à Pointe Amour, au Labrador, où le HMS Raleigh sombra en 1922. Des munitions non éclatées s’y trouvaient et on a procédé à la détonation in situ de...cours de cette opération, l’échantillonnage d’eau et de sédiments a été effectué à l’aide d’un véhicule submersible télécommandé. En ce qui concerne...l’identification des échantillons, les conditions météorologiques ainsi que les méthodes d’échantillonnage en eau profonde. DRDC Valcartier TR-2004-125 i

Drainage-Area Data for Wisconsin Streams

DTIC Science & Technology

1983-01-01

Balsam Lake, County Trunk 34 N 16 W NW1/4SW1/4 11 Polk 5 81 .7 Highway E 05341000 Bone Lake near Luck (head of Fox Creek) 35 N 16 W NW1/4NW1/4 5 Polk 1...Not determine 05341010 Fox Creek near Luck, at outlet of Bone 35 N 16 W NW1/4SE1/4 20 Polk 7 16 .6 Lake 05341030 Straight River near Balsam Lake, at...13 W SW1/4SW1/4 21 Pepin 1 9,010 Eau Celle River 05369800 Eau Galle River tributary near Hersey, 28 N 15 W SW1/4SW1/4 5 St . Croix 3 .56 U.S

Patterns in groundwater chemistry resulting from groundwater flow

NASA Astrophysics Data System (ADS)

Stuyfzand, Pieter J.

Groundwater flow influences hydrochemical patterns because flow reduces mixing by diffusion, carries the chemical imprints of biological and anthropogenic changes in the recharge area, and leaches the aquifer system. Global patterns are mainly dictated by differences in the flux of meteoric water passing through the subsoil. Within individual hydrosomes (water bodies with a specific origin), the following prograde evolution lines (facies sequence) normally develop in the direction of groundwater flow: from strong to no fluctuations in water quality, from polluted to unpolluted, from acidic to basic, from oxic to anoxic-methanogenic, from no to significant base exchange, and from fresh to brackish. This is demonstrated for fresh coastal-dune groundwater in the Netherlands. In this hydrosome, the leaching of calcium carbonate as much as 15m and of adsorbed marine cations (Na+, K+, and Mg2+) as much as 2500m in the flow direction is shown to correspond with about 5000yr of flushing since the beach barrier with dunes developed. Recharge focus areas in the dunes are evidenced by groundwater displaying a lower prograde quality evolution than the surrounding dune groundwater. Artificially recharged Rhine River water in the dunes provides distinct hydrochemical patterns, which display groundwater flow, mixing, and groundwater ages. Résumé Les écoulements souterrains influencent les différents types hydrochimiques, parce que l'écoulement réduit le mélange par diffusion, porte les marques chimiques de changements biologiques et anthropiques dans la zone d'alimentation et lessive le système aquifère. Ces types dans leur ensemble sont surtout déterminés par des différences dans le flux d'eau météorique traversant le sous-sol. Dans les "hydrosomes" (masses d'eau d'origine déterminée), les lignes marquant une évolution prograde (séquence de faciès) se développent normalement dans la direction de l'écoulement souterrain : depuis des fluctuations fortes de la qualité de l'eau vers une absence de fluctuations, de polluées vers non polluées, d'acides vers basiques, d'oxygénées vers anoxiques et méthanogènes, depuis des échanges de base inexistants vers des échanges significatifs, de l'eau douce vers l'eau saumâtre. Ceci est montré pour une nappe d'eau douce dans une dune côtière des Pays-Bas. Dans "l'hydrosome", on montre que la disparition du carbonate de calcium par lessivage à plus de 15m et celle de cations adsorbés d'origine marine (Na+, K+ et Mg2+) à plus de 2500m vers l'aval-gradient correspond à environ 5000 ans d'écoulement, depuis que la barrière de la plage avec les dunes s'est mise en place. Les zones d'alimentation ponctuelle dans les dunes sont mises en évidence par l'eau souterraine montrant une plus faible évolution prograde de sa qualité que l'eau souterraine de la dune alentour. L'eau du Rhin utilisée pour la réalimentation artificielle dans les dunes a fourni des types hydrochimiques distincts, qui marquent l'écoulement, le mélange et les âges de l'eau souterraine. Resumen El flujo subterráneo tiene una gran importancia sobre la hidroquímica de un sistema ya que reduce la mezcla por difusión, transporta las huellas químicas y biológicas de las acciones antrópicas en la zona de recarga y drena el sistema acuífero. Las tendencias globales vienen regidas por las diferencias en el flujo de agua meteórica que atraviesa el subsuelo. En un hidrosoma individual (cuerpo de agua de un origen específico), se suele desarrollar la siguiente línea de evolución (secuencia de facies) en la dirección del flujo: de gran a nula fluctuación en la calidad del agua, de agua contaminada a no contaminada, de ácida a básica, de óxica a anóxica-metanogénica, de nulo a importante cambio de base y de agua dulce a salobre. Esto puede verse, por ejemplo, en las aguas dulces presentes en las dunas costeras de Holanda. En este hidrosoma, el lixiviado de carbonato cálcico, hasta 15m, y de cationes de adsorción marina (Na+, K+ and Mg2+), hasta 2500m en la dirección del flujo corresponde a unos 5000 años de lavado desde que se desarrolló la barrera de dunas. Áreas de recarga concentrada en las dunas se evidencian porque el agua subterránea muestra un bajo estado de evolución dentro de la línea de evolución antes presentada, si se compara con el agua circundante. La recarga artificial en las dunas con agua del Río Rin proporciona características hidroquímicas diferenciadas, lo que permite caracterizar el flujo subterráneo, la mezcla y las edades de las aguas.

Acute immunosuppression and syngeneic bone marrow transplantation in ocular autoimmunity abort disease, but do not result in induction of long-term protection.

PubMed

Savion, S; Silver, P B; Chan, C C; Caspi, R R

1998-09-01

Acute immunosuppression induced by total body irradiation (TBI) or cyclophosphamide (Cy) treatment, followed by syngeneic bone marrow transplantation (SBMT), was reported to be effective in inducing long-term tolerance in some autoimmune disease models. We examined the efficacy of this approach in the mouse model of experimental autoimmune uveoretinitis (EAU). Development of EAU induced by the interphotoreceptor retinoid binding protein (IRBP) was abolished almost completely by either TBI or Cy treatment, followed by SBMT, instituted one week after priming. In parallel, IRBP-specific delayed-type hypersensitivity (DTH) responses and lymph node cell proliferation were strongly suppressed or abolished. However, when these IRBP-immunized, lymphoablated and BM reconstituted mice were rechallenged with the immunizing antigen seven weeks after the primary immunization, they were not protected from developing disease, despite the fact that DTH and lymph node cell proliferation to the antigen were suppressed relative to controls. TBI treatment appeared somewhat more effective than Cy treatment as judged by its more profound effect on immunological responses. These results demonstrate the ability of acute immunosuppression followed by reconstitution of the immune system to inhibit the development of EAU, although long-term protection from disease was not achieved.

Global Mineralogical and Aqueous Mars History Derived from OMEGA/Mars Express Data

NASA Astrophysics Data System (ADS)

Bibring, Jean-Pierre; Langevin, Yves; Mustard, John F.; Poulet, François; Arvidson, Raymond; Gendrin, Aline; Gondet, Brigitte; Mangold, Nicolas; Pinet, P.; Forget, F.; OMEGA Team; Berthé, Michel; Gomez, Cécile; Jouglet, Denis; Soufflot, Alain; Vincendon, Mathieu; Combes, Michel; Drossart, Pierre; Encrenaz, Thérèse; Fouchet, Thierry; Merchiorri, Riccardo; Belluci, GianCarlo; Altieri, Francesca; Formisano, Vittorio; Capaccioni, Fabricio; Cerroni, Pricilla; Coradini, Angioletta; Fonti, Sergio; Korablev, Oleg; Kottsov, Volodia; Ignatiev, Nikolai; Moroz, Vassilli; Titov, Dimitri; Zasova, Ludmilla; Loiseau, Damien; Pinet, Patrick; Doute, Sylvain; Schmitt, Bernard; Sotin, Christophe; Hauber, Ernst; Hoffmann, Harald; Jaumann, Ralf; Keller, Uwe; Arvidson, Ray; Duxbury, Tom; Neukum, G.

2006-04-01

Global mineralogical mapping of Mars by the Observatoire pour la Mineralogie, l'Eau, les Glaces et l'Activité (OMEGA) instrument on the European Space Agency's Mars Express spacecraft provides new information on Mars' geological and climatic history. Phyllosilicates formed by aqueous alteration very early in the planet's history (the ``phyllocian'' era) are found in the oldest terrains; sulfates were formed in a second era (the ``theiikian'' era) in an acidic environment. Beginning about 3.5 billion years ago, the last era (the ``siderikian'') is dominated by the formation of anhydrous ferric oxides in a slow superficial weathering, without liquid water playing a major role across the planet.

Feasibility Study of Economics and Performance of Solar Photovoltaics at the Sky Park Landfill Site in Eau Claire, Wisconsin. A Study Prepared in Partnership with the Environmental Protection Agency for the RE-Powering America's Land Initiative: Siting Renewable Energy on Potentially Contaminated Land and Mine Sites

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

Simon, J.; Mosey, G.

2013-01-01

The U.S. Environmental Protection Agency (EPA), in accordance with the RE-Powering America's Land initiative, selected the Sky Park Landfill site in Eau Claire, Wisconsin, for a feasibility study of renewable energy production. The National Renewable Energy Laboratory (NREL) provided technical assistance for this project. The purpose of this report is to assess the site for a possible photovoltaic (PV) system installation and estimate the cost, performance, and site impacts of different PV options. In addition, the report recommends financing options that could assist in the implementation of a PV system at the site.

Plan for a groundwater monitoring network in Taiwan

NASA Astrophysics Data System (ADS)

Hsu, Shiang-Kueen

In Taiwan, rapid economic growth, rising standards of living, and an altered societal structure have in recent years put severe demands on water supplies. Because of its stable quantity and quality, groundwater has long been a reliable source of water for domestic, agricultural, and industrial users, but the establishment of a management program that integrates groundwater and surface-water use has been hampered by the lack of groundwater data. In 1992, the Department of Water Resources (DWR) initiated a program entitled "Groundwater Monitoring Network Plan in Taiwan." Under this program, basic groundwater data, including water-level and water-quality data, are being collected, and a reliable database is being established for the purpose of managing total water resources. This paper introduces the goals, implementation stages, and scope of that plan. The plan calls for constructing 517 hydrogeologic survey stations and 990 groundwater monitoring wells within 17 years. Under this program, water-level fluctuations are continuously monitored, whereas water-quality samples are taken for analysis only at the initial drilling stage and, subsequently, at the time when a monitoring well is being serviced. In 1996, the DWR and the Water Resources Planning Commission were merged to form today's Water Resources Bureau. Résumé A Taïwan, l'expansion économique rapide, l'amélioration des conditions de vie et la transformation de la structure sociale ont provoqué, ces dernières années, une très forte demande en eau. Du fait de sa constance en qualité et en quantité, l'eau souterraine a longtemps été considérée comme une ressource en eau sûre pour les usages domestiques, agricoles et industriels. Mais la mise en place d'un programme de gestion intégrant les utilisations d'eaux souterraines et de surface a été gênée par l'absence de données sur les eaux souterraines. En 1992, le Département des Ressources en Eau a lancé le programme "Plan pour un réseau de suivi des eaux souterraines à Taïwan". D'après ce programme, les données de base concernant les eaux souterraines, comprenant les mesures de niveau et les données de qualité, ont été acquises ; une base de données sûre est en cours d'élaboration, dans le but de gérer l'ensemble des ressources en eau. Cet article présente les buts, les stades de développement et une vue d'ensemble de ce plan. Le plan impose la mise en place de 517 stations de mesures hydrogéologiques et de 990 piézomètres en 17 ans. Selon ce programme, les variations du niveau des nappes doivent être suivies en continu, tandis que des échantillons pour la qualité de l'eau seront prélevés pour analyses uniquement au cours de la phase de foration, puis au moment de la mise en service des piézomètres. En 1996, le Département des Ressources en Eau et la Commission de Planification des Ressources en Eau ont été réunis pour former l'actuel Bureau des Ressources en Eau. Resumen En Taiwan, el rápido crecimiento económico, el aumento en el nivel de vida y los cambios sociales en los últimos años han resultado en un aumento en la demanda de agua. Por su estabilidad en términos de cantidad y calidad, las aguas subterráneas han sido durante años la fuente de agua para usos domésticos, agrícolas e industriales. En los últimos años, sin embargo, el establecimiento de un programa de gestión conjunta de aguas superficiales y subterráneas se ha visto comprometido por la falta de datos correspondientes a estas últimas. En 1992, el Departamento de Recursos de Agua (DWR) inició un programa titulado "Plan de Red de Control de Aguas Subterráneas en Taiwan". Bajo este programa, se están recogiendo datos básicos, incluyendo niveles piezométricos y datos de calidad, y se está construyendo una base de datos con el propósito de gestionar los recursos de agua totales. Este artículo presenta el marco, los objetivos y el estado de implantación del plan, que pretende la construcción de 517 estaciones de medida hidrogeológicas y 990 pozos de observación durante un periodo de 17 años. Bajo este programa, los niveles de agua se miden continuamente, mientras que las muestras para análisis de calidad se toman sólo durante la perforación y cuando el pozo está en servicio. En 1996, el DWR y la Comisión de Planificación de los Recursos de Agua se unieron para formar la actual Oficina de Recursos de Agua.5

Hydrogeologic uncertainties and policy implications: The Water Consumer Protection Act of Tucson, Arizona, USA

NASA Astrophysics Data System (ADS)

Wilson, L. G.; Matlock, W. G.; Jacobs, K. L.

The 1995 Water Consumer Protection Act of Tucson, Arizona, USA (hereafter known as the Act) was passed following complaints from Tucson Water customers receiving treated Central Arizona Project (CAP) water. Consequences of the Act demonstrate the uncertainties and difficulties that arise when the public is asked to vote on a highly technical issue. The recharge requirements of the Act neglect hydrogeological uncertainties because of confusion between "infiltration" and "recharge." Thus, the Act implies that infiltration in stream channels along the Central Wellfield will promote recharge in the Central Wellfield. In fact, permeability differences between channel alluvium and underlying basin-fill deposits may lead to subjacent outflow. Additionally, even if recharge of Colorado River water occurs in the Central Wellfield, groundwater will become gradually salinized. The Act's restrictions on the use of CAP water affect the four regulatory mechanisms in Arizona's 1980 Groundwater Code as they relate to the Tucson Active Management Area: (a) supply augmentation; (b) requirements for groundwater withdrawals and permitting; (c) Management Plan requirements, particularly mandatory conservation and water-quality issues; and (d) the requirement that all new subdivisions use renewable water supplies in lieu of groundwater. Political fallout includes disruption of normal governmental activities because of the demands in implementing the Act. Résumé La loi de 1995 sur la protection des consommateurs d'eau de Tucson (Arizona, États-Unis) a été promulguée à la suite des réclamations des consommateurs d'eau de Tucson alimentés en eau traitée à partir à la station centrale d'Arizona (CAP). Les conséquences de cette loi montrent les incertitudes et les difficultés qui apparaissent lorsque le public est appeléà voter sur un problème très technique. Les exigences de la loi en matière de recharge négligent les incertitudes hydrogéologiques du fait de la confusion entre "infiltration" et "recharge". C'est ainsi que la loi laisse entendre que l'infiltration à partir des lits de rivières le long du champ captant central favorise la recharge de cette zone. En réalité, les différences de perméabilité entre les alluvions du lit et les dépôts sous-jacents remplissant le bassin peuvent provoquer un écoulement sous-jacent. En outre, même si une recharge par l'eau de la rivière Colorado se produit dans cette zone, la nappe sera progressivement salifiée. Les restrictions imposées par la loi quant à l'utilisation de l'eau de la station centrale d'Arizona affectent les quatre outils réglementaires du Code des eaux souterraines de l'Arizona de 1980, en ce qu'ils concernent la zone de gestion active de Tucson: (a) l'augmentation de l'approvisionnement (b) les conditions requises pour les prélèvements d'eau souterraine et les autorisations; (c) les conditions requises pour le plan de gestion, en particulier la pérennité du concessionnaire et les résultats en matière de qualité de l'eau et (d) la condition que tous les nouveaux districts aient recours à des ressources en eau renouvelables à la place de l'eau souterraine. Les demandes concernant la mise en oeuvre de la loi ont conduit jusqu'à l'arrêt des activités normales des instances politiques. Resumen El Acta de Protección de los Usuarios de Agua de Tucson, Arizona (EE.UU.) de 1995 (el Acta) se aprobó a raíz de las quejas de los usuarios de agua de Tucson que recibían agua tratada por el Proyecto de Arizona Central (CAP). Las consecuencias del Acta demuestran las incertidumbres y dificultades que se producen cuando se le pide al público que vote sobre temas muy técnicos. Los requerimientos de recarga del Acta desprecian incertidumbres hidrogeológicas al confundir entre "infiltración" y "recarga". Así, el Acta dice que la infiltración en los canales de los arroyos a lo largo del Campo de Producción Central aumentará la recarga a dicho campo. De hecho, la diferencia de permeabilidad entre el canal aluvial y los depósitos de relleno subyacentes puede provocar descarga subyacente. Además, incluso si el Río Colorado recargase este Campo Central, el agua subterránea se salinizaría progresivamente. Las restricciones del Acta sobre el uso del agua del CAP afectan los cuatro mecanismos legales del Código de Aguas Subterráneas de Arizona de 1980 relacionados con el Área de Gestión Activa de Tucson: (a) aumento del suministro; (b) requisitos y permisos para la extracción de aguas subterráneas (c) necesidades del Plan de Gestión, particularmente la conservación obligatoria y temas de calidad de aguas; y (d) la obligación de que todas las nuevas subdivisiones usen agua con suministro renovable en lugar de subterránea. Como problemas adicionales se incluye la perturbación de las actividades políticas normales como consecuencia de las demandas para aprobar y poner en marcha el Acta.

Modeling interactions of agriculture and groundwater nitrate contaminants: application of The STICS-Eau-Dyssée coupled models over the Seine River Basin

NASA Astrophysics Data System (ADS)

Tavakoly, A. A.; Habets, F.; Saleh, F.; Yang, Z. L.

2017-12-01

Human activities such as the cultivation of N-fixing crops, burning of fossil fuels, discharging of industrial and domestic effluents, and extensive usage of fertilizers have recently accelerated the nitrogen loading to watersheds worldwide. Increasing nitrate concentration in surface water and groundwater is a major concern in watersheds with extensive agricultural activities. Nutrient enrichment is one of the major environmental problems in the French coastal zone. To understand and predict interactions between agriculture, surface water and groundwater nitrate contaminants, this study presents a modeling framework that couples the agronomic STICS model with Eau-Dyssée, a distributed hydrologic modeling system to simulate groundwater-surface water interaction. The coupled system is implemented on the Seine River Basin with an area of 88,000 km2 to compute daily nitrate contaminants. Representing a sophisticated hydrosystem with several aquifers and including the megalopolis of Paris, the Seine River Basin is well-known as one of the most productive agricultural areas in France. The STICS-EauDyssée framework is evaluated for a long-term simulation covering 39 years (1971-2010). Model results show that the simulated nitrate highly depends on the inflow produced by surface and subsurface waters. Daily simulation shows that the model captures the seasonal variation of observations and that the overall long-term simulation of nitrate contaminant is satisfactory at the regional scale.

Identification of resident and inflammatory bone marrow derived cells in the sclera by bone marrow and haematopoietic stem cell transplantation

PubMed Central

Hisatomi, Toshio; Sonoda, Koh‐hei; Ishikawa, Fumihiko; Qiao, Hong; Nakamura, Takahiro; Fukata, Mitsuhiro; Nakazawa, Toru; Noda, Kousuke; Miyahara, Shinsuke; Harada, Mine; Kinoshita, Shigeru; Hafezi‐Moghadam, Ali; Ishibashi, Tatsuro; Miller, Joan W

2007-01-01

Aims To characterise bone marrow derived cells in the sclera under normal and inflammatory conditions, we examined their differentiation after transplantation from two different sources, bone marrow and haematopoietic stem cells (HSC). Methods Bone marrow and HSC from green fluorescent protein (GFP) transgenic mice were transplanted into irradiated wild‐type mice. At 1 month after transplantation, mice were sacrificed and their sclera examined by histology, immunohistochemistry (CD11b, CD11c, CD45), and transmission and scanning electron microscopy. To investigate bone marrow derived cell recruitment under inflammatory conditions, experimental autoimmune uveitis (EAU) was induced in transplanted mice. Results GFP positive cells were distributed in the entire sclera and comprised 22.4 (2.8)% (bone marrow) and 28.4 (10.9)% (HSC) of the total cells in the limbal zone and 18.1 (6.7)% (bone marrow) and 26.3 (3.4)% (HSC) in the peripapillary zone. Immunohistochemistry showed that GFP (+) CD11c (+), GFP (+) CD11b (+) cells migrated in the sclera after bone marrow and HSC transplantation. Transmission and scanning electron microscopy revealed antigen presenting cells among the scleral fibroblasts. In EAU mice, vast infiltration of GFP (+) cells developed into the sclera. Conclusion We have provided direct and novel evidence for the migration of bone marrow and HSC cells into the sclera differentiating into macrophages and dendritic cells. Vast infiltration of bone marrow and HSC cells was found to be part of the inflammatory process in EAU. PMID:17035278

Migration of recharge waters downgradient from the Santa Catalina Mountains into the Tucson basin aquifer, Arizona, USA

NASA Astrophysics Data System (ADS)

Cunningham, Erin E. B.; Long, Austin; Eastoe, Chris; Bassett, R. L.

Aquifers in the arid alluvial basins of the southwestern U.S. are recharged predominantly by infiltration from streams and playas within the basins and by water entering along the margins of the basins. The Tucson basin of southeastern Arizona is such a basin. The Santa Catalina Mountains form the northern boundary of this basin and receive more than twice as much precipitation (ca. 700mm/year) as does the basin itself (ca. 300mm/year). In this study environmental isotopes were employed to investigate the migration of precipitation basinward through shallow joints and fractures. Water samples were obtained from springs and runoff in the Santa Catalina Mountains and from wells in the foothills of the Santa Catalina Mountains. Stable isotopes (δD and δ18O) and thermonuclear-bomb-produced tritium enabled qualitative characterization of flow paths and flow velocities. Stable-isotope measurements show no direct altitude effect. Tritium values indicate that although a few springs and wells discharge pre-bomb water, most springs discharge waters from the 1960s or later. Résumé La recharge des aquifères des bassins alluviaux arides du sud-ouest des États-Unis est assurée surtout à partir des lits des cours d'eau et des playas dans les bassins, ainsi que par l'eau entrant à la bordure de ces bassins. Le bassin du Tucson, dans le sud-est de l'Arizona, est l'un de ceux-ci. La chaîne montagneuse de Santa Catalina constitue la limite nord de ce bassin et reçoit plus de deux fois plus de précipitations (environ 700mm/an) que le bassin (environ 300mm/an). Dans cette étude, les isotopes du milieu ont été utilisés pour analyser le déplacement de l'eau de pluie vers le bassin au travers des fissures et des fractures proches de la surface. Des échantillons d'eau ont été prélevés dans les sources et dans l'écoulement de surface de la chaîne montagneuse et dans des puits au pied de la chaîne. Les isotopes stables (δD et δ18O) et le tritium d'origine thermonucléaire permettent de caractériser qualitativement les cheminements de l'eau et leurs vitesses. Les isotopes stables ne mettent pas en évidence un effet d'altitude. Les teneurs en tritium indiquent que quelques sources et certains puits fournissent une eau ancienne, alors que l'eau de la plupart des sources date des années soixante ou est plus récente. Resumen Los acuíferos en las cuencas aluviales áridas del sudoeste de los Estados Unidos de América se recargan principalmente por la infiltración procedentes de los arroyos y playas de las propias cuencas y por entradas a lo largo de los límites de las mismas. La cuenca de Tucson, en el sudeste de Arizona es una de ellas. Las Montañas de Santa Catalina forman el contorno septentrional de esta cuenca y reciben una precipitación de más del doble (700mm/año) que la media de la propia cuenca (unos 300mm/año). En este estudio, se utilizaron isótopos ambientales para investigar la infiltración a través de fracturas y juntas superficiales. Se obtuvieron muestras de manantiales y de la escorrentía en las Montañas de Santa Catalina, así como de pozos ubicados al pie de las mismas. Los isótopos estables (Deuterio y Oxígeno-18) y el Tritio procedente de las bombas termonucleares permitieron la caracterización cualitativa de las líneas de flujo y de las velocidades. Los datos procedentes de la medida de isótopos estables no parecen presentar un efecto de altitud. Los valores de Tritio indican que aunque algunos pozos y manantiales descargan agua previa a los ensayos termonucleares, la mayoría descargan aguas de fecha posterior a 1960.

Sustainable groundwater resources, Heretaunga Plains, Hawke's Bay, New Zealand

NASA Astrophysics Data System (ADS)

Brown, L. J.; Dravid, P. N.; Hudson, N. A.; Taylor, C. B.

The Heretaunga Plains, Hawke's Bay, New Zealand, is underlain by Quaternary fluvial, estuarine-lagoonal, and marine deposits infilling a subsiding syncline. Within the depositional sequence, river-channel gravels form one of the most important aquifer systems in New Zealand. An interconnected unconfined-confined aquifer system contains groundwater recharged from the Ngaruroro River bed at the inland margin of the plain, 20km from the coast. At the coast, gravel aquifers extend to a depth of 250m. In 1994-95, 66Mm3 of high quality groundwater was ed for city and rural water supply, agriculture, industry, and horticulture. Use of groundwater, particularly for irrigation, has increased in the last 5years. Concern as to the sustainability of the groundwater resource led to a research programme (1991-96). This paper presents the results and recommends specific monitoring and research work to refine the groundwater balance, and define and maintain the sustainable yield of the aquifer system. Three critical management factors are identified. These are (1) to ensure maintenance of consistent, unimpeded groundwater recharge from the Ngaruroro River; (2) to specifically monitor groundwater levels and quality at the margins of the aquifer system, where transmissivity is <5000m2/d and summer groundwater levels indicate that ion exceeds recharge; (3) to review groundwater-quality programs to ensure that areas where contamination vulnerability is identified as being highest are covered by regular monitoring. Résumé Les plaines d'Heretaunga, dans la baie d'Hawke (Nouvelle-Zélande), sont occupées par des dépôts quaternaires fluviaux, estuariens lagunaires et marins remplissant un synclinal subsident. Dans cette séquence de dépôts, des graviers de chenaux fluviatiles forment l'un des plus importants systèmes aquifères de Nouvelle-Zélande. Un système aquifère interconnecté libre et captif contient de l'eau souterraine dont la recharge est assurée à partir du lit de la rivière Ngaruroro sur la marge intérieure de la plaine, à 20km de la côte. Sur la côte, les aquifères des graviers existent à 250m de profondeur. En 1994-95, 66hm3 d'eau souterraine d'excellente qualité ont été extraits pour l'eau potable de villes et de villages, pour l'agriculture, pour l'industrie et pour l'horticulture. L'utilisation de l'eau souterraine, en particulier pour l'irrigation, s'est accrue au cours des 5 dernières années. La prise de conscience du développement durable de la ressource en eau souterraine a conduit à un programme de recherche (1991-96). Cet article présente les résultats de ce programme et recommande les contrôles spécifiques et les travaux de recherche pour affiner le bilan d'eau souterraine, et pour définir et maintenir un rendement durable du système aquifère. Trois facteurs de gestion critique ont été identifiés. Ce sont (1) l'assurance de maintenir une recharge de la nappe conséquente et sans entrave à partir de la rivière Ngaruroro, (2) le suivi spécifique des niveaux de la nappe et de la qualité aux marges du système aquifère, où la transmissivité est inférieure à 5000 m2/j et où les niveaux de la nappe en été indiquent que les prélèvements sont supérieurs à la recharge; et (3) le ré-examen des programmes de qualité de l'eau souterraine pour s'assurer que les zones où la vulnérabilité aux contaminations est identifiée comme étant la plus élevée sont couvertes par une surveillance régulière.

Alternative Treatment in Prostate Pain Syndrome Based on Iranian Traditional Medicine

PubMed Central

Latifi, Seied Amirhossein; Kamalinejad, Mohammad; Minaiee, Bagher; Bahrami, Mohsen; Gooran, Shahram; Nikbakht Nasrabadi, Alireza

2014-01-01

Introduction: Unknown etiology and pathophysiology of prostate pain syndrome (PPS) has led to a lack of proper and competent treatment in modern medicine. According to the guidelines of European Association of Urology (EAU), use of complementary treatments is recommended for PPS. In this preliminary study, analyzing the signs and symptoms of PPS from the viewpoint of Iranian traditional medicine (ITM) was helpful in selecting the appropriate alternative treatment. Case Presentation: Two male patients diagnosed with PPS were evaluated and treated according to the ITM. Each patient took 15 mL oxymel 45 minutes after lunch and dinner. For each patient, four clinical visits were made with one week intervals and the validated Farsi version of international prostate symptom score (IPSS) and numeric pain rating score (NPRS) were completed for them. Conclusions: Considering the fact that other major pathological causes are ruled out, many of the symptoms and signs observed in these patients were similar to those associated with flatulency-related diseases in ITM. Selecting treatment with oxymel was based on this view and led to improvements in the digestive and urinary symptoms according to Farsi version of the IPSS and NPRS. PMID:25237573

Analyse chronometrique intersexes de la resolution de la tache d'horizontalite des liquides

NASA Astrophysics Data System (ADS)

Berthiaume, Francois

D'abondantes recherches ont demontre que la reussite a la tache d'horizontalite des liquides est en moyenne plus elevee chez les individus de sexe masculin que chez ceux de sexe feminin. Deux facteurs principaux ont ete proposes: il s'agit de la connaissance du principe physique de l'invariance de l'orientation des liquides et de certaines habiletes perceptives d'ordre visuel. Le but de la presente recherche est d'etablir la duree detaillee de la resolution de la tache d'horizontalite des liquides chez 185 filles et 180 garcons, ages de 15 a 19 ans et repartis en 8 groupes. Dans une version informatisee, le premier groupe trace la position de la surface de l'eau a l'interieur d'un contenant dans diverses inclinaisons et le deuxieme evalue si l'orientation d'une ligne y represente bien cette position; le troisieme groupe trace une horizontale dans un rectangle et le quatrieme juge si la ligne illustree y est bien horizontale. Quatre autres groupes executent respectivement les memes taches dans la version classique papier-crayon. Le temps accorde a la reflexion avant de commencer le trace, le temps de tracage comme tel et le temps de verification du trace complete sont calcules. Chez les groupes qui evaluent l'orientation d'une ligne sur support informatique, le temps requis pour y parvenir est note. Enfin, un questionnaire estime si les participants connaissent ou non le principe physique d'invariance de l'orientation de la surface d'un liquide. Les resultats revelent que cette connaissance est plus frequente chez les garcons dans l'ensemble des groupes. Dans le cas ou les sujets ont a tracer une ligne, les filles reussissent moins d'essais que les garcons s'il faut, sur support informatique, tracer la surface de l'eau dans un contenant incline ou a l'horizontale. Il en va de meme s'il faut, sur support papier, tracer une horizontale dans un contenant incline. Le trace de la surface de l'eau est plus exact chez les sujets connaissant le principe d'invariance et l'ecart intersexes disparait si l'analyse tient compte de cette connaissance. Sur le plan du temps de reponse, les deux sexes ne se distinguent que lors du trace de la surface de l'eau dans un contenant incline, les garcons reflechissant alors plus longtemps. Le temps mis a produire, puis a verifier un trace, ne differe pas selon le sexe des participants. Dans l'evaluation de l'orientation d'une ligne cependant, les filles ne se distinguent pas des garcons et les participants connaissant le principe d'invariance reussissent mieux que ceux l'ignorant. Par ailleurs, les filles procedent toujours moins rapidement que les garcons. Pour les contenants inclines ou a l'horizontale, si la ligne represente la surface de l'eau, la difference intersexes est annulee quand la connaissance du principe est prise en compte. (Abstract shortened by UMI.)

Quaternary Aquifer of the North China Plain-assessing and achieving groundwater resource sustainability

NASA Astrophysics Data System (ADS)

Foster, Stephen; Garduno, Hector; Evans, Richard; Olson, Doug; Tian, Yuan; Zhang, Weizhen; Han, Zaisheng

The Quaternary Aquifer of the North China Plain is one of the world's largest aquifer systems and supports an enormous exploitation of groundwater, which has reaped large socio-economic benefits in terms of grain production, farming employment and rural poverty alleviation, together with urban and industrial water-supply provision. Both population and economic activity have grown markedly in the past 25 years. Much of this has been heavily dependent upon groundwater resource development, which has encountered increasing difficulties in recent years primarily as a result of aquifer depletion and related phenomena. This paper focuses upon the hydrogeologic and socio-economic diagnosis of these groundwater resource issues, and identifies strategies to improve groundwater resource sustainability. L'aquifère Quaternaire de la Plaine du Nord de la Chine est l'un des plus grands systèmes aquifères du monde; il permet une exploitation énorme d'eau souterraine, qui a permis des très importants bénéfices socio-économiques en terme de production de céréales, d'emplois ruraux et de réduction de la pauvreté rurale, en même temps que l'approvisionnement en eau potable et pour l'industrie. La population comme l'activité économique ont remarquablement augmenté au cours de ces 25 dernières années. Elles ont été sous la forte dépendance du développement de la ressource en eau souterraine, qui a rencontré des difficultés croissantes ces dernières années, du fait du rabattement de l'aquifère et des phénomènes associés. Cet article est consacré aux diagnostiques hydrogéologique et socio-économique des retombées de cette ressource en eau souterraine; il identifie les stratégies pour améliorer la pérennité des ressources en eau souterraine. El acuífero cuaternario de la Llanura Septentrional de China es uno de los mayores sistemas acuíferos del mundo y soporta una enorme explotación de su agua subterránea, las cuales han originado grandes beneficios socioeconómicos en términos de producción de grano, empleo en agricultura y mitigación de la pobreza rural, además de proveer agua para abastecimiento urbano e industria. Tanto la población como la actividad económica han crecido mucho en los últimos 25 años con una gran dependencia de las aguas subterráneas, que ha encontrado dificultades recientes por la explotación intensiva del acuífero y fenómenos relacionados. Este artículo se centra en la diagnosis hidrogeológica y socioeconómica de los problemas relacionados con las aguas subterráneas e identifica estrategias para mejorar la sustentabilidad de este recurco.

The role of economic analysis in groundwater management in semi-arid regions: the case of Nigeria

NASA Astrophysics Data System (ADS)

Acharya, Gayatri

The aim of this paper is to use an economic framework to derive decision making rules for river basin management with a focus on groundwater resources. Using an example from northern Nigeria, the paper provides an example of how decision making for sustainable water resources management may be facilitated by comparing net benefits and costs across a river basin. It is argued that economic tools can be used to assess the value of water resources in different uses, identify and analyze management scenarios, and provide decision rules for the sustainable use and management of surface and ground water resources in the region. L'objet de cet article est l'utilisation d'un cadre économique pour établir des règles de prise de décision pour la gestion d'un bassin versant prenant en compte les ressources en eau souterraine. À partir d'un exemple du Nigéria septentrional, cet article explique comment une prise de décision pour la gestion durable de ressources en eau peut être facilitée en comparant les bénéfices nets et les coûts sur tout le bassin versant. Il est montré que les outils économiques peuvent être utilisés pour établir la valeur des ressources en eau dans les différents usages, pour identifier et analyser des scénarios de gestion et pour fournir des règles de décision pour un usage et une gestion durables des ressources en eaux de surface et souterraines dans la région. El objetivo de este artículo es utilizar un enfoque económico para deducir reglas de toma de decisión en la gestión de cuencas, haciendo énfasis en los recursos subterráneos. Por medio de un ejemplo del Norte de Nigeria, se ilustra cómo la toma de decisiones orientadas a la gestión sustentable de los recursos hídricos puede ser facilitada si se compara los beneficios netos y los costes en toda la cuenca. Se argumenta que las herramientas económicas pueden servir para establecer el valor de los recursos hídricos destinados a usos diferentes, para identificar y analizar escenarios de gestión, y para proporcionar reglas de decisión que posibiliten el uso sustentable y la gestión de los recursos superficiales y subterráneos en la región.

40 CFR 81.350 - Wisconsin.

Code of Federal Regulations, 2011 CFR

2011-07-01

... County X Buffalo County X Chippewa County X Clark County X Crawford County X Dunn County X Eau Claire... Unclassifiable/Attainment Chippewa County Unclassifiable/Attainment Clark County Unclassifiable/Attainment... Unclassifiable/Attainment Chippewa County Unclassifiable/Attainment Clark County Unclassifiable/Attainment...

40 CFR 81.350 - Wisconsin.

Code of Federal Regulations, 2010 CFR

2010-07-01

... County X Buffalo County X Chippewa County X Clark County X Crawford County X Dunn County X Eau Claire... Unclassifiable/Attainment Chippewa County Unclassifiable/Attainment Clark County Unclassifiable/Attainment... Unclassifiable/Attainment Chippewa County Unclassifiable/Attainment Clark County Unclassifiable/Attainment...

L'astronomie dans le monde

NASA Astrophysics Data System (ADS)

Manfroid, J.

2016-06-01

Chocs d’amas - Amas de galaxies - Halos sur Pluton - Makémaké - Comète sans queue – Titan – Planètes Kepler - Transit de Mercure - Quatre lasers au-dessus de Paranal – NGC 1332 - Eau sur Mars

RCT of a Promising Vocational/Employment Program for High-Risk Juvenile Offenders

PubMed Central

Schaeffer, Cindy M.; Henggeler, Scott W.; Ford, Julian D.; Mann, Marc; Chang, Rocio; Chapman, Jason E.

2013-01-01

Juvenile offenders with substance use problems are at high risk for deleterious long-term outcomes. This study evaluated the capacity of a promising vocational and employment training program in the building sector (i.e., Community Restitution Apprenticeship-Focused Training, CRAFT) to mitigate such outcomes through enhanced employment and education. Participants were 97 high-risk juvenile offenders (mean age = 15.8 years) randomized to CRAFT versus education as usual (EAU) intervention conditions. Multi-method procedures measured employment, education, substance use, mental health, and criminal outcomes through a 30-month post-baseline follow-up. CRAFT was significantly more effective than EAU at increasing rates of youth employment and GED attendance. Intervention effects were not observed, however, for months employed, hours worked, or hourly wage. Measures of youth substance use, mental health symptoms, and criminal activity showed no favorable or iatrogenic effects. The potential of CRAFT was modestly supported, and suggestions were made for future research. PMID:23958035

Dietary Omega-3 Fatty Acids Suppress Experimental Autoimmune Uveitis in Association with Inhibition of Th1 and Th17 Cell Function

PubMed Central

Shoda, Hiromi; Yanai, Ryoji; Yoshimura, Takeru; Nagai, Tomohiko; Kimura, Kazuhiro; Sobrin, Lucia; Connor, Kip M.; Sakoda, Yukimi; Tamada, Koji; Ikeda, Tsunehiko; Sonoda, Koh-Hei

2015-01-01

Omega (ω)–3 long-chain polyunsaturated fatty acids (LCPUFAs) inhibit the production of inflammatory mediators and thereby contribute to the regulation of inflammation. Experimental autoimmune uveitis (EAU) is a well-established animal model of autoimmune retinal inflammation. To investigate the potential effects of dietary intake of ω-3 LCPUFAs on uveitis, we examined the anti-inflammatory properties of these molecules in comparison with ω-6 LCPUFAs in a mouse EAU model. C57BL/6 mice were fed a diet containing ω-3 LCPUFAs or ω-6 LCPUFAs for 2 weeks before as well as after the induction of EAU by subcutaneous injection of a fragment of human interphotoreceptor retinoid-binding protein emulsified with complete Freund’s adjuvant. Both clinical and histological scores for uveitis were smaller for mice fed ω-3 LCPUFAs than for those fed ω-6 LCPUFAs. The concentrations of the T helper 1 (Th1) cytokine interferon-γ and the Th17 cytokine interleukin-17 in intraocular fluid as well as the production of these cytokines by lymph node cells were reduced for mice fed ω-3 LCPUFAs. Furthermore, the amounts of mRNAs for the Th1- and Th17-related transcription factors T-bet and RORγt, respectively, were reduced both in the retina and in lymph node cells of mice fed ω-3 LCPUFAs. Our results thus show that a diet enriched in ω-3 LCPUFAs suppressed uveitis in mice in association with inhibition of Th1 and Th17 cell function. PMID:26393358

The Adoption of Roles by Primary Care Providers during Implementation of the New Chronic Disease Guidelines in Urban Mongolia: A Qualitative Study.

PubMed

Chimeddamba, Oyun; Ayton, Darshini; Bazarragchaa, Nansalmaa; Dorjsuren, Bayarsaikhan; Peeters, Anna; Joyce, Catherine

2016-04-07

(1) BACKGROUND: In 2011, new chronic disease guidelines were introduced across Mongolia. No formal advice was provided regarding role delineation. This study aimed to analyse the roles that different primary care providers adopted, and the variations in these, in the implementation of the guidelines in urban Mongolia; (2) METHODS: Ten group interviews with nurses and ten individual interviews each with practice doctors and practice directors were conducted. Data was analysed using a thematic approach based on the identified themes relevant to role delineation; (3) RESULTS: There was some variability and flexibility in role delineation. Factors involving teamwork, task rotation and practice flexibility facilitated well the guideline implementation. However, factors including expectations and decision making, nursing shortage, and training gaps adversely influenced in the roles and responsibilities. Some role confusion and dissatisfaction was identified, often associated with a lack of training or staff turnover; (4) CONCLUSIONS: Findings suggest that adequate ongoing training is required to maximize the range of roles particular provider types, especially primary care nurses, are competent to perform. Ensuring that role delineation is specified in guidelines could remove confusion and enhance implementation of such guidelines.

Regionalized rainfall-runoff model to estimate low flow indices

NASA Astrophysics Data System (ADS)

Garcia, Florine; Folton, Nathalie; Oudin, Ludovic

2016-04-01

Estimating low flow indices is of paramount importance to manage water resources and risk assessments. These indices are derived from river discharges which are measured at gauged stations. However, the lack of observations at ungauged sites bring the necessity of developing methods to estimate these low flow indices from observed discharges in neighboring catchments and from catchment characteristics. Different estimation methods exist. Regression or geostatistical methods performed on the low flow indices are the most common types of methods. Another less common method consists in regionalizing rainfall-runoff model parameters, from catchment characteristics or by spatial proximity, to estimate low flow indices from simulated hydrographs. Irstea developed GR2M-LoiEau, a conceptual monthly rainfall-runoff model, combined with a regionalized model of snow storage and melt. GR2M-LoiEau relies on only two parameters, which are regionalized and mapped throughout France. This model allows to cartography monthly reference low flow indices. The inputs data come from SAFRAN, the distributed mesoscale atmospheric analysis system, which provides daily solid and liquid precipitation and temperature data from everywhere in the French territory. To exploit fully these data and to estimate daily low flow indices, a new version of GR-LoiEau has been developed at a daily time step. The aim of this work is to develop and regionalize a GR-LoiEau model that can provide any daily, monthly or annual estimations of low flow indices, yet keeping only a few parameters, which is a major advantage to regionalize them. This work includes two parts. On the one hand, a daily conceptual rainfall-runoff model is developed with only three parameters in order to simulate daily and monthly low flow indices, mean annual runoff and seasonality. On the other hand, different regionalization methods, based on spatial proximity and similarity, are tested to estimate the model parameters and to simulate low flow indices in ungauged sites. The analysis is carried out on 691 French catchments that are representative of various hydro-meteorological behaviors. The results are validated with a cross-validation procedure and are compared with the ones obtained with GR4J, a conceptual rainfall-runoff model, which already provides daily estimations, but involves four parameters that cannot easily be regionalized.

Managing for sustainability in an arid climate: lessons learned from 20 years of groundwater management in Arizona, USA

NASA Astrophysics Data System (ADS)

Jacobs, Katharine L.; Holway, James M.

Substantial progress has been made within central Arizona in moving towards a more sustainable water future, particularly in transitioning the urban demand from a primarily nonrenewable groundwater-based supply to increasing dependence on the Colorado River, Salt River and effluent. Management efforts include a wide range of regulatory and voluntary programs which have had mixed success. The Department of Water Resources has learned a number of key lessons throughout the years, and this paper attempts to establish the water management context and identify those lessons for the benefit of others who may want to evaluate alternative approaches to groundwater management. Themes to be discussed include evaluating water management approaches in a public policy context, the effectiveness of alternative management approaches and the relative merits of regulatory vs. nonregulatory efforts, and the importance of high-quality data in making management decisions. De nets progrès ont été faits dans le centre de l'Arizona pour aller vers une gestion plus durable de l'eau, en particulier en reportant la demande urbaine d'une alimentation basée sur l'eau souterraine primitivement non renouvelable sur une dépendance croissante des rivières Colorado et Salt et des effluents. Les efforts de gestion portent sur une large gamme de programmes de réglementation et d'actions volontaires qui ont réussi. Le Département des Ressources en Eau a appris un certain nombre de leçons clés au cours des années cet article tente d'établir le contexte de gestion de l'eau et d'identifier ces leçons pour le bénéfice de ceux qui cherchent à évaluer des approches alternatives de gestion de l'eau souterraine. Les thèmes à discuter portent sur l'évaluation des approches de gestion de l'eau dans un contexte de politique publique, l'efficacité d'approches alternatives de gestion et les mérites relatifs d'efforts de réglementation par rapport à une absence de réglementation, et l'importance de données de haute qualité dans la prise de décisions de gestion. Resumen Se ha logrado un progreso substancial en el centro de Arizona para conseguir un futuro más sustentable del agua, particularmente al trasladar la demanda urbana desde un suministro basado principalmente en aguas subterráneas no renovables hacia una mayor dependencia de las aguas superficiales de los ríos Colorado y Salado y de los efluentes de aguas depuradas. Los esfuerzos de gestión incluyen un amplio rango de programas legales y voluntarios que han tenido un éxito combinado. El Departamento de Recursos Hídricos ha aprendido diversas lecciones clave a lo largo de los años, y este artículo intenta establecer el contexto de la gestión del agua e identificar lo averiguado para beneficio de terceros que quieran evaluar enfoques alternativos para gestionar las aguas subterráneas. Entre los temas tratados, destaca la evaluación de los enfoques de gestión del agua en un contexto político público, la efectividad de enfoques alternativos de gestión y los méritos relativos de los esfuerzos regulativos y no regulativos, y la importancia de los datos de alta calidad para la toma de decisiones de gestión. Groundwater use in many areas of Arizona greatly exceeds the natural replenishment of the aquifer, so although a portion of the groundwater use is renewable, the majority is not.

75 FR 21042 - Notice of Determinations Terminating Investigations of Petitions Regarding Eligibility To Apply...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

..., Michigan. TA-W-72,042: Align Technology, Santa Clara, California. TA-W-72,173: Reliant Machine, Inc., Green...: Hutchinson Technology, Eau Claire, Wisconsin. TA-W-72,685: First Data Corp., Daytona Beach, Florida. TA-W-72...

L'astronomie dans le monde

NASA Astrophysics Data System (ADS)

Manfroid, J.

2009-06-01

L'ESA en route vers les origines de l'univers; Record de distance; Blob primordial; Novae; Expansion de l'univers; Plat ou pas?; L'eau sur Mars; Bombardement massif; M87; CoRoT; EX Lupi; Première pour ALMA; Kohoutek 4-55; Arp 194

24 CFR 3280.305 - Structural design requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., Plaquemines, St. Bernard, St. Charles, St. Mary, and Terrabonne. North Carolina: Carteret, Dare, and Hyde. (iv... Sherburne Steele Jackson Morrison Anoka Freeborn Nobles Douglas Chisapo Faribault Rock Grant Washington... Douglas Oconto Pepin Lincoln Bayfield Menominee Pierce Oneida Ashland Langlade Dunn Polk Iron Marathon Eau...

24 CFR 3280.305 - Structural design requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., Plaquemines, St. Bernard, St. Charles, St. Mary, and Terrabonne. North Carolina: Carteret, Dare, and Hyde. (iv... Sherburne Steele Jackson Morrison Anoka Freeborn Nobles Douglas Chisapo Faribault Rock Grant Washington... Douglas Oconto Pepin Lincoln Bayfield Menominee Pierce Oneida Ashland Langlade Dunn Polk Iron Marathon Eau...

Mesenchymal stem cells induce functionally active T-regulatory lymphocytes in a paracrine fashion and ameliorate experimental autoimmune uveitis.

PubMed

Tasso, Roberta; Ilengo, Cristina; Quarto, Rodolfo; Cancedda, Ranieri; Caspi, Rachel R; Pennesi, Giuseppina

2012-02-01

Mesenchymal stem/progenitor cells (MSCs) have regenerative and immunomodulatory properties, exerted by cell-cell contact and in a paracrine fashion. Part of their immunosuppressive activity has been ascribed to their ability to promote the induction of CD4+CD25+FoxP3+ T lymphocytes with regulatory functions (Treg). Here the authors studied the effect of MSCs on the induction of Treg and on the development of autoimmunity, and they examined the possibility that MSC-mediated Treg induction could be attributed to the secretion of soluble factors. The authors induced experimental autoimmune uveitis (EAU) in mice by immunization with the 1-20 peptide of the intraphotoreceptor binding protein. At the same time, some of the animals were treated intraperitoneally with syngeneic MSCs. The authors checked T-cell responses and in vitro Treg conversion by cell proliferation and blocking assays, in cell-cell contact and transwell settings. TGFβ and TGFβ receptor gene expression analyses were performed by real-time PCR. The authors found that a single intraperitoneal injection of MSCs was able to significantly attenuate EAU and that a significantly higher percentage of adaptive Treg was present in MSC-treated mice than in MSC-untreated animals. In vitro blocking of antigen presentation by major histocompatibility complex class II precluded priming and clonal expansion of antigen-specific Treg, whereas blockade of TGFβ impaired the expression of FoxP3, preventing the conversion of CD4+ T cells into functionally active Treg. The authors demonstrated that MSCs can inhibit EAU and that their immunomodulatory function is due at least in part to the induction of antigen-specific Treg in a paracrine fashion by secreting TGFβ.

Risk Group Systems for Penile Cancer Management: A Study of 203 Patients With Invasive Squamous Cell Carcinoma.

PubMed

Chaux, Alcides

2015-10-01

To evaluate the accuracy of previously published risk group systems for predicting inguinal nodal metastases in patients with penile carcinoma. Two hundred three cases of invasive penile squamous cell carcinomas (SCC) were stratified using the following systems: Solsona et al (J Urol 2001;165:1509), Hungerhuber et al (Urology 2006;68:621), and the system proposed by the European Association of Urology (EAU; Eur Urol 2004;46:1). Receiver operating characteristic (ROC) analysis was carried out to compare accuracy in predicting final nodal status and cancer-related death. Most of cases were pT2/pT3 high-grade tumors with a small percentage of low-grade pT1 carcinomas. The metastatic rates for the Solsona et al, EAU, and Hungerhuber et al systems in the high-risk category were 15 of 73 (21%), 16 of 103 (16%), and 10 of 35 (29%) in patients with clinically negative inguinal lymph nodes and 52 of 75 (69%), 55 of 93 (59%), and 34 of 47 (72%) in patients with palpable inguinal lymph nodes, respectively. Performance by ROC analysis showed a low accuracy for all stratification systems although the Solsona et al and the Hungerhuber et al systems performed better than the EAU system. Patients in intermediate-risk categories and with clinically palpable inguinal lymph nodes were more likely to have nodal metastasis than patients with clinically negative lymph nodes in the same category. These stratification systems may be useful for patients with low-grade superficial tumors and less accurate for evaluating patients with high-grade locally advanced penile carcinomas. These data may be useful for therapeutic planning of patients with penile SCC. Copyright © 2015 Elsevier Inc. All rights reserved.

In Vivo Bioluminescence Imaging for Longitudinal Monitoring of Inflammation in Animal Models of Uveitis.

PubMed

Gutowski, Michal B; Wilson, Leslie; Van Gelder, Russell N; Pepple, Kathryn L

2017-03-01

We develop a quantitative bioluminescence assay for in vivo longitudinal monitoring of inflammation in animal models of uveitis. Three models of experimental uveitis were induced in C57BL/6 albino mice: primed mycobacterial uveitis (PMU), endotoxin-induced uveitis (EIU), and experimental autoimmune uveitis (EAU). Intraperitoneal injection of luminol sodium salt, which emits light when oxidized, provided the bioluminescence substrate. Bioluminescence images were captured by a PerkinElmer In Vivo Imaging System (IVIS) Spectrum and total bioluminescence was analyzed using Living Image software. Bioluminescence on day zero was compared to bioluminescence on the day of peak inflammation for each model. Longitudinal bioluminescence imaging was performed in EIU and EAU. In the presence of luminol, intraocular inflammation generates detectable bioluminescence in three mouse models of uveitis. Peak bioluminescence in inflamed PMU eyes (1.46 × 105 photons/second [p/s]) was significantly increased over baseline (1.47 × 104 p/s, P = 0.01). Peak bioluminescence in inflamed EIU eyes (3.18 × 104 p/s) also was significantly increased over baseline (1.09 × 104 p/s, P = 0.04), and returned to near baseline levels by 48 hours. In EAU, there was a nonsignificant increase in bioluminescence at peak inflammation. In vivo bioluminescence may be used as a noninvasive, quantitative measure of intraocular inflammation in animal models of uveitis. Primed mycobacterial uveitis and EIU are both acute models with robust anterior inflammation and demonstrated significant changes in bioluminescence corresponding with peak inflammation. Experimental autoimmune uveitis is a more indolent posterior uveitis and generated a more modest bioluminescent signal. In vivo imaging system bioluminescence is a nonlethal, quantifiable assay that can be used for monitoring inflammation in animal models of uveitis.

Long-Term Therapeutic Effects of Mesenchymal Stem Cells Compared to Dexamethasone on Recurrent Experimental Autoimmune Uveitis of Rats

PubMed Central

Zhang, Lingjun; Zheng, Hui; Shao, Hui; Nian, Hong; Zhang, Yan; Bai, Lingling; Su, Chang; Liu, Xun; Dong, Lijie; Li, Xiaorong; Zhang, Xiaomin

2014-01-01

Purpose. We tested the long-term effects of different regimens of mesenchymal stem cell (MSC) administration in a recurrent experimental autoimmune uveitis (rEAU) model in rats, and compared the efficacy of MSC to that of dexamethasone (DEX). Methods. One or two courses of MSC treatments were applied to R16-specific T cell–induced rEAU rats before or after disease onsets. The DEX injections were given for 7 or 50 days continuously after disease onsets. Clinical appearances were observed until the 50th day after transfer. On the 10th day, T cells from control and MSC groups were analyzed by flow cytometry. Supernatants from the proliferation assay and aqueous humor were collected for cytokine detection. Functions of T cells and APCs in spleens also were studied by lymphocyte proliferation assays. Results. One course of MSC therapy, administered after disease onset, led to a lasting therapeutic effect, with a decreased incidence, reduced mean clinical score, and reduced retinal impairment after 50 days of observation, while multiple courses of treatment did not improve the therapeutic benefit. Although DEX and MSCs equally reduced the severity of the first episode of rEAU, the effect of DEX was shorter lasting, and DEX therapy failed to control the disease even with long periods of treatment. The MSCs significantly decreased T helper 1 (Th1) and Th17 responses, suppressed the function of antigen-presenting cells, and upregulated T regulatory cells. Conclusions. These results suggested that MSCs might be new corticosteroid spring agents, while providing fewer side effects and longer lasting suppressive effects for recurrent uveitis. PMID:25125599

Origin and heterogeneity of pore sizes in the Mount Simon Sandstone and Eau Claire Formation: Implications for multiphase fluid flow

DOE PAGES

Mozley, Peter S.; Heath, Jason E.; Dewers, Thomas A.; ...

2016-01-01

The Mount Simon Sandstone and Eau Claire Formation represent a principal reservoir - caprock system for wastewater disposal, geologic CO 2 storage, and compressed air energy storage (CAES) in the Midwestern United States. Of primary concern to site performance is heterogeneity in flow properties that could lead to non-ideal injectivity and distribution of injected fluids (e.g., poor sweep efficiency). Using core samples from the Dallas Center Structure, Iowa, we investigate pore structure that governs flow properties of major lithofacies of these formations. Methods include gas porosimetry and permeametry, mercury intrusion porosimetry, thin section petrography, and X-ray diffraction. The lithofacies exhibitmore » highly variable intra- and inter-informational distributions of pore throat and body sizes. Based on pore-throat size, samples fall into four distinct groups. Micropore-throat dominated samples are from the Eau Claire Formation, whereas the macropore-, mesopore-, and uniform-dominated samples are from the Mount Simon Sandstone. Complex paragenesis governs the high degree of pore and pore-throat size heterogeneity, due to an interplay of precipitation, non-uniform compaction, and later dissolution of cements. Furthermore, the cement dissolution event probably accounts for much of the current porosity in the unit. The unusually heterogeneous nature of the pore networks in the Mount Simon Sandstone indicates that there is a greater-than-normal opportunity for reservoir capillary trapping of non-wetting fluids — as quantified by CO 2 and air column heights — which should be taken into account when assessing the potential of the reservoir-caprock system for CO 2 storage and CAES.« less

Etude de l'influence de la temperature et de l'humidite sur les proprietes mecaniques en traction des fibres de chanvre et de coco

NASA Astrophysics Data System (ADS)

Ho Thi, Thu Nga

L'objectif de cette etude fut d'etablir l'effet de l'humidite et de la temperature sur la resistance en traction et le module elastique des fibres de chanvre et de coco. Deux etudes ont ete realisees afin d'atteindre cet objectif. La premiere vise l'absorption de l'humidite dans ces fibres en exposition dans l'air (de 0%RH a 80%RH) ainsi que l'absorption de l'eau dans ces fibres immergees dans l'eau aux differentes temperatures. La deuxieme consiste a mesurer la resistance en traction et le module elastique de ces fibres sous differentes conditions d'humidite et de temperature. En basant sur les resultats experimentaux obtenus, les methodes semi empiriques et de reseaux de neurones ont ete utilisees pour but de predire les proprietes en traction (resistance et module d'elasticite) des fibres de chanvre et de coco sous l'influence de l'humidite et de la temperature.

Study of the Tributyl Phosphate--30 Percent Dodecane Solvent; ETUDE DU SOLVANT PHOSPHATE TRIBUTYLIQUE 30 PERCENT--DODECANE (in French)

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

Leroy, P.

1967-07-01

This study, originating mainly from a literature survey, gives the principal chemical and physical features of the tributyl-phosphate (TBP) agent diluted at 30 volumes per cent in dodecane. The mixture is a very commonly used extractant in nuclear fuel processing. In this paper, the main following points are reported: -) the components (TBP and diluents) -) the TBP-diluents systems (non-loaded), -) the TBP-diluents-water systems, -) TBP-diluents-water-nitric acid systems, and -) industrial solvents. (author) [French] Cette etude, d'origine bibliographique, regroupe les caracteristiques physico-chimiques essentielles du phosphate tributylique (TBP) dilue a 30% en volume dans du dodecane. Ce melange constitue un agentmore » d'extraction tres utilise dans le traitement des combustibles nucleaires. Les principaux points traites sont les suivants: -) les constituants (TBP et diluants), -) les systemes TBP-diluants non charges, -) les systemes TBP-diluants-eau, -) les systemes TBP-diluants-eau-acide nitrique, et -) les solvants industriels. (auteur)« less

Cosmet'eau-Changes in the personal care product consumption practices: from whistle-blowers to impacts on aquatic environments.

PubMed

Bressy, Adèle; Carré, Catherine; Caupos, Émilie; de Gouvello, Bernard; Deroubaix, José-Frédéric; Deutsch, Jean-Claude; Mailler, Romain; Marconi, Anthony; Neveu, Pascale; Paulic, Laurent; Pichon, Sébastien; Rocher, Vincent; Severin, Irina; Soyer, Mathilde; Moilleron, Régis

2016-07-01

The Cosmet'eau project (2015-2018) investigates the "changes in the personal care product (PCP) consumption practices: from whistle-blowers to impacts on aquatic environments." In this project, the example of PCPs will be used to understand how public health concerns related to micropollutants can be addressed by public authorities-including local authorities, industries, and consumers. The project aims to characterize the possible changes in PCP consumption practices and to evaluate the impact of their implementation on aquatic contamination. Our goals are to study the whistle-blowers, the risk perception of consumers linked with their practices, and the contamination in parabens and their substitutes, triclosan, and triclocarban from wastewater to surface water. The project investigates the following potential solutions: modifications of industrial formulation or changes in consumption practices. The final purpose is to provide policy instruments for local authorities aiming at building effective strategies to fight against micropollutants in receiving waters.

[Non-Antibiotic Strategies to Prevent the Recurrence of Uncomplicated Urinary Tract Infections in Women].

PubMed

Bauer, H W; Bessler, W G

2016-05-01

The aim of all medical treatment is "primum nihil nocere" ("First, do no harm").Restoring the integrity of intestinal microbiota and optimising the immune response in recurrent infections, especially in the urinary tract, are treatment alternatives which are closer to this target than the usual focus on antibiotic prevention of recurrence.In the future, antibiotics will continue to be recommended for the prevention of urinary tract infections on a case-by-case basis. However, the problems of an excessive use of antibiotics, e. g. resistance and long-term interference with intestinal microbiota, are forcing us to search for alternatives. The use of probiotics alone or in combination with immunotherapeutics, or the sole use of immunotherapeutics, are important treatment options, which are already routinely available in clinical practice. These therapies are focused on the pathomechanism of an infection and tackle the root cause of the problem. Phytotherapeutics or small molecules like mannose, which restricts the adherence of bacteria to the urothelium, are complementary approaches.The EAU guidelines recommend the following treatments for the long-term prevention of urinary tract infections:Oral and parenteral immunostimulants (StroVac(®)), local estrogen replacement and administration of Lactobacillus rhamnosus and Lactobacillus reuteri. © Georg Thieme Verlag KG Stuttgart · New York.

Implementation of Theeuropeanwater Framework Directive In France: New Challenges For River Basin Organisat Ion, Planning and Participation

NASA Astrophysics Data System (ADS)

Allain, S.

The European Water Framework Directive (2000/60/EC) establishes a system of participatory river basin planning for national and international basins. The French institutional framework for water management is already very close to this system: the 1964 Water Law actually set up basin bodies, the Agences de l'Eau ("Water Agencies"), at the level of large river basins, and multipartite basin commissions, the Comités de Bassin ("River Basin Authorities"), in order to monitor the Agences de l'Eau's policies; besides, the 1992 Water Law created a planning procedure at this level, the Schéma Directeur d'Aménagement et de Gestion des Eaux (SDAGE : "General Water Management Plan"), aiming to determine general orientations for the management of water resources and having to be defined by the Comités de Bassin. At first glance therefore, the implementation of the European Water Framework Directive should not raise a lot of problems in France. However, a quick analysis of the current situation shows that it is not so obvious : if the French Water Policy set up two basin organisations, neither of them deals concretely with the management of the water resources, and the implementation of water management plans depends on many stakeholders; the SDAGE itself only partially meets the demands of the Directive, regarding e. g. the economic analysis; finally, in spite of the creation of multipartite basin commissions, the public participation is very restricted. Such an analysis leads to pay more attention to the relations to establish between organisation, planning and participation at the level of large river basins. An analysis of other elements of the French institutional framework can help us in this way : another planning procedure was actually created by the 1992 Water Law, the Schéma d'Aménagement et de Gestion des Eaux (SAGE : "Water Management Plan"), aiming to fix general objectives to manage the water resources at the level of small river basins, and having to be defined and implemented by a new tripartite entity, the Commission Locale de l'Eau (CLE : Local Water Commission), which can be considered as a real river basin organisation; an empirical analysis of the implementation of such a procedure can offer therefore many new insights and the paper will present the results of an analysis of 10 case studies. But it will be also necessary to put such an experience side by side with the political will to develop public debates and to extend the roles of the Commission Nationale du Débat Public ("Public Debate National Commission").

The Period of 2167 Erin

NASA Astrophysics Data System (ADS)

Montigiana, N.; Benedetti, W.; Mannucci, M.; Riccetti, S.

2008-09-01

Analysis of data taken in March and April 2007 by groups from Osservatorio Astronomico Margherita Hack and the University of Wisconsin-Eau Claire indicates a likely period of 5.7186 ± 0.0001 h for 2167 Erin. The amplitude of the lightcurve was 0.53 ± 0.02 mag.

Super Science Saturdays: Developing Hawaii's Natural Treasures.

ERIC Educational Resources Information Center

Hapai, Marlene Nachbar; Sing, David Kekaulike

1994-01-01

Takes a closer look at Super Science Saturday, held by the Center for Gifted and Talented Native Hawaiian Children/University of Hawaii at Hilo. These children are known to Hawaiians as Na Pua No'eau, which refers to Hawaii's children as "flowers blossoming toward self-discovery." (ZWH)

A Low Concentration of Tacrolimus/Semifluorinated Alkane (SFA) Eyedrop Suppresses Intraocular Inflammation in Experimental Models of Uveitis.

PubMed

De Majumdar, S; Subinya, M; Korward, J; Pettigrew, A; Scherer, D; Xu, H

2017-01-01

Corticosteroids remain the mainstay therapy for uveitis, a major cause of blindness in the working age population. However, a substantial number of patients cannot benefit from the therapy due to steroids resistance or intolerance. Tacrolimus has been used to treat refractory uveitis through systemic administration. The aim of this study was to evaluate the therapeutic potential of 0.03% tacrolimus eyedrop in mouse models of uveitis. 0.03% tacrolimus in perfluorobutylpentane (F4H5) (0.03% Tacrolimus/SFA) was formulated using a previously published protocol. Tacrolimus suspended in PBS (0.03% Tacrolimus/PBS) was used as a control. In addition, 0.1% dexamethasone (0.1% DXM) was used as a standard therapy control. Endotoxin-induced uveitis (EIU) and experimental autoimmune uveoretinitis (EAU) were induced in adult C57BL/6 mice using protocols described previously. Mice were treated with eyedrops three times/day immediately after EIU induction for 48 h or from day 14 to day 25 post-immunization (for EAU). Clinical and histological examinations were conducted at the end of the experiment. Pharmacokinetics study was conducted in mice with and without EIU. At different times after eyedrop treatment, ocular tissues were collected for tacrolimus measurement. The 0.03% Tacrolimus/SFA eyedrop treatment reduced the clinical scores and histological scores of intraocular inflammation in both EIU and EAU to the levels similar to 0.1% DXM eyedrop treatment. The 0.03% Tacrolimus/PBS did not show any suppressive effect in EIU and EAU. Pharmacokinetic studies showed that 15 min after topical administration of 0.03% Tacrolimus/SFA, low levels of tacrolimus were detected in the retina (48 ng/g tissue) and vitreous (2.5 ng/ml) in normal mouse eyes, and the levels were significantly higher in EIU eyes (102 ng/g tissue in the retina and 24 ng/ml in the vitreous). Tacrolimus remained detectable in intraocular tissues of EIU eyes 6 h after topical administration (68 ng/g retinal tissue, 10 ng/ml vitreous). Only background levels of tacrolimus were detected in the retina (2-8 ng/g tissue) after 0.03% Tacrolimus/PBS eyedrop administration. 0.03% Tacrolimus/SFA eyedrop can penetrate ocular barrier and reach intraocular tissue at therapeutic levels in mouse eyes, particularly under inflammatory conditions. 0.03% Tacrolimus/SFA eyedrop may have therapeutic potentials for inflammatory eye diseases including uveitis. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Technical Writing in Hydrogeology.

ERIC Educational Resources Information Center

Tinker, John R., Jr.

1986-01-01

A project for Writing Across the Curriculum at the University of Wisconsin-Eau Claire is described as a method to relate the process of writing to the process of learning hydrology. The project focuses on an actual groundwater contamination case and is designed to improve the technical writing skills of students. (JN)

Limnological Studies at Eau Galle Lake, Wisconsin. Report 1. Introduction and Water Quality Monitoring Studies.

DTIC Science & Technology

1985-03-01

the phototrophic zone, high photo- ;ynthetic activity utilized CO thus reducing the alkalinity; at the 2’ ;ame time, the release of bicarbonate...1982). Like turbidity, suspended solids levels were elevated in the phototrophic zone due to phytoplankton blooms. This was especially noticeable

Reading Professionals: The Vital Link.

ERIC Educational Resources Information Center

Gabler, Carol L.

The Family Literacy Program in Eau Claire, Wisconsin is an example of a strong linkage between professional educators, volunteers, and parents. The program uses the strengths of reading professionals working with preschool students and adult learners in order to break the intergenerational cycle of illiteracy. Cooperation and hard work are the…

Phospholipids as Biomarkers for Excessive Alcohol Use

DTIC Science & Technology

2017-03-01

although the urine results were strongly driven by two very high samples (Fig 5). Coincident with the higher glucose levels in ALD sera, levels of......and Iraq (Operation Iraqi Freedom, OIF) is a major contributor to the onset and exacerbation of EAU, a rising epidemic reported to be as high as 40

Success Models for Gifted Native Students.

ERIC Educational Resources Information Center

Sing, David K.

The Center for Gifted and Talented Native Hawaiian Children at the University of Hawaii at Hilo aims to develop culturally appropriate gifted and talented programs and identification procedures for Native Hawaiian children. Every Center program incorporates four elements of the Na Pua No'eau model: talent enhancement, self-esteem development,…

76 FR 49697 - Television Broadcasting Services; Eau Claire, WI

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-11

..., viewers have reported difficulties receiving the station's digital signal on channel 13 since the end of the digital transition. Substituting channel 38 for channel 13 will allow Gray to leverage the... Report and Order in a report to be sent to Congress and the Government Accountability Office pursuant to...

Economic evaluation of nurse practitioner and clinical nurse specialist roles: A methodological review.

PubMed

Lopatina, Elena; Donald, Faith; DiCenso, Alba; Martin-Misener, Ruth; Kilpatrick, Kelley; Bryant-Lukosius, Denise; Carter, Nancy; Reid, Kim; Marshall, Deborah A

2017-07-01

Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles. Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles and should be routinely followed. However, seven out of 15 current guideline sections (describing a decision problem, choosing type of economic evaluation, selecting comparators, determining the study perspective, estimating effectiveness, measuring and valuing health, and assessing resource use and costs) may require additional role-specific considerations to capture costs and effects of these roles. Current guidelines for economic evaluation should form the foundation for economic evaluations of nurse practitioner and clinical nurse specialist roles. The proposed role-specific considerations, which clarify application of standard guidelines sections to economic evaluation of nurse practitioner and clinical nurse specialist roles, may strengthen the quality and comprehensiveness of future economic evaluations of these roles. Copyright © 2017 Elsevier Ltd. All rights reserved.

Clinical imaging guidelines part 4: challenges in identifying, engaging and collaborating with stakeholders.

PubMed

Bettmann, Michael A; Oikarinen, Helja; Rehani, Madan; Holmberg, Ola; del Rosario Perez, Maria; Naidoo, Anusha; Do, Kyung-Hyun; Dreyer, Keith; Ebdon-Jackson, Steve

2015-04-01

The effective development and use of clinical imaging guidelines requires an understanding of who the stakeholders are, what their interests in the process are, and what roles they should play. If the appropriate stakeholders are not engaged in the right roles, it is unlikely that clinical imaging guidelines will be successfully developed, relied on, and actually used. Some stakeholders are obvious: for the development of clinical imaging guidelines, both imagers and those who request examinations, such as general practitioners, internists, and medical specialists, must be involved. To gain acceptance, other relevant groups are stakeholders, including medical societies, other health care professionals, insurers, health IT experts and vendors, and patients. The role of stakeholders must be dictated by their specific interest. For some, involvement in the creation of guidelines is the right role. For others, such as regulators or insurers, reviews or invitations to comment are required, and for others, such as medical educators, it is probably sufficient to provide information and create awareness. Only through a careful consideration of who the stakeholders are and what are their interests are the successful development, acceptance, and use of clinical imaging guidelines likely to occur. Future efforts must focus on collaboration, particularly among groups that create clinical imaging guidelines and those that can support their use, and on regulatory roles and mandates. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Place Names: Making the Basics of Geography Fun to Learn.

ERIC Educational Resources Information Center

Vogeler, Ingolf

1988-01-01

Arguing that students need to have knowledge about places and regions to understand current and past world affairs, a college-level geography course (University of Wisconsin Eau Claire) which teaches physical and cultural place names is described. Presents course objectives, topics, and activities and states that it serves student needs and…

Teaching Women's Rights and the Imperialist Agenda

ERIC Educational Resources Information Center

Long, Alex

2014-01-01

The author is a graduate student studying English at the University of Wisconsin-Eau Claire, and recently concluded co-teaching a course called The Human Experience of War. The course consisted of reading various works of British literature that spanned World Wars I and II. Through the experience of teaching this course, one recurring theme that…

Struggle for the Soul: John Lawrence Childs

ERIC Educational Resources Information Center

Stallones, Jared

2010-01-01

John Lawrence Childs was born in Eau Claire, Wisconsin on January 11, 1889, the second child of John Nelson Childs and Helen Janette (Nettie) Smith. In childhood Childs absorbed the values of industry, democracy, and a traditional, but socially conscious, religion. Childs was a Methodist and an intensely private person not given to talking about…

Engineering Assessment of Hydrodynamics and Jetty Scour at Little River Inlet North and South Carolina

DTIC Science & Technology

1992-12-01

CERC) through a reimbursable study for the US Army Engineer District, Charleston (SAC). Mr. James Joslin and Mr. Millard Dowd were the SAC repre...Principal Investigator of the reimburs - able study, Ms. Monica A. Chasten, EAU, CSEB, and Mr. William C. Seabergh, Wave Dynamics Division. Techniral

Establishment of an Off-Campus Baccalaureate Nursing Program.

ERIC Educational Resources Information Center

Ostmoe, Patricia M.

In an effort to prepare more baccalaureate level nurses for the rural areas of central Wisconsin and to accommodate the educational needs of geographically bound nontraditional students, a basic baccalaureate nursing program was established at an off-campus site. This University of Wisconsin-Eau Claire program is offered in cooperation with two…

Providing Affordable Housing: Small Communities Benefit from Upgrading Dilapidated Homes.

ERIC Educational Resources Information Center

Hestekin, Kay

1991-01-01

Describes the Affordable Housing Opportunities Program (AHOP) created by the Eau Claire County Housing Authority in Wisconsin. The AHOP buys, renovates, and sells homes for prices below fair market value. This provides safe, sanitary housing for families who could not otherwise afford it. Describes the purchase, renovation, and sale of four…

KSC-00pp0315

NASA Image and Video Library

2000-03-09

Team 393 from Morristown, Ind., sets up its robot on a table to prepare it for the FIRST (For Inspiration and Recognition of Science and Technology) Southeast Regional competition March 9-11 at the KSC Visitor Complex. KSC is co-sponsoring the team, The Bee Bots, from Morristown Junior and Senior High Schools. On the floor at right is team 386, known as Voltage: The South Brevard First Team. This team is made up of students from Eau Gallie, Satellite, Palm Bay, Melbourne, Bayside and Melbourne Central Catholic High Schools. They are sponsored by KSC as well as Harris Corp., Intersil Corp., Interface & Control Systems. Inc. and Rockwell Collins. Teams of high school students are testing the limits of their imagination using robots they have designed, with the support of business and engineering professionals and corporate sponsors, to compete in a technological battle against other schools' robots. Of the 30 high school teams competing at KSC, 16 are Florida teams co-sponsored by NASA and KSC contractors. Local high schools participating are Astronaut, Bayside, Cocoa Beach, Eau Gallie, Melbourne, Melbourne Central Catholic, Palm Bay, Rockledge, Satellite, and Titusville

Teams begin their preparations for the FIRST competition

NASA Technical Reports Server (NTRS)

2000-01-01

Team 393 from Morristown, Ind., sets up its robot on a table to prepare it for the FIRST (For Inspiration and Recognition of Science and Technology) Southeast Regional competition March 9-11 at the KSC Visitor Complex. KSC is co-sponsoring the team, The Bee Bots, from Morristown Junior and Senior High Schools. On the floor at right is team 386, known as Voltage: The South Brevard First Team. This team is made up of students from Eau Gallie, Satellite, Palm Bay, Melbourne, Bayside and Melbourne Central Catholic High Schools. They are sponsored by KSC as well as Harris Corp., Intersil Corp., Interface & Control Systems. Inc. and Rockwell Collins. Teams of high school students are testing the limits of their imagination using robots they have designed, with the support of business and engineering professionals and corporate sponsors, to compete in a technological battle against other schools' robots. Of the 30 high school teams competing at KSC, 16 are Florida teams co-sponsored by NASA and KSC contractors. Local high schools participating are Astronaut, Bayside, Cocoa Beach, Eau Gallie, Melbourne, Melbourne Central Catholic, Palm Bay, Rockledge, Satellite, and Titusville.

KSC00pp0315

NASA Image and Video Library

2000-03-09

Team 393 from Morristown, Ind., sets up its robot on a table to prepare it for the FIRST (For Inspiration and Recognition of Science and Technology) Southeast Regional competition March 9-11 at the KSC Visitor Complex. KSC is co-sponsoring the team, The Bee Bots, from Morristown Junior and Senior High Schools. On the floor at right is team 386, known as Voltage: The South Brevard First Team. This team is made up of students from Eau Gallie, Satellite, Palm Bay, Melbourne, Bayside and Melbourne Central Catholic High Schools. They are sponsored by KSC as well as Harris Corp., Intersil Corp., Interface & Control Systems. Inc. and Rockwell Collins. Teams of high school students are testing the limits of their imagination using robots they have designed, with the support of business and engineering professionals and corporate sponsors, to compete in a technological battle against other schools' robots. Of the 30 high school teams competing at KSC, 16 are Florida teams co-sponsored by NASA and KSC contractors. Local high schools participating are Astronaut, Bayside, Cocoa Beach, Eau Gallie, Melbourne, Melbourne Central Catholic, Palm Bay, Rockledge, Satellite, and Titusville

SOCS3 Deletion in T-Lymphocytes Suppresses Development of Chronic Ocular Inflammation Via Up-regulation of CTLA-4 and Expansion of Regulatory T cells

PubMed Central

Yu, Cheng-Rong; Kim, Sung-Hye; Mahdi, Rashid M.; Egwuagu, Charles E.

2013-01-01

Suppressors of cytokine signaling (SOCS) proteins are negative-feedback regulators of JAK/STAT pathway and SOCS3 contributes to host immunity by regulating the intensity/duration of cytokine signals and inflammatory responses. Mice with Socs3 deletion in myeloid cells exhibit enhanced STAT3-signaling, expansion of Th1 and Th17 cells and developed severe experimental autoimmune encephalomyelitis (EAE). Interestingly, development of the unique IL-17/IFN-γ-double producing (Th17/IFN-γ and Tc17/IFN-γ) subsets that exhibit strong cytotoxic activities and associated with pathogenesis of several autoimmune diseases, has recently been shown to depend on epigenetic suppression of SOCS3 expression, further suggesting involvement of SOCS3 in autoimmunity and tumor immunity. In this study, we generated mice with Socs3 deletion in CD4 T cell compartment (CD4-SOCS3KO) to determine in vivo effects of the loss of Socs3 in the T cell-mediated autoimmune disease, experimental autoimmune uveitis (EAU). In contrast to the exacerbation of EAE in myeloid-specific SOCS3-deleted mice, CD4-SOCS3KO mice were protected from acute and chronic uveitis. Protection from EAU correlated with enhanced expression of CTLA4 and expansion of IL-10 producing Tregs with augmented suppressive activities. We further show that SOCS3 interacts with CTLA4 and negatively regulates CTLA4 levels in T cells, providing mechanistic explanation for the expansion of Tregs in CD4-SOCS3 during EAU. Contrary to in vitro epigenetic studies, Th17/IFN-γ and Tc17/IFN-γ populations were markedly reduced in CD4-SOCS3KO, suggesting that SOCS3 promotes expansion of Th17/IFN-γ subset associated with development of severe uveitis. Thus, SOCS3 is a potential therapeutic target in uveitis and other auto-inflammatory diseases. PMID:24101549

SOCS3 deletion in T lymphocytes suppresses development of chronic ocular inflammation via upregulation of CTLA-4 and expansion of regulatory T cells.

PubMed

Yu, Cheng-Rong; Kim, Sung-Hye; Mahdi, Rashid M; Egwuagu, Charles E

2013-11-15

Suppressors of cytokine signaling (SOCS) proteins are negative-feedback regulators of the JAK/STAT pathway, and SOCS3 contributes to host immunity by regulating the intensity and duration of cytokine signals and inflammatory responses. Mice with Socs3 deletion in myeloid cells exhibit enhanced STAT3 signaling, expansion of Th1 and Th17 cells, and develop severe experimental autoimmune encephalomyelitis. Interestingly, development of the unique IL-17/IFN-γ double-producing (Th17/IFN-γ and Tc17/IFN-γ) subsets that exhibit strong cytotoxic activities and are associated with pathogenesis of several autoimmune diseases has recently been shown to depend on epigenetic suppression of SOCS3 expression, further suggesting involvement of SOCS3 in autoimmunity and tumor immunity. In this study, we generated mice with Socs3 deletion in the CD4 T cell compartment (CD4-SOCS3 knockout [KO]) to determine in vivo effects of the loss of Socs3 in the T cell-mediated autoimmune disease, experimental autoimmune uveitis (EAU). In contrast to the exacerbation of experimental autoimmune encephalomyelitis in myeloid-specific SOCS3-deleted mice, CD4-SOCS3KO mice were protected from acute and chronic uveitis. Protection from EAU correlated with enhanced expression of CTLA-4 and expansion of IL-10-producing regulatory T cells with augmented suppressive activities. We further show that SOCS3 interacts with CTLA-4 and negatively regulates CTLA-4 levels in T cells, providing a mechanistic explanation for the expansion of regulatory T cells in CD4-SOCS3 during EAU. Contrary to in vitro epigenetic studies, Th17/IFN-γ and Tc17/IFN-γ populations were markedly reduced in CD4-SOCS3KO, suggesting that SOCS3 promotes expansion of the Th17/IFN-γ subset associated with development of severe uveitis. Thus, SOCS3 is a potential therapeutic target in uveitis and other autoinflammatory diseases.

Study of dehydroxylated-rehydroxylated smectites by SAXS

NASA Astrophysics Data System (ADS)

Muller, F.; Pons, C.-H.; Papin, A.

2002-07-01

Montmorillonite and beidellite are dioctahedral 2:1 phyllosilicates. The weakness of the bonding between layers allows the intercalation of water molecules (disposed in layers) in the interlayer space. The samples studied are constituted of cv layers (cv for vacant octahedral sites in cis positions). They have been dehydroxylated. This is accompanied by the migration of the octahedral cations from former trans-octahedra to empty cis-sites therefore the layers become tv (vacant site in trans position). To characterize the stacking of the layers, SAXS (Small Angle X-ray Scattering) analyses have been investigated in natural (N) and after a dehydroxylation-rehydroxylation cycle (R) states. The SAXS pattern modelisation for Na -exchanged samples in the N state shows that the layers stack in particles with well defined interlayer distances d_{001}, corresponding to 0 water layer, 1 water layers and 2 water layers. The dehydroxylation-rehydroxylation cycle increases the proportion of interlayer distances with zero water layer and the disorder in the stacking. The decreasing of the disorder parameter with the proportion of tetrahedral charge in the N and R sample shows that the distribution of the water layers depend on the localization of the deficit of charge. Les montmorillonites et les smectites sont des phyllosilicates 2:1 dioctaédriques. Les liaisons entre feuillets sont suffisamment faibles pour permettre l'insertion, dans l'espace interfoliaire, de molécules d'eau qui se disposent en couches. Les échantillons étudiés ont des feuillets cis-vacants (le site octaédrique inoccupé est en une des deux positions “cis”). Ils ont été deshydroxylés. Ceci s'accompagne d'une migration cationique, à l'intérieur des couches octaédriques, des sites trans vers les sites cis et le feuillet devient trans-vacant. Des expériences de Diffusion X aux Petits Angles (DPA) ont permis de caractériser l'empilement des feuillets. La modélisation des diagrammes de DPAX met en évidence, pour les échantillons sodique non traités, des empilements de feuillets formant des particules avec des distances interlamellaires à 0, 1 et 2 couches d'eau. Après le cycle de déshydroxylation-réhydroxylation, la proportion de feuillets avec une distance interlamellaire correspondante à zéro couche d'eau et le désordre dans l'empi lement des feuillets augmentent. La décroissance du paramètre de désordre avec la proportion de charges tetraédriques montre que l'organi sation des couches d'eau dépend de la localisation du déficit de charge.

Basic Exploratory Research versus Guideline-Compliant Studies Used for Hazard Evaluation and Risk Assessment: Bisphenol A as a Case Study

PubMed Central

Tyl, Rochelle W.

2009-01-01

Background Myers et al. [Environ Health Perspect 117:309–315 (2009)] argued that Good Laboratory Practices (GLPs) cannot be used as a criterion for selecting data for risk assessment, using bisphenol A (BPA) as a case study. They did not discuss the role(s) of guideline-compliant studies versus basic/exploratory research studies, and they criticized both GLPs and guideline-compliant studies and their roles in formal hazard evaluation and risk assessment. They also specifically criticized our published guideline-compliant dietary studies on BPA in rats and mice and 17β-estradiol (E2) in mice. Objectives As the study director/first author of the criticized E2 and BPA studies, I discuss the uses of basic research versus guideline-compliant studies, how testing guidelines are developed and revised, how new end points are validated, and the role of GLPs. I also provide an overview of the BPA guideline-compliant and exploratory research animal studies and describe BPA pharmacokinetics in rats and humans. I present responses to specific criticisms by Myers et al. Discussion and conclusions Weight-of-evidence evaluations have consistently concluded that low-level BPA oral exposures do not adversely affect human developmental or reproductive health, and I encourage increased validation efforts for “new” end points for inclusion in guideline studies, as well as performance of robust long-term studies to follow early effects (observed in small exploratory studies) to any adverse consequences. PMID:20049112

Teledetection passive et processus decisionnel a reference spatiale: Application a l'aquaculture en milieu marin

NASA Astrophysics Data System (ADS)

Habbane, Mohamed

L'objectif de cette etude est d'elaborer un processus decisionnel a reference spatiale (PDRS) pour la mariculture. Le PDRS est applique aux eaux cotieres de la baie des Chaleurs, dans le golfe du Saint-Laurent (Canada). Une carte preliminaire regionale d'indices du potentiel maricole, d'une limite de resolution spatiale de 1 kmsp2, est produite avec des parametres du niveau 1. Ces parametres englobent la temperature de l'eau de surface, extraite des images AVHRR, la salinite, les courants ainsi que les pigments chlorophylliens, quantifies a l'aide de mesures in situ. Les images AVHRR, prises en 1994, ont ete utiliees comme reference primaire pour selectionner des aires pouvant supporter une activite maricole sur la cote nord de la baie des Chaleurs. La temperature de surface extraite de ces images permet une analyse mesoechelle a la fois qualitative et quantitative des processus cotiers observes pendant la periode d'acquisition des donnees. Les autres donnees, soit la salinite, les courants et les concentrations en pigments chlorophylliens, sont analysees de facon a identifier la variabilite spatio-temporelle des caracteristiques des eaux de surface. L'ensemble des informations permet de produire une carte preliminaire regionale d'indices du potentiel maricole de la partie centrale de la baie des Chaleurs. Selon cet indice (defini entre 0 et 1), le secteur de potentiel aquicole de 0,5 a 0,75 s'etend sur une superficie d'environ 300 kmsp2. La localisation de cette aire potentielle est en accord avec les fortes concentrations en pigments chlrophylliens, presentant des conditions environnementales ideales a une haute productivite biologique. Par la suite la carte preliminaire est modifiee en tenant compte des parametres du niveau 2. Ces parametres sont la geomorphologie littorale, la bathymetrie, les sediments en suspension, les vents, les vagues, le debit d'eau douce, la glace marine, le carbone organique dissous, les aires de peche et les sources de pollution. Ces parametres sont compares deux a deux par rapport a la carte preliminaire regionale d'indices du potentiel maricole pour determiner leur poids relatif. La carte finale produite avec ces parametres du niveau 2 presente un secteur ou les indices du potentiel maricole sont de 0,5 a 0,75. Ce secteur longe la cote et epouse les isobathes de 10 a 30 m de profondeur. L'effet de la profondeur d'eau semble avoir jouer un role important. Le secteur de potentiel maricole de 0,25 a 0,5 est toujours present et couvre une superficie d'environ 426 kmsp2. L'etude necessitera toujours un suivi des conditions environnementales prevalant dans la region. Ce suivi peut etre effectue a l'aide d'un outil de vision aerospatiale (capteurs de teledetection) et d'analyse spatio-temporelle (SIG-PDRS). (Abstract shortened by UMI.)

Putting a Face on Hunger: A Community-Academic Research Project

ERIC Educational Resources Information Center

Coffey, Nancy; Canales, Mary K.; Moore, Emily; Gullickson, Melissa; Kaczmarski, Brenda

2014-01-01

Food insecurity is a growing concern for Eau Claire County residents in Western Wisconsin. A community-academic partnership studied food insecurity through the voices of families struggling to access food and institutions that assist with hunger related problems. Data were collected through focus groups held in urban and rural parts of the county.…

Conceptual Framework for Conducting Cost Benefit Studies in Wisconsin VTAE and Cost Benefit Studies--VTAE Programs.

ERIC Educational Resources Information Center

Webb, Robert I.; And Others

The step-by-step cost benefit study, confined to measuring and comparing economic costs with economic benefits, is based on the 1971, 1972, and 1973 classes graduating from the Agribusiness-Machinery Partsman-Salesman Program at District One Technical Institute in Eau Claire, Wisconsin. Numerous tables throughout the report contain cost benefit…

Guidelines for the Delineation of Roles and Responsibilities for the Safe Delivery of Specialized Health Care in the Educational Setting.

ERIC Educational Resources Information Center

Council for Exceptional Children, Reston, VA.

These guidelines were developed by a joint task force of members and staff of four national associations, to be of assistance to persons concerned with the safe delivery of specialized health care in educational settings. The guidelines delineate the roles and responsibilities of personnel involved in the provision of specialized health care. They…

Urinary tract infections in children: EAU/ESPU guidelines.

PubMed

Stein, Raimund; Dogan, Hasan S; Hoebeke, Piet; Kočvara, Radim; Nijman, Rien J M; Radmayr, Christian; Tekgül, Serdar

2015-03-01

In 30% of children with urinary tract anomalies, urinary tract infection (UTI) can be the first sign. Failure to identify patients at risk can result in damage to the upper urinary tract. To provide recommendations for the diagnosis, treatment, and imaging of children presenting with UTI. The recommendations were developed after a review of the literature and a search of PubMed and Embase. A consensus decision was adopted when evidence was low. UTIs are classified according to site, episode, symptoms, and complicating factors. For acute treatment, site and severity are the most important. Urine sampling by suprapubic aspiration or catheterisation has a low contamination rate and confirms UTI. Using a plastic bag to collect urine, a UTI can only be excluded if the dipstick is negative for both leukocyte esterase and nitrite or microscopic analysis is negative for both pyuria and bacteriuria. A clean voided midstream urine sample after cleaning the external genitalia has good diagnostic accuracy in toilet-trained children. In children with febrile UTI, antibiotic treatment should be initiated as soon as possible to eradicate infection, prevent bacteraemia, improve outcome, and reduce the likelihood of renal involvement. Ultrasound of the urinary tract is advised to exclude obstructive uropathy. Depending on sex, age, and clinical presentation, vesicoureteral reflux should be excluded. Antibacterial prophylaxis is beneficial. In toilet-trained children, bladder and bowel dysfunction needs to be excluded. The level of evidence is high for the diagnosis of UTI and treatment in children but not for imaging to identify patients at risk for upper urinary tract damage. In these guidelines, we looked at the diagnosis, treatment, and imaging of children with urinary tract infection. There are strong recommendations on diagnosis and treatment; we also advise exclusion of obstructive uropathy within 24h and later vesicoureteral reflux, if indicated. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Development methodology of the novel Endoscopic stone treatment step 1 (EST s1) training/assessment curriculum.

PubMed

Veneziano, Domenico; Ahmed, Kamran; Van Cleynenbreugel, Ben S E P; Gözen, Ali Serdar; Palou, Joan; Sarica, Kemal; Liatsikos, Evangelos N; Sanguedolce, Francesco; Honeck, Patrick; Alvarez-Maestro, Mario; Papatsoris, Athanasios; Kallidonis, Panagiotis; Greco, Francesco; Breda, Alberto; Somani, Bhaskar

2017-07-10

Background Simulation based technical-skill assessment is a core topic of debate, especially in high-risk environments. After the introduction of the E-BLUS exam for basic laparoscopy, no more technical training/assessment urological protocols have been developed in Europe. Objective We describe the methodology used in the development of the novel Endoscopic Stone Treatment step 1 (EST s1) assessment curriculum. Materials and Methods The "full life cycle curriculum development" template was followed for curriculum development. A CTA was run to define the most important steps and details of RIRS, in accordance with EAU Urolithiasis guidelines. Training tasks were created between April 2015 and September 2015. Tasks and metrics were further analyzed by a consensus meeting with the EULIS board in February 2016. A review, aimed to study available simulators and their accordance with task requirements, was subsequently run in London on March 2016. After initial feedback and further tests, content validity of this protocol was achieved during EUREP 2016. Results The EST s1 curriculum development, took 23 months. 72 participants tested the 5 preliminary tasks during EUREP 2015, with sessions of 45 minutes each. Likert-scale questionnaires were filled-out to score the quality of training. The protocol was modified accordingly and 25 participants tested the 4 tasks during the hands-on training sessions of the ESUT 2016 congress. 134 participants finally participated in the validation study in EUREP 2016. During the same event 10 experts confirmed content validity by filling-out a Likert-scale questionnaire. Conclusion We described a reliable and replicable methodology that can be followed to develop training/assessment protocols for surgical procedures. The expert consensus meetings, strict adherence to guidelines and updated literature search towards an Endourology curriculum allowed correct training and assessment protocol development. It is the first step towards standardized simulation training in Endourology with a potential for worldwide adoption.

How institutional change and individual researchers helped advance clinical guidelines in American health care.

PubMed

Nigam, Amit

2013-06-01

Clinical guidelines are important tools for managing health care quality. Research on the origins of guidelines primarily focuses on the institutional causes of their emergence and growth. Individual medical researchers, however, have played important roles. This paper develops knowledge of the role of individual medical researchers in advancing guidelines, and of how researchers' efforts were enabled or constrained by broader institutional changes. Drawing on an analytical case study focused on the role of Kerr White, John Wennberg, and Robert Brook, it shows that guidelines were a product of the interplay between institutional change in the medical field and actions by individual researchers, acting as institutional entrepreneurs. Increased government involvement in the health care field triggered the involvement of a range of new actors in health care. These new organizations created a context that allowed individual researchers to advance guidelines by creating job opportunities, providing research funding, and creating opportunities for researchers to engage with the policy process. Individual researchers availed of this context to both advance their ideas, and to draw new actors into the field. Copyright © 2013. Published by Elsevier Ltd.

"I've Never Heard of It Before": Awareness of Open Access at a Small Liberal Arts University

ERIC Educational Resources Information Center

Kocken, Gregory J.; Wical, Stephanie H.

2013-01-01

Small colleges and universities, often late adopters of institutional repositories and open access initiatives, face challenges that have not fully been explored in the professional literature. In an effort to gauge the level of awareness of open access and institutional repositories at the University of Wisconsin-Eau Claire (UWEC), the authors of…

Bibliography of Freshwater Awareness Materials = Documentation sur la sensibilisation a l'eau douce. Bibliographie.

ERIC Educational Resources Information Center

Environment Canada, Ottawa (Ontario).

The importance of educating Canadians about their water resources is the mandate of many government and non-government agencies and groups. The aim of this bibliography is to outline what is presently available in this area in order to identify gaps in the development of water education programs and products. This educational tool has been…

Joint Venture Marketing Training: Development Marketing Plans Utilizing Foreign and American Students.

ERIC Educational Resources Information Center

Steele, David; Jones, Kevin

This paper describes a workshop prepared and presented by the Business Administration Department of the University of Wisconsin-Eau Claire, that is designed to provide training in evaluating a European market for an American product and preparing a plan for marketing the product in Europe. It is noted that the program can work with both students…

Séchage d'un enduit pigmenté avec application à l'étude d'une couche papetière

NASA Astrophysics Data System (ADS)

Bernada, P.; Bruneau, D.

1996-07-01

Paper color coating drying is investigated from several experimental view points which include drying kinetics and time evolution of moisture content profiles, pore size distribution in the dried coating, and natural binder (starch) distribution in the dried coating. A study of the effects of drying conditions on those experimental parameters is carried out. Furthermore, gelification and consolidation characteristic moisture contents of the coating are determined using a graphical approach. Le séchage d'un enduit pigmenté à l'usage d'une couche papetière est absorbé sous diverts aspects : cinétiques de séchage et évolution temporelle des profils de teneur en eau, profils de répartition de la taille des pores dans la couche séchée, et répartition finale d'un liant hydrophile de la sauce de couchage (amidon). Les conséquences des conditions de séchage sur ces paramètres expérimentaux sont mises en évidence. De plus, les teneurs en eau caractéristiques de gélification et consolidation de la sauce de couchage sont obtenues par une approche graphique.

Selected important fragrance sensitizers in perfumes--current exposures.

PubMed

Rastogi, Suresh Chandra; Johansen, Jeanne Duus; Bossi, Rossana

2007-04-01

Contact allergy to fragrance ingredients is frequent. Recommendations and regulations of some of the most frequent and potent fragrance allergens have recently been introduced. To investigate current exposures to 4 important fragrance allergens in hydroalcoholic cosmetic products. 25 popular perfume products of Danish as well as international brands were purchased from the Danish retail market. Contents of 4 important fragrance allergens, isoeugenol, hydroxy-iso-hexyl 3-cyclohexene carboxaldehyde (HICC, Lyral), were determined by gas chromatography-mass spectrometry, and atranol and chloro-atranol were determined by liquid chromatography-tandem mass spectrometry. Isoeugenol was found in 56%, HICC in 72%, atranol in 59%, and chloro-atranol in 36% of the 22 eau de toilette/eau de parfum products. The concentrations of isoeugenol were, in all products, below the recommended maximum concentration of 0.02%. HICC reached a maximum of 0.2%, which is 10-fold higher than maximum tolerable concentration considered safe by the EU Scientific Committee. The median concentrations of atranol and chloro-atranol in the investigated products were similar to those found in similar products in 2003. A significant decrease in the frequency of presence of chloro-atranol in the products was observed. There is still a wide-spread exposure to potent fragrance allergens in perfumes.

EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction.

PubMed

Oelke, Matthias; Bachmann, Alexander; Descazeaud, Aurélien; Emberton, Mark; Gravas, Stavros; Michel, Martin C; N'dow, James; Nordling, Jørgen; de la Rosette, Jean J

2013-07-01

To present a summary of the 2013 version of the European Association of Urology guidelines on the treatment and follow-up of male lower urinary tract symptoms (LUTS). We conducted a literature search in computer databases for relevant articles published between 1966 and 31 October 2012. The Oxford classification system (2001) was used to determine the level of evidence for each article and to assign the grade of recommendation for each treatment modality. Men with mild symptoms are suitable for watchful waiting. All men with bothersome LUTS should be offered lifestyle advice prior to or concurrent with any treatment. Men with bothersome moderate-to-severe LUTS quickly benefit from α1-blockers. Men with enlarged prostates, especially those >40ml, profit from 5α-reductase inhibitors (5-ARIs) that slowly reduce LUTS and the probability of urinary retention or the need for surgery. Antimuscarinics might be considered for patients who have predominant bladder storage symptoms. The phosphodiesterase type 5 inhibitor tadalafil can quickly reduce LUTS to a similar extent as α1-blockers, and it also improves erectile dysfunction. Desmopressin can be used in men with nocturia due to nocturnal polyuria. Treatment with an α1-blocker and 5-ARI (in men with enlarged prostates) or antimuscarinics (with persistent storage symptoms) combines the positive effects of either drug class to achieve greater efficacy. Prostate surgery is indicated in men with absolute indications or drug treatment-resistant LUTS due to benign prostatic obstruction. Transurethral resection of the prostate (TURP) is the current standard operation for men with prostates 30-80ml, whereas open surgery or transurethral holmium laser enucleation is appropriate for men with prostates >80ml. Alternatives for monopolar TURP include bipolar TURP and transurethral incision of the prostate (for glands <30ml) and laser treatments. Transurethral microwave therapy and transurethral needle ablation are effective minimally invasive treatments with higher retreatment rates compared with TURP. Prostate stents are an alternative to catheterisation for men unfit for surgery. Ethanol or botulinum toxin injections into the prostate are still experimental. These symptom-oriented guidelines provide practical guidance for the management of men experiencing LUTS. The full version is available online (www.uroweb.org/gls/pdf/12_Male_LUTS.pdf). Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

The Limited Role of Expert Guidelines in Teaching Psychopharmacology

ERIC Educational Resources Information Center

Salzman, Carl

2005-01-01

Objective: To consider the limited usefulness of expert guidelines for teaching psychopharmacology. Method: Potential problems using expert guidelines for teaching psychopharmacology are reviewed. Results: Expert guidelines are an important contribution to the growth of evidence-based psychiatry. As such, they may also be used to teach…

Alleviating gender role strain in adult men with traumatic brain injury: an evaluation of a set of guidelines for occupational therapy.

PubMed

Gutman, S A

1999-01-01

A set of guidelines to assist men with traumatic brain injury (TBI) to alleviate gender role strain was assessed to determine its effectiveness and acceptability to participants. Four adult male participants with TBI received the intervention (the set of guidelines) for 4 months. The intervention consisted of rebuilding self-identified gendered social roles and activities. Focused interviews and participant observation were used to determine whether gender role strain changed after intervention. The participants reported that the intervention enabled them to (a) enhance their gender role satisfaction through newly rebuilt roles and activities, (b) attain certain long-held personal goals, (c) feel more like members of society, (d) perceive a greater congruency between their internal self-images and external postinjury roles, (e) learn more about personal skills and values as men, (f) feel more comfortable using help-seeking behaviors, (g) feel a sense of shared experience and affinity, (h) feel more understood and accepted, and (i) contribute to others through community member roles. The set of guidelines for alleviating gender role strain was effective in assisting these participants to enhance their gender role satisfaction through rebuilding desired male-gendered social roles and activities. Dating, courtship, extended family member, community member, friend, and mentor-protege roles, lost as a result of TBI, were rebuilt through gender-neutral activities that facilitated a sense of volitional control, competency, and normalcy. Nonetheless, the men continued to lack desired rites of passage leading from male adolescence to adulthood.

Disaster Preparedness: Guidelines for School Nurses

ERIC Educational Resources Information Center

Doyle, Janice; Loyacono, Thomas R.

2007-01-01

These guidelines help school nurses understand their role in preparing for disasters and major emergencies. The guidelines are suitable for planning for a variety of emergency and disaster situations. Disaster Preparedness Guidelines for School Nurses is based on the four phases of disaster management as defined by the Federal Emergency Management…

Occupational Therapy and Physical Therapy Guidelines for the Public Schools.

ERIC Educational Resources Information Center

Texas Education Agency, Austin. Div. of Special Education Programs.

This document provides general guidelines to promote consistency of occupational therapy and physical therapy service delivery in the Texas educational system. These guidelines are intended to clarify the roles of occupational therapy and physical therapy as related special education services. The guidelines cover: (1) differences between the…

EFOMP policy statement 16: The role and competences of medical physicists and medical physics experts under 2013/59/EURATOM.

PubMed

Caruana, Carmel J; Tsapaki, Virginia; Damilakis, John; Brambilla, Marco; Martín, Guadalupe Martín; Dimov, Asen; Bosmans, Hilde; Egan, Gillian; Bacher, Klaus; McClean, Brendan

2018-04-01

On 5 December 2013 the European Council promulgated Directive 2013/59/EURATOM. This Directive is important for Medical Physicists and Medical Physics Experts as it puts the profession on solid foundations and describes it more comprehensively. Much commentary regarding the role and competences has been developed in the context of the European Commission project "European Guidelines on the Medical Physics Expert" published as Radiation Protection Report RP174. The guidelines elaborate on the role and responsibilities under 2013/59/EURATOM in terms of a mission statement and competence profile in the specialty areas of Medical Physics relating to medical radiological services, namely Diagnostic and Interventional Radiology, Radiation Oncology and Nuclear Medicine. The present policy statement summarises the provisions of Directive 2013/59/EURATOM regarding the role and competences, reiterates the results of the European Guidelines on the Medical Physics Expert document relating to role and competences of the profession and provides additional commentary regarding further issues arising following the publication of the RP174 guidelines. Copyright © 2018. Published by Elsevier Ltd.

Survey of Advanced Technologies in Japan, Vol. 3: Database Reports

DTIC Science & Technology

1990-05-01

INDUSTRIAL CO. LTD. Y NEC CORPORATION, CSC INFORMATION TECHNOLOGY RESEARCH LABORATORIES Y THE UNIVERSITY OF ELECTRO-COMMUNICATIONS Y TOKYO INSTITUTE...77 by the National *"eau of Standards, and is an outgrowth of research performed by IBM. which was based on information theory, using computer...Y COMMUNICATION RESEARCH LABORATORY, MINISTRY OF POSTS AND TELECOMMUNICATIONS Y MATSUSHITA ELECTRONICS CORP., ELECTRONICS RESEARCH LABORATORY Y

The Making of the Faculty: Fostering Professional Development, Curricular Innovation, and Teamwork Through a Collaborative Science Community.

ERIC Educational Resources Information Center

Ross, Jacqueline; And Others

This paper describes the efforts of a host community generally referred to as a "Collaborative Community" and comprised of the Biology and Math departments of the University of Wisconsin-Stout (UW-Stout), the Math and Biology Departments of the University of Wisconsin-Eau Claire (UW-EC), and the Departments of Math, Biology, and Chemistry of the…

Nonlinear Filtering and Approximation Techniques

DTIC Science & Technology

1991-09-01

filtering. UNIT8 Q RECERCE**No 1223 Programme 5 A utomatique, Productique, Traitement dui Signal et des Donnc~es CONSISTENT PARAMETER ESTIMATION FOR...ue’e[71 E C 2.’(Rm x [0,7]; R) is the unique solution of the Hamilton-Jacobi-Bellman equation 9u,’[7](x, t) - EAu "’[ 7](x,t) + He,’[ 7](x,t,Du,[ 7](x,t

Spanish adaptation of the recommendations for the appropriate use of social networks in urology of the European Association of Urology.

PubMed

Rodríguez-Socarrás, M E; Gómez-Rivas, J; Álvarez-Maestro, M; Tortolero, L; Ribal, M J; Garcia Sanz, M; Roupret, M

2016-09-01

To adapt to Spanish the recommendations for the appropriate use of social media (SoMe) in the urological setting prepared by the European Association of Urology (EAU). The use of SoMe has become fairly popular in the international urological community. Due to the nature of the medical content shared among healthcare professionals through SoMe, however, there is the risk of medical and legal problems. For this reason, various international urological associations such as the American Urological Association, the British Association of Urological Surgeons and EAU have published their recommendations for the appropriate use of social media. Efforts have been made to adapt and summarise the recommendations of the EAU in Spanish and to publish them in Actas Urológicas Españolas (@actasurologicas), the official journal of the Spanish Urological Association (@InfoAEU) and the American Confederation of Urology (@CAU_URO). SoMe include well-known platforms such as Twitter, Facebook and YouTube, which have undoubtedly changed the way in which people communicate and interact. SoMe offer clear advantages for communicating between professionals, working in teams, disseminating knowledge and creating professional profiles and are increasingly used by patients and healthcare practitioners. The introduction of SoMe in the urological community has started a revolution in how scientific articles are shared, how people participate in congresses and how international urological associations communicate with their followers. However, SoMe is generally an open public setting, with potential risks for confidentiality and the doctor-patient relationship due to the nature of the shared information. The present recommendations include tools for creating professional profiles, protecting confidentiality and creating honest and responsible content. SoMe represents a fascinating area for the communication and dissemination of knowledge, with considerable applicability in health care and the urological community. New efforts are being directed to extend the use of social media in the urological community, measuring its actual academic impact and standardising the language employed. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

On Recursive Policy Envelopes and Exposure Management: The Mysterious Survival of a Governmental Guideline

ERIC Educational Resources Information Center

Markussen, Rolf Andreas; Wackers, Ger

2015-01-01

Guidelines play a vital role in the governance of professional practitioners in the frontline of the welfare state towards practices based on scientific knowledge. However the viability of guidelines as a genre of governing devices is by no means self-evident. This article interrogates the somewhat mysterious survival of one particular guideline.…

Role-play for medical students learning about communication: Guidelines for maximising benefits

PubMed Central

Nestel, Debra; Tierney, Tanya

2007-01-01

Background Role-play is widely used as an educational method for learning about communication in medical education. Although educational theory provides a sound rationale for using this form of simulation, there is little published evidence for its effectiveness. Students' prior experiences of role-play may influence the way in which they engage in this method. This paper explores students' experiences with the aim of producing guidelines for maximising the benefits of role-play within this learning context. Methods First-year undergraduate medical students participated in a role-play session as part of their communication programme. Before and after the session, students completed questionnaires. In the pre-session questionnaire, students were asked about their experiences of role-play and asked to identify helpful and unhelpful elements. Immediately after the session, students answered similar questions in relation to the role-play activity they had just completed. Descriptive statistics were used to analyse quantitative data and qualitative data was thematically analysed. Results 284 students completed evaluation forms. Although 63 (22.2%) had prior unhelpful experiences, most students (n = 274; 96.5%) found this experience helpful. Summary findings were that students reported the key aspects of helpful role-play were opportunities for observation, rehearsal and discussion, realistic roles and alignment of roles with other aspects of the curriculum. Unhelpful aspects were those that evoked strong negative emotional responses and factors that contributed to a lack of realism. Conclusion Role-play was valued by students in the acquisition of communication skills even though some had prior unhelpful experiences. Guidelines for effective role-play include adequate preparation, alignment of roles and tasks with level of practice, structured feedback guidelines and acknowledgment of the importance of social interactions for learning. PMID:17335561

Role-play for medical students learning about communication: guidelines for maximising benefits.

PubMed

Nestel, Debra; Tierney, Tanya

2007-03-02

Role-play is widely used as an educational method for learning about communication in medical education. Although educational theory provides a sound rationale for using this form of simulation, there is little published evidence for its effectiveness. Students' prior experiences of role-play may influence the way in which they engage in this method. This paper explores students' experiences with the aim of producing guidelines for maximising the benefits of role-play within this learning context. First-year undergraduate medical students participated in a role-play session as part of their communication programme. Before and after the session, students completed questionnaires. In the pre-session questionnaire, students were asked about their experiences of role-play and asked to identify helpful and unhelpful elements. Immediately after the session, students answered similar questions in relation to the role-play activity they had just completed. Descriptive statistics were used to analyse quantitative data and qualitative data was thematically analysed. 284 students completed evaluation forms. Although 63 (22.2%) had prior unhelpful experiences, most students (n = 274; 96.5%) found this experience helpful. Summary findings were that students reported the key aspects of helpful role-play were opportunities for observation, rehearsal and discussion, realistic roles and alignment of roles with other aspects of the curriculum. Unhelpful aspects were those that evoked strong negative emotional responses and factors that contributed to a lack of realism. Role-play was valued by students in the acquisition of communication skills even though some had prior unhelpful experiences. Guidelines for effective role-play include adequate preparation, alignment of roles and tasks with level of practice, structured feedback guidelines and acknowledgment of the importance of social interactions for learning.

Library Instruction within the Curriculum--The Sciences, Business and Nursing. Projects Developed for a Faculty Development Seminar (Eau Claire, Wisconsin, May 21-22, August 19, and December 11, 1984).

ERIC Educational Resources Information Center

Stevens, Barbara R., Comp.; Engeldinger, Eugene A., Comp.

A general list of suggestions for effective library instruction and library instruction projects in a variety of disciplines are presented in this guide. Developed for a faculty and academic staff development seminar, the Library Instruction within the Curriculum Project, these projects illustrate diverse approaches to library instruction with the…

Cultural Resources Investigation of Eau Galle Reservoir, Pierce and St. Croix Counties, Wisconsin,

DTIC Science & Technology

1985-05-01

descriptions) 6. Roads, paths, and trails 7. Ditches, irrigation , tiling 8. Stream/channel alteration (of any descrip- tion) 9. Extensive dredging...not be limited to, the following sections. These sections.do not necessarily need to be discrete sections; however, they should be readily discernable...Collection and Treatment System at Granada , Martin County, Minnesota; KBM, Inc.; Archaeological Field Services, Inc.; Principal Investigator. 1979 An

Building Local and Transnational Feminisms: An Interview with Noelia Corrales and Lussiana Salazar of la Escuela de Español Colibrí in Matagalpa, Nicaragua

ERIC Educational Resources Information Center

Kemp, Theresa D.

2016-01-01

In 2009, the University of Wisconsin-Eau Claire's (UWEC) women's studies program offered its first iteration of the faculty-led international immersion course Women's Lives and Experiences in Nicaragua. This program was created and initially led by Dr. Rose-Marie Avin, a faculty member in the economics department and an affiliate member of both…

OMEGA: Observatoire pour la Minéralogie, l'Eau, les Glaces et l'Activité

NASA Astrophysics Data System (ADS)

Bibring, J.-P.; Soufflot, A.; Berthé, M.; Langevin, Y.; Gondet, B.; Drossart, P.; Bouyé, M.; Combes, M.; Puget, P.; Semery, A.; Bellucci, G.; Formisano, V.; Moroz, V.; Kottsov, V.; Bonello, G.; Erard, S.; Forni, O.; Gendrin, A.; Manaud, N.; Poulet, F.; Poulleau, G.; Encrenaz, T.; Fouchet, T.; Melchiori, R.; Altieri, F.; Ignatiev, N.; Titov, D.; Zasova, L.; Coradini, A.; Capacionni, F.; Cerroni, P.; Fonti, S.; Mangold, N.; Pinet, P.; Schmitt, B.; Sotin, C.; Hauber, E.; Hoffmann, H.; Jaumann, R.; Keller, U.; Arvidson, R.; Mustard, J.; Forget, F.

2004-08-01

The OMEGA visible and near-IR mapping spectrometer will reveal the mineralogical and molecular composition of the surface and atmosphere of Mars through the spectral analysis of the diffused solar light and surface thermal emission. It will provide global coverage at medium resolution (2-5 km) for altitudes from 1500 km to 4000 km, and high-resolution (<350 m) spectral images of selected areas.

Culture et Gestion d'Etangs a Poissons d'Eau Douce (Freshwater Fish Pond Culture and Management). Appropriate Technologies for Development. Manual Series--M37.

ERIC Educational Resources Information Center

Chakroff, Marilyn; Druben, Laurel, Ed.

This is the French translation of a "how-to" manual, designed as a working and teaching tool for extension agents as they establish and/or maintain local fish pond operations. The manual presents information to facilitate technology transfer and to provide a clear guide for warm water fish pond construction and management. Major topic…

"A tree must be bent while it is young": teaching urological surgical techniques to schoolchildren.

PubMed

Buntrock, Stefan

2012-01-01

Playing video games in childhood may help achieve advanced laparoscopic skills later in life. The virtual operating room will soon become a reality, as "doctor games 2.0" will doubtlessly begin to incorporate virtual laparoscopic techniques. To teach surgical skills to schoolchildren in order to attract them to urology as a professional choice later in life. As part of EAU Urology Week 2010, 108 school children aged 15-19 attended a seminar with lectures and simulators (laparoscopy, TUR, cystoscopy, and suture sets) at the 62nd Congress of the German Society of Urology in Düsseldorf. A Pub-Med and Google Scholar search was also performed in order to review the beneficial effects of early virtual surgical training. MeSh terms used were "video games," "children," and "surgical skills." Searches were performed without restriction for a certain period of time. In terms of publicity for urology, EAU Urology Week, and the German Society of Urology, the event was immensely successful. Regarding the literature search, four relevant publications were found involving children. An additional three articles evaluated the usefulness of video gaming in medical students and residents. Making use of virtual reality to attract and educate a new generation of urologists is an important step in designing the future of urology.

Readability assessment of online patient education materials provided by the European Association of Urology.

PubMed

Betschart, Patrick; Zumstein, Valentin; Bentivoglio, Maico; Engeler, Daniel; Schmid, Hans-Peter; Abt, Dominik

2017-12-01

To assess the readability of the web-based patient education material provided by the European Association of Urology. English patient education materials (PEM) as available in May 2017 were obtained from the EAU website. Each topic was analyzed separately using six well-established readability assessment tools, including Flesch-Kincaid Grade Level (FKGL), SMOG Grade Level (SMOG), Coleman-Liau Index (CLI), Gunning Fog Index (GFI), Flesch Reading Ease Formula (FRE) and Fry Readability Graph (FRG). A total of 17 main topics were identified of which separate basic and in-depth information is provided for 14 topics. Calculation of grade levels (FKGL, SMOG, CLI, GFI) showed readability scores of 7th-13th grade for basic information, 8th-15th grade for in-depth information and 7th-15th grade for single PEM. Median FRE score was 54 points (range 45-65) for basic information and 56 points (41-64) for in-depth information. The FRG as a graphical assessment revealed only 13 valid results with an approximate 8th-17th grade level. The EAU provides carefully worked out PEM for 17 urological topics. Although improved readability compared to similar analyses was found, a simplification of certain chapters might be helpful to facilitate better patient understanding.

Intravitreal injection of rapamycin-loaded polymeric micelles for inhibition of ocular inflammation in rat model.

PubMed

Wu, Wei; He, Zhifen; Zhang, Zhaoliang; Yu, Xinxin; Song, Zongming; Li, Xingyi

2016-11-20

The therapeutic efficacy of rapamycin conjugated monomethoxy poly(ethylene glycol)-poly(ε-caprolactone) (MPEG-PCL) micelles (rapamycin micelles) was evaluated in a rat experimental autoimmune uveitis (EAU) model. Rapamycin micelles exhibited spherical morphology and had a mean particle size of 40nm and a zeta-potential of -0.89mv. The water solubility of rapamycin improved by more than 1000-fold in a micellar formulation. Intravitreal injection of MPEG-PCL micelles did not result in vitreous hemorrhage or retinal detachment. Fluorescence microscopy demonstrated that labeled micelles localized to the retinal pigment epithelium for at least 14 days following injection and the drug concentration of rapamycin micelles in the retinal tissue was significantly higher than unconjugated rapamycin over this period. At the optimal concentration of rapamycin micelles (9μg/eye), clinical signs of EAU were abolished via the downregulation of the Th1 and Th17 response. There were no significant difference in T cell proliferation and delayed-type hypersensitivity between the treatment and control groups, suggesting that the therapeutic effect of rapamycin manifested locally in the eye and not systemically. These results indicate that intravitreal injection of rapamycin micelles is a promising therapy for controlling sterile intraocular inflammation. Copyright © 2016 Elsevier B.V. All rights reserved.

The Treatment of Sex Roles. Guidelines for the Development of Elementary and Secondary Instructional Materials.

ERIC Educational Resources Information Center

Holt, Rinehart & Winston, New York, NY.

Arranged in three sections, this pamphlet outlines publishers' guidelines for developing nonsexist instructional materials for elementary and secondary school use. Section 1 details the following strategies for expanding and balancing the role models of both sexes in instructional literature: illustrations reflecting a variety of dress and…

The Role of Health Services Research in Developing Practice Policy: Development of Practice Guidelines.

ERIC Educational Resources Information Center

Crall, James J.

1990-01-01

The paper offers guidance for the incorporation of treatment effectiveness research into clinical dental practice guidelines. Recommended is inclusion of patients' preferences for different outcomes as well as of clinical outcomes in development of valid practice guidelines. (DB)

Evaluation of clinical practice guidelines.

PubMed Central

Basinski, A S

1995-01-01

Compared with the current focus on the development of clinical practice guidelines the effort devoted to their evaluation is meagre. Yet the ultimate success of guidelines depends on routine evaluation. Three types of evaluation are identified: evaluation of guidelines under development and before dissemination and implementation, evaluation of health care programs in which guidelines play a central role, and scientific evaluation, through studies that provide the scientific knowledge base for further evolution of guidelines. Identification of evaluation and program goals, evaluation design and a framework for evaluation planning are discussed. PMID:7489550

Mise en oeuvre et caracterisation de pieces autotrempantes elaborees avec de nouveaux alliages meres

NASA Astrophysics Data System (ADS)

Bouchemit, Arslane Abdelkader

: L'autotrempabilite des aciers en metallurgie des poudres (MP) permet d'obtenir des pieces ayant une microstructure de trempe (martensite et/ou bainite), et ce, directement lors du refroidissement a la sortie du four de frittage (frittage industriel : 10 45 °C/min [550 a 350 °C]). Cela permet entre autres d'eliminer les traitements thermiques d'austenisation et de trempe (a l'eau : ≈ 2700 °C/min ou a l'huile : ≈ 1100 °C/min [550 a 350 °C] [17]) generalement requis apres le frittage afin d'obtenir une microstructure martensitique. Ainsi, le procede de fabrication est simplifie, moins couteux et la distorsion des pieces due au refroidissement rapide lors de la trempe est evitee. De plus, l'utilisation des bains d'huile est eliminee ce qui rend le procede plus securitaire et ecologique. Les principaux parametres commandant l'autotrempabilite sont : le taux de refroidissement et la composition chimique de l'acier. De nos jours, les systemes de refroidissement a convection forcee combines aux fours industriels permettent d'obtenir des taux de refroidissement eleves a la sortie des fours (60 300 °C/min [550 a 350 °C]) [18, 19]. De plus, le taux de refroidissement critique induisant la formation de la structure de trempe est largement influence par la composition chimique de l'acier. Ainsi, plus l'acier est allie (jusqu'a une certaine limite), plus ce taux de refroidissement critique est moindre. Le molybdene, le nickel et le cuivre sont les elements usuellement utilises en MP. Cependant, le manganese et le chrome sont moins couteux et ont un impact plus marque sur l'autotrempabilite, malgre cela, ils sont rarement utilises a cause de leur susceptibilite a l'oxydation et la degradation de la compressibilite causee par le manganese. L'objectif principal de ce projet est de developper des melanges autotrempants en ajoutant des alliages meres (MA : MA1, MA2 et MA4) fortement allies au manganese (5 15 %m) et au chrome (5 15 %m) qui contiennent beaucoup de carbone (≈ 4 %m) developpes par Ian Bailon-Poujol lors de sa maitrise [20]. La haute teneur en carbone de ces alliages meres assure la protection des elements d'alliage susceptibles a l'oxydation durant toutes les etapes du procede : dans le bain liquide lors de la fusion et l'atomisation a l'eau, pendant le broyage ainsi que lors du frittage des pieces contenant ces alliages meres. Precedemment, Ian Bailon-Poujol avait etudie le broyage de certains alliages meres atomises a l'eau et avait amorce le developpement de melanges autotrempants ainsi que des etudes de diffusion des elements d'alliage. Pour ce projet, le developpement des melanges autotrempants a implique l'optimisation de toutes les etapes de la mise en oeuvre afin d'obtenir les meilleures proprietes possibles des melanges avant frittage (ecoulement, resistance a cru...) et apres frittage (durete, microstructure...), et ce, pour des alliages meres atomises a l'eau par Ian Bailon-Poujol ainsi qu'un alliage mere de chimie similaire qui fut atomise au gaz. (Abstract shortened by ProQuest.).

Eco-environmental problems and effective utilization of water resources in the Kashi Plain, western Terim Basin, China

NASA Astrophysics Data System (ADS)

Lin, Nian-Feng; Tang, Jie; Han, Feng-Xiang

2001-02-01

Since ancient times, water resources, mainly from melting snow in the high mountains, have nourished a large area of an oasis in the Kashi Plain in the western Terim Basin, China. In the last half-century, however, the rapid growth of population and the overexploitation of water, soil, and biological resources have led to drought, salinization, and desertification in the area, and consequently have hindered the development of sustainable agriculture. In this study, groundwater reservoirs with sustainable water supplies equivalent to 44.65×108 m3/year were identified, which has made it possible to implement several projects in the area to improve the ecological and agricultural environment. Three strategies are proposed for the integrated development and management of both surface-water and groundwater resources in the area. Résumé. Depuis des temps anciens, les ressources en eaux, provenant surtout de la fonte des neiges en montagne, ont alimenté une large part d'une oasis de la plaine de Kashi, dans le bassin occidental de Terim (Chine). Au cours des derniers cinquante ans, toutefois, l'accroissement rapide de la population et la surexploitation de l'eau, des sols et des ressources biologiques ont provoqué la sécheresse, la salinisation et la désertification de la région cela a eu pour conséquence d'entraver le développement d'une agriculture durable. Cette étude identifie les réserves en eau souterraine, susceptibles de fournir durablement 44,65×108 m3/an, ce qui a permis de réaliser plusieurs projets dans cette région pour améliorer l'environnement écologique et agricole. Trois stratégies sont proposées pour le développement intégré et la gestion simultanée des ressources en eau de surface et en eau souterraine de cette région. Resumen. Los recursos hídricos, procedentes fundamentalmente del deshielo en alta montaña, han nutrido desde tiempo inmemorial una gran área de un oasis situado en las llanuras de Kashi, en la cuenca occidental de Terim (China). Sin embargo, en la última mitad de siglo, el rápido aumento de población y la sobreexplotación de los recursos hídricos, pedológicos y biológicos han producido la sequía, salinización y desertificación en la zona, y, por consiguiente, han obstaculizado el desarrollo de una agricultura sostenible. En este estudio, se identificaron reservorios de agua subterránea con unos recursos equivalentes a 44,65×108 m3/a, hecho que ha permitido establecer varios proyectos en el área para mejorar el medio ambiente ecológico y agrícola. Se proponen tres estrategias para el desarrollo integrado y la gestión en la zona, tanto de los recursos superficiales como de los subterráneos.

75 FR 76478 - Mandatory Guidelines for Federal Workplace Drug Testing Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-08

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Mandatory Guidelines for Federal Workplace Drug Testing... Drug Testing Programs (Mandatory Guidelines) which took effect on October 1, 2010 address the role and... Federal employee drug testing results that seek approval by the Secretary must submit their qualifications...

SPSP Phase III Recruiting, Selecting, and Developing Secure Power Systems Professionals: Behavioral Interview Guidelines by Job Roles

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

O'Neil, Lori Ross; Conway, T. J.; Tobey, D. H.

The Secure Power Systems Professional Phase III final report was released last year which an appendix of Behavioral Interview Guidelines by Job Roles. This new report is that appendix broken out as a standalone document to assist utilities in recruiting and developing Secure Power Systems Professionals at their site.

Impacts of afforestation on groundwater resources and quality

NASA Astrophysics Data System (ADS)

Allen, Alistair; Chapman, Deborah

2001-07-01

Plans to double the proportion of land under forest cover in Ireland by the year 2035 have been initiated. The plan, primarily financially driven, ignores potential environmental impacts of forestry, particularly impacts on groundwater resources and quality. Since groundwater supplies almost 25% of Ireland's total potable water, these impacts are important. Field investigations indicate that afforestation leads to a reduction in runoff by as much as 20%, mainly due to interception of rainfall by forest canopies. Clearfelling has the opposite impact. Implications are that uncoordinated forestry practices can potentially exacerbate flooding. Groundwater recharge is affected by forestry, largely due to greater uptake of soil water by trees and to increased water-holding capacity of forest soils, arising from higher organic contents. Recharge rates under forests can be reduced to one tenth that under grass or heathland. Groundwater quality may be affected by enhanced acidification and nitrification under forests, due partly to scavenging of atmospheric pollutants by forest canopies, and partly to greater deposition of highly acid leaf litter. The slower recharge rates of groundwater under forests lead to significant delays in manifestation of deterioration in groundwater quality. Résumé. Des plans sont à l'étude pour doubler la proportion du couvert forestier en Irlande d'ici à 2035. Le plan, primitivement déterminé sur une base financière, ignore les impacts environnementaux potentiels de la foresterie, et particulièrement les impacts sur les ressources en eau souterraine et leur qualité. Du fait que les eaux souterraines satisfont presque 25% du total de l'eau potable de l'Irlande, ces impacts sont importants. Les études de terrain montrent que le reboisement conduit à une réduction du ruissellement d'au moins 20%, principalement à cause d'une interception de la pluie par le couvert forestier. Les coupes ont un impact contraire. Les implications sont que des pratiques forestières non coordonnées sont susceptibles d'exacerber les crues. La recharge des nappes est affectée par la foresterie, surtout à cause de prélèvements plus importants de l'eau du sol par les arbres et à cause de la capacité accrue des sols forestiers à retenir de l'eau, conduisant à de plus fortes teneurs en matières organiques. Les taux de recharge sous les forêts peuvent être réduits d'un dixième par rapport à la prairie ou à la lande. La qualité de l'eau souterraine peut être affectée par une acidification accrue et par une nitrification sous les forêts, provoquées pour une part par une fixation des polluants atmosphériques par le couvert forestier et pour une autre part par un dépôt plus important d'une litière plus fortement acide. Les taux de recharge plus lente des nappes sous les forêts conduisent à des retards importants dans la manifestation de la détérioration de la qualité de l'eau souterraine. Resumen. Se han iniciado los planes para duplicar la proporción de terrenos reforestados en Irlanda hacia el año 2035. El plan, impulsado por fines económicos, ignora los impactos potenciales medioambientales de la silvicultura, y, en particular, los impactos a los recursos de aguas subterráneas y a su calidad. Puesto que el 25 % del agua potable en Irlanda es suministrada por medio de aguas subterráneas, dichos impactos son importantes. Las investigaciones de campo indican que la reforestación lleva a una reducción de la escorrentía de hasta un 20 %, fundamentalmente por la interceptación de la lluvia en las copas de los árboles, mientras que la deforestación tiene el impacto opuesto. Las implicaciones son tales que las prácticas forestales descoordinadas pueden aumentar enormemente el riesgo de inundaciones. También la recarga a los acuíferos se ve afectada por la reforestación, debido, sobre todo, al uso del agua del suelo por los árboles y a la mayor capacidad de retención de los suelos en zonas boscosas, al disponer de más materia orgánica. Las tasas de recarga en zonas boscosas pueden verse reducidas al 10 % de las estimadas en campos de hierba o brezales. La calidad de las aguas subterráneas en zonas boscosas puede verse afectada por procesos de acidificación y nitrificación adicionales, causados por la retención de contaminantes atmosféricos en las copas de los árboles, y, en parte, por la acumulación de hojas enormemente ácidas en descomposición. El hecho de que la tasa de recarga sea inferior en zonas boscosas causa un retardo en la detección de fenómenos de deterioro de la calidad de las aguas subterráneas.

Guidelines and Procedures for Meeting the Specialized Physical Health Care Needs of Pupils.

ERIC Educational Resources Information Center

Lunden, Janet, Ed.

This monograph presents the California State guidelines for providing physical health care services within the public school setting. Part I addresses administrative concerns. Included are sections on: education and chronic illness; professional roles; referral and evaluation; guidelines and procedures for transporting chronically ill pupils;…

Energy Conservation in School Transportation Systems. Energy Conservation Guidelines 4.

ERIC Educational Resources Information Center

Giesguth, John, Ed.; Scheingold, Edward, Ed.

Fourth in a series of four publications on energy conservation, this booklet offers basic guidelines for sound fuel reduction in school transportation. The pamphlet suggests ways to implement energy-saving practices, guidelines for preventive maintenance of school vehicles, a definition of the drivers' and superintendents' roles, school policies…

Functional Design of Breakwaters for Shore Protection: Empirical Methods

DTIC Science & Technology

1990-09-01

prepred by the Principal Investigator of the work unit, Ms. Julie Dean Rosati, Hy1. aulic Engineer, EAU, CSEB. COL Larry B. Fulton, EN, was Commander and...transmissibility, wave climate , etc.), morphologica. beach response may be either a salient or tombolo. Reef breakwaters are a type of detached breakwaters... climate chosen for design (USAED, Buffalo 1975; Pope and Dean 1986), as waves from the northwest were inappropriately weighted. Pope and Dean (1986) 26

Community-Oriented Counterterrorism: Incorporating National Homeland Security Mandates into the Local Community Policing Philosophy

DTIC Science & Technology

2014-12-01

both 2000 and 2007 Bw·eau of Justice Statistics Law Enforcement Management and Administrative Statistics sw’Veys. These agencies incmporate most...responded to a variety of community policing and homeland security questions in both 2000 and 2007 Bureau of Justice Statistics Law Enforcement...Management and Administrative Statistics surveys. These agencies incorporate most major U.S. police departments as well as a representative sample of smaller

Community Problems in Five West Central Counties. Report No. 7 of a Series on Quality of Life and Development in Northwestern Wisconsin, February 1976.

ERIC Educational Resources Information Center

Lambert, Virginia; Linn, Gary

As part of a study on development and the quality of life in northwestern Wisconsin, questions concerning important problems, public services, and environmental issues were asked of samples of 150 people in each of 4 west central counties (Clark, Dunn, Eau Claire, and Polk) in 1974. Responses to similar questions asked in a 1973 study of St. Croix…

Implementation of concussion guidelines in community Australian Football and Rugby League-The experiences and challenges faced by coaches and sports trainers.

PubMed

Kemp, Joanne L; Newton, Joshua D; White, Peta E; Finch, Caroline F

2016-04-01

While guidelines outlining the appropriate management of sport-related concussion have been developed and adapted for use within community sport, it remains unknown how they are experienced by those responsible for implementing them. Longitudinal study. 111 coaches and sports trainers from community-level Australian Football and Rugby League teams completed pre- and post-season surveys assessing their attitudes towards using concussion guidelines. Participants also provided post-season feedback regarding their experiences in using the guidelines. 71% of participants reported using the guidelines in the preceding season. Post-season attitude was related to pre-season attitude (p=0.002), football code (p=0.015), and team role (p=0.045). An interaction between team role and guideline use (p=0.012) was also found, with coaches who had used the guidelines, and sports trainers who had not, reporting more positive post-season attitudes towards using the concussion guidelines. Implementation challenges included disputing of decisions about return-to-play by players, parents, and coaches, and a perceived lack of time. Recommendations for improved guideline materials included using larger fonts and providing for witnessing of advice given to players. This is the first study to examine the implementation of concussion guidelines in community sport. Training of coaches/sports trainers needs enhancement. In addition, new education should be developed for parents/players about the importance of the return-to-play advice given to them by those who follow these guidelines. Information provided by those who attempted to use the guidelines will assist the refinement of implementation and dissemination processes around concussion guidelines across sports. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

The role of perceived barriers in explaining socio-economic status differences in adherence to the fruit, vegetable and fish guidelines in older adults: a mediation study.

PubMed

Dijkstra, S Coosje; Neter, Judith E; van Stralen, Maartje M; Knol, Dirk L; Brouwer, Ingeborg A; Huisman, Martijn; Visser, Marjolein

2015-04-01

We aimed to identify barriers for meeting the fruit, vegetable and fish guidelines in older Dutch adults and to investigate socio-economic status (SES) differences in these barriers. Furthermore, we examined the mediating role of these barriers in the association between SES and adherence to these guidelines. Cross-sectional. Longitudinal Aging Study Amsterdam (LASA), the Netherlands. We used data from 1057 community-dwelling adults, aged 55-85 years. SES was measured by level of education and household income. An FFQ was used to assess dietary intake and barriers were measured with a self-reported lifestyle questionnaire. Overall, 48.9 % of the respondents perceived a barrier to adhere to the fruit guideline, 40.0 % for the vegetable and 51.1 % for the fish guideline. The most frequently perceived barriers to meet the guidelines were the high price of fruit and fish and a poor appetite for vegetables. Lower-SES groups met the guidelines less often and perceived more barriers. The association between income and adherence to the fruit guideline was mediated by 'perceiving any barrier to meet the fruit guideline' and the barrier 'dislike fruit'. The association between income and adherence to the fish guideline was mediated by 'perceiving any barrier to meet the fish guideline' and the barrier 'fish is expensive'. Perceived barriers for meeting the dietary guidelines are common in older adults, especially in lower-SES groups. These barriers and in particular disliking and cost concerns explained the lower adherence to the guidelines for fruit and fish in lower-income groups in older adults.

Physical therapists' perceptions of the roles of the physical therapist assistant.

PubMed

Robinson, A J; McCall, M; DePalma, M T; Clayton-Krasinski, D; Tingley, S; Simoncelli, S; Harnish, L

1994-06-01

This longitudinal study investigated physical therapists' perceptions of the roles of physical therapist assistants (PTAs). In 1986, a questionnaire describing 79 physical therapy activities was distributed to a random sample (n = 400) of physical therapists derived from the American Physical Therapy Association (APTA) membership. In 1992, a similar questionnaire was distributed to a representative sample (n = 400) of physical therapists derived from the APTA membership. Response rates were 53% and 55% in 1986 and 1992, respectively. Respondents indicated whether each activity was included in the documentation describing PTA roles. Results revealed considerable agreement between therapists' perceptions of PTA roles and those outlined by PTA practice guidelines, and these perceptions changed little over time. Discriminant analyses suggested that therapists' perceptions of PTA roles were, in general, not predicted by supervisory experience with PTAs, therapist experience, or content of entry-level professional education curricula. Generally, therapists' perceptions of PTA roles are consistent with published practice guidelines. Therapists' perceptions on selected activities, however, were incongruent with PTA practice guidelines, suggesting the potential for inefficient or inappropriate utilization of the PTA in the delivery of selected services.

Review article: the role of practice guidelines and evidence-based medicine in perioperative patient safety.

PubMed

Crosby, Edward

2013-02-01

The purpose of this narrative review is to discuss the impact of clinical practice guidelines on the outcomes of care and patient safety. The care provided to patients has a high degree of variability, including some care that is discordant with available evidence. This inconsistency has implications for patient safety as some patients receive care that is unlikely beneficial yet may be harmful, while others are denied care that would clearly be helpful. The medical literature is expanding at an alarming rate; its quality and reliability is often poor; study methodology is frequently suboptimal, and reversal is common, even among frequently cited articles. For decades, specialty societies and other agencies have been providing clinical practice guidelines to assist physicians with the integration of evidence into clinical decision-making. Implementation of guidelines has been variable, and their goals are often not achieved due to failed uptake and application. The reasons for this shortcoming are complex and some explanations are valid. Many guidelines have not been evidence-based and many have been methodologically unsound. Physician autonomy likely also plays an important role in guideline uptake; an updated concept of autonomy that embraces appropriate guidelines is long overdue. Under certain conditions, guidelines can add value to care and improve outcomes; they need to be evidence-based, methodologically sound, and appropriately applied to patients and clinical scenarios. Simply summarizing evidence in a guideline is an inadequate process. To achieve the benefit of guidelines, implementation strategies need to be robust.

Canadian Thoracic Society 2012 guideline update: Diagnosis and management of asthma in preschoolers, children and adults

PubMed Central

Lougheed, M Diane; Lemiere, Catherine; Ducharme, Francine M; Licskai, Chris; Dell, Sharon D; Rowe, Brian H; FitzGerald, Mark; Leigh, Richard; Watson, Wade; Boulet, Louis-Philippe

2012-01-01

BACKGROUND: In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines. METHODS: Four clinical questions were identified as a focus for the updated guideline: the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy; the initiation of adjunct therapy to inhaled corticosteroids (ICS) for uncontrolled asthma; the role of a single inhaler of an ICS/long-acting beta2-agonist combination as a reliever, and as a reliever and a controller; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan. The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics. In addition, literature searches were performed to identify relevant systematic reviews and randomized controlled trials. The panel formally assessed and graded the evidence, and made 34 recommendations. RESULTS: The updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. Finally, priority areas for future research were identified. CONCLUSIONS: The present clinical practice guideline is the first update of the CTS Asthma Guidelines following the Canadian Respiratory Guidelines Committee’s new guideline development process. Tools and strategies to support guideline implementation will be developed and the CTS will continue to regularly provide updates reflecting new evidence. PMID:22536582

Guidelines for Counselling about HIV Infection and Disease. WHO AIDS Series 8.

ERIC Educational Resources Information Center

World Health Organization, Geneva (Switzerland).

The present guidelines have been prepared to provide counselors, health care workers, and others with a model for use in counseling people affected directly or indirectly by Human Immunodeficiency Virus (HIV) infection and Acquired Immune Deficiency Syndrome (AIDS). The guidelines describe the nature, role, and principles of counseling, the…

Medical Education and the Pharmaceutical Industry: A Review of Ethical Guidelines and Their Implications for Psychiatric Training

ERIC Educational Resources Information Center

Geppert, Cynthia M. A.

2007-01-01

Objective: This article reviews and summarizes eight ethical guidelines of major professional organizations regarding the pharmaceutical industry's role in the psychiatric education of trainees. Method: The author conducted a literature review of research and guidelines pertaining to the pharmaceutical industry's relationship to trainees, with…

Guidelines for Development and Evaluation of Young Farmer and Adult Programs in Agriculture/Agribusiness

ERIC Educational Resources Information Center

Bundy, Clarence E.

1974-01-01

Guidelines developed at a national seminar establish goals and action steps for developing, expanding, and/or evaluating agriculture/agribusiness programs. America's role as a major food and fiber source for the world demands educated farmers. The guidelines apply to all levels of the agriculture education program. (AG)

Role and Responsibilities of the School Nurse (Registered Nurse) and the Child with Special Health Care Needs. Guidelines.

ERIC Educational Resources Information Center

Maryland State Board of Nursing, Baltimore.

This set of guidelines by the Maryland Board of Nursing presents the role and responsibilities of the school nurse in relation to the child with special health care needs. The introduction identifies four basic issues including necessary level of preparation, who determines what nursing care can be delegated, under what conditions nursing care can…

European Association of Urology - 32nd Annual Congress (March 24-28, 2017 - London, UK).

PubMed

Sharman, R

2017-04-01

The European Association of Urology (EAU) Congress is Europe's biggest urological event and this year's meeting, in London, UK, brought together more than 13,000 participants from over 100 countries to discuss the latest research in this field. With 5 days' worth of lectures, debates, learning courses, presentations and live surgeries the congress provided plenty of opportunity to learn from the 1,400 experts presenting, as well as to network with international peers.

Report of the Working Group on Aerodynamics of Aircraft Afterbody.

DTIC Science & Technology

1986-06-01

14 I 21 2.1.71 Addy A.L. Experimeftal-Theoretical Correlation of Supersonic Jet-on Base Pressure for Cylindrical Afterbodies. J. Aircraft, Vol. 7, No...An Improved Experimental-Theoretical Base Pressure Cor- Addy A.L. relation for Conical and Cylindrical Afterbodies with Agrell J. Centered Propulsive...2.1.92 Carri~re P. Effet d’une Injection de Fluide dans l’Eau-Morte sur les Conditions de Recollement d’un Ecoulement Plan Supersonique. Comptes

Navy/ASEE (American Society for Engineering Education) Summer Faculty Research Program, 1985.

DTIC Science & Technology

1986-05-15

MECHANICAL ENGINEERING ASTRONOMY MECHANICAL ENGINEERING DEPT. 07 PHYSICS/ASTR. BETHLEHEM ,PA 18015 EAU CLAIR2 ,WI 54701 ROBERT HARTFORD TIMOTHY LANCEY...GA 30910 KLAMATH FALLS ,OR 97601 RICHARD MESSNER HORACE REYNOLDS UN:V OF NEW HAMPSHIRE GALLAUDET ELECTRICAL ENGINEERING PSYCHOLOGY E.C.E. DEPARTMENT...HOWARD’ U:V:ERSICY 4 DC CATHOLU. UNIVERSIT 4 DC HOWARD NVESC 4 DC HOWARD U NIVERSITYf 4 DC CATHOLIT’ UNIVERSITY DC GALLAUDET 4 DC AINERICA:; :;VRIY4 DE

Historical Report Atomic Bomb Tests Able and Baker (Operation Crossroads). Volume 2

DTIC Science & Technology

1946-07-25

was obvious that the Bur- eau of Medicine and Surgery representative to the Task Force, Capt. G. M. Lyon (MC), must be responsible not only for the...Reboarding and Inspection Plan of the operation by detailed planning of its own activities. 1 See Annex X, App. Ill: Bureau of Medicine and Surgery...substitute for personnel, with the expectation that the use of these animals would reveal in- formation applicable to the protection and treatment

Editorial Introduction: The INQUA LoessFest Special Issue

NASA Astrophysics Data System (ADS)

Rawling, J. Elmo, III; Schaetzl, Randall J.

2018-04-01

The annual meeting of the INQUA's (International Union for Quaternary Research) Loess and Pedostratigraphy Focus Group met in Eau Claire, Wisconsin, USA on September 22-25, 2016. Such meetings have traditionally been referred to as "LoessFests". The Loess and Pedostratigraphy Focus Group is part of INQUA's commission on Stratigraphy and Chronology (http://www.inqua.org/aboutCommissions.html). The 2017 LoessFest was held in Goran, Iran (http://www.dgt.uns.ac.rs/inqua-loess/index.php).

The Effect of Extremely Low Frequency Radiation on Human Performance: A Preliminary Study.

DTIC Science & Technology

1974-08-01

Medical Research Laboratory Prepared for: Bu,’eau of Medicine and Surgery August 1974 DISTRIBUTED BY: HIM National Technical Information Service U. S... NATIONAL TECHNICAL INFORMATION SERVICE US Nptdrslmr,iI .1 C.-In~oce SSpiiISIiold, VA. 72151 PRICES SUBJECI" TO CHARGE FORM IA7 (P’AGE I Unclassified701 DD...anecdotal evidence which attributes a rather ambiguously defined neurasthenic syndrome (general weakness, f,9tigue, laziness, sleepiness in daytime, etc

Aquatic Plant Control Research Program: Effects of Submersed Aquatic Macrophytes on Physical and Chemical Properties of Surrounding Water

DTIC Science & Technology

1988-12-01

synthetic activity of populations of epiphytes. Photosynthesis in these algae was potentially stimulated by nutrients lost from senescing portions of... photosynthesis in both studied systems were evidenced not only by daytime accumulation of DO but also by concomitant increases in pH. The same has been...declining rates of net photosynthesis during late morning and early afternoon. 43. Decreases in both conductivity and calcium concentration noted in Eau

Preferences for Expansion of Public Services in Five West Central Wisconsin Counties. Report No. 8 of a Series on Quality of Life and Development in Northwestern Wisconsin, February 1976.

ERIC Educational Resources Information Center

Lambert, Virginia

As part of a study of the quality of life in northwestern Wisconsin, 1974 sample populations (N=150 residents per county) from each of 4 west central counties (Dunn, Clark, Eau Claire, and Polk) were presented with a list of public service programs and asked if they should be "expanded", "kept the same", or "cut…

“A Tree Must Be Bent While It Is Young”: Teaching Urological Surgical Techniques to Schoolchildren

PubMed Central

Buntrock, Stefan

2012-01-01

Background Playing video games in childhood may help achieve advanced laparoscopic skills later in life. The virtual operating room will soon become a reality, as “doctor games 2.0” will doubtlessly begin to incorporate virtual laparoscopic techniques. Objectives To teach surgical skills to schoolchildren in order to attract them to urology as a professional choice later in life. Materials and Methods As part of EAU Urology Week 2010, 108 school children aged 15–19 attended a seminar with lectures and simulators (laparoscopy, TUR, cystoscopy, and suture sets) at the 62nd Congress of the German Society of Urology in Düsseldorf. A Pub-Med and Google Scholar search was also performed in order to review the beneficial effects of early virtual surgical training. MeSh terms used were “video games,” “children,” and “surgical skills.” Searches were performed without restriction for a certain period of time. Results In terms of publicity for urology, EAU Urology Week, and the German Society of Urology, the event was immensely successful. Regarding the literature search, four relevant publications were found involving children. An additional three articles evaluated the usefulness of video gaming in medical students and residents. Conclusions Making use of virtual reality to attract and educate a new generation of urologists is an important step in designing the future of urology. PMID:23573467

Interleukin-35 induces regulatory B cells that suppress autoimmune disease.

PubMed

Wang, Ren-Xi; Yu, Cheng-Rong; Dambuza, Ivy M; Mahdi, Rashid M; Dolinska, Monika B; Sergeev, Yuri V; Wingfield, Paul T; Kim, Sung-Hye; Egwuagu, Charles E

2014-06-01

Interleukin-10 (IL-10)-producing regulatory B (Breg) cells suppress autoimmune disease, and increased numbers of Breg cells prevent host defense to infection and promote tumor growth and metastasis by converting resting CD4(+) T cells to regulatory T (Treg) cells. The mechanisms mediating the induction and development of Breg cells remain unclear. Here we show that IL-35 induces Breg cells and promotes their conversion to a Breg subset that produces IL-35 as well as IL-10. Treatment of mice with IL-35 conferred protection from experimental autoimmune uveitis (EAU), and mice lacking IL-35 (p35 knockout (KO) mice) or defective in IL-35 signaling (IL-12Rβ2 KO mice) produced less Breg cells endogenously or after treatment with IL-35 and developed severe uveitis. Adoptive transfer of Breg cells induced by recombinant IL-35 suppressed EAU when transferred to mice with established disease, inhibiting pathogenic T helper type 17 (TH17) and TH1 cells while promoting Treg cell expansion. In B cells, IL-35 activates STAT1 and STAT3 through the IL-35 receptor comprising the IL-12Rβ2 and IL-27Rα subunits. As IL-35 also induced the conversion of human B cells into Breg cells, these findings suggest that IL-35 may be used to induce autologous Breg and IL-35(+) Breg cells and treat autoimmune and inflammatory disease.

Assessment of basin-scale hydrologic impacts of CO2 sequestration, Illinois basin

USGS Publications Warehouse

Person, M.; Banerjee, A.; Rupp, J.; Medina, C.; Lichtner, P.; Gable, C.; Pawar, R.; Celia, M.; McIntosh, J.; Bense, V.

2010-01-01

Idealized, basin-scale sharp-interface models of CO2 injection were constructed for the Illinois basin. Porosity and permeability were decreased with depth within the Mount Simon Formation. Eau Claire confining unit porosity and permeability were kept fixed. We used 726 injection wells located near 42 power plants to deliver 80 million metric tons of CO2/year. After 100 years of continuous injection, deviatoric fluid pressures varied between 5.6 and 18 MPa across central and southern part of the Illinois basin. Maximum deviatoric pressure reached about 50% of lithostatic levels to the south. The pressure disturbance (>0.03 MPa) propagated 10-25 km away from the injection wells resulting in significant well-well pressure interference. These findings are consistent with single-phase analytical solutions of injection. The radial footprint of the CO2 plume at each well was only 0.5-2 km after 100 years of injection. Net lateral brine displacement was insignificant due to increasing radial distance from injection well and leakage across the Eau Claire confining unit. On geologic time scales CO2 would migrate northward at a rate of about 6 m/1000 years. Because of paleo-seismic events in this region (M5.5-M7.5), care should be taken to avoid high pore pressures in the southern Illinois basin. ?? 2010 Elsevier Ltd.

Osteoarthritis guidelines: a progressive role for topical nonsteroidal anti-inflammatory drugs

PubMed Central

Stanos, Steven P

2013-01-01

Current treatment guidelines for the treatment of chronic pain associated with osteoarthritis reflect the collective clinical knowledge of international experts in weighing the benefits of pharmacologic therapy options while striving to minimize the negative effects associated with them. Consideration of disease progression, pattern of flares, level of functional impairment or disability, response to treatment, coexisting conditions such as cardiovascular disease or gastrointestinal disorders, and concomitant prescription medication use should be considered when creating a therapeutic plan for a patient with osteoarthritis. Although topical nonsteroidal anti-inflammatory drugs historically have not been prevalent in many of the guidelines for osteoarthritis treatment, recent evidence-based medicine and new guidelines now support their use as a viable option for the clinician seeking alternatives to typical oral formulations. This article provides a qualitative review of these treatment guidelines and the emerging role of topical nonsteroidal anti-inflammatory drugs as a therapy option for patients with localized symptoms of osteoarthritis who may be at risk for oral nonsteroidal anti-inflammatory drug-related serious adverse events. PMID:23589694

Osteoarthritis guidelines: a progressive role for topical nonsteroidal anti-inflammatory drugs.

PubMed

Stanos, Steven P

2013-01-01

Current treatment guidelines for the treatment of chronic pain associated with osteoarthritis reflect the collective clinical knowledge of international experts in weighing the benefits of pharmacologic therapy options while striving to minimize the negative effects associated with them. Consideration of disease progression, pattern of flares, level of functional impairment or disability, response to treatment, coexisting conditions such as cardiovascular disease or gastrointestinal disorders, and concomitant prescription medication use should be considered when creating a therapeutic plan for a patient with osteoarthritis. Although topical nonsteroidal anti-inflammatory drugs historically have not been prevalent in many of the guidelines for osteoarthritis treatment, recent evidence-based medicine and new guidelines now support their use as a viable option for the clinician seeking alternatives to typical oral formulations. This article provides a qualitative review of these treatment guidelines and the emerging role of topical nonsteroidal anti-inflammatory drugs as a therapy option for patients with localized symptoms of osteoarthritis who may be at risk for oral nonsteroidal anti-inflammatory drug-related serious adverse events.

Guidelines for Nonsexist Use of Language in NCTE Publications.

ERIC Educational Resources Information Center

National Council of Teachers of English, Urbana, IL.

Written in response to a resolution passed at the 1974 convention of the National Council of Teachers of English, these guidelines are based on the assumption that the sexist usage of language aids in arbitrary assignation of roles to both men and women and would be better omitted. Although directed specifically to editors, these guidelines for…

Comparison of Western and Asian Guidelines Concerning the Management of Colon Cancer.

PubMed

Pellino, Gianluca; Warren, Oliver; Mills, Sarah; Rasheed, Shahnawaz; Tekkis, Paris P; Kontovounisios, Christos

2018-02-01

Guidelines are important to standardize treatments and optimize outcomes. Several societies have published authoritative guidelines for patients with colon cancer, and a certain degree of variation can be predicted. This study aims to compare Western and Asian guidelines for the management of colon cancer. A literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies published between 2010 and 2017 by the online resources from the official Web sites of the societies/panels. Sources included guidelines by European Society of Medical Oncology, the Japanese Society for Cancer of the Colon and Rectum, and the National Comprehensive Cancer Network. Only full-text studies and the latest guidelines dealing with colon cancer were included. Studies and guidelines were separately assessed by 2 authors, who independently identified discrepancies and areas for further research. These were discussed and agreed with by all the authors. The recommendations of the guidelines of each society were compared, seeking discrepancies and potential areas for improvement. Endoscopic techniques for the management of early colon cancer are discussed in detail in the Asian guidelines. Asian guidelines advocate extended (D3) lymphadenectomy on a routine basis in T3/T4 and in selected T2 patients, whereas such an approach is still under investigation in Western countries. Only US guidelines describe neoadjuvant chemotherapy and radiotherapy. All the guidelines recommend adjuvant treatment in selected stage II patients, but agreement exists that this is performed without solid evidence, because better outcomes are hypothesized based on studies including stage III or stage II/III patients. The role of cytoreductive surgery with intra-abdominal chemotherapy is dubious, and European guidelines only recommend it in the setting of trials. Asian guidelines endorse an aggressive surgical approach to peritoneal disease. Only US guidelines include a patient advocate in the drafting panel. Bias may have arisen from country-specific socioeconomic and cultural issues, and from the latest available updates. Surgical approaches to colon cancer differ significantly among Western and Asian guidelines, reflecting different concepts of treatment. The role of adjuvant treatment in node-negative disease and quality-of-life assessment need further research.

Current trends in guideline development: a cause for concern.

PubMed

Stephens, R G; Kogon, S L; Bohay, R N

1996-02-01

Although the development and use of practice-related guidelines as educational aids has a long history in the health professions, scientific assessment indicates that they have had limited success in changing practice patterns. This is principally due to the exclusion of practitioners from the development process, and the lack of a credible scientific basis for many guidelines. Past failures have led to new methods of guideline development based on a critical analysis of scientific data. These methods, which involve legitimate professional organizations at all stages of the development process, are clearly a step in the right direction. Unfortunately, there are signs that current guideline developers still fail to recognize the critical nature of the new methods or the need for an open and inclusive development process. It is even more disquieting that the objective of some guideline developers, such as licensing bodies, is the formulation of standards or review criteria, particularly when there are very few therapeutic practices with a sufficient scientific basis to justify such a designation. National and provincial societies, as well as dental educators, need to assume a leadership role to ensure that if guidelines are required, they will be developed as credible aids for the improvement of patient care. In this paper, the authors recount why the "traditional process" of guideline development resulted in guidelines that were mistrusted by the profession and, as a result, ineffective. They also outline the widely-documented current methodology, which should be followed if guidelines are to be accepted by the profession. Finally, they discuss the critical issue of who should develop guidelines, and examine their role in dental practice and education.

Détermination des paramètres bioécologiques et entomologiques d’Anopheles gambiae sl dans la transmission du paludisme à Bandundu-ville, République Démocratique de Congo

PubMed Central

Matubi, Emery Metelo; Bukaka, Eric; Luemba, Trésor Bakambana; Situakibanza, Hyppolite; Sangaré, Ibrahim; Mesia, Gauthier; Ngoyi, Dieudonné Mumba; Maniania, Nguya Kalemba; Akikwa, Charles Ngandote; Kanza, Jean Pierre Basilua; Tamfum, Jean-Jacques Muyembe; sudi, Jonas Nagahuedi Bongo

2015-01-01

Introduction La présente étude a été menée à Bandundu-ville (RDC) en vue d'identifier les paramètres écologiques et entomologiques modulant la transmission du paludisme ainsi que leur tendance saisonnière dans cette agglomération. Méthodes Cette étude a été réalisée dans la période du 1er juin au 31 décembre 2011. Des prospections des gîtes larvaires d'anophèles avec récolte ont été réalisées, les paramètres physiques, physico-chimiques et environnementaux déterminés. La densité larvaire a été estimée selon une échelle de classes de densité, inspirée de la méthode de Carron pour chaque type de gîtes. Quarante-huit maisons ont été sélectionnées et prospectées pour la récolte des moustiques par pulvérisation intradomicilaire. L'identification des moustiques a été faite sur base des critères morphologiques de Gilles et Demeillon. L'Indice sporozoïtique (Is) a été déterminé par le test ELISA CSP de Plasmodium falciparum à l'Institut National de Recherche Biomédicale selon le protocole de Robert Wirtz. Les autres paramètres entomologiques comme la densité, le taux d'agressivité, le taux d'inoculation entomologique (TIE) ainsi que l'indice de stabilité ont été déterminés selon le protocole de l'OMS. La régression linéaire a été réalisée au seuil de signification de 0,05 pour identifier les déterminants de la densité larvaire. Résultats Cent-sept gîtes larvaires ont été identifiés et caractérisés en 5 types (digues et puits d'eau, collections d'eau maraîchère et concasseurs moellons, marais Régie de distribution d'eau, marais le long des rivières et ruisseaux et flaques d'eau de pluies). La densité larvaire moyenne a été de 117,4±64,1. Quatre mille cinq cents quatre-vingt-huit moustiques ont été capturés et identifiés, parmi lesquels 1.258 Anopheles gambiae sl avec une densité de 8,86, un taux d'agressivité de 1,55 piqûre par homme par nuit, l'Is de 5,6%, un TIE de 0,085 piqûre infectante par homme par nuit, l'espérance de vie moyenne d'anophèles de 16,4 jours et un indice stabilité de 6,512. L'analyse des données a montré que la superficie des gîtes larvaires influençait significativement la densité larvaire (p < 0,001). Par contre, la turbidité et la conductivité des gîtes influençaient négativement la densité larvaire (p < 0,05, IC 95%). Conclusion Les diverses biotopes, la forte densité d’Anopheles gambiae sl, le TIE et l'indice de stabilité placent Bandundu-ville en zone endémique stable. PMID:26848355

Hydrochemistry of waters from five cenotes and evaluation of their suitability for drinking-water supplies, northeastern Yucatan, Mexico

NASA Astrophysics Data System (ADS)

Alcocer, Javier; Lugo, Alfonso; Marín, Luis E.; Escobar, Elva

Waters from five cenotes that are currently being used for aquatic recreational activities and that lie along the Cancun-Tulum touristic corridor, Mexico, were evaluated hydrochemically to determine whether the cenotes may be considered as potential drinking-water sources. Several parameters exceed the Mexican Drinking Water Standards (MDWS), but since they do not pose a significant health threat, four of the five cenotes may be used as drinking-water sources. The common contaminants in the Yucatan Peninsula, fecal coliforms and nitrate, are in most cases below the MDWS (0-460 MPN/100ml and 0.31-1.18mg/L, respectively). Although these four cenotes meet the MDWS, a careful groundwater management policy needs to be developed to avoid contamination (fecal and nitrates) and salt-water intrusion. Résumé Les eaux de cinq cénotés, qui sont normalement utilisées pour des activités de plein air, dans la région touristique de Cancun-Tulum (Mexique), ont été soumises à analyses chimiques pour savoir si les cénotés peuvent être considérés comme des sources d'eau potable. Plusieurs paramètres dépassent les normes mexicaines en matière d'eau potable; mais comme ceux-ci ne posent pas de problème réel de santé, quatre des cinq cénotés peuvent être captés pour l'eau potable. Les contaminants habituels dans les eaux de la presqu'île du Yucatan, coliformes fécaux et concentrations élevées en nitrate, sont la plupart du temps au-dessous des normes (respectivement 0 à 460 germes/100ml et 0,31 à 1,18mg/l). Bien que ces quatre cénotés satisfassent aux normes, il est nécessaire de mettre en place des règles précises de l'utilisation de l'eau souterraine, afin d'éviter la contamination par les germes fécaux et par les nitrates, ainsi que l'intrusion marine. Resumen Se analizó hidroquímica y bacteriológicamente el agua de algunos cenotes localizados a lo largo del corredor turístico Cancun-Tulum, que actualmente se utilizan para diversas actividades recreativas, para determinar su potencial de uso como fuente de abastecimiento de agua potable. La mayor parte de los parámetros excedieron los criterios establecidos en la Norma Mexicana para Agua Potable (NMAP), sin embargo, como éstas no representan una riesgo para la salud, el agua de cuatro de los cinco cenotes puede ser emplada como fuente de abastecimiento de agua potable. Los contaminantes comúnes del agua subterránea de la península de Yucatán, coliformes fecales y nitratos, se encuentran en la mayoría de los casos por debajo de la NMAP (0-460 NMP/ 100ml y 0.31-1.18mg/l, respectivamente). A pesar de que estos cuatro cenotes cumplen con la NMAP, es necesario desarrollar una política de manejo adecuada del agua subterránea para evitar la contaminación de este recurso (fecal y por nitratos), así como la intrusión de agua salina.

The role of nurses/social workers in using a multidimensional guideline for diagnosis of anxiety and challenging behaviour in people with intellectual disabilities.

PubMed

Pruijssers, Addy; van Meijel, Berno; Maaskant, Marian; Keeman, Noortje; Teerenstra, Steven; van Achterberg, Theo

2015-07-01

This study seeks (1) to investigate the impact of the implementation of the 'Diagnostic Guideline for Anxiety and challenging behaviours in clients with intellectual disability' on nurses/social workers' knowledge and self-efficacy; and (2) to evaluate the role of nurses/social workers in the diagnostic process when applying the guideline. Nurses/social workers have extensive contact with clients with intellectual disabilities. Despite this key position, the contribution of nurses/social workers to the diagnosis of mental health problems and challenging behaviours is rather limited. The authors developed the multidimensional 'Diagnostic Guideline for Anxiety and challenging behaviours'. In this article, the implementation of this guideline is evaluated concerning knowledge and self-efficacy of nurses/social workers, as well the role of nurses/social workers in the diagnostic process. This study employed a comparative multiple case study design. Qualitative and quantitative research methods. Working with the 'Diagnostic Guideline for Anxiety and challenging behaviours' led to a statistically significant increase in knowledge and self-efficacy among the nurses/social workers in the experimental condition, compared with nurses/social workers in the control condition. Nurses/social workers and psychologists appreciated the more active contribution of the nurses/social workers in the diagnostic process. Working with the guideline increased the knowledge and self-efficacy of nurses/social workers, and led to more active participation of nurses/social workers in the diagnostic process. After following a training programme, nurses/social workers can effectively contribute to the diagnostic process in clients with anxiety and related challenging behaviours. © 2015 John Wiley & Sons Ltd.

A look at statin cost-effectiveness in view of the 2013 ACC/AHA cholesterol management guidelines.

PubMed

Deaño, Roderick C; Pandya, Ankur; Jones, Erica C; Borden, William B

2014-09-01

The 2013 cholesterol management guidelines presented a major shift in recommendations on which patients at risk of cardiovascular disease should be treated and how to treat them. Implementation of the guidelines is estimated to increase substantially the number of people who would be eligible for statin therapy. As the medical community considers the broad population impact of the new cholesterol guidelines, the issue of cost-effectiveness plays a role. This review covers the basic fundamentals of cost-effectiveness analysis and summarizes the key cost-effectiveness studies that relate to the new cholesterol guidelines.

European guidelines for workplace drug testing in urine.

PubMed

Taskinen, Sanna; Beck, Olof; Bosch, Tessa; Brcak, Michaela; Carmichael, Duncan; Fucci, Nadia; George, Claire; Piper, Mark; Salomone, Alberto; Schielen, Wim; Steinmeyer, Stefan; Weinmann, Wolfgang

2017-06-01

These European Guidelines for Workplace Drug Testing in Urine have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The first version of these urine guidelines was published in 2002. Since then, the guidelines have been followed by many laboratories in different European countries and their role has been essential particularly in countries lacking legislation for workplace drug testing. In 2014, the EWDTS started a guidelines updating project and published a new version of the urine guidelines in 2015. Here we represent this updated version of the urine guidelines. The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing should use these guidelines as a template for accreditation. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Sediment-Overlying Water Relationships Affecting Wintertime Dissolved Oxygen Conditions in the Big Eau Pleine Reservoir, Wisconsin.

DTIC Science & Technology

1992-07-01

22202-4302. and to the Office of Managel ent and Bidget . P worki Reduction Pfo4ect(07T4-016 Wahington. DC 20S03. -1. AGENCY USE ONLY (Leave blank) 2...higher pool elevation can not be maintained, it is likely that additional aerators must be installed for incremental use to meet periodic heavy oxygen...install additional aerators throughout the reservoir for incremental use as needed to enhance oxygen diffusion processes. The difficulty with this

Evaluation of Head Mounted and Head Down Information Displays During Simulated Mine-Countermeasures Dives to 42 msw

DTIC Science & Technology

2008-04-01

visualisation tête basse (VTB) ou d’un visiocasque pour l’exécution de leurs tâches courantes sous l’eau. Neuf plongeurs de lutte contre les mines ont...existe peu d’information empirique sur l’aptitude des plongeurs à utiliser un dispositif multifonction de visualisation tête basse (VTB) ou d’un...experiment, the diver was also linked to the researchers and operations crew via audio communications. 11 Display Screen Chamber Laptop Diver

Environmental and Water Quality Operational Studies: Limnological Studies at Eau Galle, Lake, Wisconsin. Report 2. Special Studies and Summary.

DTIC Science & Technology

1987-03-01

received greater attention (Kalff and Knoechel 1978). As implied in the study of Nicholls, Kennedy, and Hammett (1980), and perhaps applicable 35 . I...from associated increases in DIN availability (Nicholls, Kennedy, and Hammett 1980). Since Cyanophytes among other algae are effective at luxuriously...phytoplankton % in Lake Erken. Symb. Bot. Ups. 17:163. (In German.) Nicholls, K. H., W. Kennedy, and C. Hammett . 1980. A fish-kill in Heart Lake

Physical therapist assistants' perceptions of the documented roles of the physical therapist assistant.

PubMed

Robinson, A J; DePalma, M T; McCall, M

1995-12-01

This study investigated physical therapist assistants' (PTAs) perceptions of the documented roles of PTAs and compared those perceptions with those of physical therapists from a previous study. A questionnaire that described 79 physical therapy activities was distributed to a sample (n = 400) of PTAs derived from the American Physical Therapy Association membership. The response rate was 56% (n = 225). Respondents indicated whether each activity was included in the documentation describing PTA roles. Discriminant analyses were used to determine whether demographic factors predicted the pattern of responses. In addition, meta-analytic techniques were used to determine whether PTA responses were different from those of physical therapists gathered previously. The greatest agreement of PTA opinions with published guidelines occurred for treatment implementation activities, and the lowest level of agreement occurred for items designated as administrative activities. Responses of PTAs were different from those of physical therapists on 21 of the 79 activities. The greatest number of these differences occurred for evaluative functions (n = 9). Physical therapist assistants' perceptions of documented PTA roles were generally less consistent with published guidelines than were those of physical therapists. Physical therapist assistants' perceptions of the roles of the PTA were, for some activities, not consistent with written guidelines. Using the data provided in this study, discussions to revise the documentation of the scope of PTA practice may focus on those activities for which disagreement between PTAs and physical therapists exists and for which opinions differ markedly from published guidelines. [Robinson AJ, DePalma MT, McCall M. Physical therapist assistants' perceptions of the documented roles of the physical therapist assistant.

GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale.

PubMed

Welch, Vivian A; Akl, Elie A; Guyatt, Gordon; Pottie, Kevin; Eslava-Schmalbach, Javier; Ansari, Mohammed T; de Beer, Hans; Briel, Matthias; Dans, Tony; Dans, Inday; Hultcrantz, Monica; Jull, Janet; Katikireddi, Srinivasa Vittal; Meerpohl, Joerg; Morton, Rachael; Mosdol, Annhild; Petkovic, Jennifer; Schünemann, Holger J; Sharaf, Ravi N; Singh, Jasvinder A; Stanev, Roger; Tonia, Thomy; Tristan, Mario; Vitols, Sigurd; Watine, Joseph; Tugwell, Peter

2017-10-01

This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for development of clinical, public health, and health system guidelines. We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve. We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation. Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Return of the pulmonary nodule: the radiologist's key role in implementing the 2015 BTS guidelines on the investigation and management of pulmonary nodules.

PubMed

Graham, Richard N J; Baldwin, David R; Callister, Matthew E J; Gleeson, Fergus V

2016-01-01

The British Thoracic Society has published new comprehensive guidelines for the management of pulmonary nodules. These guidelines are significantly different from those previously published, as they use two malignancy prediction calculators to better characterize the risk of malignancy. There are recommendations for a higher nodule size threshold for follow-up (≥5 mm or ≥80 mm(3)) and a reduction of the follow-up period to 1 year for solid pulmonary nodules; both of these will reduce the number of follow-up CT scans. PET-CT plays a crucial role in characterization also, with an ordinal scale being recommended for reporting. Radiologists will be the key in implementing these guidelines, and routine use of volumetric image-analysis software will be required to manage patients with pulmonary nodules correctly.

Falling on stony ground? A qualitative study of implementation of clinical guidelines' prescribing recommendations in primary care.

PubMed

Rashidian, Arash; Eccles, Martin P; Russell, Ian

2008-02-01

We aimed to explore key themes for the implementation of guidelines' prescribing recommendations. We interviewed a purposeful sample of 25 participants in British primary care in late 2000 and early 2001. Thirteen were academics in primary care and 12 were non-academic GPs. We asked about implementation of guidelines for five conditions (asthma, coronary heart disease prevention, depression, epilepsy, menorrhagia) ensuring variation in complexity, role of prescribing in patient management, GP role in prescribing and GP awareness of guidelines. We used the Theory of Planned Behaviour to design the study and the framework method for the analysis. Seven themes explain implementation of prescribing recommendations in primary care: credibility of content, credibility of source, presentation, influential people, organisational factors, disease characteristics, and dissemination strategy. Change in recommendations may hinder implementation. This is important since the development of evidence-based guidelines requires change in recommendations. Practitioners do not have a universal view or a common understanding of valid 'evidence'. Credibility is improved if national bodies develop primary care guidelines with less input from secondary care and industry, and with simple and systematic presentation. Dissemination should target GPs' perceived needs, improve ownership and get things right in the first implementation attempt. Enforcement strategies should not be used routinely. GPs were critical of guidelines' development, relevance and implementation. Guidelines should be clear about changes they propose. Future studies should quantify the relationship between evidence base of recommendations and implementation, and between change in recommendations and implementation. Small but important costs and side effects of implementing guidelines should be measured in evaluative studies.

A participatory approach to integrated aquifer management: The case of Guanajuato State, Mexico

NASA Astrophysics Data System (ADS)

Sandoval, Ricardo

Guanajuato State, located in central Mexico, with less than 2% of the country's area, has almost 17,000 deep water wells, from which nearly 4,000 cubic hectometers (hm3) per year are being extracted, more than 1,000 hm3 over the estimated renewable yield. Since, in Mexico, water is administered under federal jurisdiction by the National Water Commission (CNA, for its Spanish acronym), the state government faces the challenge of ensuring its population's economic development without formal means of intervention. Being thus limited to apply mandatory policies and measures, the state water program has focused on the implementation of a two-sided strategy. First, basic hydrogeological studies and mathematical groundwater hydrodynamic models were developed upon a comprehensive survey of existing wells and a general revision of the state's geological framework. Second, a structure for water user's participation in water management actions was promoted (from the dissemination of information to the implementation of pilot efficient water use projects) with financial, technical and political support from the state. Simultaneously, a coordinated effort towards the completion of the water user's registry was performed with the federal authority along with other supporting measures such as training and monitoring programs. In this paper, a general overview of the project's achievements and challenges is presented. L'État de Guanajuato, situé dans la partie centrale du Mexique, avec moins de 2% de la surface du pays, a près de 17 000 puits profonds, d'où sont extraits près de 4 000 hm3 par an, soit plus de 1 000 hm3 de plus que le débit renouvelable estimé. Comme au Mexique l'eau est administrée dans le cadre d'une juridiction fédérale, le gouvernement de l'État fait tout son possible pour assurer le développement de sa population sans moyens formels d'intervention. Étant ainsi limité à appliquer des politiques et des mesures de recommandations, le programme Eau de l'État s'est appliqué à développer une stratégie sur deux plans. Tout d'abord, des études hydrogéologiques de base et des modèles mathématiques d'écoulement et de transport de nappe ont été réalisés à partir d'un suivi d'ensemble des puits existants et d'une révision générale du contexte géologique de l'État. Ensuite, on a soutenu une structure de participation des usagers de l'eau aux actions de gestion de l'eau, à partir de la dissémination de l'information pour la mise en place de projets pilotes efficaces d'utilisation de l'eau, avec des aides financières, techniques et politiques de l'État. Simultanément, un effort coordonné en vue de l'achèvement de l'enregistrement des usagers de l'eau a été fait avec l'autorité fédérale, en même temps que d'autres mesures de soutien, telles que des programmes de formation et des campagnes de surveillance. Cet article présente une vue d'ensemble des réalisations de projets et des défis. Resumen El Estado de Guanajuato, situado en el centro de México, ocupa menos del 2% de la superficie del país. Tiene casi 17.000 pozos profundos, de los cuales se extrae cerca de 4.000 hm3/a, lo que supone un exceso de 1.000 hm3/a respecto a la recarga anual. Puesto que el agua es administrada a nivel federal en México, el gobierno del Estado afronta el reto de asegurar el desarrollo de la población sin disponer de medios formales de intervención. Dadas las limitaciones para aplicar políticas y medidas reguladoras, el programa del agua en el Estado tiene como objetivo principal la implantación de una doble estrategia. Por un lado, desarrollar estudios hidrogeológicos básicos y modelos matemáticos de flujo y transporte de los acuíferos, basándose en una campaña exhaustiva de pozos existentes y en una revisión del marco geológico del Estado. Por otro lado, promover-con soporte financiero, técnico y político-una estructura de participación de los usuarios en las acciones de gestión, incluyendo desde la difusión de la información hasta la implantación de proyectos piloto para un uso eficiente del agua. Simultáneamente, se ha llevado a cabo un esfuerzo coordinado con la autoridad federal para completar el registro de usuarios del agua, además de promover otras medidas de ayuda, como programas de capacitación y campañas de muestreo. En este artículo, se ofrece una visión general de los logros y retos del proyecto.

Water-resources reconnaissance of Île de la Gonâve, Haiti

NASA Astrophysics Data System (ADS)

Troester, Joseph W.; Turvey, Michael D.

Île de la Gonâve is a 750-km2 island off the coast of Haiti. The depth to the water table ranges from less than 30 m in the Eocene and Upper Miocene limestones to over 60 m in the 300-m-thick Quaternary limestone. Annual precipitation ranges from 800-1,400 mm. Most precipitation is lost through evapotranspiration and there is virtually no surface water. Roughly estimated from chloride mass balance, about 4% of the precipitation recharges the karst aquifer. Cave pools and springs are a common source for water. Hand-dug wells provide water in coastal areas. Few productive wells have been drilled deeper than 60 m. Reconnaissance field analyses indicate that groundwater in the interior is a calcium-bicarbonate type, whereas water at the coast is a sodium-chloride type that exceeds World Health Organization recommended values for sodium and chloride. Tests for the presence of hydrogen sulfide-producing bacteria were negative in most drilled wells, but positive in cave pools, hand-dug wells, and most springs, indicating bacterial contamination of most water sources. Because of the difficulties in obtaining freshwater, the 110,000 inhabitants use an average of only 7 L per person per day. L'Île de la Gonâve est une île de 750 km2 au large de la côte d'Haïti. La profondeur de la nappe varie entre moins de 30 m dans les calcaires de l'Éocène et du Miocène supérieur à plus de 60 m dans les calcaires quaternaires épais de 300 m. Les précipitations annuelles sont comprises entre 800-1.400 mm. La plus grande partie des précipitations est perdue par évapotranspiration et il n'y a pratiquement pas d'eau de surface. Le bilan de masse des chlorures permet d'estimer à 4% des précipitations le montant de la recharge de l'aquifère karstique. Des bassins dans les grottes et des sources sont la source d'eau courante. Des puits creusés à la main fournissent de l'eau dans les zones côtières. Quelques puits productifs ont été forés dépassant 60 m de profondeur. L'analyse des reconnaissances de terrain indique que les eaux souterraines à l'intérieur de l'île sont de faciès bicarbonaté calcique, tandis que l'eau près de la côte a un faciès chloruré sodique dépassant les valeurs recommandées par l'OMS pour le sodium et les chlorures. Des tests pour la présence de bactéries productrices d'hydrogène sulfuré se sont révélés négatifs dans la plupart des forages, mais positifs dans la plupart des sources captées et tous les autres sources, bassins de grottes et puits creusés à la main, ce qui indique une contamination bactérienne de la plupart des sources d'eau. Du fait des difficultés pour s'approvisionner en eau douce, les 110.000 habitants utilisent en moyenne seulement 7 L par personne et par jour. La Isla de la Gonavê, cercana a la costa de Haití, tiene 750 km2. La profundidad al nivel freático está comprendida entre menos de 30 m para las calcitas del Eoceno y Mioceno Superior y más de 60 m en el acuífero de calcitas cuaternarias, el cual posee 300 m de espesor. La precipitación anual varía entre 800-1.400 mm, si bien la mayor parte se pierde por evapotranspiración y prácticamente no hay aguas superficiales. Según un balance de masas de cloruros, alrededor del 4% de la precipitación recarga el acuífero kárstico. Las cavidades y manantiales son una fuente habitual de agua. Los pozos excavados proporcionan agua en las áreas costeras. Pocos pozos productivos se han perforado a más de 60 m. El reconocimiento de los análisis de campo indica que las aguas subterráneas son de tipo bicarbonatado-cálcico en el interior, mientras que es de tipo clorurado-sódico en la costa, donde se sobrepasan las concentraciones recomendadas por la Organización Mundial de la Salud para sodio y cloruro. Los ensayos efectuados para detectar la presencia de bacterias productoras de sulfuro de hidrógeno resultaron negativos en la mayoría de los pozos perforados, pero fueron positivos en la muchos manantiales explotados y en todos los manantiales, cavidades y pozos excavados, hecho que indica la contaminación bacteriana de la mayor parte de fuentes de agua. Debido a las dificultades para obtener agua dulce, los 110.000 habitantes utilizan una media de sólo 7 L por persona al día.

Application of remote-sensing data to groundwater exploration: A case study of the Cross River State, southeastern Nigeria

NASA Astrophysics Data System (ADS)

Edet, A. E.; Okereke, C. S.; Teme, S. C.; Esu, E. O.

The Cross River State, Nigeria, is underlain by the Precambrian-age crystalline basement complex and by rocks of Cretaceous to Tertiary age. The exploration for groundwater in this area requires a systematic technique in order to obtain optimum results, but the non-availability of funds and facilities has made it extremely difficult to carry out site investigations prior to the drilling of water wells. Therefore, the failure rate is as high as 80%. In order to delineate areas that are expected to be suitable for future groundwater development, black and white radar imagery and aerial photographs were used to define some hydrological and hydrogeological features in parts of the study area. Lineament and drainage patterns were analysed using length density and frequency. Lineament-length density ranges from 0.04-1.52 lineament frequency is 0.11-5.09 drainage-length density is 0.17-0.94, and the drainage frequency is 0.16-1.53. These range of values reflect the differences in the probability of groundwater potentials. Results were then used to delineate areas of high, medium, and low groundwater potential. Study results also indicate that correlations exist between lineament and drainage patterns, lithology, water temperature, water conductivity, well yield, transmissivity, longitudinal conductance, and the occurrence of groundwater. Résumé La géologie de l'Etat de Cross River (Nigéria) est constituée d'un socle cristallin d'âge précambrien et de roches datées du Crétacé au Tertiaire. Dans cette région, l'exploration des eaux souterraines nécessite une analyse systématique pour obtenir les meilleurs résultats ; cependant le manque de moyens a rendu particulièrement difficile les recherches de sites de forage destinés au captage de l'eau. C'est pourquoi le taux d'échec a atteint 80%. Afin de délimiter les zones susceptibles de permettre la future mise en valeur des eaux souterraines, des images radar et des photos aériennes en noir et blanc ont été utilisées pour mettre en évidence certains phénomènes hydrologiques et hydrogéologiques en certains points de la région étudiée. L'analyse des réseaux de linéaments et de drainage a porté sur la densité de leurs longueurs et sur leur fréquence. La densité de longueur des linéaments s'étend de 0,04 à 1,52 et la fréquence des linéaments de 0,11 à 5,09 ; la densité des longueurs de drainage est comprise entre 0,17 et 0,94, et la fréquence du drainage entre 0,16 et 1,53. Ces gammes de valeurs rendent compte des différences dans la probabilité des potentiels en eau souterraine. Ces résultats ont ensuite été utilisés pour délimiter les zones à potentiel en eau souterraine fort, moyen et faible. Les résultats de l'étude indiquent aussi qu'il existe des corrélations entre les réseau de linéaments et de drainage, la lithologie, la température de l'eau, la conductivité de l'eau, le rendement des puits, la transmissivité, la conductance longitudinale et la présence d'eau souterraine. Resumen Bajo el Estado de Cross River, Nigeria, subyace un complejo basal cristalino del Precámbrico, así como rocas de edad entre Cretácica y Terciaria. La exploración hidrogeológica en esta área requiere una técnica sistemàtica para poder alcanzar resultados óptimos, pero la falta de medios y de infraestructura ha hecho extremadamente difícil el poder realizar investigaciones previas a la perforación de los pozos, de manera que el porcentaje de fallos se eleva al 80%. Para poder delinear las áreas adecuadas para el posterior desarrollo hidrogeológico, se han usado imágenes de radar en blanco y negro y fotografías aéreas, con el objetivo de definir algunos rasgos hidrológicos e hidrogeológicos en partes del área de estudio. Se analizaron los esquemas de lineamiento y drenaje usando densidad y frecuencia de longitudes. La densidad de longitudes de lineamiento oscila entre 0.04-1.52 y la frecuencia entre 0.11-5.09. La densidad de longitud de drenaje oscila entre 0.17-0.94 y su frecuencia entre 0.16-1.53. Estos rangos de valores reflejan las diferencias en el grado potencial de extracción de aguas subterráneas, que se dibuja en unos mapas siguiendo la clasificación de potencial alto, medio o bajo. Los resultados del estudio indican que existen correlaciones entre los esquemas de lineamiento y drenaje, litología, temperatura y conductividad del agua, descenso en el pozo, transmisividad, conductancia longitudinal y la presencia de agua subterránea.

Organizational characteristics and processes are important in the adoption of the Alberta Nutrition Guidelines for Children and Youth in child-care centres.

PubMed

Farmer, Anna P; Nikolopoulos, Hara; McCargar, Linda; Berry, Tanya; Mager, Diana

2015-06-01

The objective of the present study was to gain an understanding of the organizational characteristics and processes in two child-care centres that may influence adoption of the Alberta Nutrition Guidelines for Children and Youth (ANGCY). In-depth qualitative case studies. Data were collected through direct observations, key informant interviews and field notes. Diffusion of Innovations theory guided the evaluation and intrinsic case analysis. Two urban child-care centres in Edmonton, Alberta, Canada identified as exemplary early adopter cases. Ten key informants comprised of directors, junior and senior staff members participated in interviews. Organizational processes such as leadership, networking and knowledge brokering, health champions and organizational culture positively influenced adoption behaviour in child-care centres. A key determinant influencing organizational behaviour within both centres was the directors' strong leadership. Acceptance of and adherence to the guidelines were facilitated by organizational factors, such as degree of centralization, formalization and complexity, level of staff training and education. Knowledge brokering by directors was important for transferring and exchanging information across the centre. All child-care staff embraced their informal role as health champions as essential to supporting guideline adherence and encouraging healthy food and eating environments. Organizational processes and characteristics such as leadership, knowledge brokering and networking, organizational culture and health champions played an important role in the adoption of nutrition guidelines in child-care centres. The complex interplay of decision making, organization of work and specialization of roles influenced the extent to which nutrition guidelines were adopted.

Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare.

PubMed

Richter Sundberg, Linda; Garvare, Rickard; Nyström, Monica Elisabeth

2017-05-11

The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease. A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data. The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: 'clinical knowledge and experience', 'potential guideline consequences' and 'needs of vulnerable groups'. The frequency of the use of various criteria in discussions varied over time. Gender, professional status, and interpersonal skills were perceived to affect individuals' relative influence on group discussions. The study shows that guideline development groups make compromises between rigour and pragmatism. The formal guideline development model incorporated multiple aspects, but offered few details on how the different criteria should be handled. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from clarifying the role of the group-related factors and non-research evidence, such as clinical experience and ethical considerations, in decision-processes during guideline development.

Use of NCCN Guidelines, Other Guidelines, and Biomarkers for Colorectal Cancer Screening.

PubMed

Williams, Christina D; Grady, William M; Zullig, Leah L

2016-11-01

Colorectal cancer (CRC) remains a common cancer and significant public health burden. CRC-related mortality is declining, partly due to the early detection of CRC through robust screening. NCCN has established the NCCN Guidelines for CRC Screening to help healthcare providers make appropriate screening recommendations according to the patient's risk of developing CRC. This review describes the evolution of CRC screening guidelines for average-risk individuals, discusses the role of NCCN Guidelines for CRC Screening in cancer prevention, and comments on the current and emerging use of biomarkers for CRC screening. Copyright © 2016 by the National Comprehensive Cancer Network.

Pediatric constipation therapy using guidelines and polyethylene glycol 3350.

PubMed

Bell, Edward A; Wall, Geoffrey C

2004-04-01

To review current guidelines on the treatment of functional constipation in pediatric patients, with an emphasis on the role of polyethylene glycol 3350 (PEG 3350). Primary medical literature published in English was identified by MEDLINE search (1980-May 2003). Recently published treatment guidelines relating to pediatric functional constipation and its pharmacotherapy are assessed and compared. Published trials evaluating PEG 3350 in pediatric subjects are discussed and their results applied to the clinical role and use of this new agent. Constipation is a common disorder among children. A number of factors may play a role. A variety of medications are commonly used for this disorder, although few treatments have undergone evaluation by controlled clinical trials. Consensus guidelines recommend either osmotic laxatives, mineral oil, or their combination for maintenance treatment in concert with patient and parental education and behavioral training. PEG 3350 solution (MiraLax) has been shown in recent clinical studies to be an effective maintenance treatment for pediatric constipation. PEG 3350 is an effective and well-tolerated treatment choice for pediatric constipation, especially as an adjunct to education and behavioral training. PEG 3350 is an option for children with constipation who have failed or are intolerant of other pharmacotherapies.

Physicians must honor refusal of treatment to restore competency by non-dangerous inmates on death row.

PubMed

Zonana, Howard

2010-01-01

The role of physicians in death penalty cases has provoked discussion in both the legal system as well as in professional organizations. Professional groups have responded by developing ethical guidelines advising physicians as to current ethical standards. Psychiatric dilemmas as a subspecialty with unique roles have required more specific guidelines. A clinical vignette provides a focus to explicate the conflicts. © 2010 American Society of Law, Medicine & Ethics, Inc.

The impact of hygiene and localised treatment on the quality of drinking water in Masaka, Rwanda.

PubMed

Uwimpuhwe, Monique; Reddy, Poovendhree; Barratt, Graham; Bux, Faizal

2014-01-01

The worldwide prevalence of waterborne diseases has been attributed to the lack of safe water, inadequate sanitation and hygiene. This study evaluated socio-demographic factors, microbiological quality of water at source and point of use (POU) at households, water handling and sanitation practices in a rural Rwandan community. Thirty five water samples from the source, Nyabarongo River, and water at point of use (POU) treated with the Slow Sand Filter (SSF) and Sûr'Eau methods, were analysed for total coliform and faecal coliform counts. Turbidity was measured in household samples. A structured questionnaire regarding water collection, storage, usage and waterborne disease awareness was administered to 324 women. Despite the significant reduction in coliforms and faecal coliforms from the Nyabarongo River following treatment using either SSF or Sûr'Eau, the water at point of use was found to be unsafe for human consumption. The frequency of diarrheal diseases were significantly higher among people who did not wash hands before food preparation (P = 0.002) and after using a toilet (P = 0.007) than among those who did. There was a statistically significant association between education levels and water treatment practices at the households (P < 0.05). Participants had limited knowledge regarding water storage practices for prevention of household water contamination. A combination of treatment methods with appropriate water handling should be considered. In addition, education is a fundamental precursor to advocating water treatment at POU.

Medical Malpractice Implications of Clinical Practice Guidelines.

PubMed

Ruhl, Douglas S; Siegal, Gil

2017-08-01

Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

Clinical guidelines: proliferation and medicolegal significance.

PubMed Central

Hurwitz, B

1994-01-01

Guidelines seeking to influence and regulate clinical activity are currently gaining a new cultural ascendancy on both sides of the Atlantic. Statutory agencies may be charged with developing clinical guidelines, and civil courts, in deciding actions in negligence, could be influenced by standards of care expressed in guideline statements. Clinical guidelines are not accorded unchallengeable status: they have been subject to careful scrutiny by British and American courts to establish their authenticity and relevance. In the United States, compliance with clinical guidelines cannot be used as a defence against liability if a physician's conduct is held to have been negligent, and third party organisations can be held liable if their clinical guidelines are found to be a contributory cause of patient harm. Guidelines have not usurped the role of the expert witness in court. The importance the law attaches to customary practice means that atypical or bizarre guidelines are unlikely to be accepted as embodying a legally required standard of clinical care. PMID:10136259

Nutrition guidelines for undergraduate medical curricula: a six-country comparison.

PubMed

Crowley, Jennifer; Ball, Lauren; Laur, Celia; Wall, Clare; Arroll, Bruce; Poole, Phillippa; Ray, Sumantra

2015-01-01

To assess nutrition curriculum guidelines for undergraduate medical education in the United States, Canada, the United Kingdom, Republic of Ireland, Australia, and New Zealand to highlight potential opportunities for shared learning on the advancement of nutrition in medical education. A comprehensive list of professional bodies, councils, organizations, and other groups relevant to education or nutrition was compiled for each country after a review of relevant white and gray literature. All documents that were published from 2000 onwards, and that provided guidance on nutrition education within undergraduate medical education for one of the identified countries were included in the review. Each curriculum guideline was evaluated for 1) the organization's or group's role in undergraduate medical education; 2) the extent of nutrition-related recommendations; and 3) mandatory implementation. In the countries reviewed, a total of six nutrition-related curriculum guidelines were identified. All countries, aside from the Republic of Ireland, currently have externally visible curriculum guidelines to inform medical schools in undergraduate nutrition education, yet there is little evidence of mandatory enforcement. Curriculum guidelines predominantly focus on basic nutrition principles, nutrition assessment, the role of nutrition in health, interdisciplinary teamwork, and the provision of nutrition counseling. Notable differences exist regarding the scope and detail of curriculum guidelines for the reviewed countries. There are promising developments in nutrition curriculum guidelines for medical schools within the reviewed countries. Differences in the scope and detail of nutrition curriculum guidelines may influence the nutrition education provided to medical students, and the subsequent nutrition care provided by doctors in these countries. Consideration is required as to how to monitor and evaluate the nutrition competence of doctors in relation to routine health care practices, as well as the impact of their competency levels on patients' nutrition behavior and health outcomes.

Nutrition guidelines for undergraduate medical curricula: a six-country comparison

PubMed Central

Crowley, Jennifer; Ball, Lauren; Laur, Celia; Wall, Clare; Arroll, Bruce; Poole, Phillippa; Ray, Sumantra

2015-01-01

Aim To assess nutrition curriculum guidelines for undergraduate medical education in the United States, Canada, the United Kingdom, Republic of Ireland, Australia, and New Zealand to highlight potential opportunities for shared learning on the advancement of nutrition in medical education. Methods A comprehensive list of professional bodies, councils, organizations, and other groups relevant to education or nutrition was compiled for each country after a review of relevant white and gray literature. All documents that were published from 2000 onwards, and that provided guidance on nutrition education within undergraduate medical education for one of the identified countries were included in the review. Each curriculum guideline was evaluated for 1) the organization’s or group’s role in undergraduate medical education; 2) the extent of nutrition-related recommendations; and 3) mandatory implementation. Results In the countries reviewed, a total of six nutrition-related curriculum guidelines were identified. All countries, aside from the Republic of Ireland, currently have externally visible curriculum guidelines to inform medical schools in undergraduate nutrition education, yet there is little evidence of mandatory enforcement. Curriculum guidelines predominantly focus on basic nutrition principles, nutrition assessment, the role of nutrition in health, interdisciplinary teamwork, and the provision of nutrition counseling. Notable differences exist regarding the scope and detail of curriculum guidelines for the reviewed countries. Conclusion There are promising developments in nutrition curriculum guidelines for medical schools within the reviewed countries. Differences in the scope and detail of nutrition curriculum guidelines may influence the nutrition education provided to medical students, and the subsequent nutrition care provided by doctors in these countries. Consideration is required as to how to monitor and evaluate the nutrition competence of doctors in relation to routine health care practices, as well as the impact of their competency levels on patients’ nutrition behavior and health outcomes. PMID:25733949

Using guidelines to improve neonatal health in China and Vietnam: a qualitative study.

PubMed

Raven, Joanna; Liu, Xiaoyun; Hu, Dan; Zhu, Weiming; Hoa, Dinh Thi Phuong; Thi, Le Minh; Duong, Doan Thi Thuy; Alonso-Garbayo, Alvaro; Martineau, Tim

2016-11-11

Neonatal health (NH) remains a major problem in many countries. Children dying before 28 days often suffer from conditions that are preventable or treatable with proven, cost-effective interventions. The knowledge gaps are no longer about what should be done, but to understand why guidelines including these interventions are not followed. Using a behaviour change framework, this study explores neonatal health guidelines use and the role of management in supporting effective usage in two rural settings in China and Vietnam. Semi-structured interviews with policy makers, health care managers and providers (n = 49) and focus group discussions with women, husbands and grandmothers who had experienced maternal and NH care services within the last year (n = 7) were conducted. Data were analysed using the framework approach. Guidelines are not readily available at county, township and village levels in the study sites in China, whereas, in Vietnam, guidelines are available, accepted and being used at facility level. Improvements in implementation could be made in both settings. Factors influencing guidelines use common to both settings included: lack of equipment and supplies; shortage of staff with NH care experience; and guidelines not in line with patient practices. Factors specific to China included: poor guidelines dissemination; and disagreement with guidelines. There was limited community engagement in NH services in China, whereas in Vietnam, community members were actively involved in decision making and provision of services. Managers have an important role in supporting NH guidelines use through: ensuring guidelines are available; allocating appropriate resources; supporting and monitoring staff in their use; and engaging with local communities to promote effective practices. Engaging managers to support implementation is crucial. Management systems that provide the necessary resources, competent staff, and monitoring, regulatory and incentive frameworks as well as community engagement are needed to promote adoption of guidelines. Further research on how best to strengthen local level management so that they tailor interventions to support guideline use to their specific context is needed. This will ensure that proven interventions to address NH problems are used, and that countries move closer to achieving the new Sustainable Development Goal 3 target.

Barriers and Enablers to Implementation of Dietary Guidelines in Early Childhood Education Centers in Australia: Application of the Theoretical Domains Framework.

PubMed

Grady, Alice; Seward, Kirsty; Finch, Meghan; Fielding, Alison; Stacey, Fiona; Jones, Jannah; Wolfenden, Luke; Yoong, Sze Lin

2018-03-01

To identify perceived barriers and enablers to implementation of dietary guidelines reported by early childhood education center cooks, and barriers and enablers associated with greater implementation based on assessment of center menu compliance. Cross-sectional telephone interview. Early childhood education centers, New South Wales, Australia. A total of 202 cooks responsible for menu planning; 70 centers provided a menu for review of compliance with dietary guidelines. Barriers and enablers to dietary guideline implementation were determined using a tool assessing constructs of the Theoretical Domains Framework (TDF). Higher scores (≥6) for each construct indicated enablers to guideline implementation; lower scores (<6) suggested barriers. Multivariable linear regression identified TDF constructs associated with greater guideline implementation. Scores were lowest for reinforcement (mean, 5.85) and goals (mean, 5.89) domains, and highest for beliefs about consequences (mean, 6.51) and social/professional role and identity (mean, 6.50). The skills domain was positively associated with greater implementation of guidelines based on menu review (P = .01). Cooks perceived social/professional role and identity, and beliefs about consequences to be enablers to dietary guideline implementation; however, only the skills domain was associated with greater implementation. There are opportunities to target the incongruence in perceptions vs reality of the barriers and enablers to implementation. Future research could examine the utility of the TDF to identify barriers and enablers to implementation to inform intervention development and for evaluating interventions to examine intervention mechanisms. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Counseling Supervision within a Feminist Framework: Guidelines for Intervention

ERIC Educational Resources Information Center

Degges-White, Suzanne E.; Colon, Bonnie R.; Borzumato-Gainey, Christine

2013-01-01

Feminist supervision is based on the principles of feminist theory. Goals include sharing responsibility for the supervision process, empowering the supervisee, attending to the contextual assumptions about clients, and analyzing gender roles. This article explores feminist supervision and guidelines for providing counseling supervision…

Guidelines for the Practice of Adaptive Diabetes Education for Visually Impaired Persons.

ERIC Educational Resources Information Center

Berkowitz, Kathy

1993-01-01

This article presents guidelines developed by the American Association of Diabetes Educators concerning adaptive diabetes education for visually impaired persons (ADEVIP). The article discusses definitions, values, and assumptions; recommended professional educational background; role delineation; and process and content of ADEVIP. (DB)

Management Guidelines for Database Developers' Teams in Software Development Projects

NASA Astrophysics Data System (ADS)

Rusu, Lazar; Lin, Yifeng; Hodosi, Georg

Worldwide job market for database developers (DBDs) is continually increasing in last several years. In some companies, DBDs are organized as a special team (DBDs team) to support other projects and roles. As a new role, the DBDs team is facing a major problem that there are not any management guidelines for them. The team manager does not know which kinds of tasks should be assigned to this team and what practices should be used during DBDs work. Therefore in this paper we have developed a set of management guidelines, which includes 8 fundamental tasks and 17 practices from software development process, by using two methodologies Capability Maturity Model (CMM) and agile software development in particular Scrum in order to improve the DBDs team work. Moreover the management guidelines developed here has been complemented with practices from authors' experience in this area and has been evaluated in the case of a software company. The management guidelines for DBD teams presented in this paper could be very usefully for other companies too that are using a DBDs team and could contribute towards an increase of the efficiency of these teams in their work on software development projects.

Closing the gap between science and practice: the need for professional leadership.

PubMed

Eagle, Kim A; Garson, Arthur J; Beller, George A; Sennett, Cary

2003-01-01

Major opportunity exists to better align clinical science and clinical practice. To do so will require efforts not only to develop clinical practice guidelines, but to facilitate their application in practice. The American College of Cardiology operates a program to develop and assess the effectiveness of tools that facilitate the application of guidelines in practice. Here we review what we have learned about the process of guideline implementation, lay out the major research questions that need to be addressed, and argue that professional societies play a critical role in moving from guideline development to application.

Hydraulic properties of Mt. Simon aquifer, Prairie Island Indian community, southeastern Minnesota, 2001

USGS Publications Warehouse

Winterstein, Thomas A.

2002-01-01

Hantush and Theis methods type curves were fitted to the measured drawdown and recovery curves in the observation well. The results of matching the type curves to the measured data indicate that leakage is negligible from the overlying Eau Claire confining unit into the Mt. Simon aquifer. The transmissivity and storage coeffi-cients for the Mt. Simon aquifer, determined by both methods, are 3, 000 ft2/d and 3 x 10-4, respectively. The average hydraulic conductivity, assuming an aquifer thickness of 233 ft, is 10 ft/d.

Surface Observation Climatic Summaries (SOCS) for Hanau AAF, Germany

DTIC Science & Technology

1992-03-01

COVER CEILING VS VISIDILITY--POP (PNDN HOURLY 038)....................... D-2-1 S"Y CUME--POP (P1FRO DOURLY 018)................................. .. D-3...PART. SPECIFIED PHENOMENA VS WIND DIRECTION--PERCENT OCCURRENCE FREQUENCY. THESE TABLES INCLUDE SUMHARY OF MONTH FOR ALL HORS AIM YEAR COMBINED. WIND...TOTAL FISCIP PRCIP FISCIP PCWIP &/OR sym &/OR 093? 1NO. or EauE SAND TO VS ORB JW .0 13.9 .S 5.4 19.9 35.9 3.2 56.9 3140 mU .1 6.9 a.0 16.9 27.1 16.3

Validation of a novel cost effective easy to produce and durable in vitro model for kidney-puncture and PNL-Simulation.

PubMed

Klein, Jan Thorsten; Rassweiler, Jens; Rassweiler-Seyfried, Marie-Claire Charlotte

2018-03-29

Nephrolithiasis is one of the most common diseases in urology. According to the EAU Guidelines, a percutaneous nephrolitholapaxy (PNL) is recommended when treating a kidney stone >2 cm. Nowadays PNL is performed even for smaller stones (<1 cm) using miniaturized instruments. The most challenging part of any PNL is the puncture of the planned site. PNL-novice surgeons need to practice this step in a safe environment with an ideal training model. We developed and evaluated a new, easy to produce, in-vitro model for the training of the freehand puncture of the kidney. Porcine kidneys with ureters were embedded in ballistic gel. Food coloring and preservative agent were added. We used the standard imaging modalities of X-ray and ultrasound to validate the training model. An additional new technique, the iPAD guided puncture, was evaluated. Five novices and three experts conducted 12 punctures for each imaging technique. Puncture time, radiation dose, and number of attempts to a successful puncture were measured. Mann-Whitney-U, Kruskal-Wallis, and U-Tests were used for statistical analyses. The sonographic guided puncture is slightly but not significantly faster than the fluoroscopic guided puncture and the iPAD assisted puncture. Similarly, the most experienced surgeon's time for a successful puncture was slightly less than that of the residents, and the experienced surgeons needed the least attempts to perform a successful puncture. In terms of radiation exposure, the residents had a significant reduction of radiation exposure compared to the experienced surgeons. The newly developed ballistic gel kidney-puncture model is a good training tool for a variety of kidney puncture techniques, with good content, construct, and face validity.

Evidence-based guidelines for wise use of electronic games by children.

PubMed

Straker, Leon; Abbott, Rebecca; Collins, Rachel; Campbell, Amity

2014-01-01

Electronic games (e-games) are widely used by children, often for substantial durations, yet to date there are no evidence-based guidelines regarding their use. The aim of this paper is to present guidelines for the wise use of e-games by children based on a narrative review of the research. This paper proposes a model of factors that influence child-e-games interaction. It summarises the evidence on positive and negative effects of use of e-games on physical activity and sedentary behaviour, cardio-metabolic health, musculoskeletal health, motor coordination, vision, cognitive development and psychosocial health. Available guidelines and the role of guidelines are discussed. Finally, this information is compiled into a clear set of evidence-based guidelines, about wise use of e-games by children, targeting children, parents, professionals and the e-game industry. These guidelines provide an accessible synthesis of available knowledge and pragmatic guidelines based on e-game specific evidence and related research.

Adherence to radiography guidelines for low back pain: a survey of chiropractic schools worldwide.

PubMed

Ammendolia, Carlo; Taylor, John A M; Pennick, Victoria; Côté, Pierre; Hogg-Johnson, Sheilah; Bombardier, Claire

2008-01-01

This study describes instruction provided at chiropractic schools worldwide on the use of spine radiography and compares instruction with evidence-based guidelines for low back pain. Individuals responsible for radiology instruction at accredited chiropractic schools throughout the world were contacted and invited to participate in a Web-based survey. The survey included questions on the role of conventional radiography in chiropractic practice and instruction given to students for its use in patients with acute low back pain. Of the 33 chiropractic schools identified worldwide, 32 (97%) participated in the survey. Consistent with the guidelines, 25 (78%) respondents disagreed that "routine radiography should be used prior to spinal manipulative therapy," 29 (91%) disagreed that there "was a role for full spine radiography for assessing patients with low back pain," and 29 (91%) disagreed that "oblique views should be part of a standard radiographic series for low back pain." However, only 14 (44%) respondents concurred with the guidelines and disagreed with the statement that there "is a role for radiography in acute low back pain in the absence of 'red flags' for serious disease." This survey suggests that many aspects of radiology instruction provided by accredited chiropractic schools appear to be evidence based. However, there appears to be a disparity between some schools and existing evidence with respect to the role of radiography for patients with acute low back pain without "red flags" for serious disease. This may contribute to chiropractic overutilization of radiography for low back pain.

Nutrition: An Anti-Cancer Diet?

ERIC Educational Resources Information Center

Grady, Denise; Siwolop, Sana

1984-01-01

Presents seven dietary guidelines on ways to reduce the risk of contracting cancer, discussing scientific evidence supporting the guidelines. Includes a list of foods indicating possible role in cancer, sources, recommendations related to amount/frequency of intake, and hazards of megadoses. Foods cited include fats, vitamins, alcohol, caffeine,…

Guidelines for Psychological Practice in Health Care Delivery Systems

ERIC Educational Resources Information Center

American Psychologist, 2013

2013-01-01

Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism.

PubMed

Saric, Muhamed; Armour, Alicia C; Arnaout, M Samir; Chaudhry, Farooq A; Grimm, Richard A; Kronzon, Itzhak; Landeck, Bruce F; Maganti, Kameswari; Michelena, Hector I; Tolstrup, Kirsten

2016-01-01

Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Quality appraisal of clinical practice guidelines on the use of physiotherapy in rheumatoid arthritis: a systematic review.

PubMed

Hurkmans, Emalie J; Jones, Anamaria; Li, Linda C; Vliet Vlieland, Theodora P M

2011-10-01

To assess the quality of guidelines published in peer-reviewed literature concerning the role of physiotherapy in the management of patients with RA. A systematic literature search for clinical practice guidelines that included physiotherapy interventions was performed in four electronic databases. We assessed the quality of the selected guidelines using the appraisal of guidelines for research and evaluation (AGREE) instrument. In addition, the recommendations of guidelines with the highest quality scores were summarized. Eight clinical practice guidelines fulfilled the inclusion criteria. Scope/purpose was the most often adequately addressed AGREE domain (in seven of the eight guidelines) and applicability the least (in two of the eight guidelines). Based on the AGREE domain scores, six guidelines could be recommended or strongly recommended for clinical use. Five out of these six (strongly) recommended guidelines included a recommendation on exercise therapy and/or patient education, with these interventions being recommended in every case. Transcutaneous electrical nerve stimulation and thermotherapy were recommended in four of these six guidelines. US, thermotherapy, low-level laser therapy, massage, passive mobilization and balneotherapy were addressed in one or two of these six guidelines. Six of eight clinical practice guidelines addressing physiotherapy interventions were recommended or strongly recommended according to the AGREE instrument. In general, guideline recommendations on physiotherapy intervention, from both the recommended guidelines as well as from the not recommended guidelines, lacked detail concerning mode of delivery, intensity, frequency and duration.

Women in landscape architecture and heritage conservation

NASA Astrophysics Data System (ADS)

Bostenaru-Dan, Maria; Theodoridou, Magda; Hayashi, Mikiko; Anghelache, Mirela Adriana

2017-04-01

This contribution present research done by Marie Curie fellows in Italy. The first author investigated early landscape architecture in Italy, by Italian and by mobile Romanian landscape planers. The very first one was princess Jeanne Ghyca, who did the parterre d'eau at villa Gamberaia by Florence. This villa influenced the landscape architecture of Italy such as Piero Porcinai or Marie Teresa Parpagliolo. Maria Teresa Parpagliolo is the next name to deal as, since she designed the landscape of the EUR (Esposizione Universale Roma), in a time when Mussolini denied the contribution of women. Water characterises also this planning, with an aquarium being built currently under the lake. Maria Teresa Parpagliolo also worked with Elena Luzzatto, the first women architect in Italy, at the design of the military cemetery in Rome. This work will also be presented. Elena Luzzatto contributed to other Roman cemeteries as well, designing funerary stones for Verano and the cemetery at Prima Porta which will be presented. The work on cemeteries will be put in context of Rome (acatholic cemetery for example) and Italy (Carlo Scarpa, Aldo Rossi contributions). The investigation on the role of women will be compared to other programmes dealing with, for example the COST network genderSTE dealing with cities and climate change which are relevant for landscape, and MOMOWO, a European culture project on early woman planers. The next two authors did research on conservation issues, through the network EPISCON, and this is resulting in role models for the GEMS booklet and the Romanian role models booklet. The fourth author also was a Marie Curie fellow in Italy, at the ROSE school in Pavia, doing research on earthquake mitigation along with the first author's Marie Curie stay. The story will also be promoted in the Marie Curie Alumni chapter Romania.

Critical features of peer assessment of clinical performance to enhance adherence to a low back pain guideline for physical therapists: a mixed methods design.

PubMed

Maas, Marjo J M; van Dulmen, Simone A; Sagasser, Margaretha H; Heerkens, Yvonne F; van der Vleuten, Cees P M; Nijhuis-van der Sanden, Maria W G; van der Wees, Philip J

2015-11-12

Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously published randomized controlled trial showed that PA was more effective than the usual strategy "case discussion" in improving adherence to a low back pain guideline. Peer assessment aims to enhance knowledge, communication, and hands-on clinical skills consistent with guideline recommendations. Participants observed and evaluated clinical performance on the spot in a role-play simulating clinical practice. Participants performed three roles: physical therapist, assessor, and patient. This study explored the critical features of the PA program that contributed to improved guideline adherence in the perception of participants. Dutch physical therapists working in primary care (n = 49) organized in communities of practice (n = 6) participated in the PA program. By unpacking the program we identified three main tasks and eleven subtasks. After the program was finished, a questionnaire was administered in which participants were asked to rank the program tasks from high to low learning value and to describe their impact on performance improvement. Overall ranking results were calculated. Additional semi-structured interviews were conducted to elaborate on the questionnaires results and were transcribed verbatim. Questionnaires comments and interview transcripts were analyzed using template analysis. Program tasks related to performance in the therapist role were perceived to have the highest impact on learning, although task perceptions varied from challenging to threatening. Perceptions were affected by the role-play format and the time schedule. Learning outcomes were awareness of performance, improved attitudes towards the guideline, and increased self-efficacy beliefs in managing patients with low back pain. Learning was facilitated by psychological safety and the quality of feedback. The effectiveness of PA can be attributed to the structured and performance-based design of the program. Participants showed a strong cognitive and emotional commitment to performing the physical therapist role. That might have contributed to an increased awareness of strength and weakness in clinical performance and a motivation to change routine practice.

Guidelines and Value-Based Decision Making: An Evolving Role for Payers.

PubMed

McCauley, Janet L

2015-01-01

Payers use evidence-based guidelines to promote effective health diagnoses and treatments for their members and to ensure that members are not subject to harmful or wasteful care. Payer guidelines inform coverage, but the content of these guidelines relies on the same evidentiary base as clinical treatment guidelines. Recent strategies to foster value through benefit design and alternative reimbursement methodologies illustrate emerging applications for evidence-based guidelines. The current focus on cost effectiveness within health technology assessment, comparative effectiveness research in collaboration with payers, and transparency around payer evidence assessment could better align payers' interests in evidence-based care with those of other stakeholders. The move to value in health care will depend upon credible clinical evidence to enable informed decision making. ©2015 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

The Role of Affective and Motivational Factors in Designing Personalized Learning Environments

ERIC Educational Resources Information Center

Kim, ChanMin

2012-01-01

In this paper, guidelines for designing virtual change agents (VCAs) are proposed to support students' affective and motivational needs in order to promote personalized learning in online remedial mathematics courses. Automated, dynamic, and personalized support is emphasized in the guidelines through maximizing "interactions" between VCAs and…

National R & D Policy: An Industrial Perspective.

ERIC Educational Resources Information Center

Schmitt, Roland W.

1984-01-01

An analysis of how the government can and cannot use research and development (R&D) policy to improve the nation's industrial posture suggests four guidelines for federal R&D policy. These guidelines are outlined and discussed. Areas analyzed include federal role; competition from Japan; support for university research, immigration policy,…

Guidelines to Student Activity Fund Accounting. Revised.

ERIC Educational Resources Information Center

Association of School Business Officials International, Reston, VA.

This booklet provides guidelines to help school business officials develop sound procedures for keeping proper accounts of and managing the money raised and spent in the course of conducting student activity programs. The booklet notes the roles of the administrators and activity advisers related to management of the student activity fund, then…

Newspaper Guidelines for High School Journalists.

ERIC Educational Resources Information Center

Campbell, Laurence R.

This study attempts to determine what principals, advisers, and others believe is the role of high school student newspapers, and it suggests guidelines to follow in writing these newspapers. The study is based on a questionnaire sent to selected principals, headmasters of nonpublic schools, newspaper advisers, and editors of junior college and…

An Introduction to Archival Automation: A RAMP Study with Guidelines.

ERIC Educational Resources Information Center

Cook, Michael

Developed under a contract with the International Council on Archives, these guidelines are designed to emphasize the role of automation techniques in archives and records services, provide an indication of existing computer systems used in different archives services and of specific computer applications at various stages of archives…

Compliance with AAPM Practice Guideline 1.a: CT Protocol Management and Review — from the perspective of a university hospital

PubMed Central

Bour, Robert K.; Pozniak, Myron; Ranallo, Frank N.

2015-01-01

The purpose of this paper is to describe our experience with the AAPM Medical Physics Practice Guideline 1.a: “CT Protocol Management and Review Practice Guideline”. Specifically, we will share how our institution's quality management system addresses the suggestions within the AAPM practice report. We feel this paper is needed as it was beyond the scope of the AAPM practice guideline to provide specific details on fulfilling individual guidelines. Our hope is that other institutions will be able to emulate some of our practices and that this article would encourage other types of centers (e.g., community hospitals) to share their methodology for approaching CT protocol optimization and quality control. Our institution had a functioning CT protocol optimization process, albeit informal, since we began using CT. Recently, we made our protocol development and validation process compliant with a number of the ISO 9001:2008 clauses and this required us to formalize the roles of the members of our CT protocol optimization team. We rely heavily on PACS‐based IT solutions for acquiring radiologist feedback on the performance of our CT protocols and the performance of our CT scanners in terms of dose (scanner output) and the function of the automatic tube current modulation. Specific details on our quality management system covering both quality control and ongoing optimization have been provided. The roles of each CT protocol team member have been defined, and the critical role that IT solutions provides for the management of files and the monitoring of CT protocols has been reviewed. In addition, the invaluable role management provides by being a champion for the project has been explained; lack of a project champion will mitigate the efforts of a CT protocol optimization team. Meeting the guidelines set forth in the AAPM practice guideline was not inherently difficult, but did, in our case, require the cooperation of radiologists, technologists, physicists, IT, administrative staff, and hospital management. Some of the IT solutions presented in this paper are novel and currently unique to our institution. PACS number: 87.57.Q PMID:26103176

Do guidelines on euthanasia and physician-assisted suicide in Dutch hospitals and nursing homes reflect the law? A content analysis.

PubMed

Hesselink, B A M; Onwuteaka-Philipsen, B D; Janssen, A J G M; Buiting, H M; Kollau, M; Rietjens, J A C; Pasman, H R W

2012-01-01

To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process.

Food, plant food, and vegetarian diets in the US dietary guidelines: conclusions of an expert panel.

PubMed

Jacobs, David R; Haddad, Ella H; Lanou, Amy Joy; Messina, Mark J

2009-05-01

We summarize conclusions drawn from a panel discussion at the "Fifth International Congress on Vegetarian Nutrition" about the roles of and emphasis on food, plant food, and vegetarianism in current and future US dietary guidelines. The most general recommendation of the panel was that future dietary guidelines, following the lead of the 2005 Dietary Guidelines Advisory Committee, should emphasize food-based recommendations and thinking to the full extent that evidence allows. Although nutrient-based thinking and Dietary Reference Intakes (DRIs) may help ensure an adequate diet in the sense that deficiency states are avoided, the emphasis on DRIs may not capture many important nutritional issues and may inhibit a focus on foods. More generally, in the context of the conference on vegetarian nutrition, this report focuses on the history and structure of the Dietary Guidelines Advisory Committee, on various plant food-oriented recommendations that are supported by literature evidence, and on mechanisms for participating in the process of forming dietary guidelines. Among recommendations that likely would improve health and the environment, some are oriented toward increased plant food consumption and some toward vegetarianism. The literature on health effects of individual foods and whole lifestyle diets is insufficient and justifies a call for future food-oriented research, including expanding the evidence base for plant-based and vegetarian diets. The Dietary Guidelines Advisory Committee's role should be carried forward to creation of a publicly accessible icon (eg, the current pyramid) and related materials to ensure that the science base is fully translated for the public.

Biochemical and physiological responses of oil palm to bud rot caused by Phytophthora palmivora.

PubMed

Moreno-Chacón, Andrés Leonardo; Camperos-Reyes, Jhonatan Eduardo; Ávila Diazgranados, Rodrigo Andrés; Romero, Hernán Mauricio

2013-09-01

In recent years, global consumption of palm oil has increased significantly, reaching almost 43 million tons in 2010. The sustainability of oil palm (Elaeis guineensis) cultivation has been compromised because of the bud rot disease whose initial symptoms are caused by Phytophthora palmivora. There was a significant incidence of the disease, from an initial stage 1 of the disease to the highest stage 5, that affected photosynthetic parameters, content of pigments, sugars, polyamines, enzymatic antioxidant activities, phenylalanine ammonia-lyase (PAL, EC 4.3.1.5) and β-(1,3) glucanase (β-Gluc, EC 3.2.1.39). In healthy palms photosynthesis was 13.29 μmol CO2 m(-2) s(-1) in average, while in stage 5 the average photosynthesis was around 3.66 μmol CO2 m(-2) s(-1). Additionally, total chlorophyll was reduced by half at the last stage of the disease. On the contrary, the contents of putrescine, spermine and spermidine increased three, nine and twelve times with respect to stage 5, respectively. Antioxidant enzyme activities, as well as the phenylalanine ammonia-lyase and β-(1,3) glucanase showed an increase as the severity of the disease increased, with the latter increasing from 0.71 EAU in healthy palms to 2.60 EAU in plants at stage 5 of the disease. The peroxidase (POD, EC 1.11.1.7) enzymatic activity and the content of spermidine were the most sensitive indicators of disease. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Patch test results with patients' own perfumes, deodorants and shaving lotions: results of the IVDK 1998-2002.

PubMed

Uter, W; Geier, J; Schnuch, A; Frosch, P J

2007-03-01

Assessment of the value of patch testing patients' own perfumes, eau de toilette, deodorants and shaving lotions with regard to diagnosing contact allergy to fragrances, and an analysis of the spectrum of concurrent patch test reactions to single fragrance allergens. Data of the Information Network of Departments of Dermatology (IVDK; http://www.ivdk.org) regarding patch test results with above products brought in by the patient, considered as possible cause of contact dermatitis, were retrospectively analysed. Between 1998 and 2002, 1468 patients were patch tested with 2557 single products (deodorants, n = 1094; eau de toilette, n = 598; perfume, n = 530; and pre- or after-shave, n = 325; remainder not classifiable), mostly 'as is'. Positive reactions were observed in 129 patients (to 191 products). In 58 of these patients, no further patch test reactions to the fragrance mix (FM-I), Myroxylon pereirae resin (balsam of Peru) or 4-(4-hydroxy-4-methyl-pentyl)-3-cyclohexencarboxaldehyde (e.g. Lyral(R)) were found. A strong association between contact sensitivity to the above commercial allergens and positive reactions to products was observed. Some single compounds such as ylang-ylang oil, propolis and especially oak moss absolute are important allergens in the 'perfume-positive' subgroup, but less in a subgroup positive to own deodorants. Patch testing this scope of products, brought in by the patient, can be regarded as a simple, safe and effective method to diagnose clinically relevant contact sensitization - the more so, as the composition of such products is ever-changing, and the sensitivity of established 'screening allergens' is thus insufficient.

German disease management guidelines: surgical therapies for chronic heart failure.

PubMed

Sindermann, J R; Klotz, S; Rahbar, K; Hoffmeier, A; Drees, G

2010-02-01

The German Disease Management Guideline "Chronic Heart Failure" intends to guide physicians working in the field of diagnosis and treatment of heart failure. The guideline provides a tool on the background of evidence based medicine. The following short review wants to give insights into the role of some surgical treatment options to improve heart failure, such as revascularization, ventricular reconstruction and aneurysmectomy, mitral valve reconstruction, ventricular assist devices and heart transplantation. (c) Georg Thieme Verlag KG Stuttgart-New York.

Use of National Comprehensive Cancer Network and Other Guidelines and Biomarkers for Colorectal Cancer Screening

PubMed Central

Williams, Christina D.; Grady, William M.; Zullig, Leah L.

2016-01-01

Colorectal cancer (CRC) remains a common cancer and significant public health burden. CRC-related mortality is declining, in part due to the early detection of CRC through robust screening. The National Comprehensive Cancer Network (NCCN) has established CRC screening guidelines to aid healthcare providers in making appropriate recommendations for screening according to a patient’s risk of developing CRC. The purpose of this review is to describe the evolution of CRC screening guidelines for average risk individuals, discuss the role of NCCN CRC screening guidelines in cancer prevention, and comment on the current and emerging use of biomarkers for CRC screening. PMID:27799515

Steps Toward Massage Therapy Guidelines: A First Report to the Profession

PubMed Central

Grant, Keith Eric; Balletto, John; Gowan-Moody, Donelda; Healey, Dale; Kincaid, Diana; Lowe, Whitney; Travillian, Ravensara S.

2008-01-01

The massage profession has grown rapidly since the late 1980s. As with business startups that begin informally and successfully mature into larger enterprises, growth brings new organizational challenges, together with greater visibility and opportunity. The maturation of massage as a health care profession increases the need for a process to formalize the synthesis of massage therapy knowledge from clinical experience and research—to collect what we know and to make such baseline knowledge widely available to practitioners, consumers, and other health care stakeholders. In short, we need to create a process for setting guidelines. The present paper lays out the motivations and framework for creating massage therapy guidelines that are informed both by research and by clinical experience. It also acts as a report to the massage therapy profession and to other stakeholders about the work of the Best Practices Committee of the Massage Therapy Foundation since 2006. And it has the additional goal of providing a health care literature basis for future academic discussions of massage. The discussion here is based on a definition from the Institute of Medicine and on research into the nature of expertise. Guidelines are targeted for submission to the National Guideline Clearinghouse. Challenges in creating guidelines for massage therapy are discussed. Various stakeholders are considered. Current literature from the wider scope of health care is extensively reviewed. Topics addressed include guideline creation, credentialing of complementary and alternative medicine practitioners, definition of competence, and the increasing role of technology (that is, informatics) in managing training and task-necessary competencies. Finally, a process for creation of massage therapy guidelines is proposed. A central feature of the proposal is the use of a “World Café” symposium to elicit knowledge and solutions from diverse experts. The role of transparency and broad and open peer review is emphasized as essential to the usability and credibility of guidelines. PMID:21589815

Steps toward massage therapy guidelines: a first report to the profession.

PubMed

Grant, Keith Eric; Balletto, John; Gowan-Moody, Donelda; Healey, Dale; Kincaid, Diana; Lowe, Whitney; Travillian, Ravensara S

2008-08-20

The massage profession has grown rapidly since the late 1980s. As with business startups that begin informally and successfully mature into larger enterprises, growth brings new organizational challenges, together with greater visibility and opportunity. The maturation of massage as a health care profession increases the need for a process to formalize the synthesis of massage therapy knowledge from clinical experience and research-to collect what we know and to make such baseline knowledge widely available to practitioners, consumers, and other health care stakeholders. In short, we need to create a process for setting guidelines.The present paper lays out the motivations and framework for creating massage therapy guidelines that are informed both by research and by clinical experience. It also acts as a report to the massage therapy profession and to other stakeholders about the work of the Best Practices Committee of the Massage Therapy Foundation since 2006. And it has the additional goal of providing a health care literature basis for future academic discussions of massage.The discussion here is based on a definition from the Institute of Medicine and on research into the nature of expertise. Guidelines are targeted for submission to the National Guideline Clearinghouse. Challenges in creating guidelines for massage therapy are discussed. Various stakeholders are considered. Current literature from the wider scope of health care is extensively reviewed. Topics addressed include guideline creation, credentialing of complementary and alternative medicine practitioners, definition of competence, and the increasing role of technology (that is, informatics) in managing training and task-necessary competencies. Finally, a process for creation of massage therapy guidelines is proposed. A central feature of the proposal is the use of a "World Café" symposium to elicit knowledge and solutions from diverse experts. The role of transparency and broad and open peer review is emphasized as essential to the usability and credibility of guidelines.

Standards and Guidelines in Telemedicine and Telehealth

PubMed Central

Krupinski, Elizabeth A.; Bernard, Jordana

2014-01-01

The development of guidelines and standards for telemedicine is an important and valuable process to help insure effective and safe delivery of quality healthcare. Some organizations, such as the American Telemedicine Association (ATA), have made the development of standards and guidelines a priority. The practice guidelines developed so far have been well received by the telemedicine community and are being adopted in numerous practices, as well as being used in research to support the practice and growth of telemedicine. Studies that utilize published guidelines not only help bring them into greater public awareness, but they also provide evidence needed to validate existing guidelines and guide the revision of future versions. Telemedicine will continue to grow and be adopted by more healthcare practitioners and patients in a wide variety of forms not just in the traditional clinical environments, and practice guidelines will be a key factor in fostering this growth. Creation of guidelines is important to payers and regulators as well as increasingly they are adopting and integrating them into regulations and policies. This paper will review some of the recent ATA efforts in developing telemedicine practice guidelines, review the role of research in guidelines development, review data regarding their use, and discuss some of areas where guidelines are still needed. PMID:27429261

The 2015 Resuscitation Council of Asia (RCA) guidelines on adult basic life support for lay rescuers.

PubMed

Chung, Sung Phil; Sakamoto, Tetsuya; Lim, Swee Han; Ma, Mathew Huei-Ming; Wang, Tzong-Luen; Lavapie, Francis; Krisanarungson, Sopon; Nonogi, Hiroshi; Hwang, Sung Oh

2016-08-01

This paper introduces adult basic life support (BLS) guidelines for lay rescuers of the resuscitation council of Asia (RCA) developed for the first time. The RCA BLS guidelines for lay rescuers have been established by expert consensus among BLS Guidelines Taskforce of the RCA on the basis of the 2015 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science with Treatment Recommendations. The RCA recommends compression-only CPR for lay rescuers and emphasizes high-quality CPR with chest compression depth of approximately 5cm and chest compression rate of 100-120min(-1). Role of emergency medical dispatchers in helping lay rescuers recognize cardiac arrest and perform CPR is also emphasized. The RCA guidelines will contribute to help Asian countries establish and implement their own CPR guidelines in the context of their domestic circumstances. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The management of scabies outbreaks in residential care facilities for the elderly in England: a review of current health protection guidelines.

PubMed

White, L C J; Lanza, S; Middleton, J; Hewitt, K; Freire-Moran, L; Edge, C; Nicholls, M; Rajan-Iyer, J; Cassell, J A

2016-11-01

Commonly thought of as a disease of poverty and overcrowding in resource-poor settings globally, scabies is also an important public health issue in residential care facilities for the elderly (RCFE) in high-income countries such as the UK. We compared and contrasted current local Health Protection Team (HPT) guidelines for the management of scabies outbreaks in RCFE throughout England. We performed content analysis on 20 guidelines, and used this to create a quantitative report of their variation in key dimensions. Although the guidelines were generally consistent on issues such as the treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. We conclude that the heterogeneous nature of the guidelines reviewed is an argument in favour of national guidelines being produced.

In honor of the Teratology Society's 50th anniversary: The role of Teratology Society members in the development and evolution of in vivo developmental toxicity test guidelines.

PubMed

Tyl, Rochelle W

2010-06-01

Members of the Teratology Society (established in 1960) were involved in the first governmental developmental and reproductive toxicity testing guidelines (1966) by FDA following the thalidomide epidemic, followed by other national and international governmental testing guidelines. The Segment II (developmental toxicity) study design, described in rodents and rabbits, has evolved with additional enhanced endpoints and better descriptions, mechanistic insights, range-finding studies, and toxico/pharmacokinetic ADME information (especially for pharmaceuticals). Society members were also involved in the development of the current screening assays and tests for endocrine disruptors (beginning in 1996) and are now involved with developing new testing guidelines (e.g., the extended one-generation protocol), and evaluating the current test guidelines and new initiatives under ILSI/HESI sponsorship. New initiatives include ToxCast from the U.S. EPA to screen, prioritize, and predict toxic chemicals by high throughput and high-content in vitro assays, bioinformation, and modeling to reduce (or eliminate) in vivo whole animal studies. Our Society and its journal have played vital roles in the scientific and regulatory accomplishments in birth defects research over the past 50 years and will continue to do so in the future. Happy 50th anniversary! (c) 2010 Wiley-Liss, Inc.

The Dietary guideline 2005 and physical activities role in weight management of University Arkansas at Pine Bluff

USDA-ARS?s Scientific Manuscript database

To evaluate the effectiveness of the weight loss initiative, researchers at the University of Arkansas at Pine Bluff conducted an obesity prevention intervention based on the Dietary Guidelines for Americans approach. A 12 month study was conducted that focused on interventions to improve physical ...

Guidelines for Public Libraries in the 21st Century.

ERIC Educational Resources Information Center

Gill, Philip

This paper highlights some of the issues that arose during the drafting of a revised version of the IFLA (International Federation of Library Associations and Institutions) Guidelines for Public Libraries. The sections of the new document are outlined as follows: (1) The Role and Purpose of the Public Library; (2) The Legal and Financial…

FAO/INFOODS Guidelines for Checking Food Composition Data Prior to the Publication of a User Table/Database, Version 1.0

USDA-ARS?s Scientific Manuscript database

Food composition data play an essential role in many sectors, including nutrition, health, agriculture, environment, food labeling and trade. Over the last 25 years, International Network of Food Data Systems (INFOODS) has developed many international standards, guidelines and tools to obtain harmo...

Information Technology Policies. SPEC Kit 218.

ERIC Educational Resources Information Center

Leung, Shirley; Bisom, Diane

The objectives of this survey were: to gather information on the development of institutional information technology policies and guidelines for responsible computing and use of electronic information; to identify the scope of such policies and guidelines; and to determine the role of the library in the development and/or use of the policies and…

Facilitating Children's Divorce Adjustment: Guidelines for Parents and Practitioners. Issues in Education.

ERIC Educational Resources Information Center

Langenbrunner, Mary

2000-01-01

Provides guidelines to facilitate children's emotional adjustment to their parents' divorce. Suggestions include avoiding arguing in front of children, allowing children to spend quality time with both parents, keeping children's daily routines as normal as possible, avoiding putting children in the middle or in the "missing parent" role, allowing…

In-Service Training Guidelines for Secondary School Teachers of Psychology.

ERIC Educational Resources Information Center

American Psychological Association, Washington, DC.

Guidelines for the continuing education of secondary school psychology teachers are presented. Because for many people, high school psychology is the first and only opportunity for systematic exposure to the field, the secondary psychology teacher plays a vital role in the public's basic understanding of psychology. Psychology teachers must help…

Revised CIOMS research ethics guidance: on the importance of process for credibility.

PubMed

Schuklenk, Udo

2017-01-01

This paper reviews the 2016 CIOMS International Ethical Guidelines for Health-related Research Involving Humans. I argue that these new guidelines constitute a significant improvement over the guidelines they replace. However, the procedures put in place by CIOMS resulted in an authoring group consisting of a majority of authors and advisors hailing from the global North, while the guidelines squarely aim at influencing policies in the global South. I question CIOMS' strategy to produce a consensus based document, and raise concerns about frequent appeals to authority designed to establish the credibility of these guidelines and the processes that led to them. It is unclear why it should be the role of a small organisation such as CIOMS to try to guide the research ethics policies in countries of the global South.

Using Role Play To Develop Cultural Competence.

ERIC Educational Resources Information Center

Shearer, Ruth; Davidhizar, Ruth

2003-01-01

Role playing is a useful method for teaching cultural competence in nurse-patient situations. Successful implementation depends on identification of objectives and grading criteria, adequate time, guidelines for role specifications, monitoring of the process, delineation of the relationship to theory, and facilitation of constructive analysis.…

Comparison of International Guidelines on Mucosal Melanoma of the Head and Neck: A Comprehensive Review of the Role of Radiation Therapy.

PubMed

Pittaka, Maria; Kardamakis, Dimitrios; Spyropoulou, Despina

2016-01-01

Mucosal melanomas of the head and neck are rare pathological entities that correlate with poor prognosis due to their high propensity for local failure and distant metastases. The exact role of radiation therapy in the management of mucosal melanoma patients has not yet been fully proven, even though in everyday clinical practice these patients are referred for radiotherapy, in an effort to improve locoregional control. The guidelines of various societies on the role of radiation therapy for the treatment of mucosal melanoma of the head and neck region are very limited. We reviewed and analyzed the guidelines developed in the U.S.A. (National Comprehensive Cancer Network), Canada (Cancer Care Ontario and Canadian Medical Association), Europe (European Society for Medical Oncology and European Society for Radiotherapy and Oncology) and Australia and New Zealand (Cancer Council Australia) and isolated evidence for the management of mucosal melanomas of the head and neck region with radiation therapy worldwide. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Role of ivabradine and heart rate lowering in chronic heart failure: guideline update.

PubMed

Chow, Sheryl L; Page, Robert Lee; Depre, Christophe

2018-06-14

This review summarizes the current management of heart failure (HF) in patients with reduced ejection fraction and the potential role of heart rate lowering agents in select populations, as recommended in the updated guidelines. Areas covered: PubMed was searched for studies that evaluated the role of heart rate lowering or ivabradine in HF management. Expert commentary: Targeting heart rate may offer benefit when added to renin-angiotensin aldosterone antagonists, and beta-blockers. Ivabradine is a heart rate lowering agent that acts on the funny current (I f ) in the sinoatrial node, thereby reducing heart rate without directly affecting cardiac contraction and relaxation. Clinical data from a phase 3 trial demonstrated that ivabradine reduced the composite endpoint of cardiovascular death or hospital admission for worsening systolic HF, while maintaining an acceptable safety profile in patients receiving standard of care therapy. These data, in addition to more recently published guidelines, suggest ivabradine as a promising new treatment option for lowering heart rate after optimizing standard therapy in select patients with chronic HF.

Water-Resources Investigations in Wisconsin, 2002

USGS Publications Warehouse

Hueschen, K. A.; Jones, S.Z.; Fuller, J.A.

2002-01-01

Runoff for rivers in the state ranged from 67 percent of the average annual runoff (1964–2001) at the Kewaunee River site in the northeast part of the state to 160 percent of the average annual runoff (1944–2001) at the Eau Galle River at Spring Valley site in the west central part of the state. Departures of runoff in the 2001 water year as a percent of long-term average runoff in the state (determined using stations with drainage areas greater than 150 square miles and at least 20 years of record) are shown in figure 4.

Study of Some Mineral Exchangers for Use in Water at High Temperature; ETUDE DE QUELQUES ECHANGEURS MINERAUX UTILISABLES DANS L'EAU A HAUTE TEMPERATURE

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

Hure, J.; Platzer, R.; Bittel, R.

1959-10-31

The study of the use of ion exchangers at high temperatures was made with a view to the purification of water in reactors. Natural ion exchangers with mineral structures (clay of the montmorillonite type), natural mineral compounds so treated as to give them the properties of ion exchangers (activated graphite), and synthetic mineral compounds (zirconium phosphates and hydroxides and thorium hydroxide) were investigated. The preparation of the minerals is described, and the results obtained with them are discussed in detail. (J.S.R.)

Factors Influencing Manual Performance in Cold Water Diving

DTIC Science & Technology

2008-04-01

montrent que « l’engourdissement » n’avait pas d’incidence sur la dextérité à une profondeur de 40 m (p > 0,05). Dans l’eau à 25 ºC, les gants en ...sensibilité tactile et la dextérité proprement dite. Le rendement ( en anglais performance ou p) a été évalué à des profondeurs de 0,4 m et de 40 m, avec...communication et d’affichage fait en sorte que l’aptitude des plongeurs à utiliser des systèmes de commande complexes constitue un facteur important de la

Characterization, Analysis and Significance of Defects in Composite Materials. Conference Proceedings: Meeting of the Structures and Materials Panel (56th) held in London, England on 12-14 April 1983

DTIC Science & Technology

1983-07-01

directional glass fibre, uni-directional carbon fibre and woven glass fabrJ (two weave styles ) all impregnated with epoxy resin.’-- An expanding mandrel...son emballage etanche pour revenir a temperature ambiante avant utllisatlon, - absorption d’eau si le preimpregn§ a tie laisse trop longtemps en...g6n~ralement de petite taille laisses par inadvortance nor le lieu do drapoge peuvent no- sir, par 6lectricitri statique, me caller sur la face cachie

Measured and Modeled Long-Wave Infrared Signature of Quest in Q280

DTIC Science & Technology

2008-03-01

l’eau chaude par rapport à l’air froid , a constitué un autre cas permet- tant de mieux comprendre les signatures infrarouge et de mettre au point des...d’intensité énergétique infrarouge à l’horizon et dans la valeur absolue de l’in- tensité énergétique de la mer : le modèle laisse prévoir...ports de l’Arctique favorise fortement d’autres recherches sur les signatures infrarouge des navires en eaux froides et dans des conditions hivernales

Gestion des ressources hydriques adaptee aux changements climatiques pour la production optimale d'hydroelectricite. Etude de cas: Bassin versant de la riviere Manicouagan

NASA Astrophysics Data System (ADS)

Haguma, Didier

Il est dorenavant etabli que les changements climatiques auront des repercussions sur les ressources en eau. La situation est preoccupante pour le secteur de production d'energie hydroelectrique, car l'eau constitue le moteur pour generer cette forme d'energie. Il sera important d'adapter les regles de gestion et/ou les installations des systemes hydriques, afin de minimiser les impacts negatifs et/ou pour capitaliser sur les retombees positives que les changements climatiques pourront apporter. Les travaux de la presente recherche s'interessent au developpement d'une methode de gestion des systemes hydriques qui tient compte des projections climatiques pour mieux anticiper les impacts de l'evolution du climat sur la production d'hydroelectricite et d'etablir des strategies d'adaptation aux changements climatiques. Le domaine d'etude est le bassin versant de la riviere Manicouagan situe dans la partie centrale du Quebec. Une nouvelle approche d'optimisation des ressources hydriques dans le contexte des changements climatiques est proposee. L'approche traite le probleme de la saisonnalite et de la non-stationnarite du climat d'une maniere explicite pour representer l'incertitude rattachee a un ensemble des projections climatiques. Cette approche permet d'integrer les projections climatiques dans le probleme d'optimisation des ressources en eau pour une gestion a long terme des systemes hydriques et de developper des strategies d'adaptation de ces systemes aux changements climatiques. Les resultats montrent que les impacts des changements climatiques sur le regime hydrologique du bassin de la riviere Manicouagan seraient le devancement et l'attenuation de la crue printaniere et l'augmentation du volume annuel d'apports. L'adaptation des regles de gestion du systeme hydrique engendrerait une hausse de la production hydroelectrique. Neanmoins, une perte de la performance des installations existantes du systeme hydrique serait observee a cause de l'augmentation des deversements non productibles dans le climat futur. Des strategies d'adaptation structurale ont ete analysees pour augmenter la capacite de production et la capacite d'ecoulement de certaines centrales hydroelectriques afin d'ameliorer la performance du systeme. Une analyse economique a permis de choisir les meilleures mesures d'adaptation et de determiner le moment opportun pour la mise en oeuvre de ces mesures. Les resultats de la recherche offrent aux gestionnaires des systemes hydriques un outil qui permet de mieux anticiper les consequences des changements climatiques sur la production hydroelectrique, incluant le rendement de centrales, les deversements non productibles et le moment le plus opportun pour inclure des modifications aux systemes hydriques. Mots-cles : systemes hydriques, adaptation aux changements climatiques, riviere Manicouagan

Role of surgery in brain metastases.

PubMed

Laghari, Altaf Ali; Ahmed, Syed Ijlal; Shamim, Muhammad Shahzad

2017-08-01

Brain metastases remain the commonest type of brain tumour, being four times more common than primary brain tumours. Although surgical intervention may be recommended for one of various reasons in the management of these tumours, including but not limited to conformation of diagnosis, relief of mass effect, improvement of neurological status and prolongation of survival, the guidelines for management of brain metastases remain largely subjective and therefore controversial. Herein the authors have attempted to review some of the existing evidence on role of surgery in the management of brain metastases and have presented their selected guidelines for the readers.

The importance of Good Clinical Practice guidelines and its role in clinical trials

PubMed Central

Vijayananthan, A; Nawawi, O

2008-01-01

Good Clinical Practice (GCP) is an international ethical and scientific quality standard for the design, conduct, performance, monitoring, auditing, recording, analyses and reporting of clinical trials. It also serves to protect the rights, integrity and confidentiality of trial subjects. It is very important to understand the background of the formation of the ICH-GCP guidelines as this, in itself, explains the reasons and the need for doing so. In this paper, we address the historical background and the events that led up to the formation of these guidelines. Today, the ICH-GCP guidelines are used in clinical trials throughout the globe with the main aim of protecting and preserving human rights. PMID:21614316

Prospective systematic review registration: perspective from the Guidelines International Network (G-I-N).

PubMed

Van der Wees, Philip; Qaseem, Amir; Kaila, Minna; Ollenschlaeger, Guenter; Rosenfeld, Richard

2012-02-09

Clinical practice and public health guidelines are important tools for translating research findings into practice with the aim of assisting health practitioners as well as patients and consumers in health behavior and healthcare decision-making. Numerous programs for guideline development exist around the world, with growing international collaboration to improve their quality. One of the key features in developing trustworthy guidelines is that recommendations should be based on high-quality systematic reviews of the best available evidence. The review process used by guideline developers to identify and grade relevant evidence for developing recommendations should be systematic, transparent and unbiased. In this paper, we provide an overview of current international developments in the field of practice guidelines and methods to develop guidelines, with a specific focus on the role of systematic reviews. The Guidelines International Network (G-I-N) aims to stimulate collaboration between guideline developers and systematic reviewers to optimize the use of available evidence in guideline development and to increase efficiency in the guideline development process. Considering the significant benefit of systematic reviews for the guideline community, the G-I-N Board of Trustees supports the international prospective register of systematic reviews (PROSPERO) initiative. G-I-N also recently launched a Data Extraction Resource (GINDER) to present and share data extracted from individual studies in a standardized template. PROSPERO and GINDER are complementary tools to enhance collaboration between guideline developers and systematic reviewers to allow for alignment of activities and a reduction in duplication of effort.

[SERV clinical practice guidelines: management of retinal vein occlusion. Sociedad Española de Retina y Vitreo].

PubMed

Gómez-Ulla, F; Abraldes, M J; Basauri, E; Fernández, M; García-Layana, A; Gili, P; Montero, J; Nadal, J; Morales, V; Saravia, M; Cabrera, F; Cervera, E

2010-09-01

A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined. Review of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries. Taking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings. Although there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion. Copyright © 2010. Published by Elsevier Espana.

Coronary Catheterization Laboratory Role for Post-Resuscitation Care Without ST Elevation Myocardial Infarction.

PubMed

Kumar, Kris; Lotun, Kapildeo

2018-05-07

Out of hospital cardiac arrest management of patients with non-ST myocardial infarction per current American Heart Association and European Resuscitation Council guidelines leave the decision in regard to early angiography up to the physician operators. Guidelines are clear on the positive impact of early intervention on survival and improvement on left ventricular function in patients presenting with cardiac arrest and ST elevation myocardial infarction on electrocardiogram. This review aims to analyze the data that current guidelines are based upon in regards to out of hospital cardiac arrest with electrocardiogram findings of non-ST elevation myocardial infarction as well as other clinical trials that support early angiography and reperfusion strategies as well as future studies that are in trial to study the role of the coronary catheterization laboratory in cardiac arrest. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). Part VIII: Medicolegal considerations and recommendations.

PubMed

1986-06-06

These resuscitation guidelines were developed to "enhance the quality of care while protecting the patient's right to accept or reject therapy and to clarify the physician's role in making decisions to provide, withhold, or withdraw life support." Among the issues covered are the obligation to provide cardiopulmonary resuscitation (CPR), reasons to withhold or withdraw CPR, and the liability risks of CPR providers--laypersons, CPR teachers and organizations, and hospitals. Also discussed are the role of hospital ethics committees and medicolegal considerations in treating minors. The guidelines conclude with recommendations that states enact legislation allowing allied health personnel to render emergency care more effectively outside the hospital, providing "good samaritan" immunity to laypersons administering CPR, requiring basic life support training for police and firefighters, and acknowledging the patient's right to self determination in life-or-death decisions.

Psychiatry's Role in the Management of Human Trafficking Victims: An Integrated Care Approach.

PubMed

Gordon, Mollie; Salami, Temilola; Coverdale, John; Nguyen, Phuong T

2018-03-01

Human trafficking is an outrageous human rights violation with potentially devastating consequences to individuals and the public health. Victims are often underrecognized and there are few guidelines for how best to identify, care for, and safely reintegrate victims back into the community. The purpose of this paper is to propose a multifaceted, interdisciplinary, and interprofessional guideline for providing care and services to human trafficking victims. Databases such as PubMed and PsycINFO were searched for papers outlining human trafficking programs with a primary psychiatric focus. No integrated care models that provide decisional guidelines at different points of intervention for human trafficking patients and that highlight the important role of psychiatric consultation were found. Psychiatrists and psychologists are pivotal to an integrated care approach in health care settings. The provision of such a comprehensive and integrated model of care should facilitate the identification of victims, promote their recovery, and reduce the possibility of retraumatization.

Integrating ergonomics into engineering design: the role of objects.

PubMed

Hall-Andersen, Lene Bjerg; Broberg, Ole

2014-05-01

The objective of this study was to explore the role of objects in integrating ergonomic knowledge in engineering design processes. An engineering design case was analyzed using the theoretical concepts of boundary objects and intermediary objects: Boundary objects facilitate collaboration between different knowledge domains, while the aim of an intermediary object is to circulate knowledge and thus produce a distant effect. Adjustable layout drawings served as boundary objects and had a positive impact on the dialog between an ergonomist and designers. An ergonomic guideline document was identified as an intermediary object. However, when the ergonomic guidelines were circulated in the design process, only some of the guidelines were transferred to the design of the sterile processing plant. Based on these findings, recommendations for working with objects in design processes are included. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

The role of yogurt in improving the quality of the American diet and meeting dietary guidelines

USDA-ARS?s Scientific Manuscript database

The Dietary Guidelines for Americans (DGA) recommend 3 daily servings of lowfat or nonfat dairy products, however, two-thirds of Americans do not meet that goal. Including lowfat or nonfat yogurt as part of an overall healthful diet can be a positive step towards meeting the DGA. Yogurt contains cal...

Preventing Indoor Air Quality Problems in Educational Facilities: Guidelines for Hot, Humid Climates. Revised.

ERIC Educational Resources Information Center

Odom, J. David; DuBose, George

This manual addresses the errors that occur during new construction that subsequently contribute to indoor air quality (IAQ) problems in newly constructed buildings in hot and humid climates, and offers guidelines for preventing them during the design and construction phases. It defines the roles and responsibilities of the design team, the…

The Role of Faculty in the Effectiveness of Fully Online Programs

ERIC Educational Resources Information Center

Al-Salman, Sami M.

2013-01-01

The enormous growth of online learning creates the need to develop a set of standards and guidelines for fully online programs. While many guidelines do exist, web-based programs still fall short in the recognition, adoption, or the implementation of these standards. One consequence is the high attrition rates associated with web-based distance…

Strategy Guideline. Demonstration Home

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

Hunt, A.; Savage, C.

2012-12-01

This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

Strategy Guideline: Demonstration Home

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

Savage, C.; Hunt, A.

2012-12-01

This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

Benchmarking of venous thromboembolism prophylaxis practice with ENT.UK guidelines.

PubMed

Al-Qahtani, Ali S

2017-05-01

The aim of this study was to benchmark our guidelines of prevention of venous thromboembolism (VTE) in ENT surgical population against ENT.UK guidelines, and also to encourage healthcare providers to utilize benchmarking as an effective method of improving performance. The study design is prospective descriptive analysis. The setting of this study is tertiary referral centre (Assir Central Hospital, Abha, Saudi Arabia). In this study, we are benchmarking our practice guidelines of the prevention of VTE in the ENT surgical population against that of ENT.UK guidelines to mitigate any gaps. ENT guidelines 2010 were downloaded from the ENT.UK Website. Our guidelines were compared with the possibilities that either our performance meets or fall short of ENT.UK guidelines. Immediate corrective actions will take place if there is quality chasm between the two guidelines. ENT.UK guidelines are evidence-based and updated which may serve as role-model for adoption and benchmarking. Our guidelines were accordingly amended to contain all factors required in providing a quality service to ENT surgical patients. While not given appropriate attention, benchmarking is a useful tool in improving quality of health care. It allows learning from others' practices and experiences, and works towards closing any quality gaps. In addition, benchmarking clinical outcomes is critical for quality improvement and informing decisions concerning service provision. It is recommended to be included on the list of quality improvement methods of healthcare services.

Male Gender Role Conflict and Multiculturalism: Implications for Counseling Psychology

ERIC Educational Resources Information Center

Wester, Stephen R.

2008-01-01

The new multicultural guidelines reemphasized the importance of developing knowledge of, and skills in working with, individuals outside of the majority group. In this article, the author will detail recent advances in understanding how identified consequences of male gender role socialization, specifically male gender role conflict (GRC),…

Consensus on the guidelines for the dietary management of classical galactosemia.

PubMed

Kerckhove, Kristel Vande; Diels, Marianne; Vanhaesebrouck, Sigrid; Luyten, Karin; Pyck, Nancy; De Meyer, An; Van Driessche, Marleen; Robert, Martine; Corthouts, Karen; Caris, Ariane; Duchateau, Emilie; Dassy, Martine; Bihet, Genevieve

2015-02-01

Worldwide there is scientific discussion about the dietary management of galactosemia. The dietary management is very different in several countries among Europe, the US and Canada. The main points of discussion are related to the fact that i) despite a strict diet some patients still have poor outcomes; ii) there is lack of scientific knowledge about the role of endogenous production of galactose on disease evolution, with or without diet. The aim of the current work was the creation of a Belgian consensus on dietary guidelines for the management of galactosemia. A step-wise approach was used to achieve a consensus, including: a workshop, a Delphi round, discussion groups and a round table of different Belgian experts. The consensus is an agreement between strict guidelines (strict limitation of fruits, vegetables and soybean products/French guidelines) and the more liberal guidelines (comparable with a diet free of lactose/guidelines of UK and the Netherlands). The consensus document consists of different modules, including the medical context, the theoretical background of dietary guidelines and the age-specific practical dietary guidelines. A Belgian consensus on the guidelines for the dietary management of classical galactosemia was developed despite the uncertainties of the efficacy and practical application of these guidelines. The final consensus is based on scientific knowledge and practical agreement among experts. In the future, regular revision of the guidelines is recommended and a uniform European guideline is desirable. Copyright © 2014 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Summary of International Guidelines for Physical Activity Following Pregnancy

PubMed Central

Evenson, Kelly R.; Mottola, Michelle F.; Owe, Katrine M.; Rousham, Emily K.; Brown, Wendy J.

2014-01-01

Postpartum physical activity can improve mood, maintain cardiorespiratory fitness, improve weight control, promote weight loss, and reduce depression and anxiety. This review summarizes current guidelines for postpartum physical activity worldwide. PubMed (MedLINE) was searched for country-specific government and clinical guidelines on physical activity following pregnancy through the year 2013. Only the most recent guideline was included in the review. An abstraction form facilitated extraction of key details and helped to summarize results. Six guidelines were identified from five countries (Australia, Canada, Norway, United Kingdom, United States). All guidelines were embedded within pregnancy-related physical activity recommendations. All provided physical activity advice related to breastfeeding and three remarked about physical activity following Caesarean delivery. Recommended physical activities mentioned in the guidelines included aerobic (3/6), pelvic floor exercise (3/6), strengthening (2/6), stretching (2/6), and walking (2/6). None of the guidelines discussed sedentary behavior. The guidelines that were identified lacked specificity for physical activity. Greater clarity in guidelines would be more useful to both practitioners and the women they serve. Postpartum physical activity guidelines have the potential to assist women to initiate or resume physical activity following childbirth, so that they can transition to meeting recommended levels of physical activity. Health care providers have a critical role in encouraging women to be active at this time, and the availability of more explicit guidelines may assist them to routinely include physical activity advice in their postpartum care. PMID:25112589

Groundwater targeting in a hard-rock terrain using fracture-pattern modeling, Niva River basin, Andhra Pradesh, India

NASA Astrophysics Data System (ADS)

Srinivasa Rao, Y.; Reddy, T. V. K.; Nayudu, P. T.

2000-09-01

In hard-rock terrain, due to the lack of primary porosity in the bedrock, joints, fault zones, and weathered zones are the sources for groundwater occurrence and movement. To study the groundwater potential in the hard-rock terrain and drought-prone area in the Niva River basin, southern Andhra Pradesh state, India, Landsat 5 photographic data were used to prepare an integrated hydrogeomorphology map. Larsson's integrated deformation model was applied to identify the various fracture systems, to pinpoint those younger tensile fracture sets that are the main groundwater reservoirs, and to understand the importance of fracture density in groundwater prospecting. N35°-55°E fractures were identified as tensile and N35°-55°W fractures as both tensile and shear in the study area. Apparently, these fractures are the youngest open fractures. Wherever N35°-55°E and N35°-55°W fracture densities are high, weathered-zone thickness is greater, water-table fluctuations are small, and well yields are high. Groundwater-potential zones were delineated and classified as very good, good to very good, moderate to good, and poor. Résumé. Dans les roches de socle, l'absence de porosité primaire dans la roche fait que les fractures, les zones de faille et les zones d'altération sont les sites où l'eau souterraine est présente et s'écoule. Pour étudier le potentiel en eau souterraine dans la région de socle sujette à la sécheresse du bassin de la rivière Niva (sud de l'État d'Andhra Pradesh, Inde), des données photographiques de Landsat 5 ont été utilisées pour préparer une carte hydro-géomorphologique. Le modèle intégré de déformation de Larssons a été mis en œuvre pour identifier les différents systèmes de fractures, pour mettre l'accent sur les ensembles de fractures en extension les plus jeunes qui constituent les principaux réservoirs d'eau souterraine, et pour comprendre l'importance de la densité de fractures pour la prospection de l'eau souterraine. Dans la région étudiée, les fractures N35°-55°E ont été identifiées comme étant en extension, et les fractures N35°-55°W comme étant à la fois en extension et en cisaillement. Ces fractures sont apparemment les fractures ouvertes les plus jeunes. Partout où la densité des fractures N35°-55°E et N35°-55°W est élevée, la zone altérée est plus épaisse, les fluctuations de la nappe sont faibles et les rendements des puits sont forts. Des zones à potentiel en eau souterraine ont ainsi été délimitées et classées en excellent, bon à très bon, assez bon et médiocre. Resumen. Las zonas de fracturación y de meteorización son las que condicionan el flujo de agua subterránea en rocas duras, debido a la falta de porosidad primaria en la matriz rocosa. Se utilizaron cinco conjuntos de datos fotográficos del satélite Landsat con el fin de preparar un mapa integrado hidrogeomorfológico de la cuenca del río Niva, al sur del estado Andhra Pradesh (India). El objetivo era estudiar el potencial de aguas subterráneas en esta región, que es propensa a períodos de sequía, en la que predominan las rocas duras. Se aplicó el modelo de deformación integrado de Larsson a la identificación de los sistemas de fracturación. El propósito era, por un lado, identificar los conjuntos de fracturas de tracción más jóvenes, que desempeñan un papel principal como reservorios de aguas subterráneas. Por otro lado, se quería comprender la importancia de la densidad de fracturación en el desarrollo de las aguas subterráneas. Se identificó una familia de fracturas de tracción con orientación N35°-55°E y otra familia N35°-55°W que contenía tanto bandas de cizalla como fracturas de tracción. Aparentemente, se trataba de las fracturas abiertas más recientes. El espesor de la zona de meteorización es grande cuando la densidad de fracturas de estas dos familias es elevada, hecho que está asociado a fluctuaciones pequeñas del nivel freático y a caudales elevados. Se estableció una clasificación de las aguas subterráneas como zona muy buena, buena-muy buena, moderadamente buena, y regular.

Groundwater socio-ecology and governance: a review of institutions and policies in selected countries

NASA Astrophysics Data System (ADS)

Mukherji, Aditi; Shah, Tushaar

2005-03-01

Groundwater is crucial for the livelihoods and food security of millions of people, and yet, knowledge formation in the field of groundwater has remained asymmetrical. While, scientific knowledge in the discipline (hydrology and hydrogeology) has advanced remarkably, relatively little is known about the socio-economic impacts and institutions that govern groundwater use. This paper therefore has two objectives. The first is to provide a balanced view of the plus and the down side of groundwater use, especially in agriculture. In doing so, examples are drawn from countries such as India, Pakistan, Bangladesh, China, Spain and Mexico—all of which make very intensive use of groundwater. Second, institutions and policies that influence groundwater use are analyzed in order to understand how groundwater is governed in these countries and whether successful models of governance could be replicated elsewhere. Finally, the authors argue that there is a need for a paradigm shift in the way groundwater is presently perceived and managed—from management to governance mode. In this attempt, a number of instruments such as direct regulation, indirect policy levers, livelihood adaptation and people's participation will have to be deployed simultaneously in a quest for better governance. L'eau souterraine est cruciale pour la survie et la sécurité alimentaire de plusieurs millions de personnes mais cependant la foramtion en matière d'eaux souterraines reste asymmétrique. Alors que la connaissance scientifique dans la discipline (hydrologie et hydrogéologie) a avancée de manière remarquable, on connaît peu de choses sur les impacts socio-économiques et les institutions qui gouvernent l'utilisation des eaux souterraines. Cet article a par conséquent deux objectifs. Le premier est d'assurer un point de vue balancé entre le côté positif et le côté négatif de l'utilisation de l'eau souterraine, spécialement en agriculture. De cette manière, des exemples d'utilisation intensive des eaux souterraines sont présentés, provenant de pays tels que l'Inde, le Pakistan, le Bangladesh, la Chîne, l'Espagne et le Mexique. En second lieu, les institutions et les politiques qui influencent l' utilisation de l'eau souterraine sont analysées de telle manière à comprendre comment l'eau souterraine est gérée dans ces pays et comment les modèles de gestion présentant un certain succès pourraient être répliqués ailleurs. Finalement, les auteurs arguent qu'il existe un besoin pour un changement de paradigme dans le sens où l'eau souterraine est actuellement perçue et gérée du mode administratif au mode gouvernemental. Dans cette démarche un certain nombre d'instruments comme la régulation directe, les leviers politiques indirectes, l'adaptation vitale et la participation populaire devront être déployées simultanément dans la quête d'une meilleure gestion. El agua subterránea es crítica para la subsistencia y para la salubridad de la comida de millones de personas. Sin embargo, la formación de conocimientos en el campo de aguas subterráneas ha permanecido asimétrico. Mientras que el concocimiento científico en la disciplina (hidrología e hidrogeología) ha avanzado increíblemente, se conoce relativemente poco sobre los impactos socio-económicos y las instituciones que controlan el uso del agua subterránea. Este artículotiene dos objetivos. El primero es presenter una visión balanceada de los aspectos positivos y negativos concernientes al uso de agua subterránea, especialmente en la agricultura. Con este objetivo se presentan ejemplos de la India, Pakistán, Bangladesh, China, España y México ya que todos estos países hacen uso intensivo del agua subterránea. El segundo objetivo es el análisis de las instituciones y políticas que influyen en el uso del agua subterránea con el fin de entender cómo se gobierna el agua subterránea en estos países y si los modelos exitosos que pueden ser replicados en otros lugares. Finalmente los autores proponen que existe la necesidad de cambiar el paradigma en lo referente a la percepción y al manejo del agua subterránea desde su administración hasta su gobierno. En este intento, con el objeto de alcanzar un mejor gobierno, se debe implementar un número de instrumentos simultáneamente i.e la regulación directa, la política indirecta, la adaptación de las actividades de subsistencia y la participación de los usarios.

Estimation of the depth to the fresh-water/salt-water interface from vertical head gradients in wells in coastal and island aquifers

NASA Astrophysics Data System (ADS)

Izuka, Scot K.; Gingerich, Stephen B.

An accurate estimate of the depth to the theoretical interface between fresh, water and salt water is critical to estimates of well yields in coastal and island aquifers. The Ghyben-Herzberg relation, which is commonly used to estimate interface depth, can greatly underestimate or overestimate the fresh-water thickness, because it assumes no vertical head gradients and no vertical flow. Estimation of the interface depth needs to consider the vertical head gradients and aquifer anisotropy that may be present. This paper presents a method to calculate vertical head gradients using water-level measurements made during drilling of a partially penetrating well; the gradient is then used to estimate interface depth. Application of the method to a numerically simulated fresh-water/salt-water system shows that the method is most accurate when the gradient is measured in a deeply penetrating well. Even using a shallow well, the method more accurately estimates the interface position than does the Ghyben-Herzberg relation where substantial vertical head gradients exist. Application of the method to field data shows that drilling, collection methods of water-level data, and aquifer inhomogeneities can cause difficulties, but the effects of these difficulties can be minimized. Résumé Une estimation précise de la profondeur de l'interface théorique entre l'eau douce et l'eau salée est un élément critique dans les estimations de rendement des puits dans les aquifères insulaires et littoraux. La relation de Ghyben-Herzberg, qui est habituellement utilisée pour estimer la profondeur de cette interface, peut fortement sous-estimer ou surestimer l'épaisseur de l'eau douce, parce qu'elle suppose l'absence de gradient vertical de charge et d'écoulement vertical. L'estimation de la profondeur de l'interface requiert de prendre en considération les gradients verticaux de charge et l'éventuelle anisotropie de l'aquifère. Cet article propose une méthode de calcul des gradients verticaux de charge à partir des mesures de niveau piézométrique faites en cours de foration d'un puits incomplet; le gradient est alors utilisé pour estimer la profondeur de l'interface. L'application de cette méthode à un système eau douce - eau salée simulé numériquement montre que la méthode est la plus précise lorsque le gradient est mesuré dans un puits pénétrant profondément dans l'aquifère. Même en utilisant un puits peu profond, la méthode estime la position de l'interface avec plus de précision que ne le fait la relation de Ghyben-Herzberg lorsqu'il existe un gradient vertical de charge bien marqué. L'application de la méthode à des données de terrain montre que la foration, les méthodes de mesure de niveau et les hétérogénéités au sein de l'aquifère peuvent être la cause de difficultés, mais que les effets de ces difficultés peuvent être réduits. Resumen Para la estimación de la productividad de pozos en acuíferos costeros y en islas es necesaria una estimación precisa de la profundidad de la interfaz teórica entre agua dulce y agua salada. La relación de Ghyben-Herzberg, usada habitualmente para estimar la profundidad de la interfaz, puede subestimar o sobrestimar el espesor de agua dulce, al asumir la ausencia de flujos y gradientes verticales. La estimación de la profundidad de la interfaz debe considerar tanto estos gradientes verticales, como la posible anisotropía del acuífero. En este artículo se presenta un método para calcular los gradientes verticales de niveles a partir de las medidas obtenidas durante la perforación de un pozo parcialmente penetrante para, a partir de este gradiente, estimar la profundidad de la interfaz. La aplicación del método a un sistema de agua dulce/agua salada simulado numéricamente muestra que el método es más preciso cuando el gradiente se mide en un pozo profundo. Incluso en el caso de un pozo superficial, el método permite una estimación más precisa de la profundidad de la interfaz que la aplicación de la fórmula de Ghyben-Herzberg, en los casos en los que existen gradientes verticales significativos. La aplicación del método a datos reales muestra que la perforación, la recogida de datos de niveles y la heterogeneidad en el acuífero pueden causar dificultades en la aplicación del método, pero que estas pueden minimizarse.

Simulation of groundwater drainage into a tunnel in fractured rock and numerical analysis of leakage remediation, Romeriksporten tunnel, Norway

NASA Astrophysics Data System (ADS)

Kitterød, N.-O.; Colleuille, H.; Wong, W. K.; Pedersen, T. S.

2000-09-01

Standard geostatistical methods for simulation of heterogeneity were applied to the Romeriksporten tunnel in Norway, where water was leaking through high-permeable fracture zones into the tunnel while it was under construction, causing drainage problems on the surface. After the tunnel was completed, artificial infiltration of water into wells drilled from the tunnel was implemented to control the leakage. Synthetic heterogeneity was generated at a scale sufficiently small to simulate the effects of remedial actions that were proposed to control the leakage. The flow field depends on the variance of permeabilities and the covariance model used to generate the heterogeneity. Flow channeling is the most important flow mechanism if the variance of the permeability field is large compared to the expected value. This condition makes the tunnel leakage difficult to control. The main effects of permeability changes due to sealing injection are simulated by a simple perturbation of the log-normal probability density function of the permeability. If flow channeling is the major transport mechanism of water into the tunnel, implementation of artificial infiltration of water to control the leakage requires previous chemical-sealing injection to be successful. Résumé. Des méthodes géostatistiques standard ont été employées pour simuler l'hétérogénéité des zones de fractures à fortes perméabilitées dans lesquelles, au cours de la construction du tunnel ferroviaire de Romeriksporten (Norvège), l'eau s'est écoulée, causant des problèmes de drainage en surface. Quand les travaux ont été terminés, l'injection d'eau dans des puits forés à partir du tunnel a été réalisée pour contrôler ces infiltrations. Une hétérogénéité synthétique a été créée à une échelle suffisamment petite pour simuler les effets de l'injection d'eau. Le champ des écoulements dépend de la variance des perméabilités et de la covariance du modèle utilisé pour générer l'hétérogénéité. La chenalisation de l'écoulement est le mécanisme d'écoulement le plus important si la variance du champ de perméabilité est grande par rapport à la valeur moyenne. Cette condition fait que les infiltrations dans le tunnel sont difficiles à contrôler. L'étanchéification du tunnel par des produits chimiques est simulé par une simple perturbation de la fonction de densité de probabilité log-normale de la perméabilité. Si la chenalisation de l'écoulement est le principal mécanisme de transport d'eau entrant dans le tunnel, la création d'une injection artificielle de l'eau pour contrôler l'infiltration dans le tunnel impose, pour réussir, une imperméabilisation préalable par des produits chimiques. Resumen. Se han aplicado métodos estadísticos convencionales para la simulación de la heterogeneidad en el túnel de Roeriksporte (Noruega), donde la presencia de agua en zonas fracturadas de alta permeabilidad originó problemas de drenaje en superficie durante su construcción. Una vez finalizado el túnel, para controlar la infiltración se inyectó agua en los pozos situados en su interior. La generación del campo heterogéneo se realizó a una escala lo suficientemente pequeña que permitiera simular los efectos de las medidas de control propuestas. El campo de flujo depende de la varianza de las permeabilidades y del modelo de covarianza utilizado para generar la heterogeneidad. El flujo a través de canales es el mecanismo dominante si la varianza del campo de permeabilidad es grande en relación con el valor esperado. Este hecho condiciona que las filtraciones en el túnel sean difíciles de controlar. Los principales efectos de los cambios de permeabilidad originados por las inyecciones para el sellado del túnel se simularon mediante una simple perturbación de la función de densidad de probabilidad lognormal de la permeabilidad. Si el flujo a través de canales es el principal mecanismo de la presencia de agua en el túnel, el control de las filtraciones mediante técnicas de inyección de agua en pozos de recarga requiere de la inyección previa de un producto químico para el sellado de las fisuras.

Evaluation of probabilistic flow in two unsaturated soils

NASA Astrophysics Data System (ADS)

Boateng, Samuel

2001-11-01

A variably saturated flow model is coupled to a first-order reliability algorithm to simulate unsaturated flow in two soils. The unsaturated soil properties are considered as uncertain variables with means, standard deviations, and marginal probability distributions. Thus, each simulation constitutes an unsaturated probability flow event. Sensitivities of the uncertain variables are estimated for each event. The unsaturated hydraulic properties of a fine-textured soil and a coarse-textured soil are used. The properties are based on the van Genuchten model. The flow domain has a recharge surface, a seepage boundary along the bottom, and a no-flow boundary along the sides. The uncertain variables are saturated water content, residual water content, van Genuchten model parameters alpha (α) and n, and saturated hydraulic conductivity. The objective is to evaluate the significance of each uncertain variable to the probabilistic flow. Under wet conditions, saturated water content and residual water content are the most significant uncertain variables in the sand. For dry conditions in the sand, however, the van Genuchten model parameters α and n are the most significant. Model parameter n and saturated hydraulic conductivity are the most significant for the wet clay loam. Saturated water content is most significant for the dry clay loam. Résumé. Un modèle d'écoulement variable en milieu saturé est couplé à un algorithme d'exactitude de premier ordre pour simuler les écoulements en milieu non saturé dans deux sols. Les propriétés des sols non saturés sont considérés comme des variables incertaines avec des moyennes, des écarts-types et des distributions de probabilité marginale. Ainsi chaque simulation constitue un événement d'écoulement non saturé probable. La sensibilité des variables incertaines est estimée pour chaque événement. Les propriétés hydrauliques non saturées d'un sol à texture fine et d'un sol à texture grossière sont utilisées. Les propriétés sont basées sur le modèle de van Genuchten. Le domaine d'écoulement possède une surface de recharge, une limite de fuite à sa base et des limites sans écoulement sur les côtés. Les variables incertaines sont la teneur en eau à saturation, la teneur en eau résiduelle, les paramètres alpha (α) et n du modèle de van Genuchten et la conductivité hydraulique à saturation. L'objectif est d'évaluer la signification de chacune des variables incertaines dans l'écoulement probabiliste. Dans des conditions humides, la teneur en eau à saturation et la teneur en eau résiduelle sont les variables incertaines les plus significatives dans le sable. Toutefois, dans des conditions sèches dans le sable, les paramètres α et n du modèle de van Genuchten sont les plus significatifs. Le paramètre n du modèle et la conductivité hydraulique à saturation sont les plus significatifs pour un sol argileux humide. La teneur en eau à saturation est très significative pour le sol argileux sec. Resumen. Se ha acoplado un modelo de flujo de saturación variable con un algoritmo de fiabilidad de primer orden con el fin de simular el flujo no saturado en dos tipos de suelos. Se ha tratado las propiedades del suelo no saturado como variables inciertas, a las que se asigna las medias, desviaciones estándar y distribuciones de probabilidad marginal correspondientes. Así, cada simulación constituye un evento probabilístico de flujo no saturado y la sensibilidad de las variables inciertas es estimada para cada evento. Se ha utilizado las propiedades de la conductividad hidráulica no saturada de dos suelos con dos tipos de textura - fina y gruesa - mediante el modelo de van Genuchten. El dominio de flujo está delimitado por una superficie de recarga, base de goteo y contornos laterales de flujo nulo. Las variables inciertas son el contenido de agua residual, el de saturación, los parámetros del modelo de van Genuchten (α y n) y la conductividad hidráulica saturada. El objetivo era evaluar la contribución de cada variable incierta al flujo probabilístico. Para arenas, las variables inciertas más importantes, en condiciones de humedad, son el contenido de agua residual y el de saturación en ausencia de humedad, lo son ambos parámetros del modelo de van Genuchten. Para margas arcillosas, las variables más significativas en condiciones húmedas son el parámetro n y la conductividad hidráulica saturada; en condiciones secas, el contenido de agua en saturación.

A thick lens of fresh groundwater in the southern Lihue Basin, Kauai, Hawaii, USA

NASA Astrophysics Data System (ADS)

Izuka, Scot; Gingerich, Stephen

2002-11-01

A thick lens of fresh groundwater exists in a large region of low permeability in the southern Lihue Basin, Kauai, Hawaii, USA. The conventional conceptual model for groundwater occurrence in Hawaii and other shield-volcano islands does not account for such a thick freshwater lens. In the conventional conceptual model, the lava-flow accumulations of which most shield volcanoes are built form large regions of relatively high permeability and thin freshwater lenses. In the southern Lihue Basin, basin-filling lavas and sediments form a large region of low regional hydraulic conductivity, which, in the moist climate of the basin, is saturated nearly to the land surface and water tables are hundreds of meters above sea level within a few kilometers from the coast. Such high water levels in shield-volcano islands were previously thought to exist only under perched or dike-impounded conditions, but in the southern Lihue Basin, high water levels exist in an apparently dike-free, fully saturated aquifer. A new conceptual model of groundwater occurrence in shield-volcano islands is needed to explain conditions in the southern Lihue Basin. Résumé. Dans le sud du bassin de Lihue (Kauai, Hawaii, USA), il existe une épaisse lentille d'eau souterraine douce dans une vaste région à faible perméabilité. Le modèle conceptuel conventionnel pour la présence d'eau souterraine à Hawaii et dans les autres îles de volcans en bouclier ne rend pas compte d'une lentille d'eau douce si épaisse. Dans ce modèle conceptuel, les accumulations de lave dont sont formés la plupart des volcans en bouclier couvrent de vastes régions à relativement forte perméabilité, avec des lentilles d'eau douce peu épaisses. Dans le sud du bassin de Lihue, les laves remplissant le bassin et les sédiments constituent une région étendue à faible conductivité hydraulique régionale, qui, sous le climat humide du bassin, est saturée presque jusqu'à sa surface; les surfaces piézométriques sont plusieurs centaines de mètres au-dessus du niveau de la mer à quelques kilomètres de la côte. On pensait jusqu'à présent que des niveaux piézométriques aussi élevés dans des îles de volcans en bouclier n'existaient que dans le cas de nappes perchées ou de blocage par un dyke, mais dans le sud du bassin de Lihue, des niveaux piézométriques élevés existent dans un aquifère apparemment sans dyke et complètement saturé. Un nouveau modèle conceptuel de présence d'eau souterraine dans les îles de volcans en bouclier est nécessaire pour expliquer les conditions observées dans le sud du bassin de Lihue. Resumen. Se ha determinado la existencia de un espeso lentejón de aguas subterráneas dulces en una extensa región de baja permeabilidad situada al sur de la cuenca de Lihue, en Kauai (Hawaii, Estados Unidos de América). El modelo conceptual convencional de las aguas subterráneas en Hawai y en otros cinturones de islas volcánicas no considera la existencia de lentejones tan gruesos de agua dulce. En dicho modelo, las acumulaciones de flujos de lava que constituyen la mayoría de los cinturones volcánicos se desarrollan en grandes áreas de permeabilidad relativamente baja y con pequeños lentejones de agua dulce. En el sur de la cuenca de Lihue, las lavas de relleno y los sedimentos forman una región extensa de baja conductividad hidráulica regional que, con el clima húmedo de la zona, está saturada hasta prácticamente la superficie del terreno, mientras que el nivel freático se encuentra centenares de metros por encima del nivel del mar a pocos kilómetros de la línea de costa. Se creía hasta ahora que, en los cinturones de islas volcánicas, tales niveles sólo tenían lugar en acuíferos colgados o en condiciones de confinamiento por diques, pero, al sur de la cuenca de Lihue, se dan en acuíferos completamente saturados que no están limitados por diques. Se necesita un nuevo modelo conceptual de las aguas subterráneas en cinturones de islas volcánicas para explicar las condiciones halladas en la cuenca meridional de Lihue.

[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.

Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease.

PubMed

Cameron, Daniel J; Johnson, Lorraine B; Maloney, Elizabeth L

2014-09-01

Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions - the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1-13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.

[Standards and guidelines of radiation protection and safety in dental X-ray examinations].

PubMed

Guo, X L; Li, G; Cheng, Y; Yu, Q; Wang, H; Zhang, Z Y

2017-12-09

With the rapid development of imaging technology, the application of dental imaging in diagnosis, treatment planning, intraoperative surgical navigation, monitoring of treatment or lesion development and assessment of treatment outcomes is playing an essential role in oral healthcare. The increased total number of dental X-ray examinations is accompanied by a relatively significant increase in collective dose to patients as well as to dental healthcare workers, which is harmful to human bodies to a certain degree. Some radiation protection standards and guidelines in dental radiology have been published in European countries, US, Canada and Australia, etc. Adherence to these standards and guidelines helps to achieve images with diagnostic quality and avoid unnecessary and repeated exposures. However, no radiation protection standard or guideline with regard to dental X-ray examinations has been put in force so far in mainland China. Therefore, a literature review on available radiation protection standards and guidelines was conducted to provide reference to the development of radiation protection standards or guidelines in mainland China.

Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease

PubMed Central

Cameron, Daniel J; Johnson, Lorraine B; Maloney, Elizabeth L

2014-01-01

Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions – the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1–13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols. PMID:25077519

Guidelines as rationing tools: a qualitative analysis of psychosocial patient selection criteria for cardiac procedures

PubMed Central

Giacomini, Mita K.; Cook, Deborah J.; Streiner, David L.; Anand, Sonia S.

2001-01-01

Background Cardiac procedure guidelines often include psychosocial criteria for selecting patients that potentially introduce social value judgements into clinical decisions and decisions about the rationing of care. The aim of this study was to investigate the terms and justifications for and the meanings of psychosocial patient characteristics used in cardiac procedure guidelines. Methods We selected English-language guidelines published since 1990 and chapters in textbooks published since 1989. These guidelines amalgamated multiple sources of evidence and expertise and made recommendations regarding patient selection for specific procedures. A multidisciplinary team of physicians and social scientists extracted passages regarding psychosocial criteria and developed categories and conceptual relationships to describe and interpret their content. Results Sixty-five papers met the criteria for inclusion in the study. Forty-five (69%) mentioned psychosocial criteria as procedure indications or contraindications. The latter fell into several categories, including behavioural and psychological issues, relationships with significant others, financial resources, social roles and environmental circumstances. Interpretation Psychosocial characteristics are portrayed as having 2 roles in patient selection: as risk factors intrinsic to the candidate or as indicators of need for special intervention. Guidelines typically simply list psychosocial contraindications without clarifying their specific nature or providing any justification for their use. Psychosocial considerations can help in the evaluation of patients for cardiac procedures, but they become ethically controversial when used to restrict access. The use of psychosocial indications and contraindications could be improved by more precise descriptions of the psychosocial problem at issue, explanations regarding why the criterion matters and justification of the characteristic using a biological rationale or research evidence. PMID:11258209

The Role of Aspirin in the Prevention of Cardiovascular Disease

PubMed Central

Ittaman, Sunitha V.; VanWormer, Jeffrey J.; Rezkalla, Shereif H.

2014-01-01

Aspirin therapy is well-accepted as an agent for the secondary prevention of cardiovascular events and current guidelines also define a role for aspirin in primary prevention. In this review, we describe the seminal trials of aspirin use in the context of current guidelines, discuss factors that may influence the effectiveness of aspirin therapy for cardiovascular disease prevention, and briefly examine patterns of use. The body of evidence supports a role for aspirin in both secondary and primary prevention of cardiovascular events in selected population groups, but practice patterns may be suboptimal. As a simple and inexpensive prophylactic measure for cardiovascular disease, aspirin use should be carefully considered in all at-risk adult patients, and further measures, including patient education, are necessary to ensure its proper use. PMID:24573704

Influence of water vapour and permanent gases on the atmospheric optical depths and transmittance

NASA Astrophysics Data System (ADS)

Badescu, V.

1991-05-01

The influence of the atmospheric state on the extinction of direct solar radiation has been studied by using a four layer atmospheric model. Simple analytical formulae are established for the spectral optical depths of permanent gases and water vapour. These formulae use the ground level values of air pressure, temperature and relative huniidity. An additional parameter, related to the vertical distribution of the hunmidity content, is used for a better estimation of the water vapour optical depth. Good agreement between theory and measurements is found. The paper shows the dependence of the atmospheric spectral transmittance on the above mentioned parameters. L'influence de l'état atmosphérique sur l'extinction de la radiation solaire directe a été étudiée à l'aide d'un modèle atmosphérique développé antérieurement par l'auteur. Des formules simples ont été établies pour l'épaisseur optique spectrale des gaz et de la vapeur d'eau. Ces formules utilisent les valeurs de la pression atmosphérique, de la température et de l'humidité relative, mesurées au niveau du sol. Un paramètre supplémentaire, lié à la distribution verticale du contenu d'humidité, est utilisé pour calculer l'épaisseur optique due à la vapeur d'eau. La théorie est en bon accord avec les résultats des mesures. Le travail montre la dépendance de la transmittance atmosphérique spectrale en fonction des paramètres spécifiés ci-dessus.

The Instrument for Measuring the Implementation Situation of Traditional Chinese Medicine Guideline: Evaluation and Application

PubMed Central

Wang, Yangyang; Chen, Yaolong; Wang, Xiaoyun; Deng, Jingwen

2017-01-01

Clinical practice guidelines play an important role in reducing the variations in clinical practices and improving the quality of care. To assess the real effect, measuring its implementation situation is needed. The implementation situation can be reflected by testing the consistency between the actual clinical practice and the guideline. We constructed an instrument to measure the implementation situation of Traditional Chinese Medicine (TCM) guideline through consistency testing. The main objectives of our study were to validate the instrument and evaluate the implementation situation of menopause syndrome guideline of TCM, using the data from the consistency test of comparing the medical records with the guideline. A total of 621 cases were included for data analysis. Cronbach's Alpha coefficient is 0.73. The model fit of 7 items in four dimensions was good (SRMR = 0.04; GFI = 0.97; NFI = 0.97; TLI = 0.96; CFI = 0.98; AGFI = 0.90). This instrument is of good reliability and validity. It can help the guideline developers to measure the implementation situation, find the reasons affecting the implementation, and revise the guideline. The method of using consistency test to measure the implementation situation may provide a sample for evaluating the guideline implementation in other fields. PMID:29234379

Civil-Military Engagement: An Empirical Account of Humanitarian Perceptions of Civil-Military Coordination During the Response to Typhoon Haiyan.

PubMed

Bollettino, Vincenzo

2016-02-01

This study sought to identify how humanitarian actors in natural disasters coordinate (or communicate) with the military to identify the needs of disaster-affected populations, identify how coordination should be undertaken for the delivery of relief goods, perceive the effectiveness of such coordination, perceive the role that training played in preparation for coordinating with the military and the effectiveness of this training, and view the overall civil-military engagement and its implications for the independence of the humanitarian sector. A survey instrument focused on participant perceptions of the civil-military engagement in response to Typhoon Haiyan in the Philippines was sent to country directors and agency leads who played a role in the response. Although the data supported anecdotal accounts that the coordination between civilian and military actors during the disaster relief efforts in Typhoon Haiyan worked well, they also revealed that fewer than half of the respondents were familiar with the Guidelines on the Use of Foreign Military and Civil Defence Assets in Disaster Relief (the "Oslo Guidelines") and only 12% of respondents thought that the Oslo Guidelines were used to develop organizational policy on humanitarian aid agency engagement with military actors. Humanitarians felt that international militaries and the Philippines Armed Forces played an important role in ensuring that aid reached people in need, particularly in the early days of the response. However, less than half of the respondents were familiar with the Oslo Guidelines.

The development of guidelines for drug and alcohol dependence treatment: affecting policy and practice.

PubMed

Heather, N; Mattick, R P

1994-01-01

The rationale and methodology behind the Australian Quality Assurance Project is described. The Project aimed to develop guidelines for treatment content based on three sources of information: research findings, current practice and expert opinion. The issue of the gap between research and practice is discussed, as well as the role of dissemination in altering clinician behaviour.

Board Certified Behavior Analysts and Related Ethical and Professional Practice Considerations for Rural Schools

ERIC Educational Resources Information Center

Menendez, Anthony L.; Mayton, Michael R.; Yurick, Amanda L.

2017-01-01

When rural school districts employ Board Certified Behavior Analysts (BCBAs) to assist in meeting the needs of students with disabilities, it is important that they be aware of the ethical and professional guidelines to which BCBAs are required to adhere. This article describes the role of these guidelines within the practice of BCBAs and presents…

Enhancing Role-Play Activities with Pocket Camcorder Technology: Strategies for Counselor-Educators

ERIC Educational Resources Information Center

Walter, Sara Meghan; Thanasiu, Page L.

2011-01-01

Counselor-educators can benefit from specific guidelines and creative suggestions when implementing role-play and technology-related teaching strategies in counseling training programs. Therefore, the purpose of this article is to: (a) discuss the use of role-play and video recording in counselor education; (b) introduce counselor-educators to…

Evaluating Nextgen Closely Spaced Parallel Operations Concepts with Validated Human Performance Models: Flight Deck Guidelines

NASA Technical Reports Server (NTRS)

Hooey, Becky Lee; Gore, Brian Francis; Mahlstedt, Eric; Foyle, David C.

2013-01-01

The objectives of the current research were to develop valid human performance models (HPMs) of approach and land operations; use these models to evaluate the impact of NextGen Closely Spaced Parallel Operations (CSPO) on pilot performance; and draw conclusions regarding flight deck display design and pilot-ATC roles and responsibilities for NextGen CSPO concepts. This document presents guidelines and implications for flight deck display designs and candidate roles and responsibilities. A companion document (Gore, Hooey, Mahlstedt, & Foyle, 2013) provides complete scenario descriptions and results including predictions of pilot workload, visual attention and time to detect off-nominal events.

The Lebanese Society for Infectious Diseases and Clinical Microbiology (LSIDCM) guidelines for adult community-acquired pneumonia (Cap) in Lebanon.

PubMed

Moghnieh, Rima; Yared Sakr, Nadine; Kanj, Souha S; Musharrafieh, Umayya; Husni, Rula; Jradeh, Mona; Al-Awar, Ghassan; Matar, Madona; Jureij, Wafa; Antoine, Saad; Azar, Eid; Abi Hanna, Pierre; Minari, Afaf; Hammoud, Jamale; Kfoury, Joumana; Mahfouz, Tahsin; Abou Chakra, Diaa; Zaatari, Mohamad; Tabbarah, Zuhayr A

2014-01-01

Adult community-acquired pneumonia (CAP) is a common cause of morbidity and mortality which is managed by different disciplines in a heterogeneous fashion. Development of consensus guidelines to standardize these wide variations in care has become a prime objective. The Lebanese Society of Infectious Diseases and Clinical Microbiology (LSIDCM) convened to set Lebanese national guidelines for the management of CAP since it is a major and a prevalent disease affecting the Lebanese population. These guidelines, besides being helpful in direct clinical practice, play a major role in establishing stewardship programs in hospitals in an effort to contain antimicrobial resistance on the national level. These guidelines are intended for primary care practitioners and emergency medicine physicians. They constitute an appropriate starting point for specialists' consultation being based on the available local epidemiological and resistance data. This document includes the following: 1/ Rationale and scope of the guidelines; 2/ Microbiology of CAP based on Lebanese data; 3/ Clinical presentation and diagnostic workup of CAP; 4/ Management and prevention strategies based on the IDSA/ATS Consensus Guidelines, 2007, and the ESCMID Guidelines, 2011, and tailored to the microbiological data in Lebanon; 5/ Comparison to regional guidelines. The recommendations made in this document were graded based on the strength of the evidence as in the 2007 IDSA/ATS Consensus Guidelines. Hopefully, these guidelines will be an important step towards standardization of CAP care in Lebanon and set the agenda for further research in this area.

Extraterrestrial hydrogeology

NASA Astrophysics Data System (ADS)

Baker, Victor R.; Dohm, James M.; Fairén, Alberto G.; Ferré, Ty P. A.; Ferris, Justin C.; Miyamoto, Hideaki; Schulze-Makuch, Dirk

2005-03-01

Subsurface water processes are common for planetary bodies in the solar system and are highly probable for exoplanets (planets outside the solar system). For many solar system objects, the subsurface water exists as ice. For Earth and Mars, subsurface saturated zones have occurred throughout their planetary histories. Earth is mostly clement with the recharge of most groundwater reservoirs from ample precipitation during transient ice- and hot-house conditions, as recorded through the geologic and fossilized records. On the other hand, Mars is mostly in an ice-house stage, which is interrupted by endogenic-driven activity. This activity catastrophically drives short-lived hydrological cycling and associated climatic perturbations. Regional aquifers in the Martian highlands that developed during past, more Earth-like conditions delivered water to the northern plains. Water was also cycled to the South Polar Region during changes in climate induced by endogenic activity and/or by changes in Mars' orbital parameters. Venus very likely had a warm hydrosphere for hundreds of millions of years, before the development of its current extremely hot atmosphere and surface. Subsequently, Venus lost its hydrosphere as solar luminosity increased and a run-away moist greenhouse took effect. Subsurface oceans of water or ammonia-water composition, induced by tidal forces and radiogenic heating, probably occur on the larger satellites Europa, Ganymede, Callisto, Titan, and Triton. Tidal forces operating between some of the small bodies of the outer solar system could also promote the fusion of ice and the stability of inner liquid-water oceans. Les processus de subsurface impliquant l'eau sont communs pour les corps planétaires du système solaire et sont très probables sur les exoplanètes (planètes en dehors du système solaire). Pour plusieurs objets du systèmes solaire, l'eau de subsurface est présente sous forme de glace. Pour la Terre et Mars, les zones saturées de subsurface apparaissent à travers toute leur histoire planétaire. La Terre est particulièrement clémente avec la recharge des réservoirs, avec de amples précipitations, des conditions glaciaires et de fortes chaleurs, comme l'atteste les enregistrements géologiques et paléontologiques. D'un autre côté, Mars se trouve dans une phase essentiellement glaciaire, qui est interrompue par des activités contraintes par les phénomènes endogéniques. Cette activité conduit de manière catastrophique à des cycles hydrologiques et à des perturbations climatiques brutaux. Les aquifères régionaux dans les haute terres martiennes qui se sont formés dans des conditions similaires aux conditions terrestres, alimentent les plaines du Nord. L'eau a également été déplacée vers le Pôle Sud martien durant des changements marqués par une forte activité endogénique et une modification des paramètres de l'orbite de Mars. Venus possèdait vrais emblablement une hydrosphère chaude durant des millions d'année, avant le développement de son atmosphère et sa surface particulièrement chaude. Par après Venus a perdit son hydrosphère alors que la luminosité solaire augmentait et qu'une humidité liée à un effet de serre s'installait. Les océans de subsurface d'eau ou d'eau ammoniacale, induits par les forces de marée et le chauffage radiogénique, apparaissent probablement sur les satellites les plus importants (Europa, Ganymede, Callisto, Titan, Triton). Les forces de marée entre les petits corps externes du système solaire peuvent également occasionner la fusion de glace et la stabilité des océans internes d'eau liquide. Los procesos hídricos subsuperficiales son comunes en cuerpos planetarios del sistema solar y son altamente probables para exoplanetas (planetas fuera del sistema solar). Para muchos cuerpos del sistema solar, el agua subsuperficial existe como hielo. Para la Tierra y Marte han ocurrido zonas saturadas subsuperficiales a través de sus historias planetarias. La Tierra es principalmente generosa con la recarga de la mayoría de reservorios de aguas subterráneas a partir de amplia precipitación reconocida en condiciones transitorias calientes y heladas, tal y como aparece en los registros fósiles y geológicos. Por otro lado, Marte se encuentra principalmente en una etapade cámara de hielo la cual es interrumpida por actividad de tipo endogénico. Esta actividad pone en funcionamiento catastróficamente ciclos hidrológicos de vida corta y perturbaciones climáticas asociadas. Acuíferos regionales en las montañas de Marte que se desarrollaron en el pasado en condiciones similares a la Tierra distribuyen agua a las planicies del norte. El agua ha sido transportada hacia el sur de la región polar durante cambios en el clima inducidos por actividad endogénica y/o cambios en los parámetros orbitales de Marte. Venus muy probablemente tuvo una hidrósfera caliente durante cientos de millones de años, antes de que se desarrollara su atmósfera y superficie actual extremadamente caliente. Subsecuentemente, Venus perdió su hidrósfera a medida que la luminosidad solar aumentó y un efecto de invernadero húmedo escapatorio se llevó a cabo. Océanos subsuperficiales de composición agua o amoniaco-agua, inducidos por fuerzas de marea y calentamiento radiogénico, probablemente ocurren en los satélites más grandes como Europa, Ganimeda, Callisto, Titan y Triton. Las fuerzas de marea que operan entre los cuerpos pequeños del sistema solar externo podrían también promover la fusión de hielo y la estabilidad de líquido interno-aguas de los océanos.

Benchmarking progress in the implementation of the Fourth Joint Societies' Task Force Guidelines on the Prevention of Cardiovascular Disease in Clinical Practice.

PubMed

Morgan, Karen; Burke, Helen; McGee, Hannah

2013-02-01

The Fourth Joint Societies' Task Force (4th JTF) Guidelines on Cardiovascular Disease Prevention in Clinical Practice are agreed, evidence-based standards of care across European countries and professions. In advance of the publication of the 5th JTF Guidelines in 2012, this work assesses the extent to which the 4th JTF guidelines have been implemented. Qualitative study of guideline implementation in 13 European countries, focusing on the themes of guideline implementation structures, processes, and outcomes. Key personnel in 13 selected countries completed interviews or comparable questionnaires: they were national coordinators for CVD prevention (n = 14) and representatives of the national cardiac society (n = 9), heart foundations (n = 11), health ministry (n = 8), and service providers (n = 3). Interview and service-related data from each country were compiled to provide a detailed overview. Ten of the 13 countries used European Society of Cardiology (ESC) guidelines on prevention at a national level, where three broad approaches to implementation were identified. In all 10 countries, multidisciplinary alliances oversaw implementation, but ongoing promotion of the guidelines was not evident, with just two of the 10 countries conducting evaluation of implementation. Barriers to implementation included weak health authority support, the unwieldy nature of the guidelines, guideline fatigue, and the lesser role of prevention in national healthcare systems. Substantial progress had been made in implementing the guidelines, but countries struggled with the task. Some rebalancing of the ESC focus may be warranted so that part of the effort dedicated to improving guidelines might be redirected at translating them into practice.

Higher Education Funding: The Role of the Institutional Researcher in the Development of Student/Faculty Ratio Guidelines. AIR 1988 Annual Forum Paper.

ERIC Educational Resources Information Center

Gosman, Erica J.; Bartram, John W.

The experiences are described of the University of Colorado institutional researcher in serving on a statewide task force charged with revising the student/faculty ratio guidelines that form the basis of the faculty funding formula. Following a description of the task force structure and procedures, the methodology employed in analyzing and…

Impact of quality of evidence on the strength of recommendations: an empirical study

PubMed Central

Djulbegovic, Benjamin; Trikalinos, Thomas A; Roback, John; Chen, Ren; Guyatt, Gordon

2009-01-01

Background Evidence is necessary but not sufficient for decision-making, such as making recommendations by clinical practice guideline panels. However, the fundamental premise of evidence-based medicine (EBM) rests on the assumed link between the quality of evidence and "truth" and/or correctness in making guideline recommendations. If this assumption is accurate, then the quality of evidence ought to play a key role in making guideline recommendations. Surprisingly, and despite the widespread penetration of EBM in health care, there has been no empirical research to date investigating the impact of quality of evidence on the strength of recommendations made by guidelines panels. Methods The American Association of Blood Banking (AABB) has recently convened a 12 member panel to develop clinical practice guidelines (CPG) for the use of fresh-frozen plasma (FFP) for 6 different clinical indications. The panel was instructed that 4 factors should play a role in making recommendation: quality of evidence, uncertainty about the balance between desirable (benefits) and undesirable effects (harms), uncertainty or variability in values and preferences, and uncertainty about whether the intervention represents a wise use of resources (costs). Each member of the panel was asked to make his/her final judgments on the strength of recommendation and the overall quality of the body of evidence. "Voting" was anonymous and was based on the use of GRADE (Grading quality of evidence and strength of recommendations) system, which clearly distinguishes between quality of evidence and strength of recommendations. Results Despite the fact that many factors play role in formulating CPG recommendations, we show that when the quality of evidence is higher, the probability of making a strong recommendation for or against an intervention dramatically increases. Probability of making strong recommendation was 62% when evidence is "moderate", while it was only 23% and 13% when evidence was "low" or "very low", respectively. Conclusion We report the first empirical evaluation of the relationship between quality of evidence pertinent to a clinical question and strength of the corresponding guideline recommendations. Understanding the relationship between quality of evidence and probability of making (strong) recommendation has profound implications for the science of quality measurement in health care. PMID:19622148

Computer Controlled Resonator Measurements with a 12-Liter Pyrex Sphere and a 100-Liter Titanium Sphere.

DTIC Science & Technology

1981-06-30

04 C0 4~ >NC- -C 04 0 C)’ 00) Ci 04 0 C - 4 iim ClV thermistor L ___ Fig.4. Tmpertur eau in ciruit amplifier has selectable gain of 20 dB or 40 dB over...useful up to 500 kHz. The converter was adjusted to be linear over 80 dB. 6. Temperature measurements A cal ibrated thermistor which forms one arm of a...formed by stretching piano wire inside a ring. Three 5" long bars welded into this ring form feet in tripod fashion. The tension of these piano wires is

Extension spatiale de la salinisation des ressources en eau et modèle conceptuel des sources salées dans la plaine des Triffa (Maroc nord-oriental)

NASA Astrophysics Data System (ADS)

Boughriba, Mimoun; Melloul, Abderrahmane; Zarhloule, Yassine; Ouardi, Abdelillah

2006-09-01

The succession of drought years and excessive abstraction in the plain of Triffa caused deterioration in water quality and endangers future exploitation of groundwater resources. A combination of geophysical surveys, including electrical resistivity and hydrochemical data has been used to identify the geographical extension of salinization and identify its origin. Electrical conductivity measurements are used to show the history of salinization in space and time. In this paper, a first conceptual model of the brackish springs has been established. To cite this article: M. Boughriba et al., C. R. Geoscience 338 (2006).

Développement durable à l'échelle de la planète et gestion des ressources en eau et en solsSustainable development on a global scale and management of water and soil resources

NASA Astrophysics Data System (ADS)

Petit, Michel

2003-06-01

Despite some controversies, an international consensus on what is sustainable development has emerged, the nature of which is first specified. Then the author explains why the implementation of the measures consistent with this consensus comes up against obstacles, particularly political ones, which makes clear why the topic is still under animated debate. Examples will be taken in the domain of the management of water and soils resources. To cite this article: M. Petit, C. R. Geoscience 335 (2003).

Cyclic injection, storage, and withdrawal of heated water in a sandstone aquifer at St. Paul, Minnesota: Field observations, preliminary model analysis, and aquifer thermal efficiency

USGS Publications Warehouse

Miller, Robert T.

1989-01-01

The Franconia-Ironton-Galesville aquifer is a consolidated sandstone, approximately 60 m thick, the top of which is approximately 180 m below the land surface. It is confined above by the St. Lawrence Formation--a dolomitic sandstone 8-m thick--and below by the Eau Claire Formation--a shale 30-m thick. Initial hydraulic testing with inflatable packers indicated that the aquifer has four hydraulic zones with distinctly different values of relative horizontal hydraulic conductivity. The thickness of each zone was determined by correlating data from geophysical logs, core samples, and the inflatablepacker tests.

Expectation of sickness absence duration: a review on statements and methods used in guidelines in Europe and North America

PubMed Central

Mousavi, S. Mohsen; Delclos, George L.; Benavides, Fernando G.; Lorente, Mercedes; Kunz, Regina

2016-01-01

Background: Certifying physicians play a key role in the management of sickness absence and are often provided with guidelines. Some of these guidelines contain statements on expected sickness absence duration, according to diagnosis. We were interested in exploring the evidence base of these statements. Methods: We identified guidelines through a survey of EUMASS members and a literature search of the Internet and PubMed. We extracted the statements and methods from the guidelines. We compared: diagnoses that were addressed, expected durations and development processes followed. Next, we presented our findings to the developers, to afford them an opportunity to comment and/or correct any misinterpretations. Results: We identified 4 guidelines from social insurance institutions (France, Serbia, Spain and Sweden) and 4 guidelines from private organisations (1 Netherlands, 3 US). Guidelines addressed between 63 and some 63000 health conditions (ICD 10 codes). Health conditions overlapped among guidelines. Direct comparison is hampered by differences in coding (ICD 9 or 10) and level of aggregation (three or four digit, clustering of diseases and treatment situations). Expectations about duration are defined as minimum, maximum, and optimum or mean or median and percentile distribution, stratified to age and work requirements. In a sample of 5 diagnoses we found overlap in expected duration but also differences. Guidelines are developed differently, pragmatic expert consensus being used most, supplemented with data on sickness absence from different registers, other guidelines and non-systematic literature reviews. The effectiveness of these guidelines has not yet been formally evaluated. Conclusions: Expectations about duration of sickness absence by diagnosis are expressed in several guidelines. The expectations are difficult to compare, their evidence base is unclear and their effectiveness needs to be established. PMID:26705569

Guideline of guidelines: asymptomatic microscopic haematuria.

PubMed

Linder, Brian J; Bass, Edward J; Mostafid, Hugh; Boorjian, Stephen A

2018-02-01

The aim of the present study was to review major organizational guidelines on the evaluation and management of asymptomatic microscopic haematuria (AMH). We reviewed the haematuria guidelines from: the American Urological Association; the consensus statement by the Canadian Urological Association, Canadian Urologic Oncology Group and Bladder Cancer Canada; the American College of Physicians; the Joint Consensus Statement of the Renal Association and British Association of Urological Surgeons; and the National Institute for Health and Care Excellence. All guidelines reviewed recommend evaluation for AMH in the absence of potential benign aetiologies, with the evaluation including cystoscopy and upper urinary tract imaging. Existing guidelines vary in their definition of AMH (role of urine dipstick vs urine microscopy), the age threshold for recommending evaluation, and the optimal imaging method (computed tomography vs ultrasonography). Of the reviewed guidelines, none recommended the use of urine cytology or urine markers during the initial AMH evaluation. Patients should have ongoing follow-up after a negative initial AMH evaluation. Significant variation exists among current guidelines for AMH with respect to who should be evaluated and in what manner. Given the patient and health system implications of balancing appropriately focused and effective diagnostic evaluation, AMH represents a valuable future research opportunity. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Role of Cranial Molding Orthosis (Helmet) Therapy for Patients With Positional Plagiocephaly.

PubMed

Tamber, Mandeep S; Nikas, Dimitrios; Beier, Alexandra; Baird, Lissa C; Bauer, David F; Durham, Susan; Klimo, Paul; Lin, Alexander Y; Mazzola, Catherine; McClung-Smith, Catherine; Mitchell, Laura; Tyagi, Rachana; Flannery, Ann Marie

2016-11-01

No evidence-based guidelines exist on the role of cranial-molding orthosis (helmet) therapy for patients with positional plagiocephaly. To address the clinical question: "Does helmet therapy provide effective treatment for positional plagiocephaly?" and to make treatment recommendations based on the available evidence. The US National Library of Medicine Medline database and the Cochrane Library were queried by using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and, based on the quality of the literature, recommendations were made (Levels I-III). Fifteen articles met criteria for inclusion into the evidence tables. There was 1 prospective randomized controlled trial (Class II), 5 prospective comparative studies (Class II), and 9 retrospective comparative studies (Class II). There is a fairly substantive body of nonrandomized evidence that demonstrates more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy. Specific criteria regarding the measurement and quantification of deformity and the most appropriate time window in infancy for treatment of positional plagiocephaly with a helmet remains elusive. In general, infants with a more severe presenting deformity and infants who are helmeted early in infancy tend to have more significant correction (and even normalization) of head shape. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_5.

[The role of atherogenic dyslipidaemia in clinical practice guidelines].

PubMed

Pedro-Botet, Juan; Mantilla-Morató, Teresa; Díaz-Rodríguez, Ángel; Brea-Hernando, Ángel; González-Santos, Pedro; Hernández-Mijares, Antonio; Pintó, Xavier; Millán Núñez-Cortés, Jesús

2016-01-01

Atherogenic dyslipidaemia is underdiagnosed, undertreated, and under-controlled. The aim of the present study was to assess the positioning of clinical guidelines as regards atherogenic dyslipidaemia. The major clinical guidelines of scientific societies or official agencies issued between January 1, 2012 and March 31, 2015 were collected from the MEDLINE database. High-density lipoprotein (HDL) cholesterol, triglycerides, atherogenic dyslipidaemia, non-HDL cholesterol, and apolipoprotein (apo) B were gathered from the 10 selected guidelines, and it was assessed whether these parameters were considered a cardiovascular risk factor, a therapeutic target, or proposed a pharmacological strategy. American guidelines, except the National Lipid Association (NLA), do not consider HDL cholesterol and triglycerides in cardiovascular prevention. The NLA emphasises the relevance of atherogenic dyslipidaemia. The Canadian guidelines introduced non-HDL cholesterol and ApoB as alternative targets, and proposes non-statin treatment in the presence of low HDL cholesterol and hypertriglyceridaemia. The International Atherosclerosis Society (IAS) and National Institute for Health and Care Excellence (NICE) guidelines promote the importance of non-HDL cholesterol. European, Brazilian and Japanese guidelines highlight HDL cholesterol and triglycerides, but with the limitation that the main evidence comes from sub-analysis of clinical studies. The clinical guidelines analysed do not consider, or unconvincingly address, the importance of atherogenic dyslipidaemia. Copyright © 2016 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

Development of an ergonomics guideline for the furniture manufacturing industry.

PubMed

Mirka, Gary A

2005-03-01

Industry-specific ergonomics guidelines are an important component in the four-pronged approach to workplace ergonomics currently pursued by the United States Occupational Safety and Health Administration. The American Furniture Manufacturers Association has taken the initiative of developing such a guideline for its members. The result of this effort is the "AFMA Voluntary Ergonomics Guideline for the Furniture Manufacturing Industry", a document that includes basic information about ergonomics program components as well as a compilation of work-proven, ergonomics best practices as submitted by members of the furniture manufacturing community. This guideline was developed through an industry-research-government partnership and made strategic use of the unique attributes that each sector brought to this effort. Outlined in this paper are some of the characteristics of this partnership including, the roles played by each, the different motivations for pursuing the guideline, the challenges faced during the development of the document, the successes experienced in this process, as well as a proposed outline for measuring the effectiveness of this effort. The hope is that this summary, and some of the lessons learned contained herein, would be helpful to others considering the prospect of developing such a guideline for their industry.

Core clerkship directors: their current resources and the rewards of the role.

PubMed

Ephgrave, Kimberly; Margo, Katherine L; White, Christopher; Hammoud, Maya; Brodkey, Amy; Painter, Thomas; Juel, Vern C; Shaw, Darlene; Ferguson, Kristi

2010-04-01

To conduct a national multidisciplinary investigation assessing core clinical clerkships and their directors, variances in resources from national guidelines, and the impact of the clerkship director role on faculty members' academic productivity, advancement, and satisfaction. A multidisciplinary working group of the Alliance for Clinical Education (ACE), representing all seven core clinical disciplines, created and distributed a survey to clerkship directors at 125 U.S. MD-granting medical schools, in academic year 2006-2007. A total of 544 clerkship directors from Internal Medicine (96), Family Medicine (91), Psychiatry, (91), Pediatrics (79), Surgery (71), Neurology (60), and Obstetrics-Gynecology (56) responded, representing over 60% of U.S. core clinical clerkships. The clerkship directors were similar across disciplines in demographics and academic productivity, though clinical and clerkship activities varied. Departmental staff support for clerkships averaged 0.69 people, distinctly less than the ACE's 2003 guideline of a full-time coordinator in all disciplines' clerkships. Clerkship directors reported heavy clinical responsibilities, which, as in previous studies, were negatively related to academic productivity. However, many clerkship directors felt the role enhanced their academic advancement; a large majority felt it significantly enhanced their career satisfaction. The resources and rewards of the clerkship director role were similar across disciplines. Expectations of clerkship directors were considerable, including responsibility for clinical material and the learning environment. Resources for many fall short of those stated in the ACE guidelines, particularly regarding support staff. However, the findings indicate that the clerkship director role can have benefits for academic advancement and strongly enhances career satisfaction.

“A question of balance”: addressing the public health impacts of multinational enterprises in the OECD Guidelines for Multinational Enterprises

PubMed Central

Yang, Joshua S.; McDaniel, Patricia A.; Malone, Ruth E.

2012-01-01

Background The global community is beginning to address non-communicable diseases, but how to increase the accountability of multinational enterprises (MNEs) for the health impacts of their products and practices remains unclear. We examine the Organization for Economic Cooperation and Development’s (OECD) efforts to do so through voluntary MNE guidelines. Methods We developed a historical case study of how the OECD Guidelines for Multinational Enterprises were developed and revised from 1973–2000 through an analysis of publicly available archived OECD and tobacco industry documents. Results The first edition of the Guidelines was a purely economic instrument. Outside pressures and a desire to ward off more stringent regulatory efforts resulted in the addition over time of guidelines related to the environment, consumer interests, sustainable development, and human rights. Conclusion Despite their voluntary nature, the Guidelines can play a role in efforts to help balance the interests of MNEs and public health by providing a starting point for efforts to create binding provisions addressing MNEs’ contributions to disease burden or disease reduction. PMID:23046298

Implementation of asthma guidelines to West Australian community pharmacies: an exploratory, quasi-experimental study

PubMed Central

Trevenen, Michelle; Murray, Kevin; Kendall, Peter A; Schneider, Carl R; Clifford, Rhonda

2016-01-01

Objectives Pharmacy assistants are often the first point of contact for patients presenting in community pharmacies. The current role of pharmacy assistants in the supply of asthma-reliever medications (short-acting β-agonists) was identified as a barrier to appropriate guideline-based care. The aim of this research was to devise and evaluate a team-based intervention to formalise the role of pharmacy assistants and to improve asthma guideline-based care in community pharmacy. Design A controlled pre-post intervention study was conducted in 336 metropolitan pharmacies located in Perth, Western Australia. Pharmacies were stratified into 2 groups (187 intervention and 149 control) based on known confounders for asthma control. The intervention was designed using a common-sense approach and resources developed included a checklist, videos and web page. Delivery was via workshops (25 pharmacies) or academic detailing (162 pharmacies). Pharmacy practice was assessed preintervention and postintervention via covert simulated patient methodology. Primary outcome measures included patient medical referral, device use demonstration and counselling, internal referral and/or direct involvement of a pharmacist in consultations. Results There was a significant increase in patient medical referral in intervention pharmacies from 32% to 47% (p=0.0007) from preintervention to postintervention, while control pharmacies showed a non-significant decrease from 50% to 44% (p=0.22). Device counselling was not routinely carried out at any stage or in any cohort of this research and no significant changes in internal referral were observed. Conclusions Increases in medical referral indicate that asthma guideline compliance can be improved in community pharmacy if implementation employs a team-based approach and involves pharmacy assistants. However, results were variable and the intervention did not improve practice related to device counselling or internal referral/pharmacist involvement. Undertaking more workshops may have improved results. Guideline implementation in community pharmacy should consider the role of pharmacy assistants and how to overcome logistical barriers to pharmacy participation in implementation activities. PMID:27580836

Mobilization of metals from Eau Claire siltstone and the impact of oxygen under geological carbon dioxide sequestration conditions

NASA Astrophysics Data System (ADS)

Shao, Hongbo; Kukkadapu, Ravi K.; Krogstad, Eirik J.; Newburn, Matt K.; Cantrell, Kirk J.

2014-09-01

To investigate the impact of O2 as an impurity co-injected with CO2 on geochemical interactions, especially trace metal mobilization from a geological CO2 sequestration (GCS) reservoir rock, batch studies were conducted with Eau Claire siltstone collected from CO2 sequestration sites. The rock was reacted with synthetic brines in contact with either 100% CO2 or a mixture of 95 mol% CO2-5 mol% O2 at 10.1 MPa and 75 °C. Both microscopic and spectroscopic measurements, including 57Fe-Mössbauer spectroscopy, Laser Ablation-Inductively Coupled Plasma-Mass Spectrometry, powder X-ray diffraction, scanning electron microscopy-energy dispersive X-ray spectroscopy, and chemical extraction were combined in this study to investigate reaction mechanisms. The Eau Claire siltstone contains quartz (52 wt%), fluorapatite (40%), and aluminosilicate (5%) as major components, and dolomite (2%), pyrite (1%), and small-particle-/poorly-crystalline Fe-oxides as minor components. With the introduction of CO2 into the reaction vessel containing rock and brine, the leaching of small amounts of fluorapatite, aluminosilicate, and dolomite occurred. Trace metals of environmental concern, including Pb, As, Cd, and Cu were detected in the leachate with concentrations up to 400 ppb in the CO2-brine-rock reaction system within 30 days. In the presence of O2, the oxidation of Fe(II) and the consequent changes in the reaction system, including a reduction in pH, significantly enhanced the mobilization of Pb, Cd, and Cu, whereas As concentrations decreased, compared with the reaction system without O2. The presence of O2 resulted in the formation of secondary Fe-oxides which appear to be Fe(II)-substituted P-containing ferrihydrite. Although the rock contained only 1.04 wt% total Fe, oxidative dissolution of pyrite, leaching and oxidation of structural Fe(II) in fluorapatite, and precipitation of Fe-oxides significantly decreased the pH in brine with O2 (pH 3.3-3.7), compared with the reaction system without O2 (pH 4.2-4.4). In the CO2-rock-brine system without O2, the majority of As remained in the rock, with about 1.1% of the total As being released from intrinsic Fe-oxides to the aqueous phase. The release behavior of As to solution was consistent with competitive adsorption between phosphate/fluoride and As on Fe-oxide surfaces. In the presence of O2 the mobility of As was reduced due to enhanced adsorption onto both intrinsic and secondary Fe-oxide surfaces. When O2 was present, the dominant species in solution was the less toxic As(V). This work will advance our understanding of the geochemical reaction mechanisms that occur under GCS conditions and help to evaluate the risks associated with geological CO2 sequestration.

Academy of Osseointegration's Summit on Clinical Practice Guidelines for the Edentulous Maxilla: Overview, Process, and Outcomes-Changing the Face of Implant Dentistry.

PubMed

Stanford, Clark M

2016-01-01

Starting in 2012, the Academy of Osseointegration initiated the planning process for an AO Summit to develop clinical practice guidelines (CPGs) for management of the edentulous maxilla. A planning committee led by Professor Clark Stanford and Dr Ole Jensen created a work plan based on five domain areas to be addressed by the summit. The five domain areas were defined as: (1) role of grafting for ridge development for implant placement, (2) role of implant design and systems in management of the edentulous maxilla, (3) role of imaging to guide implant placement, (4) role of biologics to assist in ridge development, and (5) role of prosthetic management. The summit was held in August 2014, and the results are presented in this overview. All of the supporting systematic reviews and the detailed CPGs are presented in this special edition of JOMI. While the evidence was observed to be weak in regard to the literature for most of the systematic reviews, the summit strived to establish the current best evidence and practical CPGs that will assist clinicians in practice.

[Evaluation of hospital admissions: admission guidelines implementation in a pediatric emergency department].

PubMed

Katz, Manuel; Warshawsky, Sheila S; Rosen, Shirley; Barak, Nurit; Press, Joseph

2004-10-01

To develop and implement locally tailored pediatric admission guidelines for use in a pediatric emergency department and evaluate the appropriateness of admissions based on these guidelines. Our Study was based on the development of admission guidelines by senior physicians, using the Delphi Consensus Process, for use in the Pediatric Emergency Department (PED) at Soroka University Medical Center (Soroka). We evaluated the appropriateness of admissions to the pediatric departments of Soroka on 33 randomly selected days in 1999 and 2000 prior to guideline implementation and 30 randomly selected days in 2001, after guideline implementation. A total of 1037 files were evaluated. A rate of 12.4% inappropriate admissions to the pediatric departments was found based on locally tailored admission guidelines. There was no change in the rate of inappropriate admissions after implementation of admission guidelines in PED. Inappropriate admissions were associated with age above 3 years, hospital stay of two days or less and the season. The main reasons for evaluating an admission as inappropriate were that the admission did not comply with the guidelines and that the case could be managed in an ambulatory setting. There were distinctive differences in the characteristics of the Bedouin and Jewish populations admitted to the pediatric departments, although no difference was found in the rate of inappropriate admissions between these populations. Patient management in Soroka PED is tailored to the conditions of this medical center and to the characteristics of the population it serves. The admission guidelines developed reflect these special conditions. Lack of change in the rate of inappropriate admissions following implementation of the guidelines indicates that the guidelines reflect the physicians' approach to patient management that existed in Soroka PED prior to guideline implementation. Hospital admission guidelines have a role in the health management system; however, these guidelines must be tailored to reflect local characteristics and needs.

Confidentiality of College and University Faculty Personnel Files: Its Appropriate Role in Institutional Affairs [and] Statement on Access to and Disclosures from Employee Records. Self-Regulation Initiatives: Guidelines for Colleges and Universities, Nos. 7 and 8.

ERIC Educational Resources Information Center

American Council on Education, Washington, DC.

Guidelines for colleges concerning the privacy of employee records are presented in two policy statements. Institutional policy should minimize intrusiveness, maximize fairness, and create legitimate expectations of confidentiality. In addition to strengthening professional equity of treatment, confidentiality permits consideration of both adverse…

Etudes physiques des mélanges eau-cryoprotecteurs

NASA Astrophysics Data System (ADS)

Vassoille, R.; Perez, J.

The aim of the following review is to present the most important studies concerning the physical properties of water-solutes mixtures used in cryobiology. Cryobiology is a branch of biology which deals with the very low temperature behaviour of cells. This technique is developed today in several directions. The creation of banks of cells and perhaps in a short time of small organs, is the purpose of much research in this domain. Before freezing, living cells are generally put in a solution containing one or more solutes. The role of these solutes is to protect the cells against damage due to crystallization of water (cryoprotectors). The mechanisms of cryoprotection are not well known ; nevertheless the vitreous state formation during cooling is often invoked. So, it is possible to avoid crystallization damage such as mechanical strain (due to an increase of volume of about 10 %) and salt effects (due to osmotic pressure). The conditions in which the vitreous state is obtained, maintained during cooling, storage at low temperature and rewarming can be defined by physical studies presented in the following review. Le présent travail est essentiellement une revue bibliographique des principales études physiques qui ont été réalisées avec des solutions de composés habituellement employés en cryobiologie. La cryobiologie est une branche de la biologie qui s'intéresse au comportement des cellules à basse température. Cette discipline est actuellement en plein développement dans des domaines très divers. Son principal but est la création de banques de cellules de plus en plus complexes avec comme perspective la conservation des organes. Les cellules vivantes sont généralement placées avant congélation dans une solution contenant divers composés dont le rôle est de protéger les cellules contre les effets de la cristallisation de l'eau. L'action protectrice de ces cryoprotecteurs est encore mal connue; cependant, la formation d'un état vitreux lors du refroidissement est souvent invoquée. Ainsi, il est possible d'éviter les dommages liés à la cristallisation : contrainte mécanique due à l'augmentation de volume, effets de sel dus à l'existence d'un gradient de pression osmotique de part et d'autre de la membrane cellulaire. Les conditions d'obtention et de maintien de cet état vitreux lors des opérations de congélation peuvent être définies par des études physiques dont nous proposons une revue.

Cancer related fatigue: implementing guidelines for optimal management.

PubMed

Pearson, Elizabeth J M; Morris, Meg E; McKinstry, Carol E

2017-07-18

Cancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies. A mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round. Forty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management. Translating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may be further enhanced with guideline adaptation, professional education and integration with existing practices.

Disseminating and implementing guidelines: article 13 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Grimshaw, Jeremy M; Schünemann, Holger J; Burgers, Jako; Cruz, Alvaro A; Heffner, John; Metersky, Mark; Cook, Deborah

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the thirteenth of a series of 14 articles that were prepared to advise guideline developers in respiratory and other diseases. This article focuses on current concepts and research evidence about how to disseminate and implement guidelines optimally on a national and international level to improve quality of care. In this article we address the following questions: What frameworks can aid guideline dissemination and implementation; what are the effects of different guideline dissemination and implementation strategies; and, what is the role of guideline developers in guideline dissemination and implementation? We identified existing systematic reviews and relevant methodological research. Our conclusions are based on evidence from published literature, experience from guideline developers, and workshop discussions. The Knowledge to Action cycle proposed by Graham and colleagues (J Contin Educ Health Prof 2006;26:13-24) provides a useful framework for planning dissemination and implementation activities that emphasize the need for tailored approaches based on an assessment of local barriers. There are a broad range of interventions that are generally effective at improving the uptake of evidence. The best intervention depends on likely barriers, available resources, and other practical considerations. Financial interventions (such as pay for performance) appear to be as effective as other interventions that aim to change professional behavior. Guideline developers who do not have responsibility for guideline implementation in their jurisdiction should support those with responsibility for implementation by considering the "implementability" of their guidelines.

Primary care physician management, referral, and relations with specialists concerning patients at risk for cancer due to family history.

PubMed

Wood, M E; Flynn, B S; Stockdale, A

2013-01-01

Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management. Copyright © 2013 S. Karger AG, Basel.

The Federal Role in Fostering University-Industry Cooperation.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

Three well-known forms of university-industry collaboration (research parks, cooperative research centers, and industrial extension services) were examined, along with the federal role of stimulating cooperation. The objective was to develop information and guidelines to help policymakers in designing new or revised federal initiatives to promote…

Neuroprotection effect of interleukin (IL)-17 secreted by reactive astrocytes is emerged from a high-level IL-17-containing environment during acute neuroinflammation

PubMed Central

Hu, M H; Zheng, Q F; Jia, X Z; Li, Y; Dong, Y C; Wang, C Y; Lin, Q Y; Zhang, F Y; Zhao, R B; Xu, H W; Zhou, J H; Yuan, H P; Zhang, W H; Ren, H

2014-01-01

An increase in interleukin (IL)-17A-producing cells, particularly at sites of tissue inflammation, is observed frequently, yet the mechanism is not fully understood. This study aims to dissect the role of IL-17 in autoimmunity-mediated neuroinflammation. The cytokine milieu containing elevated IL-17, which often appears in active states of autoimmunity, was mimicked in vitro by a supernatant obtained from rat peripheral blood monocytes stimulated with phorbol mystistate acetate (PMA)/ionomycin. The application of such inflammatory media on only primary cultured cerebellar granule neurones resulted in significant apoptosis, but the presence of astrocytes largely prevented the effect. The supernatants of the stimulated astrocytes, especially those that contained the highest level of IL-17, achieved the best protection, and this effect could be blocked by anti-IL-17 antibodies. Protein IL-17 inhibited intracellular calcium increase and protected the neurones under inflammatory attack from apoptosis. IL-17, but not interferon (IFN)-γ, in the inflammatory media contributed to astrocyte secretion of IL-17, which depended on the Janus kinase/signal transducers and activators of transcription (JAK/STAT) pathway activation. The astrocytes that were treated with IL-17 alone or with prolonged treatment of the inflammatory media failed to produce sufficient levels of IL-17. Moreover, confirmatory data were obtained in vivo in a monophasic experimental autoimmune uveitis (EAU) in Lewis rats; in this preparation, the high-level IL-17-containing the cytokine milieu was demonstrated, along with IL-17 secretion by the resident neural cells. The antagonism of IL-17 at a late stage disturbed the disease resolution and resulted in significant neural apoptosis. Our data show a dynamic role of IL-17 in the maintenance of homeostasis and neuroprotection in active neuroinflammation. PMID:24117055

Sexually Transmitted Diseases Treatment Guidelines, 2015

PubMed Central

Workowski, Kimberly A.; Bolan, Gail A.

2016-01-01

Summary These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30–May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR–12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs. PMID:26042815

[Brazilian guidelines for marketing baby food: history, limitations and perspectives].

PubMed

Monteiro, Renata

2006-05-01

The objective of this paper is to present and discuss Brazilian policy concerning actions to protect breastfeeding, especially the history, international and national background, limitations, and perspectives of the Brazilian Guidelines for the Marketing of Baby Food, Pacifiers and Bottles. The Brazilian Guidelines, which play a crucial role in protecting breastfeeding against industry marketing strategies, were based on the International Code of Marketing of Breastmilk Substitutes, proposed by the World Health Organization in 1981. The first version of the Brazilian Guidelines was released in 1988, and there were subsequent revisions in 1992 and 2001/2002. In 2006, the Guidelines became national law. However, the strides made over this period in terms of regulation have been few because the law is not always observed. Thus, it is essential that all actors involved, including government officials, manufacturers and sellers of baby food and other baby products, teaching and health professionals and their associations, international bodies, and non-governmental organizations make a commitment to enforce the current law.

"Guidelines Recommendations on the Treatment of Tricuspid Regurgitation. Where Are We and Where Do We Go With Transcatheter Valve Intervention".

PubMed

Vahanian, Alec; Brochet, Eric; Juliard, Jean-Michel

2018-01-01

Tricuspid regurgitation (TR) is an important clinical problem because it is frequent and carries a poor prognosis when it is left uncorrected. However, there is still a lack of awareness of tricuspid disease in the medical community. The indications for evaluation and surgical interventions in patients with TR were recently updated in the ESC/EACTS guidelines. Transcatheter tricuspid valve intervention (TTVI), almost exclusively valve repair, is at an early stage of development as only a few hundreds of patients have been treated. The first-in-man valve implantation was very recently performed. The recent ESC/EACTS Guidelines state that "The potential role of transcatheter tricuspid valve treatment in high-risk patients needs to be determined". We shall review here which lessons of interest for TTVI can be learned from the Guidelines as regards evaluation and indications for surgery and try to imagine what could be the place of TTVI in the Guidelines in the future.

New cholesterol guidelines for the management of atherosclerotic cardiovascular disease risk: a comparison of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines with the 2014 National Lipid Association recommendations for patient-centered management of dyslipidemia.

PubMed

Adhyaru, Bhavin B; Jacobson, Terry A

2015-05-01

This review discusses the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults and compares it with the 2014 National Lipid Association (NLA) Recommendations for Patient-Centered Management of Dyslipidemia. The review discusses some of the distinctions between the guidelines, including how to determine a patient's atherosclerotic cardiovascular disease risk, the role of lipoprotein treatment targets, the importance of moderate- and high-intensity statin therapy, and the use of nonstatin therapy in light of the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial. Copyright © 2015 Elsevier Inc. All rights reserved.

Clinical guidelines in primary care: a survey of general practitioners' attitudes and behaviour.

PubMed Central

Siriwardena, A N

1995-01-01

BACKGROUND: In the United Kingdom little is known about general practitioners' attitudes to and behaviour concerning clinical guidelines. AIM: A study was performed to investigate these two under-researched areas. METHOD: In 1994 a postal questionnaire on clinical guidelines was sent to all 326 general practitioner principals on the list of Lincolnshire Family Health Services Authority. The questionnaire consisted of 20 attitude statements and an open question on clinical guidelines, as well as surveying characteristics and behaviour of respondents. RESULTS: Of the 326 general practitioners sent questionnaires, 213 (65%) replied. Most respondents (78%) reported having been involved in writing inhouse guidelines. An even greater proportion (92%) reported having participated in clinical audit. Respondents were generally in favour of clinical guidelines, with mean response scores indicating a positive attitude to guidelines in 15 of the 20 statements, a negative attitude in four and equivocation in one. The majority of respondents felt that guidelines were effective in improving patient care (69%). Members (or fellows) of the Royal College of General Practitioners had a more positive attitude than non-members towards guidelines. They were also significantly more likely than non-members to have written inhouse guidelines, as were those who had participated in audit compared with those who had not participated in audit. A substantial minority (over a quarter) of general practitioners were concerned that guidelines may be used for setting performance-related pay, or that they may lead to 'cookbook' medicine, reduce clinical freedom or stifle innovation. There was also concern that guidelines should be scientifically valid. CONCLUSION: This study suggests that many general practitioners in the Lincolnshire Family Health Services Authority area have produced written inhouse guidelines. This is largely sustained by positive attitudes about the effectiveness and benefits of clinical guidelines. The positive attitude of RCGP members supports it in its continuing role in developing, implementing and evaluating guidelines in primary care. The question of whether incorporation of guidelines into clinical audit is an effective means to disseminate systematic research-based guidelines warrants further study. PMID:8745861

Integrated prostate cancer centers might cause an overutilization of radiotherapy for low-risk prostate cancer: A comparison of treatment trends in the United States and Germany from 2004 to 2011.

PubMed

Hager, Benjamin; Kraywinkel, Klaus; Keck, Bastian; Katalinic, Alexander; Meyer, Martin; Zeissig, Sylke Ruth; Stabenow, Roland; Froehner, Michael; Huber, Johannes

2015-04-01

Aim of the study was to analyze changes in primary treatment for low-risk prostate cancer across different healthcare systems. We compared "Surveillance Epidemiology and End Results" data (USA) with data from four German federal epidemiological cancer registries, both from 2004 to 2011. We excluded metastatic disease and patients aged ⩾80 years. Thereof, we identified 132,506 (USA) and 54,159 (Germany) patients with low-risk according to the 2014 EAU guidelines. We tested treatment trends for statistical significance with a linear regression model. Active treatment was radical prostatectomy (RP) in 36.1% vs. 66.2% and radiotherapy (RT) in 38.4% vs. 11.8%. No active treatment (NAT) was reported in 24.2% vs. 16.2% (p<0.001 each). Through the study period the use of RP decreased from 37.1% to 34.2% in the USA (p=0.04) and was constant at a mean of 66.2% in Germany (p=0.8). The use of RT in the USA decreased from 42.8% to 31.8% (p<0.001), while it was stable in Germany (p=0.09). The NAT group grew from 18.0% to 33.2% in the USA (p<0.001), while it was stable in Germany until 2009 (p=0.3). From 2009 to 2011 there also was an increase of the NAT group in Germany from 15.2% to 19.4% (p=0.001). In contrast to former evidence we found the relative use of RT for low-risk prostate cancer much higher in the USA compared to Germany. The implementation of integrated prostate cancer centers in the USA might explain this observation. Deferred and defensive treatment strategies showed a steady increase in the USA. This development seems delayed in Germany by several years. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

EAU standardised medical terminology for urologic imaging: a taxonomic approach.

PubMed

Loch, Tillmann; Carey, Brendan; Walz, Jochen; Fulgham, Pat Fox

2015-05-01

The terminology and abbreviations used in urologic imaging have generally been adopted on an ad hoc basis by different speciality groups; however, there is a need for shared nomenclature to facilitate clinical communication and collaborative research. This work reviews the current nomenclature for urologic imaging used in clinical practice and proposes a taxonomy and terminology for urologic imaging studies. A list of terms used in urologic imaging were compiled from guidelines published by the European Association of Urology and the American Urological Association and from the American College of Radiology Appropriateness Criteria. Terms searched were grouped into broad categories based on technology, and imaging terms were further stratified based on the anatomic extent, contrast or phases, technique or modifiers, and combinations or fusions. Terms that had a high degree of utilisation were classified as accepted. We propose a new taxonomy to define a more useful and acceptable nomenclature model acceptable to all health professionals involved in urology. The major advantage of a taxonomic approach to the classification of urologic imaging studies is that it provides a flexible framework for classifying the modifications of current imaging modalities and allows the incorporation of new imaging modalities. The adoption of this hierarchical classification model ranging from the most general to the most detailed descriptions should facilitate hierarchical searches of the medical literature using both general and specific terms. This work is limited in its scope, as it is not currently all-inclusive. This will hopefully be addressed by future modification as others embrace the concept and work towards uniformity in nomenclature. This paper provides a noncomprehensive list of the most widely used terms across different specialties. This list can be used as the basis for further discussion, development, and enhancement. In this paper we describe a classification system for urologic imaging terms with the aim of aiding health professionals and ensuring that the terms used are more consistent. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Development of Castration Resistant Prostate Cancer can be Predicted by a DNA Hypermethylation Profile.

PubMed

Angulo, Javier C; Andrés, Guillermo; Ashour, Nadia; Sánchez-Chapado, Manuel; López, Jose I; Ropero, Santiago

2016-03-01

Detection of DNA hypermethylation has emerged as a novel molecular biomarker for prostate cancer diagnosis and evaluation of prognosis. We sought to define whether a hypermethylation profile of patients with prostate cancer on androgen deprivation would predict castrate resistant prostate cancer. Genome-wide methylation analysis was performed using a methylation cancer panel in 10 normal prostates and 45 tumor samples from patients placed on androgen deprivation who were followed until castrate resistant disease developed. Castrate resistant disease was defined according to EAU (European Association of Urology) guideline criteria. Two pathologists reviewed the Gleason score, Ki-67 index and neuroendocrine differentiation. Hierarchical clustering analysis was performed and relationships with outcome were investigated by Cox regression and log rank analysis. We found 61 genes that were significantly hypermethylated in greater than 20% of tumors analyzed. Three clusters of patients were characterized by a DNA methylation profile, including 1 at risk for earlier castrate resistant disease (log rank p = 0.019) and specific mortality (log rank p = 0.002). Hypermethylation of ETV1 (HR 3.75) and ZNF215 (HR 2.89) predicted disease progression despite androgen deprivation. Hypermethylation of IRAK3 (HR 13.72), ZNF215 (HR 4.81) and SEPT9 (HR 7.64) were independent markers of prognosis. Prostate specific antigen greater than 25 ng/ml, Gleason pattern 5, Ki-67 index greater than 12% and metastasis at diagnosis also predicted a negative response to androgen deprivation. Study limitations included the retrospective design and limited number of cases. Epigenetic silencing of the mentioned genes could be novel molecular markers for the prognosis of advanced prostate cancer. It might predict castrate resistance during hormone deprivation and, thus, disease specific mortality. Gene hypermethylation is associated with disease progression in patients who receive hormone therapy. It could serve as a marker of the treatment response. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Australian Football League concussion guidelines: what do community players think?

PubMed

White, Peta E; Donaldson, Alex; Sullivan, S John; Newton, Joshua; Finch, Caroline F

2016-01-01

Preventing concussion in sport is a global challenge. To assess community-level adult male Australian Football players' views on following the Australian Football League's (AFL) concussion guidelines. 3 focus groups, each comprising 6 players from 1 regional league, were conducted until saturation of issues raised. Discussions followed a semistructured script and were audio-recorded and transcribed verbatim. Thematic analysis was conducted by 2 coders independently. Identified advantages of the guidelines included highlighting the seriousness of concussion; changing the culture around playing with concussion and shifting return-to-play decision responsibility from players to others. Disadvantages included players being removed from play unnecessarily; removal of players' rights to decide if they are fit to play and players changing their behaviours to avoid being removed from play. Identified facilitators to guideline use included local league enforcement; broad information dissemination and impartial medically trained staff to assess concussion. Identified barriers to guideline use included players' desire to play at all costs; external pressure that encouraged players to return to play prematurely; and inconvenience and cost. Players generally understand that the AFL concussion guidelines protect their long-term welfare. However, their desire to play at all costs and help their team win is a common barrier to reporting concussion and adhering to guidelines. Leagues should take a lead role by mandating and enforcing the use of the guidelines and educating coaches, game day medical providers and players. The return-to-play component of the guidelines is complex and needs further consideration in the context of community sport.

Integrating palliative care into disease management guidelines.

PubMed

Emanuel, Linda; Alexander, Carla; Arnold, Robert M; Bernstein, Richard; Dart, Richard; Dellasantina, Christopher; Dykstra, Lee; Tulsky, James

2004-12-01

Palliative care should not be reserved for those who are close to dying; as a comprehensive approach to minimizing illness-related suffering, it is appropriate for patients with significant illness from the time of diagnosis on. The American Hospice Foundation Guidelines Committee's initiative aims to provide a practical approach for guideline writers and others to integrate palliative care into disease management and care services whenever it is relevant. A consensus approach was used to design recommendations for upgrading existing disease management and service guidelines to include palliative care. A template is described for identifying stages in disease management guidelines when integration of palliative care is appropriate: (1) Introductory sections to disease management guidelines should include prognosis and other disease consequences; (2) Diagnostic sections should include recommendations for conducting a whole patient assessment; (3) Treatment sections should include discernment of patient goals for care, continuous goal reassessment, palliative care interventions to reduce suffering as needed, and treatment decisions should include discussion of the type of expected improvement. Service guidelines should note the role of interdisciplinary team care as well as palliative care consultative or care services; (4) Sections that conclude the care provided to incurable patients should not end without recommendations on grief and bereavement care, and care during the last hours of living. The American Hospice Foundation Guidelines Committee recommends integration of relevant aspects of palliative care in introductory, diagnostic, treatment, and closing sections of management guidelines for all significant illnesses.

Clinical guideline for nurse-led early extubation after coronary artery bypass: an evaluation.

PubMed

Hawkes, Claire; Foxcroft, David R; Yerrell, Paul

2010-09-01

This paper is a report of an investigation of the development, implementation and outcomes of a clinical guideline for nurse-led early extubation of adult coronary artery bypass graft patients. Healthcare knowledge translation and utilization is an emerging but under-developed research area. The complex context for guideline development and use is methodologically challenging for robust and rigorous evaluation. This study contributes one such evaluation. This was a mixed methods evaluation, with a dominant quantitative study with a secondary qualitative study in a single UK cardiac surgery centre. An interrupted time series study (N = 567 elective coronary artery bypass graft patients) with concurrent within person controls was used to measure the impact of the guideline on the primary outcome: time to extubation. Semi-structured interviews with 11 clinical staff, informed by applied practitioner ethnography, explored the process of guideline development and implementation. The data were collected between January 2001 and January 2003. There was no change in the interrupted time series study primary outcome as a consequence of the guideline implementation. The qualitative study identified three themes: context, process and tensions highlighting that the guideline did not require clinicians to change their practice, although it may have helped maintain practice through its educative role. Further investigation and development of appropriate methods to capture the dynamism in healthcare contexts and its impact on guideline implementation seems warranted. Multi-site mixed methods investigations and programmes of research exploring knowledge translation and utilization initiatives, such as guideline implementation, are needed.

Groundwater components in the alluvial aquifer of the alpine Rhone River valley, Bois de Finges area, Wallis Canton, Switzerland

NASA Astrophysics Data System (ADS)

Schürch, Marc; Vuataz, François-D.

2000-09-01

Source, type, and quantity of various components of groundwater, as well as their spatial and temporal variations were determined by different hydrochemical methods in the alluvial aquifer of the upper Rhone River valley, Bois de Finges, Wallis Canton, Switzerland. The methods used are hydrochemical modeling, stable-isotope analysis, and chemical analysis of surface water and groundwater. Sampling during high- and low-water periods determined the spatial distribution of the water chemistry, whereas monthly sampling over three years provided a basis for understanding seasonal variability. The physico-chemical parameters of the groundwater have spatial and seasonal variations. The groundwater chemical composition of the Rhone alluvial aquifer indicates a mixing of weakly mineralized Rhone River water and SO4-rich water entering from the south side of the valley. Temporal changes in groundwater chemistry and in groundwater levels reflect the seasonal variations of the different contributors to groundwater recharge. The Rhone River recharges the alluvial aquifer only during the summer high-water period. Résumé. Origine, type et quantité de nombreux composants d'eau de l'aquifère alluvial dans la vallée supérieure du Rhône, Bois de Finges, Valais, Suisse, ainsi que leurs variations spatiales et temporelles ont été déterminés par différentes méthodes hydrochimiques. Les méthodes utilisées sont la modélisation hydrochimique, les isotopes stables, ainsi que l'échantillonnage en période de hautes eaux et de basses eaux pour étudier la distribution spatiale de la composition chimique, alors qu'un échantillonnage mensuel pendant trois ans sert à comprendre les processus de la variabilité saisonnière. Les paramètres physico-chimiques des eaux souterraines montrent des variations spatiales et saisonnières. La composition chimique de l'aquifère alluvial du Rhône indique un mélange entre une eau peu minéralisée venant du Rhône et une eau sulfatée s'écoulant du versant sud. La modification temporelle des paramètres chimiques des eaux souterraines et de la piézométrie reflètent les variations saisonnières des apports d'eau de la nappe souterraine. En période de hautes eaux durant l'été, seul le Rhône recharge l'aquifère alluvial. Resumen. Se ha determinado el origen, tipo y cantidad de diversos elementos de las aguas subterráneas en el acuífero aluvial del valle superior del río Ródano (Bois de Finges, Cantón de Wallis, Suiza), así como sus variaciones espaciales y temporales, mediante métodos hidroquímicos. Entre las herramientas utilizadas, se incluye la modelación hidroquímica, el análisis de isótopos estables y el análisis químico de aguas superficiales y subterráneas. El muestreo en épocas de estiaje y lluvias sirvió para determinar la distribución espacial de la química del agua, mientras que la variabilidad estacional fue caracterizada por medio de muestreos mensuales durante un período de tres años. Los parámetros físicoquímicos de las aguas subterráneas muestran variaciones espaciales y estacionales. La composición química de las aguas subterráneas del acuífero aluvial del río Ródano indica que hay mezcla entre las aguas débilmente mineralizadas del río y las aguas cargadas en sulfato (SO4-2) que proceden de la parte meridional de valle. Los cambios temporales en la química de las aguas subterráneas y en los niveles piezométricos reflejan las variaciones estacionales de las diferentes contribuciones de la recarga. El río Ródano recarga al acuífero aluvial únicamente durante el período estival, cuando el caudal es elevado.

The ASM Curriculum Guidelines for Undergraduate Microbiology: A Case Study of the Advocacy Role of Societies in Reform Efforts

PubMed Central

Horak, Rachel E. A.; Merkel, Susan; Chang, Amy

2015-01-01

A number of national reports, including Vision and Change in Undergraduate Biology Education: A Call to Action, have called for drastic changes in how undergraduate biology is taught. To that end, the American Society for Microbiology (ASM) has developed new Curriculum Guidelines for undergraduate microbiology that outline a comprehensive curriculum for any undergraduate introductory microbiology course or program of study. Designed to foster enduring understanding of core microbiology concepts, the Guidelines work synergistically with backwards course design to focus teaching on student-centered goals and priorities. In order to qualitatively assess how the ASM Curriculum Guidelines are used by educators and learn more about the needs of microbiology educators, the ASM Education Board distributed two surveys to the ASM education community. In this report, we discuss the results of these surveys (353 responses). We found that the ASM Curriculum Guidelines are being implemented in many different types of courses at all undergraduate levels. Educators indicated that the ASM Curriculum Guidelines were very helpful when planning courses and assessments. We discuss some specific ways in which the ASM Curriculum Guidelines have been used in undergraduate classrooms. The survey identified some barriers that microbiology educators faced when trying to adopt the ASM Curriculum Guidelines, including lack of time, lack of financial resources, and lack of supporting resources. Given the self-reported challenges to implementing the ASM Curriculum Guidelines in undergraduate classrooms, we identify here some activities related to the ASM Curriculum Guidelines that the ASM Education Board has initiated to assist educators in the implementation process. PMID:25949769

The ASM Curriculum Guidelines for Undergraduate Microbiology: A Case Study of the Advocacy Role of Societies in Reform Efforts.

PubMed

Horak, Rachel E A; Merkel, Susan; Chang, Amy

2015-05-01

A number of national reports, including Vision and Change in Undergraduate Biology Education: A Call to Action, have called for drastic changes in how undergraduate biology is taught. To that end, the American Society for Microbiology (ASM) has developed new Curriculum Guidelines for undergraduate microbiology that outline a comprehensive curriculum for any undergraduate introductory microbiology course or program of study. Designed to foster enduring understanding of core microbiology concepts, the Guidelines work synergistically with backwards course design to focus teaching on student-centered goals and priorities. In order to qualitatively assess how the ASM Curriculum Guidelines are used by educators and learn more about the needs of microbiology educators, the ASM Education Board distributed two surveys to the ASM education community. In this report, we discuss the results of these surveys (353 responses). We found that the ASM Curriculum Guidelines are being implemented in many different types of courses at all undergraduate levels. Educators indicated that the ASM Curriculum Guidelines were very helpful when planning courses and assessments. We discuss some specific ways in which the ASM Curriculum Guidelines have been used in undergraduate classrooms. The survey identified some barriers that microbiology educators faced when trying to adopt the ASM Curriculum Guidelines, including lack of time, lack of financial resources, and lack of supporting resources. Given the self-reported challenges to implementing the ASM Curriculum Guidelines in undergraduate classrooms, we identify here some activities related to the ASM Curriculum Guidelines that the ASM Education Board has initiated to assist educators in the implementation process.

French Experience with Buprenorphine : Do Physicians Follow the Guidelines?

PubMed Central

Guillou Landreat, Morgane; Rozaire, Charles; Guillet, Jean yves; Victorri Vigneau, Caroline; Le Reste, Jean Yves; Grall Bronnec, Marie

2015-01-01

Opiate dependence affects about 15,479,000 people worldwide. The effectiveness of opiate substitution treatments (OST) has been widely demonstrated. Buprenorphine plays a particular role in opiate dependence care provision in France. It is widely prescribed by physicians and national opiate substitution treatment guidelines have been available since 2004. In order to study the prescribing of buprenorphine, we used a questionnaire sent by email, to a large sample of physicians. These physicians were either in practice, or belonged to an addiction treatment network or a hospital. The main objective of this work was to measure the extent to which the theoretical, clinical attitude of physicians towards prescribing buprenorphine (BHD) complied with the statutory guidelines. We showed that the physicians we interviewed rarely took into account the guidelines regarding buprenorphine prescription. The actual prescribing of Buprenorphine differed from the guidelines. Only 42% of independent Family Physicians (FPs), working outside the national health care system, had prescribed buprenorphine as a first-time prescription and 40% of FPs do not follow up patients on buprenorphine. In terms of compliance with the guidelines, 55% of FPs gave theoretical answers that only partially complied with the guidelines. The variations in compliance with the guidelines was noted according to different variables and took into particular account whether the physician were affiliated to a network or in training. PMID:26479400

Student Performance Evaluation. Physical Educators for Equity. Module 7.

ERIC Educational Resources Information Center

Uhlir, Ann

Guidelines are presented to aid secondary school physical education teachers in evaluating student performance in a way that avoids sex-role stereotyping and sex discrimination. Suggestions made for conducting testing in a bias-free setting include: (1) avoid sex-differentiated role tasks; (2) organize motor-performance testing procedures so that…

Friends' Organizations: The Supportive Element Essential to Libraries.

ERIC Educational Resources Information Center

Progar, Dorothy

Reviewed are the history and public relations, financial and service roles of lay "Friends of the Library" groups. Programs and techniques useful in the pursuit of these roles are suggested. Guidelines for a constitution, fee schedule, and administrative structure plus a bibliography give potential friends organizations help in…

Coaching and Counseling: Where To Draw the Line.

ERIC Educational Resources Information Center

Colvert, Audra L.

Examining the role of the forensics coach as counselor, this paper attempts to define the role more clearly and offers guidelines and suggestions concerning where to draw the line between coaching and counseling "forensicators." The paper advances the premise that coaches have many responsibilities which include significant dimensions of…

The School Site in Environmental Education.

ERIC Educational Resources Information Center

MacGown, Richard H.

Realizing that school sites can play an important role in enhancing the educational process, guidelines dealing with the development of a school site for environmental education purposes are presented. First, the roles of this site for environmental studies are explained as: (1) an ecology laboratory, (2) an environmental management laboratory,…

Development of an Official Guideline for the Economic Evaluation of Drugs/Medical Devices in Japan.

PubMed

Shiroiwa, Takeru; Fukuda, Takashi; Ikeda, Shunya; Takura, Tomoyuki; Moriwaki, Kensuke

2017-03-01

In Japan, cost-effectiveness evaluation was implemented on a trial basis from fiscal year 2016. The results will be applied to the future repricing of drugs and medical devices. On the basis of a request from the Central Social Insurance Medical Council (Chuikyo), our research team drafted the official methodological guideline for trial implementation. Here, we report the process of developing and the contents of the official guideline for cost-effectiveness evaluation. The guideline reflects discussions at the Chuikyo subcommittee (e.g., the role of quality-adjusted life-year) and incorporates our academic perspective. Team members generated research questions for each section of the guideline and discussions on these questions were carried out. A draft guideline was prepared and submitted to the Ministry of Health, Labour and Welfare (MHLW), and then to the subcommittee. The draft guideline was revised on the basis of the discussions at the subcommitte, if appropriate. Although the "public health care payer's perspective" is standard in this guideline, other perspectives can be applied as necessary depending on the objective of analysis. On the basis of the discussions at the subcommittee, quality-adjusted life-year will be used as the basic outcome. A discount rate of 2% per annum for costs and outcomes is recommended. The final guideline was officially approved by the Chuikyo general assembly in February 2016. This is the first officially approved guideline for the economic evaluation of drugs and medical devices in Japan. The guideline is expected to improve the quality and comparability of submitted cost-effectiveness data for decision making. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A survey of the awareness, knowledge, policies and views of veterinary journal Editors-in-Chief on reporting guidelines for publication of research

PubMed Central

2014-01-01

Background Wider adoption of reporting guidelines by veterinary journals could improve the quality of published veterinary research. The aims of this study were to assess the knowledge and views of veterinary Editors-in-Chief on reporting guidelines, identify the policies of their journals, and determine their information needs. Editors-in-Chief of 185 journals on the contact list for the International Association of Veterinary Editors (IAVE) were surveyed in April 2012 using an online questionnaire which contained both closed and open questions. Results The response rate was 36.8% (68/185). Thirty-six of 68 editors (52.9%) stated they knew what a reporting guideline was before receiving the questionnaire. Editors said they had found out about reporting guidelines primarily through articles in other journals, via the Internet and through their own journal. Twenty of 57 respondents (35.1%) said their journal referred to reporting guidelines in its instructions to authors. CONSORT, REFLECT, and ARRIVE were the most frequently cited. Forty-four of 68 respondents (68.2%) believed that reporting guidelines should be adopted by all refereed veterinary journals. Qualitative analysis of the open questions revealed that lack of knowledge, fear, resistance to change, and difficulty in implementation were perceived as barriers to the adoption of reporting guidelines by journals. Editors suggested that reporting guidelines be promoted through communication and education of the veterinary community, with roles for the IAVE and universities. Many respondents believed a consensus policy on guideline implementation was needed for veterinary journals. Conclusions Further communication and education about reporting guidelines for editors, authors and reviewers has the potential to increase their adoption by veterinary journals in the future. PMID:24410882

Guidelines warfare over interventional techniques: is there a lack of discourse or straw man?

PubMed

Manchikanti, Laxmaiah; Benyamin, Ramsin M; Falco, Frank J E; Caraway, David L; Datta, Sukdeb; Hirsch, Joshua A

2012-01-01

Guideline development seems to have lost some of its grounding as a medical science. At their best, guidelines should be a constructive response to assist practicing physicians in applying the exponentially expanding body of medical knowledge. In fact, guideline development seems to be evolving into a cottage industry with multiple, frequently discordant guidance on the same subject. Evidence Based Medicine does not always provide for conclusive opinions. With competing interests of payers, practitioners, health policy makers, and third parties benefiting from development of the guidelines as cost saving measures, guideline preparation has been described as based on pre-possession, vagary, rationalization, or congeniality of conclusion. Beyond legitimate differences in opinions regarding the evidence that could yield different guidelines there are potentials for conflicts of interest and various other issues play a major role in guideline development. As is always the case, conflicts of interest in guideline preparation must be evaluated and considered. Following the development of American Pain Society (APS) guidelines there has been an uproar in interventional pain management communities on various issues related to not only the evidence synthesis, but conflicts of interest. A recent manuscript published by Chou et al, in addition to previous publications, appears to have limited clinician involvement in the development of APS guidelines, and demonstrates some of these challenges clearly. This manuscript illustrates the deficiencies of Chou et al's criticisms, and demonstrates their significant conflicts of interest, and use a lack of appropriate evaluations in interventional pain management as a straw man to support their argument. Further, this review will attempt to demonstrate that excessive focus on this straw man has inhibited critique of what we believe to be flaws in the approach.  

Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care- an Evidence-Based Guideline from ECCO and ESPGHAN.

PubMed

Turner, Dan; Ruemmele, Frank M; Orlanski-Meyer, Esther; Griffiths, Anne M; Carpi, Javier Martin de; Bronsky, Jiri; Veres, Gabor; Aloi, Marina; Strisciuglio, Caterina; Braegger, Christian P; Assa, Amit; Romano, Claudio; Hussey, Séamus; Stanton, Michael; Pakarinen, Mikko; de Ridder, Lissy; Katsanos, Konstantinos; Croft, Nick; Navas-López, Victor; Wilson, David C; Lawrence, Sally; Russell, Richard K

2018-05-30

The contemporary management of ambulatory ulcerative colitis (UC) continues to be challenging with ∼20% of children needing a colectomy within childhood years. We thus aimed to standardize daily treatment of paediatric UC and inflammatory bowel diseases (IBD)-unclassified through detailed recommendations and practice points. These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). An extensive literature search with subsequent evidence appraisal using robust methodology was performed before two face-to-face meetings. All 40 included recommendations and 86 practice points, were endorsed by 43 experts in Paediatric IBD with at least an 88% consensus rate. These guidelines centre on initial use of mesalamine (including topical), before using steroids, thiopurines and, for more severe disease, anti-TNF. The use of other emerging therapies and the role of surgery are also covered. Algorithms are provided to aid therapeutic decision making based on clinical assessment and the paediatric UC activity index (PUCAI). Advice on contemporary therapeutic targets incorporating the use of calprotectin and the role of therapeutic drug monitoring are presented, as well as other management considerations around pouchitis, extraintestinal manifestations, nutrition, growth, psychology and transition. A brief section on disease classification using the PIBD-classes criteria and IBDU is also part of these guidelines. These guidelines provide a guide to clinicians managing children with UC and IBDU to provide modern management strategies while maintaining vigilance around appropriate outcomes and safety issues.

[Pharmaceutical product quality control and good manufacturing practices].

PubMed

Hiyama, Yukio

2010-01-01

This report describes the roles of Good Manufacturing Practices (GMP) in pharmaceutical product quality control. There are three keys to pharmaceutical product quality control. They are specifications, thorough product characterization during development, and adherence to GMP as the ICH Q6A guideline on specifications provides the most important principles in its background section. Impacts of the revised Pharmaceutical Affairs Law (rPAL) which became effective in 2005 on product quality control are discussed. Progress of ICH discussion for Pharmaceutical Development (Q8), Quality Risk Management (Q9) and Pharmaceutical Quality System (Q10) are reviewed. In order to reconstruct GMP guidelines and GMP inspection system in the regulatory agencies under the new paradigm by rPAL and the ICH, a series of Health Science studies were conducted. For GMP guidelines, product GMP guideline, technology transfer guideline, laboratory control guideline and change control system guideline were written. For the GMP inspection system, inspection check list, inspection memo and inspection scenario were proposed also by the Health Science study groups. Because pharmaceutical products and their raw materials are manufactured and distributed internationally, collaborations with other national authorities are highly desired. In order to enhance the international collaborations, consistent establishment of GMP inspection quality system throughout Japan will be essential.

Clinical practice guidelines in complementary and alternative medicine. An analysis of opportunities and obstacles. Practice and Policy Guidelines Panel, National Institutes of Health Office of Alternative Medicine.

PubMed

1997-01-01

An estimated 1 of 3 Americans uses some form of complementary and alternative medicine (CAM), such as acupuncture, homeopathy, or herbal medicine. In 1995, the National Institutes of Health Office of Alternative Medicine convened an expert panel to examine the role of clinical practice guidelines in CAM. The panel concluded that CAM practices currently are unsuitable for the development of evidence-based practice guidelines, in part because of the lack of relevant outcomes data from well-designed clinical trials. Moreover, the notions of standardization and appropriateness, inherent in guideline development, face challenging methodologic problems when applied to CAM, which considers many different treatment practices appropriate and encourages highly individualized care. Due to different belief systems and divergent theories about the nature of health and illness, CAM disciplines have fundamental differences in how they define target conditions, causes of disease, interventions, and outcome measures of effectiveness. These differences are even more striking when compared with those used by Western medicine. The panel made a series of recommendations on strategies to strengthen the evidence base for future guideline development in CAM and to meet better the current information needs of clinicians, patients, and guideline developers who seek information about CAM treatments.

Australian and New Zealand Anaesthetic Allergy Group Perioperative Anaphylaxis Investigation Guidelines.

PubMed

Scolaro, R J; Crilly, H M; Maycock, E J; McAleer, P T; Nicholls, K A; Rose, M A; The, Rih

2017-09-01

These guidelines are a consensus document developed by a working party of the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) to provide an approach to the investigation of perioperative anaphylaxis. They focus primarily on the use of skin testing as it is the investigation with the greatest clinical utility for the identification of the likely causative agent and potentially safer alternatives. The practicalities and process of skin testing, its limitations, and the place of other tests are discussed. These guidelines also address the roles of graded challenge and in vitro testing. The implications of anaphylaxis associated with neuromuscular blocking agents, beta-lactam antibiotics, local anaesthetic agents and chlorhexidine are discussed. Evidence for the recommendations is derived from literature searches using the words skin test, allergy, anaphylaxis, anaesthesia, and each of the individual agents listed in these guidelines. The individual articles were then reviewed for suitability for inclusion in these guidelines. Where evidence was not strong, as is the situation for many perioperative agents, expert consensus from the ANZAAG working party was used. These guidelines are intended for use by specialists involved in the investigation of perioperative allergy. They have been approved following peer review by members of ANZAAG and are available on the ANZAAG website: http://www.anzaag.com/anaphylaxis-management/testing-guidelines.pdf.

Sex-Role Stereotyping and Women's Studies. A Resource Guide for Teachers Including Suggestions, Units of Study, and Resource Lists.

ERIC Educational Resources Information Center

Ontario Dept. of Education, Toronto.

This document was developed to assist educators in the ongoing task of developing a learning environment that is free from sex-role stereotyping, and a curriculum that accurately depicts the roles of women. As a resource guide, this document actively supports a number of Ontario's Ministry of Education guidelines concerning the education of…

Practical Diagnosis and Management of Dementia Due to Alzheimer’s Disease in the Primary Care Setting: An Evidence-Based Approach

PubMed Central

Kerwin, Diana R.

2013-01-01

Objective: To review evidence-based guidance on the primary care of Alzheimer’s disease and clinical research on models of primary care for Alzheimer’s disease to present a practical summary for the primary care physician regarding the assessment and management of the disease. Data Sources: References were obtained via search using keywords Alzheimer’s disease AND primary care OR collaborative care OR case finding OR caregivers OR guidelines. Articles were limited to English language from January 1, 1990, to January 1, 2013. Study Selection: Articles were reviewed and selected on the basis of study quality and pertinence to this topic, covering a broad range of data and opinion across geographical regions and systems of care. The most recent published guidelines from major organizations were included. Results: Practice guidelines contained numerous points of consensus, with most advocating a central role for the primary care physician in the detection, diagnosis, and treatment of Alzheimer’s disease. Review of the literature indicated that optimal medical and psychosocial care for people with Alzheimer’s disease and their caregivers may be best facilitated through collaborative models of care involving the primary care physician working within a wider interdisciplinary team. Conclusions: Evidence-based guidelines assign the primary care physician a critical role in the care of people with Alzheimer’s disease. Research on models of care suggests the need for an appropriate medical/nonmedical support network to fulfill this role. Given the diversity and breadth of services required and the necessity for close coordination, nationwide implementation of team-based, collaborative care programs may represent the best option for improving care standards for patients with Alzheimer’s disease. PMID:24392252

Cost/Risk Analysis for Disk Retirement. Volume 1

DTIC Science & Technology

1984-02-03

comparing Figures 4-4, 4-5, and 4- 6 , which is similar for the other 4-8 co C)) 0 - 6 row L. 0ý ci 41C~j <o u ) 4.-1 LG)) a)L I- . > c- Ca 0. 4-)>C ~.0...4-1 M&T3B-9201 7. AUT’l)R(a) 6 . CONTRACT OR GRANT NUMBER(&) S. W. Hopkins, P. M. Besuner, C. A. Eau, Jr.., D. W. Allison, J. W. Eischeni, J. N...Analysis Associates 2225 East Bayshore Road, P. 0. Box 51470 PE 61102F * Palo Al%’o. CA 94303 3400 00 01 I I. CONTROLLING OFFICE NAME AND ADDRESS t2. REPORT

Effects of water extraction in a vulnerable phreatic aquifer: Consequences for groundwater contamination by pesticides, Sint-Jansteen area, The Netherlands

NASA Astrophysics Data System (ADS)

Gaus, Irina

Pesticides are a potential threat to the quality of extracted groundwater when the water-supply area is used for agricultural activities. This problem is discussed for the water-supply area of Sint-Jansteen, The Netherlands, where measured pesticide concentrations in the extracted water regularly exceed EU limits (0.1μg/L). Groundwater samples taken from the aquifer within the water-supply area show low contamination, but samples taken from the extracted water occasionally contain pesticides, making the water inadequate for drinking-water purposes. The more intense contamination of the extracted water is caused by the change in the natural groundwater flow pattern near the extraction wells. In this area, pesticide use cannot be avoided easily, and an approach is given to differentiate pesticide use in the area according to expected travel time toward the wells and the chemical characteristics of the pesticides. A groundwater flow model for the area is developed and the effects of groundwater extraction on the natural flow pattern are evaluated. Using particle tracking, the travel-time zones are determined. Combining these results and the degradation behavior of certain pesticides led to an optimal scheme to integrate agricultural activities and groundwater extraction in the area. This is illustrated for five different types of pesticides (atrazine, simazine, bentazone, MCPA, and mecoprop). Résumé Les pesticides sont une menace potentielle pour la qualité de l'eau souterraine prélevée lorsque la zone de captage est soumise à des activités agricoles. Ce problème est discuté dans le cas de la zone de captage de Sint-Jansteen (Pays-Bas), où les concentrations mesurées en pesticides dans les eaux pompées dépassent régulièrement les normes européennes (0,1μg/L). Les échantillons d'eau souterraine prélevés dans l'aquifère dans la zone de captage montrent une faible contamination, mais les échantillons d'eau pompée contiennent occasionnellement des pesticides, ce qui rend l'eau impropre à la consommation. La contamination plus importante de l'eau pompée est provoquée par la modification des directions d'écoulement souterrain naturel au voisinage des puits de pompage. Dans cette région, l'usage des pesticides ne peut pas être évité facilement; c'est pourquoi une approche est développée pour différencier les usages de pesticides dans ce secteur en fonction des temps de parcours prévus en direction des puits et des caractéristiques chimiques des pesticides. Un modèle d'écoulement des eaux souterraines pour cette région a été développé et les effets des pompages sur les directions d'écoulement naturel ont étéévalués. Les zones de temps de parcours ont été déterminées au moyen de la méthode du suivi de particules (particle tracking). La combinaison de ces résultats avec le comportement de certains pesticides au cours de leur dégradation conduit à un schéma optimisé conciliant les activités agricoles et les prélèvements d'eaux souterraines dans cette région. Cette question est abordée pour cinq types de pesticides (atrazine, simazine, bentazone, MCPA et mecoprop). Resumen Los pesticidas son una amenaza para la calidad de las aguas subterráneas cuando el área de suministro se encuentra en una zona agrícola. Un ejemplo tiene lugar en la zona de Sint-Jansteen, Holanda, donde mientras que las muestras de agua subterránea tomadas directamente del acuífero tienen un bajo nivel de contaminación por pesticidas, las muestras tomadas del agua extraída exceden con regularidad los límites de la UE (0.1μg/l), lo que hace que el agua sea no potable. Esta diferencia está causada por las variaciones respecto al régimen de flujo natural a consecuencia de las propias extracciones. En esta zona el uso de pesticidas es difícilmente evitable, por lo que se está desarrollando un método para diferenciar la posibilidad de uso de pesticidas en función de las características químicas de los pesticidas y de su tiempo de tránsito esperado hasta los pozos de abastecimiento. Se está desarrollando un modelo matemático para evaluar los efectos de las extracciones sobre el flujo subterráneo natural. Usando el método de seguimiento de partículas se calculan los tiempos de tránsito, y combinando estos resultados con la biodegradación potencial de los pesticidas se diseña un esquema óptimo para la integración de actividades agrícolas y de uso de boca en el área. Esta metodología se muestra para distintos tipos de pesticidas.

Use and abuse of the urban groundwater resource: Implications for a new management strategy

NASA Astrophysics Data System (ADS)

Drangert, J.-O.; Cronin, A. A.

Various human activities threaten the groundwater quality and resource under urban areas, and yet residents increasingly depend on it for their livelihood. The anticipated expansion of the world's urban population from 3 to 6 billion in the coming 50 years does not only pose a large water management threat but also provides an opportunity to conserve groundwater in a better way than up to now. The authors argue for a new way to manage urban activities in order to conserve the precious groundwater resource. The focus is on the quality of the discharged water after use in households. Restrictions on what is added to water while using it, e.g. detergents, excreta, paint residues, oils, and pharmaceuticals, are important to simplify the treatment and reuse of used water. Avoiding mixing different wastewater flows has the same positive effect. If increased volumes of wastewater can be treated and reused, the demand on the groundwater resource is reduced, as also occurs with demand management measures. Reduced discharge of polluted water to the environment from households and utilities also conserves the quality of groundwater and reduces sophisticated treatment costs. L'urbanisation conduit à une demande élevée et concentrée d'eau de qualité adéquate, accompagnée du rejet d'importants volumes correspondants d'eaux usées. La nourriture est importée dans les villes tandis que les micro-organismes et les nutriments provenant des excrétas humains sont rejetés dans les rivières, les lacs et aussi les eaux souterraines. De plus, une large gamme de biens de consommation est évacuée par les égouts. Les créances environnementales, c'est-à-dire l'appauvrissement des conditions environnementales qui demandera des apports humains et économiques pour la réhabilitation, sont habituelles dans toutes les villes, et pas seulement dans l'hémisphère sud, comme cela est indiqué dans le rapport sur l'alimentation en eau et la santé publique du monde (publié par l'OMS et UNICEF), établissant que la plupart des eaux résiduaires des zones urbaines reste non traitée (65% en Asie, 86% en Amérique latine et 100% en Afrique). La tâche à réaliser pour l'homme est de protéger les ressources en eau souterraine en sorte qu'elle reste disponible pour les habitants des villes dans le futur. Dans les prochaines 50 années, il faut s'attendre à ce que la population urbaine s'accroisse de 3 à 6 milliards de personnes selon les estimations des Nations Unies; aussi il est impératif de ne pas continuer à polluer les eaux souterraines sous les nouvelles zones urbaines en cours de construction. Dans cet article, nous analyserons la qualité des eaux souterraines et leur protection à la lumière des récents changements de politique de l'eau, c'est-à-dire de la gestion de l'alimentation en eau jusqu'à une gestion de la demande et en abordant éventuellement la période de gestion du recyclage. La urbanización lleva a una demanda elevada y concentrada de agua de calidad adecuada, acompañada por el vertido de volúmenes análogamente mayores de aguas residuales. Los alimentos se importan a ciudades donde los microorganismos y nutrientes de los excrementos humanos son descargados a ríos, lagos y, también, aguas subterráneas. Más aún, gran número de los bienes de consumo son eliminados vía las tuberías de las cloacas. Las deudas medioambientales, es decir, el empobrecimiento de las condiciones medioambientales, que requerirán de aportaciones humanas y económicas para rehabilitarlas, son comunes a todas las ciudades, sobretodo en el Hemisferio Sur, donde, según la Valoración Global de Suministro de Agua y Saneamiento (OMS y UNICEF), la mayor parte de las aguas residuales urbanas no son tratadas (65% en Asia, 86% en Latinoamérica, 100% en África). La tarea pendiente consiste en proteger los recursos de aguas subterráneas para que estén disponibles de forma rápida para los habitantes urbanos también el futuro. En los próximos 50 años, se espera que la población urbana aumente de 3,000 a 6,000 millones de personas, según estimaciones de las Naciones Unidas, por lo que es imperativo dejar de contaminar las aguas subterráneas existentes bajo las nuevas áreas urbanas en construcción. En este artículo, se escudriña la calidad de las aguas subterráneas y su protección a la luz de los cambios recientemente introducidos en las políticas del agua, esto es, desde la gestión de los abastecimientos de agua a la gestión de la demanda y, eventualmente, hastaa la gestión de la reutilitzación.

The Evolution of Physical Activity Promotion.

PubMed

Richards, Elizabeth Ann

2015-08-01

A physically active lifestyle has numerous physical and mental health benefits for patients of all ages. Despite these significant benefits, a majority of Americans do not meet current physical activity guidelines. Health care providers, especially nurses, play a vital role in physical activity promotion. Over the past several decades, exercise and physical activity guidelines have evolved from a focus on structured, vigorous exercise to a focus on moderate-intensity "lifestyle" physical activity. The author updates nurses on physical activity guidelines and provides tips for promoting physical activity, with a focus on lifestyle activities such as walking to work. This article also addresses new research findings on the importance of decreasing sedentary and sitting time, even in physically active people.

A guideline for heavy ion radiation testing for Single Event Upset (SEU)

NASA Technical Reports Server (NTRS)

Nichols, D. K.; Price, W. E.; Malone, C.

1984-01-01

A guideline for heavy ion radiation testing for single event upset was prepared to assist new experimenters in preparing and directing tests. How to estimate parts vulnerability and select an irradiation facility is described. A broad brush description of JPL equipment is given, certain necessary pre-test procedures are outlined and the roles and testing guidelines for on-site test personnel are indicated. Detailed descriptions of equipment needed to interface with JPL test crew and equipment are not provided, nor does it meet the more generalized and broader requirements of a MIL-STD document. A detailed equipment description is available upon request, and a MIL-STD document is in the early stages of preparation.

Is "processed" a four-letter word? The role of processed foods in achieving dietary guidelines and nutrient recommendations.

PubMed

Dwyer, Johanna T; Fulgoni, Victor L; Clemens, Roger A; Schmidt, David B; Freedman, Marjorie R

2012-07-01

This paper, based on the symposium "Is 'Processed' a Four-Letter Word? The Role of Processed Foods in Achieving Dietary Guidelines and Nutrient Recommendations in the U.S." describes ongoing efforts and challenges at the nutrition-food science interface and public health; addresses misinformation about processed foods by showing that processed fruits and vegetables made important dietary contributions (e.g., fiber, folate, potassium, vitamins A and C) to nutrient intake among NHANES 2003-2006 participants, that major sources of vitamins (except vitamin K) were provided by enrichment and fortification and that enrichment and fortification helped decrease the percentage of the population below the Estimated Average Requirement for vitamin A, thiamin, folate, and iron; describes how negative consumer perceptions and consumer confusion about processed foods led to the development of science-based information on food processing and technology that aligns with health objectives; and examines challenges and opportunities faced by food scientists who must balance consumer preferences, federal regulations, and issues surrounding food safety, cost, unintended consequences, and sustainability when developing healthful foods that align with dietary guidelines.

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

PubMed

Hemphill, J Claude; Greenberg, Steven M; Anderson, Craig S; Becker, Kyra; Bendok, Bernard R; Cushman, Mary; Fung, Gordon L; Goldstein, Joshua N; Macdonald, R Loch; Mitchell, Pamela H; Scott, Phillip A; Selim, Magdy H; Woo, Daniel

2015-07-01

The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. A formal literature search of PubMed was performed through the end of August 2013. The writing committee met by teleconference to discuss narrative text and recommendations. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. Evidence-based guidelines are presented for the care of patients with acute intracerebral hemorrhage. Topics focused on diagnosis, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations. Results of new phase 3 trials were incorporated. Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted. These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage. © 2015 American Heart Association, Inc.

Guidelines for appropriate care: the importance of empirical normative analysis.

PubMed

Berg, M; Meulen, R T; van den Burg, M

2001-01-01

The Royal Dutch Medical Association recently completed a research project aimed at investigating how guidelines for 'appropriate medical care' should be construed. The project took as a starting point that explicit attention should be given to ethical and political considerations in addition to data about costs and effectiveness. In the project, two research groups set out to design guidelines and cost-effectiveness analyses (CEAs) for two circumscribed medical areas (angina pectoris and major depression). Our third group was responsible for the normative analysis. We undertook an explorative, qualitative pilot study of the normative considerations that played a role in constructing the guidelines and CEAs, and simultaneously interviewed specialists about the normative considerations that guided their diagnostic and treatment decisions. Explicating normative considerations, we argue, is important democratically: the issues at stake should not be left to decision analysts and guideline developers to decide. Moreover, it is a necessary condition for a successful implementation of such tools: those who draw upon these tools will only accept them when they can recognize themselves in the considerations implied. Empirical normative analysis, we argue, is a crucial tool in developing guidelines for appropriate medical care.

Compliance With the AAOS Guidelines for Treatment of Osteoarthritis of the Knee: A Survey of the American Association of Hip and Knee Surgeons.

PubMed

Carlson, Victor Rex; Ong, Alvin Chua; Orozco, Fabio Ramiro; Hernandez, Victor Hugo; Lutz, Rex William; Post, Zachary Douglas

2018-02-01

The American Academy of Orthopaedic Surgeons (AAOS) published a series of evidence-based guidelines for treatment of knee osteoarthritis (OA). We studied compliance with these guidelines among orthopaedic surgeons. We sent a survey to members of the American Association of Hip and Knee Surgeons. It included five clinical vignettes based on the Kellgren-Lawrence radiographic system for classification of knee OA. Respondents selected treatment currently supported or not supported by the AAOS guidelines. Of 345 responses, the frequency of use of recommended interventions was 80%, 82%, 21%, 50%, and 98% for OA at stages 0 through 4, respectively. For stage 2 and stage 3 OA, intra-articular hyaluronic acid was the most commonly selected intervention not recommended by the AAOS. Apparently, AAOS guidelines on the treatment of OA have not reached the orthopaedic community, resulting in lack of treatment consensus and continued use of modalities with no proven patient benefits. Management of moderate to severe knee OA does not align with AAOS guidelines. We encourage researchers to conduct clinical trials to identify the role of intra-articular corticosteroids in treating this condition.

The evolution of groundwater rights and groundwater management in New Mexico and the western United States

NASA Astrophysics Data System (ADS)

DuMars, Charles T.; Minier, Jeffrie D.

Historically, rights in water originated as public property and only later became individualized rights to utilize the public resource, in a manner consistent with the public welfare needs of society, but protected by principles of property law. Five basic regulatory systems for rights in groundwater in the United States have evolved to date. The problems raised by the hydrologic differences between groundwater hydraulically connected to stream systems and groundwater in non-replenished aquifers have been resolved to some extent by a couple of leading court cases. Numerical modeling and other technical methodologies have also evolved to evaluate the scientific issues raised by the different hydrologic conditions, but these are not immune from criticism. The current role of aquifers is evolving into that of storage facilities for recycled water, and their utilization in this manner may be expanded even further in the future. The policy implications of the choices relating to joint management of ground and surface water cannot be overstated. As this paper demonstrates, proactive administration of future groundwater depletions that affect stream systems is essential to the ultimate ability to plan for exploitation, management and utilization of water resources in a rational way that coordinates present and future demand with the reality of scarcity of supply. The examples utilized in this paper demonstrate the need for capacity building, not just to develop good measurement techniques, or to train talented lawyers and judges to write good laws, but also for practical professional water managers to keep the process on a rational course, avoiding limitless exploitation of the resource as well as conservative protectionism that forever precludes its use. Historiquement, les droits d'eau étaient à l'origine un bien public; ils sont devenus plus tard des droits individualisés pour utiliser la ressource publique conformément aux besoins de salut public de la société, mais protégés par des principes de lois de propriété. Cinq systèmes de réglementation de base pour les droits sur les eaux souterraines aux États-Unis ont évolué jusqu'à aujourd'hui. Les problèmes posés par les différences hydrologiques entre les eaux souterraines hydrauliquement connectées aux cours d'eau et celles d'aquifères non réalimentés ont été résolus jusqu'à un certain point par quelques cas de jugement. La modélisation numérique et d'autres méthodologies techniques ont également évolué pour évaluer les résultats scientifiques apportés dans différentes conditions hydrologiques, mais ne sont pas à l'abri de critiques. Le rôle courant des aquifères évolue entre celui des possibilités de stockage pour l'eau recyclée et leur utilisation dans ce but peut être même étendue plus loin dans le futur. Les implications politiques des choix relatifs à la gestion simultanée des eaux souterraines et de surface ne doivent pas être exagérées. Comme le montre cet article, la gestion active de l'épuisement futur des nappes qui affecte les systèmes fluviaux est essentielle pour la capacité finale à planifier l'exploitation, la gestion et l'utilisation des ressources en eau d'une manière rationnelle qui coordonne la demande actuelle et future à la réalité de la rareté de l'alimentation. Les exemples utilisés dans cet article démontrent le besoin d'une capacité d'élaboration, non seulement pour développer de bonnes techniques de mesure, ou pour former d'excellents avocats et juges pour écrire de bonnes lois, mais aussi pour que des praticiens gestionnaires de l'eau maintiennent le processus dans un cours rationnel pour éviter une exploitation sans limite des ressources aussi bien qu'un protectionnisme conservateur qui empêche son usage à jamais. Históricamente, los derechos del agua se originaron como un bien público que se transformaron después en derechos individualizados para usar los recursos públicos, de forma coherente con las necesidades de bienestar social, pero protegidos por los principios de la ley de propiedad. Hasta el momento, cinco sistemas reguladores básicos han evolucionado en los Estados Unidos de América en relación a los derechos en las aguas subterráneas. Los problemas surgidos por las diferencias hidrológicas entre las aguas subterráneas conectadas a corrientes superficiales y las aguas subterráneas en acuíferos sobreexplotados han sido resueltos hasta cierto punto por un par de casos judiciales notables. La modelación numérica y otras metodologías técnicas han evolucionado también para evaluar aspectos científicos asociados a diversas circunstancias hidrológicas, pero no son inmunes a las críticas. El papel actual de los acuíferos está evolucionando hacia el de instalaciones de almacenamiento de agua reciclada y su utilización de esta forma puede expandirse incluso más en el futuro. Las implicaciones políticas de las decisiones relativas a la gestión conjunta de las aguas superficiales y subterráneas no pueden ser exageradas. Como este artículo demuestra, una administración proactiva de las extracciones futuras de aguas subterráneas con efectos en los ecosistemas superficiales es esencial para la capacidad final de planificar la explotación, gestión y utilización de los recursos hídricos de forma racional, coordinando las demandas presentes y futuras con la realidad de la escasez de suministro. Los ejemplos empleados en este artículo demuestran la necesidad de construir capacidad y no únicamente de desarrollar buenas técnicas de medida, o la de educar reguladores y jueces de talento que redacten buenas leyes, pero también de gestores profesionales y aplicados del agua que mantengan el proceso en un compromiso entre evitar la explotación ilimitada del recurso y ejercer un proteccionismo conservador que impida su uso para siempre.

Guideline Implementation: Energy-Generating Devices, Part 1-Electrosurgery.

PubMed

Eder, Sheryl P

2017-03-01

Energy-generating devices are standard equipment in the surgical suite, with electrosurgical units being the most common type of electrical device used in the OR. Prevention of injuries to patients and personnel related to the use of energy-generating devices is a key component of the perioperative nurse's role. The AORN "Guideline for safe use of energy-generating devices" provides guidance on the use and maintenance of devices that deliver energy in the forms of radiofrequency waves, ultrasound waves, or lasers. This article focuses on key points of the guideline, which address precautions specific to electrosurgical units, patients with implanted electronic devices, and minimally invasive surgery, and documentation of the use of energy-generating devices. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Guideline Implementation: Energy-Generating Devices, Part 2-Lasers.

PubMed

Burlingame, Byron L

2017-04-01

Lasers have been used in the OR for many years and are essential tools in many different types of procedures. However, laser beams that come into contact with unintended targets directly or via reflection can cause injury to patients or personnel or pose other hazards, such as fires. The new AORN "Guideline for safe use of energy-generating devices" provides guidance on the use of all energy-generating devices in the OR. This article focuses on key points of the guideline that address the safe use of lasers. These include the components of the laser safety program, the responsibilities of the personnel in roles specific to use of a laser, laser safety measures, and documentation of laser use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Stakeholder opinions on a transformational model of pain management in long-term care.

PubMed

Hadjistavropoulos, Thomas; Janzen Claude, Jennifer A; Hadjistavropoulos, Heather; Marchildon, Gregory P; Kaasalainen, Sharon; Gallagher, Romayne; Beattie, B Lynn

2011-07-01

Pain in older adults with dementia who reside in long-term care (LTC) facilities tends to be undertreated, despite important guidelines designed to ameliorate this problem. A group of public policy and geriatric pain experts recently concluded that existing guidelines are not being implemented because they fail to take into account policy and resource realities. The group published a set of more feasible guidelines that confront these realities (e.g., a recommendation for very brief pain assessments that can be conducted by nursing staff at least weekly). We asked stakeholders to provide opinions on the possibility of implementation of these guidelines within their LTC facilities. Our results support the feasibility of, interest in, and desirability of implementation. They also support an increased role for nurse leadership in LTC pain management. These results could be used to strengthen advocacy efforts for improvement in pain management. Copyright 2011, SLACK Incorporated.

Unmet needs in obesity management: From guidelines to clinic.

PubMed

Ritten, Angela; LaManna, Jacqueline

2017-10-01

Despite the rather slow acceptance of obesity as a disease state, several obesity staging systems and weight-management guidelines have been developed and are in use, along with an ever-growing number of treatment options. Many primary care clinicians, including nurse practitioners (NPs), are at the forefront of clinical efforts to assist individuals with obesity, but face challenges due to lack of alignment and consensus among the various staging systems and guidelines. This is further complicated by shortfalls in clinical training related to obesity management and increasing complexities in reimbursement for obesity-related services. Unmet needs in the management of obesity thus stretch from guidelines to clinic. This article examines the principal barriers to effective management of individuals with obesity and considers how concerns might be overcome, with particular emphasis on the role of the NP. ©2017 American Association of Nurse Practitioners.

Contributions of groundwater conditions to soil and water salinization

NASA Astrophysics Data System (ADS)

Salama, Ramsis B.; Otto, Claus J.; Fitzpatrick, Robert W.

Salinization is the process whereby the concentration of dissolved salts in water and soil is increased due to natural or human-induced processes. Water is lost through one or any combination of four main mechanisms: evaporation, evapotranspiration, hydrolysis, and leakage between aquifers. Salinity increases from catchment divides to the valley floors and in the direction of groundwater flow. Salinization is explained by two main chemical models developed by the authors: weathering and deposition. These models are in agreement with the weathering and depositional geological processes that have formed soils and overburden in the catchments. Five soil-change processes in arid and semi-arid climates are associated with waterlogging and water. In all represented cases, groundwater is the main geological agent for transmitting, accumulating, and discharging salt. At a small catchment scale in South and Western Australia, water is lost through evapotranspiration and hydrolysis. Saline groundwater flows along the beds of the streams and is accumulated in paleochannels, which act as a salt repository, and finally discharges in lakes, where most of the saline groundwater is concentrated. In the hummocky terrains of the Northern Great Plains Region, Canada and USA, the localized recharge and discharge scenarios cause salinization to occur mainly in depressions, in conjunction with the formation of saline soils and seepages. On a regional scale within closed basins, this process can create playas or saline lakes. In the continental aquifers of the rift basins of Sudan, salinity increases along the groundwater flow path and forms a saline zone at the distal end. The saline zone in each rift forms a closed ridge, which coincides with the closed trough of the groundwater-level map. The saline body or bodies were formed by evaporation coupled with alkaline-earth carbonate precipitation and dissolution of capillary salts. Résumé La salinisation est le processus par lequel la concentration des sels dissous dans l'eau et les sols s'accroît sous l'effet de processus naturels ou anthropiques. L'eau est perdue par l'une ou l'autre combinaison de quatre principaux mécanismes : l'évaporation, l'évapotranspiration, l'hydrolyse et la drainance entre aquifères. La salinité augmente depuis les limites des bassins jusqu'au fond des vallées et le long des axes d'écoulement souterrain. La salinisation est expliquée au moyen de deux principaux modèles chimiques développés par les auteurs : l'altération et le dépôt. Ces modèles sont en accord avec les processus géologiques d'altération et de dépôt qui ont formé les sols et qui recouvrent les bassins versants. Cinq processus d'évolution de sols sous climats aride et semi-aride sont associés à l'eau et à des formations aquifères. Dans tous les cas présentés, l'eau souterraine est le principal agent géologique qui transporte, accumule et dépose les sels. A l'échelle de petits bassins versants dans le sud et dans l'ouest de l'Australie, l'eau est consommée par évapotranspiration et par hydrolyse. L'eau souterraine salée coule le long des berges de rivières et s'accumule dans des paléochenaux, qui fonctionnent comme des zones de stockage de sels, et finalement s'écoule dans des lacs, où la plupart des eaux salées se concentrent. Dans les formations bosselées des grandes plaines du nord du Canada et des États-Unis, des scénarios d'alimentation et de décharge localisées conduisent la salinisation à se produire surtout dans les dépressions, en association avec la formation de sols et d'infiltrations salins. A l'échelle régionale dans les bassins fermés, ce processus peut être à l'origine de playas ou de lacs salés. Dans les aquifères continentaux des bassins de rift du Soudan, la salinité augmente le long des axes d'écoulement souterrain et forme ainsi une zone saline à leur extrémité. La zone saline de chaque rift constitue une crête, qui coïncide avec le creux piézométrique. Le ou les ensembles salins se sont formés par évaporation couplée à la précipitation d'un carbonate alcalino-terreux et à la dissolution de sels par capillarité. Resumen La salinización es el proceso por el cual la concentración de sales disueltas en el agua o el suelo aumenta por causas naturales o antrópicas. El contenido de agua se reduce por uno o una combinación de los siguientes mecanismos: evaporación, evapotranspiración, hidrólisis y goteo entre acuíferos. La salinidad aumenta en la dirección del flujo subterráneo, desde los puntos de recarga hacia los de descarga. La salinización se puede explicar por dos modelos químicos que se pueden definir como erosión y deposición y que están de acuerdo con los clásicos procesos geológicos que tienen los mismos nombres. Se conocen cinco procesos de salinización de suelos ligados al agua o a la extracción de la misma en climas áridos o semiáridos. En todos los casos que se presentan el agua subterránea es el principal agente geológico de transmisión, acumulación y descarga de sales. A escala de pequeña cuenca, en Australia Occidental y del Sur, el agua se pierde mediante evapotranspiración e hidrólisis. El agua subterránea salina fluye a lo largo de los cauces de los arroyos y se acumula en los paleocanales, que actúan como depósitos, hasta que finalmente descarga en los lagos, donde se acumula la mayor parte de la salinidad. En los hummocks de la Zona Norte de los Grandes Llanos de Canadá y EEUU, la recarga localizada y el tipo de descarga provocan que la salinización tenga lugar fundamentalmente en las depresiones. A escala regional y en cuencas cerradas este mismo mecanismo provoca playas o lagos salinos. En los acuíferos continentales de los rift del Sudán, la salinidad se incrementa a lo largo de las líneas de flujo subterráneo y se concentra en el límite distal. La zona salina en cada rift forma una cresta cerrada que se manifiesta en los mapas piezométricos. El cuerpo o cuerpos salinos se formaron por evaporación, acoplada con la precipitación de carbonatos y la disolución de sales capilares.

Role of UASBs in River Water Quality Conservation in India

NASA Astrophysics Data System (ADS)

Gali, Veeresh; Thakur, Manisha; Gupta, Ashok Kumar; Ganguly, Rajiv

2018-03-01

Appropriate low-cost treatment technologies are a prerequisite for sound management of natural water resources against pollution in developing countries. Among the existing technologies available, UASB is found to be economically viable for India when considering all factors including operation and maintenance cost and treatment efficiency. However, this technology suffers setbacks in meeting the effluent guidelines prescribed by the government of India. Post treatment is supplemental to this process to meet the effluent standards in terms of removal of organic matter, suspended solids, pathogens and nutrients. Recent stringent effluent guidelines notified by the Ministry of Environment, Forests and Climate Change, Government of India has further reduced the limits of BOD by 3 times, COD and TSS by 5 times, NH4-N and total Nitrogen by 10 times as compared to the previous guidelines. Fecal Coliforms has been specified as <100MPN/100mL. In this paper, the present scenario of UASB based STPs and their role in river conservation is reviewed against the backdrop of stringent effluent guidelines. The minimum removal rates of BOD, COD and TSS in these plants are around 42 - 44% and the average removal rates are reported to be 66%, 61% and 65% respectively. The enhanced removal of BOD (97%), COD (98%) and TSS has been reported in STPs in conjunction with post treatment facilities such as facultative aerated lagoons, aeration tanks and polishing ponds.

Designing a Visual Factors-Based Screen Display Interface: The New Role of the Graphic Technologist.

ERIC Educational Resources Information Center

Faiola, Tony; DeBloois, Michael L.

1988-01-01

Discusses the role of the graphic technologist in preparing computer screen displays for interactive videodisc systems, and suggests screen design guidelines. Topics discussed include the grid system; typography; visual factors research; color; course mobility through branching and software menus; and a model of course integration. (22 references)…

[Gender dysphoria in children and adolescents - treatment guidelines and follow-up study].

PubMed

Meyenburg, Bernd; Kröger, Anne; Neugebauer, Rebecca

2015-01-01

Treatment guidelines for transidentity in children and adolescents are presently under discussion. We present an overview of the various treatment modalities. Further, follow-up data on children and adolescents referred for gender-identity problems are presented. Of the 84 patients seen for the first time more than 3 years before follow-up, 37 mailed in the completed questionnaires. In addition, 33 patients agreed to answer some short follow-up questions. We assessed steps of treatment, gender role, psychopathology, and psychotherapy. We compared differences in psychopathology in patients with vs. without gender role change and in patients with intense vs. less intense psychotherapy. A total of 22 patients had completely changed gender role, and some had started hormonal treatment und sex reassignment surgery. Most patients were satisfied with the treatment results. All patients showed less psychopathology on follow-up, independent of role change or intensity of psychotherapy. In general, the patients reported little psychopathology. Our follow-up results support the present treatment approach. In patients with little psychopathology, low-frequency supportive treatment appears sufficient to obtain safe judgement on hormonal of surgical treatment.

Adherence to dietary guidelines for fruit, vegetables and fish among older Dutch adults; the role of education, income and job prestige.

PubMed

Dijkstra, S C; Neter, J E; Brouwer, I A; Huisman, M; Visser, M

2014-01-01

Little is known about socio-economic differences in dietary intake among older adults. In this study we describe self-reported dietary adherence to the fruit, vegetables and fish guidelines among older Dutch adults and investigate the independent associations of three socio-economic status (SES) indicators with adherence to these guidelines. Cross sectional data-analyses. The Longitudinal Aging Study Amsterdam (LASA), the Netherlands. 1057 community dwelling older adults, aged 55-85 years. Fruit, vegetable and fish intake was assessed using a short food frequency questionnaire. We measured SES using self-reported levels of education, household income and occupational prestige. 82.5% of the respondents reported to adhere to the fruit guideline, 65.1% to the vegetables guideline, and 31.7% to the fish guideline. After adjustment for confounders and the other two SES indicators, respondents in the lowest education group adhered less often to the vegetables guideline (OR 0.39 (95% CI 0.22-0.70)) compared to those in the highest education group. Respondents in the lowest income group adhered less often to the fruit (0.44 (95 % CI 0.22-0.91) and fish guideline (OR 0.55 (95% CI 0.33-0.91) compared to those in the highest groups. Occupational prestige was not independently associated with adherence any the guidelines. Self-reported adherence to the fruit, vegetables and fish guidelines among older adults can be improved and particularly in those with a low SES. Education and income have independent and unique contributions to dietary adherence. Future research should investigate potential pathways through which these specific SES indicators influence dietary adherence.

Developing an Ethical Framework for All Geoscientists: AGI Guidelines for Ethical Professional Conduct

NASA Astrophysics Data System (ADS)

Boland, Maeve A.; Leahy, P. Patrick; Keane, Christopher M.

2016-04-01

In 1997, a group of geoscientists and others recognized the need for a broad-based set of ethical standards for the geosciences that would be an expression of the highest common denominator of values for the profession. The American Geosciences Institute (AGI) coordinated the development of the 1999 AGI Guidelines for Ethical Professional Conduct and their subsequent revision in 2015. AGI is a nonprofit federation of 51 geoscientific and professional organizations that span the geosciences and have approximately 250,000 members. AGI serves as a voice for shared interests in the geoscience community and one of its roles is to facilitate collaboration and discussion among its member societies on matters of common or overarching concern. In this capacity, AGI convened a working group to create the 1999 Guidelines for Ethical Professional Conduct and a further working group to revise the Guidelines in 2015 through a consensus process involving all member societies. The Guidelines are an aspirational document, setting out ideals and high levels of achievement for the profession. They have no provision for disciplinary of enforcement action and they do not supersede the ethics statements or codes of any member society. The 1999 Guidelines pay considerable attention to the professional behavior of geoscientists. The 2015 Guidelines place greater emphasis on the societal context of the geosciences and the responsibilities of geoscientists in areas such as communication, education, and the challenges of understanding complex natural systems. The 2015 Guidelines have been endorsed by 29 member societies to date. To translate the aspirations in the Guidelines into specific actions, AGI has facilitated discussions on the practical implications of aspects of the Guidelines. One outcome of these discussions has been a Consensus Statement Regarding Access and Inclusion of Individuals Living with Disabilities in the Geosciences.

Australian Football League concussion guidelines: what do community players think?

PubMed Central

White, Peta E; Donaldson, Alex; Sullivan, S John; Newton, Joshua

2016-01-01

Background Preventing concussion in sport is a global challenge. To assess community-level adult male Australian Football players’ views on following the Australian Football League's (AFL) concussion guidelines. Methods 3 focus groups, each comprising 6 players from 1 regional league, were conducted until saturation of issues raised. Discussions followed a semistructured script and were audio-recorded and transcribed verbatim. Thematic analysis was conducted by 2 coders independently. Results Identified advantages of the guidelines included highlighting the seriousness of concussion; changing the culture around playing with concussion and shifting return-to-play decision responsibility from players to others. Disadvantages included players being removed from play unnecessarily; removal of players’ rights to decide if they are fit to play and players changing their behaviours to avoid being removed from play. Identified facilitators to guideline use included local league enforcement; broad information dissemination and impartial medically trained staff to assess concussion. Identified barriers to guideline use included players’ desire to play at all costs; external pressure that encouraged players to return to play prematurely; and inconvenience and cost. Conclusions Players generally understand that the AFL concussion guidelines protect their long-term welfare. However, their desire to play at all costs and help their team win is a common barrier to reporting concussion and adhering to guidelines. Leagues should take a lead role by mandating and enforcing the use of the guidelines and educating coaches, game day medical providers and players. The return-to-play component of the guidelines is complex and needs further consideration in the context of community sport. PMID:28890801

Regional and national guideline recommendations for digital ano-rectal examination as a means for anal cancer screening in HIV positive men who have sex with men: a systematic review.

PubMed

Ong, Jason J; Chen, Marcus; Grulich, Andrew E; Fairley, Christopher K

2014-08-01

Although anal cancer is common in HIV positive men who have sex with men, few centres offer systematic screening. Regular digital ano-rectal examination (DARE) is a type of screening that has been recommended by some experts. How widely this forms part of HIV management guidelines is unclear. The protocol was registered prospectively (CRD42013005188; http://www.crd.york.ac.uk/PROSPERO/). We systematically reviewed 121 regional and national HIV guidelines and searched for guidelines from http://hivinsite.ucsf.edu/global?page=cr-00-04#SauguidelineX, PubMed and Web of Science databases up to 5th August 2013 for recommendations of DARE as a means of anal cancer screening in HIV positive MSM. Guidelines were examined in detail if they were clinical guidelines, including both prevention and treatment protocols and were in English. Guidelines were excluded if they were restricted to limited areas (e.g. antiretroviral therapy only, children or pregnant women, strategies for prevention/testing). Information was extracted regarding recommendation of DARE as a screening method, the frequency of DARE recommended, target population for screening and the strength of evidence supporting this. 30 regional and national guidelines were included and examined in detail. Only 2 recommended DARE. The 'European AIDS Clinical Society Guidelines' recommends DARE every 1-3 years for HIV positive MSM whilst the 'US Guideline for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents' recommends an annual DARE for the HIV + population in general. None of these guidelines specify the age of commencing screening. In each case, the highest level of evidence supporting these two recommendations was expert opinion. Few HIV guidelines discuss or recommend DARE as a means of anal cancer screening. Studies of the efficacy, acceptability and cost-effectiveness of DARE are needed to assess its role in anal cancer screening.

Policy at play: The implementation of Healthy Eating and Active Living Guidelines in municipal child care settings.

PubMed

McKay, Kelly; Nigro, Sherry

2017-03-01

In 2012, Ottawa Public Health (OPH) partnered with the City of Ottawa Municipal Child Care (MCC) Services to develop Healthy Eating and Active Living (HEAL) Guidelines. The Guidelines aim to promote consistent standards of practice in child care settings related to healthy environments and food, physical activity, physical literacy, decreased sedentary behaviours, and positive role modeling by staff. The Guidelines targeted 498 children aged 18 months to 5 years, attending MCC centres. Resources and training were provided to 10 supervisors, 63 child care educators and 9 cooks. Components of the Guidelines were piloted in 5 MCC sites prior to being launched in 10 MCC sites across Ottawa, Ontario. Two project Advisory Groups supported the development of the Guidelines. Staff training, resources, recipes and menus were provided. An evaluation was conducted and has informed the Guidelines' subsequent community implementation. In 2015, accompanying web-based resources and e-modules were developed. The evaluation demonstrated environmental and programming changes. Parent satisfaction was high and preliminary findings showed no real changes in food costs. Following implementation, the cooks reported high compliance to the 6-week menu plans provided, and the number of sites offering 120 minutes or more of daily physical activity increased. Through novel intersectoral partnerships, OPH was able to implement and evaluate HEAL Guidelines in tandem. The interdisciplinary project Advisory Groups, training of cooks, and engagement of the Ontario Coaches Association were all innovative elements of this project and may influence future public health activity in this area.

Free and open source enabling technologies for patient-centric, guideline-based clinical decision support: a survey.

PubMed

Leong, T Y; Kaiser, K; Miksch, S

2007-01-01

Guideline-based clinical decision support is an emerging paradigm to help reduce error, lower cost, and improve quality in evidence-based medicine. The free and open source (FOS) approach is a promising alternative for delivering cost-effective information technology (IT) solutions in health care. In this paper, we survey the current FOS enabling technologies for patient-centric, guideline-based care, and discuss the current trends and future directions of their role in clinical decision support. We searched PubMed, major biomedical informatics websites, and the web in general for papers and links related to FOS health care IT systems. We also relied on our background and knowledge for specific subtopics. We focused on the functionalities of guideline modeling tools, and briefly examined the supporting technologies for terminology, data exchange and electronic health record (EHR) standards. To effectively support patient-centric, guideline-based care, the computerized guidelines and protocols need to be integrated with existing clinical information systems or EHRs. Technologies that enable such integration should be accessible, interoperable, and scalable. A plethora of FOS tools and techniques for supporting different knowledge management and quality assurance tasks involved are available. Many challenges, however, remain in their implementation. There are active and growing trends of deploying FOS enabling technologies for integrating clinical guidelines, protocols, and pathways into the main care processes. The continuing development and maturation of such technologies are likely to make increasingly significant contributions to patient-centric, guideline-based clinical decision support.

Pediatric Sepsis Guidelines: Summary for resource-limited countries

PubMed Central

Khilnani, Praveen; Singhi, Sunit; Lodha, Rakesh; Santhanam, Indumathi; Sachdev, Anil; Chugh, Krishan; Jaishree, M.; Ranjit, Suchitra; Ramachandran, Bala; Ali, Uma; Udani, Soonu; Uttam, Rajiv; Deopujari, Satish

2010-01-01

Justification: Pediatric sepsis is a commonly encountered global issue. Existing guidelines for sepsis seem to be applicable to the developed countries, and only few articles are published regarding application of these guidelines in the developing countries, especially in resource-limited countries such as India and Africa. Process: An expert representative panel drawn from all over India, under aegis of Intensive Care Chapter of Indian Academy of Pediatrics (IAP) met to discuss and draw guidelines for clinical practice and feasibility of delivery of care in the early hours in pediatric patient with sepsis, keeping in view unique patient population and limited availability of equipment and resources. Discussion included issues such as sepsis definitions, rapid cardiopulmonary assessment, feasibility of early aggressive fluid therapy, inotropic support, corticosteriod therapy, early endotracheal intubation and use of positive end expiratory pressure/mechanical ventilation, initial empirical antibiotic therapy, glycemic control, and role of immunoglobulin, blood, and blood products. Objective: To achieve a reasonable evidence-based consensus on the basis of published literature and expert opinion to formulating clinical practice guidelines applicable to resource-limited countries such as India. Recommendations: Pediatric sepsis guidelines are presented in text and flow chart format keeping resource limitations in mind for countries such as India and Africa. Levels of evidence are indicated wherever applicable. It is anticipated that once the guidelines are used and outcomes data evaluated, further modifications will be necessary. It is planned to periodically review and revise these guidelines every 3–5 years as new body of evidence accumulates. PMID:20606908

[Clinical guidelines for the management of schizophrenia:Aims and limitations (Ι)].

PubMed

Margariti, M; Hadjulis, M; Lazaridou, M; Angelidis, G F; Fotopoulos, V; Markaki, L; Koulouri, F

2017-01-01

The initiative for the development of national treatment guidelines, dates back to the '90s. In Greece, however, National Clinical Guidelines for the management of schizophrenia were first formulated in 2014 when a Working Group was set up for this purpose by the Greek Ministry of Health. The objective of this Working Group was to provide evidence-based recommendations covering the pharmacological and psychosocial treatment of schizophrenia as well as the development of appropriate treatment services. The Working Group utilized the NICE Guideline (National Institute of Clinical Excellence, 2010, 2014) for the management of Psychosis & Schizophrenia as the main guide to develop the Greek National Guidelines , and in addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists 2005) , as well as other relevant sources. The Working Group also took into consideration the available Greek bibliography as well as the external evaluations of the Greek psychiatric reform programs. A special effort was made to adapt the international experience to the current Greek landscape with the constraints resulting from the uneven dispersion of mental health services, the lack of coordination between services, the incomplete sectorization of mental health services provided as part of the National Health System, the still underdeveloped Primary Care Health Service, and last but not least the difficult economic situation in Greece. After the preparation of the draft guidelines, a thorough consultation followed with the relevant stakeholders, including mental health professionals, user associations and representatives of the Greek Ombudsman. Additionally, the Hellenic Psychiatric Association established an Expert Committee in Spring 2016, that contributed with its observations to the final exercise. This article will be followed by two further publications (incorporating the Hellenic Psychiatric Association comments) which include: (1) the summary recommendations regarding the pharmacological, psychological and psychosocial interventions in the treatment of schizophrenia, and (2) the summary recommendations regarding: (a) the role of primary health care service and the role of the family physician in the treatment of schizophrenia (b) the summary recommendations regarding continuity of care and c) the summary recommendations regarding community interventions with documented effectiveness in the treatment of schizophrenia.

EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy.

PubMed

Muraro, A; Werfel, T; Hoffmann-Sommergruber, K; Roberts, G; Beyer, K; Bindslev-Jensen, C; Cardona, V; Dubois, A; duToit, G; Eigenmann, P; Fernandez Rivas, M; Halken, S; Hickstein, L; Høst, A; Knol, E; Lack, G; Marchisotto, M J; Niggemann, B; Nwaru, B I; Papadopoulos, N G; Poulsen, L K; Santos, A F; Skypala, I; Schoepfer, A; Van Ree, R; Venter, C; Worm, M; Vlieg-Boerstra, B; Panesar, S; de Silva, D; Soares-Weiser, K; Sheikh, A; Ballmer-Weber, B K; Nilsson, C; de Jong, N W; Akdis, C A

2014-08-01

Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Biomedical waste management guidelines 2016: What's done and what needs to be done.

PubMed

Singhal, Lipika; Tuli, Arpandeep Kaur; Gautam, Vikas

2017-01-01

The latest biomedical waste (BMW) management guidelines which have been introduced in 2016 are simplified and made easier so that they can be easily followed by various health agencies. The categories of BMW have been reduced from ten (in 1998) to four in the latest (2016) guidelines. Many changes have been made in these latest guidelines, which have been summarised in the article below. The segregation of hospital waste plays a very important role, so the waste has to be sorted out at the source of generation according to the category to which it belongs as given in the newer guidelines. Newer waste treatment facilities such as plasma pyrolysis, encapsulation, inertisation have been introduced, and we have to do away with older facilities such as incineration as toxic fumes (dioxins and furans) are produced which are harmful to both health and environment. We can even think of using these wastewater treatment plants to remove the antimicrobial resistance genes during the processing of the waste, which is being generated from the hospitals.

Role of the family doctor in the management of adults with obesity: a scoping review

PubMed Central

Elmitt, Nicholas; Haelser, Emily; Douglas, Kirsty A

2018-01-01

Objectives Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology. Setting Primary care. Adult patients. Included papers Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate papers were identified and 225 articles included after full-text review. Primary and secondary outcome measures Data were extracted on the family doctors’ involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned. Results 110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations. Conclusions There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development. PMID:29453301

Qualité des eaux de la station de traitement de la ville de Skikda, Algérie Essais d'optimisation de la clarification

NASA Astrophysics Data System (ADS)

Meghzili, B.; Medjram, M. S.; Achour, S.

2005-05-01

A cause de la sécheresse qui a sévit durant une décennie, la station de traitement de l'eau potable de la ville de Skikda Algérie, en vue de combler le déficit en eau, utilise un mélange des eaux de surface (barrage) et des eaux souterraines (forage). Les résultats des analyses physico-chimiques de ces eaux montrent la présence de micropolluants, notamment le mercure, avec une concentration de 0.035 mg/l pour les eaux de surface et une concentration de 0.02 mg/l pour les eaux souterraines. Ces résultats obtenus, montrent également que la concentration en matières organiques dépasse, pour les deux sources, les normes OMS. Afin de réduire les effets de cette pollution, nous avons calculé les doses nécessaires des différents réactifs utilisés sur la base des essais d'optimisation réalisés en laboratoire. Les résultats obtenus nous ont permis de conclure que les doses de 30 à 60 mg/l de sulfate d'aluminium (S.A) sont nécessaires à une bonne élimination de la turbidité et des matières organiques (M.O) et que l'utilisation du charbon active en poudre (C.A.P) permet la réduction de la teneur en mercure au dessous du seuil admissible. L'utilisation d'un adjuvant (chaux vive) permet d'améliorer les résultats surtout pour la turbidité (4 mg/l). Une préchloration au break point semble intéressante pour améliorer la phase de floculation.

The Contribution of the Future SWOT Mission to Improve Simulations of River Stages and Stream-Aquifer Interactions at Regional Scale

NASA Astrophysics Data System (ADS)

Saleh, Firas; Filipo, Nicolas; Biancamaria, Sylvain; Habets, Florence; Rodriguez, Enersto; Mognard, Nelly

2013-09-01

The main objective of this study is to provide a realistic simulation of river stage in regional river networks in order to improve the quantification of stream-aquifer exchanges and better assess the associated aquifer responses that are often impacted by the magnitude and the frequency of the river stage fluctuations. This study extends the earlier work to improve the modeling of the Seine basin with a focus on simulating the hydrodynamics behavior of the Bassée alluvial wetland, a 120 km reach of the Seine River valley located south- east of Paris. The Bassée is of major importance for the drinking-water supply of Paris and surroundings, in addition to its particular hydrodynamic behavior due to the presence of a number of gravels. In this context, the understanding of stream-aquifer interactions is required for water quantity and quality preservation. A regional distributed process-based hydro(geo)logical model, Eau-Dyssée, is used. It aims at the integrated modeling of the hydrosystem to manage the various elements involved in the quantitative and qualitative aspects of water resources. Eau-Dyssée simulates pseudo 3D flow in aquifer systems solving the diffusivity equation with a finite difference numerical scheme. River flow is simulated with a Muskingum model. In addition to the in-stream discharge, a river stage estimate is needed to calculate the water exchange at the stream-aquifer interface using a conductance model. In this context, the future SWOT mission and its high-spatial resolution imagery can provide surface water level measurements at the regional scale that will permit to better characterize the Bassée complex hydro(geo)logical system and better assess soil water content. Moreover, the Bassée is considered as a potential target for the framework of the AirSWOT airborne campaign in France, 2013.

Extraction of water and solutes from argillaceous rocks for geochemical characterisation: Methods, processes and current understanding

NASA Astrophysics Data System (ADS)

Sacchi, Elisa; Michelot, Jean-Luc; Pitsch, Helmut; Lalieux, Philippe; Aranyossy, Jean-François

2001-01-01

This paper summarises the results of a comprehensive critical review, initiated by the OECD/NEA "Clay Club," of the extraction techniques available to obtain water and solutes from argillaceous rocks. The paper focuses on the mechanisms involved in the extraction processes, the consequences on the isotopic and chemical composition of the extracted pore water and the attempts made to reconstruct its original composition. Finally, it provides some examples of reliable techniques and information, as a function of the purpose of the geochemical study. Résumé. Cet article résume les résultats d'une synthèse critique d'ensemble, lancée par le OECD/NEA "Clay Club", sur les techniques d'extraction disponibles pour obtenir l'eau et les solutés de roches argileuses. L'article est consacré aux mécanismes impliqués dans les processus d'extraction, aux conséquences sur la composition isotopique et chimique de l'eau porale extraite et aux tentatives faites pour reconstituer sa composition originelle. Finalement, il donne quelques exemples de techniques fiables et d'informations, en fonction du but de l'étude géochimique. Resúmen. Este artículo resume los resultados de una revisión crítica exhaustiva (iniciada por el "Clay Club" OECD/NEA) de las técnicas de extracción disponibles para obtener agua y solutos en rocas arcillosas. El artículo se centra en los mecanismos involucrados en los procesos extractivos, las consecuencias en la composición isotópica y química del agua intersticial extraída, y en los intentos realizados para reconstruir su composición original. Finalmente, se presentan algunos ejemplos de técnicas fiables e información, en función del propósito del estudio geoquímico.

Structure of a two-dimensional crystal in a Langmuir monolayer: grazing incidence X-ray diffraction and macroscopic properties

NASA Astrophysics Data System (ADS)

Flament, C.; Gallet, F.; Graner, F.; Goldmann, M.; Peterson, I.; Renault, A.

1994-06-01

Grazing incidence X-ray diffraction is performed on a Langmuir monolayer made of pure fluorescent NBD-stearic acid, spread at the free surface of water. It shows several intense narrow peaks in the solid phase, at the same wavevectors as the brightest peaks observed earlier by electron diffraction, for a monolayer transferred onto an amorphous polymer substrate. Thus the solid phase has the same crystalline structure on water and on solid substrate. The relative peak intensities are comparable in both experiments, and in the proposed model for the molecular structure. This model also accounts for the very large anisotropy of the crystalline phase and its optical properties. This phase could be ferroelectric, as previously assumed in order to explain the elongated shape of the crystals. Une monocouche de Langmuir, composée d'acide NBD-stéarique fluorescent pur, déposée à la surface libre de l'eau, est analysée par diffraction de rayons X sous incidence rasante. On détecte plusieurs pics étroits et intenses dans la phase solide, aux mêmes vecteurs d'onde que les pics les plus brillants précédemment observés par diffraction électronique, pour une monocouche transférée sur un substrat de polymère amorphe. La phase solide a donc la même structure cristalline sur l'eau et sur substrat solide. Les intensités relatives des pics sont comparables dans les deux expériences, ainsi que dans le modèle proposé pour la structure moléculaire. Ce modèle rend également compte de l'anisotropie très importante de la phase cristalline et de ses propriétés optiques. Il pourrait s'agir d'une phase ferroélectrique, comme cela avait été précédemment supposé pour expliquer la forme allongée des cristaux.

Development of a standardised training curriculum for robotic surgery: a consensus statement from an international multidisciplinary group of experts.

PubMed

Ahmed, Kamran; Khan, Reenam; Mottrie, Alexandre; Lovegrove, Catherine; Abaza, Ronny; Ahlawat, Rajesh; Ahlering, Thomas; Ahlgren, Goran; Artibani, Walter; Barret, Eric; Cathelineau, Xavier; Challacombe, Ben; Coloby, Patrick; Khan, Muhammad S; Hubert, Jacques; Michel, Maurice Stephan; Montorsi, Francesco; Murphy, Declan; Palou, Joan; Patel, Vipul; Piechaud, Pierre-Thierry; Van Poppel, Hendrik; Rischmann, Pascal; Sanchez-Salas, Rafael; Siemer, Stefan; Stoeckle, Michael; Stolzenburg, Jens-Uwe; Terrier, Jean-Etienne; Thüroff, Joachim W; Vaessen, Christophe; Van Der Poel, Henk G; Van Cleynenbreugel, Ben; Volpe, Alessandro; Wagner, Christian; Wiklund, Peter; Wilson, Timothy; Wirth, Manfred; Witt, Jörn; Dasgupta, Prokar

2015-07-01

To explore the views of experts about the development and validation of a robotic surgery training curriculum, and how this should be implemented. An international expert panel was invited to a structured session for discussion. The study was of a mixed design, including qualitative and quantitative components based on focus group interviews during the European Association of Urology (EAU) Robotic Urology Section (ERUS) (2012), EAU (2013) and ERUS (2013) meetings. After introduction to the aims, principles and current status of the curriculum development, group responses were elicited. After content analysis of recorded interviews generated themes were discussed at the second meeting, where consensus was achieved on each theme. This discussion also underwent content analysis, and was used to draft a curriculum proposal. At the third meeting, a quantitative questionnaire about this curriculum was disseminated to attendees to assess the level of agreement with the key points. In all, 150 min (19 pages) of the focus group discussion was transcribed (21 316 words). Themes were agreed by two raters (median agreement κ 0.89) and they included: need for a training curriculum (inter-rater agreement κ 0.85); identification of learning needs (κ 0.83); development of the curriculum contents (κ 0.81); an overview of available curricula (κ 0.79); settings for robotic surgery training ((κ 0.89); assessment and training of trainers (κ 0.92); requirements for certification and patient safety (κ 0.83); and need for a universally standardised curriculum (κ 0.78). A training curriculum was proposed based on the above discussions. This group proposes a multi-step curriculum for robotic training. Studies are in process to validate the effectiveness of the curriculum and to assess transfer of skills to the operating room. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Adaptation of Cost Analysis Studies in Practice Guidelines.

PubMed

Zervou, Fainareti N; Zacharioudakis, Ioannis M; Pliakos, Elina Eleftheria; Grigoras, Christos A; Ziakas, Panayiotis D; Mylonakis, Eleftherios

2015-12-01

Clinical guidelines play a central role in day-to-day practice. We assessed the degree of incorporation of cost analyses to guidelines and identified modifiable characteristics that could affect the level of incorporation.We selected the 100 most cited guidelines listed on the National Guideline Clearinghouse (http://www.guideline.gov) and determined the number of guidelines that used cost analyses in their reasoning and the overall percentage of incorporation of relevant cost analyses available in PubMed. Differences between medical specialties were also studied. Then, we performed a case-control study using incorporated and not incorporated cost analyses after 1:1 matching by study subject and compared them by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement requirements and other criteria.We found that 57% of guidelines do not use any cost justification. Guidelines incorporate a weighted average of 6.0% (95% confidence interval [CI] 4.3-7.9) among 3396 available cost analyses, with cardiology and infectious diseases guidelines incorporating 10.8% (95% CI 5.3-18.1) and 9.9% (95% CI 3.9- 18.2), respectively, and hematology/oncology and urology guidelines incorporating 4.5% (95% CI 1.6-8.6) and 1.6% (95% CI 0.4-3.5), respectively. Based on the CHEERS requirements, the mean number of items reported by the 148 incorporated cost analyses was 18.6 (SD = 3.7), a small but significant difference over controls (17.8 items; P = 0.02). Included analyses were also more likely to directly relate cost reductions to healthcare outcomes (92.6% vs 81.1%, P = 0.004) and declare the funding source (72.3% vs 53.4%, P < 0.001), while similar number of cases and controls reported a noncommercial funding source (71% vs 72.7%; P = 0.8).Guidelines remain an underused mechanism for the cost-effective allocation of available resources and a minority of practice guidelines incorporates cost analyses utilizing only 6% of the available cost analyses. Fulfilling the CHEERS requirements, directly relating costs with healthcare outcomes and transparently declaring the funding source seem to be valued by guideline-writing committees.

Implementation of asthma guidelines to West Australian community pharmacies: an exploratory, quasi-experimental study.

PubMed

Watkins, Kim; Trevenen, Michelle; Murray, Kevin; Kendall, Peter A; Schneider, Carl R; Clifford, Rhonda

2016-08-31

Pharmacy assistants are often the first point of contact for patients presenting in community pharmacies. The current role of pharmacy assistants in the supply of asthma-reliever medications (short-acting β-agonists) was identified as a barrier to appropriate guideline-based care. The aim of this research was to devise and evaluate a team-based intervention to formalise the role of pharmacy assistants and to improve asthma guideline-based care in community pharmacy. A controlled pre-post intervention study was conducted in 336 metropolitan pharmacies located in Perth, Western Australia. Pharmacies were stratified into 2 groups (187 intervention and 149 control) based on known confounders for asthma control. The intervention was designed using a common-sense approach and resources developed included a checklist, videos and web page. Delivery was via workshops (25 pharmacies) or academic detailing (162 pharmacies). Pharmacy practice was assessed preintervention and postintervention via covert simulated patient methodology. Primary outcome measures included patient medical referral, device use demonstration and counselling, internal referral and/or direct involvement of a pharmacist in consultations. There was a significant increase in patient medical referral in intervention pharmacies from 32% to 47% (p=0.0007) from preintervention to postintervention, while control pharmacies showed a non-significant decrease from 50% to 44% (p=0.22). Device counselling was not routinely carried out at any stage or in any cohort of this research and no significant changes in internal referral were observed. Increases in medical referral indicate that asthma guideline compliance can be improved in community pharmacy if implementation employs a team-based approach and involves pharmacy assistants. However, results were variable and the intervention did not improve practice related to device counselling or internal referral/pharmacist involvement. Undertaking more workshops may have improved results. Guideline implementation in community pharmacy should consider the role of pharmacy assistants and how to overcome logistical barriers to pharmacy participation in implementation activities. 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/

The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania

PubMed Central

Mori, Amani Thomas; Kaale, Eliangiringa Amos; Ngalesoni, Frida; Norheim, Ole Frithjof; Robberstad, Bjarne

2014-01-01

Background Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. Methods This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. Findings The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. Conclusions Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence. PMID:24416293

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Role of Cranial Molding Orthosis (Helmet) Therapy for Patients With Positional Plagiocephaly.

PubMed

Tamber, Mandeep S; Nikas, Dimitrios; Beier, Alexandra; Baird, Lissa C; Bauer, David F; Durham, Susan; Klimo, Paul; Lin, Alexander Y; Mazzola, Catherine; McClung-Smith, Catherine; Mitchell, Laura; Tyagi, Rachana; Flannery, Ann Marie

2016-11-01

No evidence-based guidelines exist on the role of cranial-molding orthosis (helmet) therapy for patients with positional plagiocephaly. To address the clinical question: "Does helmet therapy provide effective treatment for positional plagiocephaly?" and to make treatment recommendations based on the available evidence. The US National Library of Medicine Medline database and the Cochrane Library were queried by using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and, based on the quality of the literature, recommendations were made (Levels I-III). Fifteen articles met criteria for inclusion into the evidence tables. There was 1 prospective randomized controlled trial (Class II), 5 prospective comparative studies (Class II), and 9 retrospective comparative studies (Class II). There is a fairly substantive body of nonrandomized evidence that demonstrates more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy. Specific criteria regarding the measurement and quantification of deformity and the most appropriate time window in infancy for treatment of positional plagiocephaly with a helmet remains elusive. In general, infants with a more severe presenting deformity and infants who are helmeted early in infancy tend to have more significant correction (and even normalization) of head shape. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_5.

The role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of Tanzania.

PubMed

Mori, Amani Thomas; Kaale, Eliangiringa Amos; Ngalesoni, Frida; Norheim, Ole Frithjof; Robberstad, Bjarne

2014-01-01

Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence.

Analysis of the 2015 American and European guidelines for the management of infective endocarditis.

PubMed

Tattevin, P; Mainardi, J-L

2016-12-01

The optimal management of infective endocarditis requires a broad range of expertise (infectious disease specialists, cardiologists, microbiologists, cardiac surgeons, and intensivists). Given the low level of evidence currently available to support the management of infective endocarditis, international guidelines have always been particularly awaited and rather well implemented. Their cautious analysis of the medical literature and the range of expertise combined within the groups in charge of these guidelines are usually broadly acknowledged and respected. The publications, a few weeks apart, of the 2015 updates of the American and European guidelines, was quite disturbing. Indeed, several discrepancies on major therapeutic propositions were observed, including empirical treatment (penicillin M+penicillin A+gentamicin for Europeans in acutely ill patients; penicillin A+beta-lactamase inhibitor+gentamicin for Americans), or first-line treatment for the most common pathogen responsible for endocarditis in 2016, Staphylococcus aureus (trimethoprim-sulfamethoxazole+clindamycin as an alternative in the European guidelines, while this regimen is not even mentioned in the American guidelines). Other discrepancies were observed, although less significant: the role of positron emission tomography labelled with 18 F-fluorodeoxyglucose and administration modalities for aminoglycosides. We aimed to detail the main changes brought upon by these guidelines, their discrepancies, and the 'pros' and 'cons' that may help you select the best treatment regimen for your patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Fertility preservation for medical reasons in girls and women: British fertility society policy and practice guideline.

PubMed

Yasmin, Ephia; Balachandren, Neerujah; Davies, Melanie C; Jones, Georgina L; Lane, Sheila; Mathur, Raj; Webber, Lisa; Anderson, Richard A

2018-04-01

Fertility preservation in the female poses several challenges due to the invasive nature of the techniques available to achieve it. The guideline aims to bring together the evidence available for the measures for fertility preservation and their outcome. The guideline addresses fertility preservation for medical reasons and includes both oncological and non-oncological causes. The techniques that the guideline considers are: (i) embryo and oocyte cryopreservation; (ii) ovarian tissue cryopreservation; (iii) GnRH agonist suppression and (iv) ovarian transposition. Although ovarian tissue cryopreservation is still considered experimental, the availability of this technique is gaining momentum as more live births from auto-transplanted tissue are reported. The guideline also highlights use of current treatment modalities for benign and malignant conditions that have a better fertility sparing profile. The guideline recommends a multidisciplinary approach in counselling women and girls about the risk to their fertility and available techniques. The role of psychological support in assisting women and girls with decision-making is highlighted. The guideline also highlights the risks associated with these techniques. Women need to be medically fit to undergo invasive procedures. Fertility preservation techniques are appropriate when treatment has curative intent. Fertility preservation is a subject of on-going research on outcomes of different techniques and at the time of publication, studies are still likely to emerge adding to the available literature.

Defending the Mentally Disabled.

ERIC Educational Resources Information Center

Cournos, Francine; And Others

1984-01-01

Discusses the role of mental health and social services personnel in helping patients apply for recertification for Supplementary Security Income (SSI) benefits. Describes the appeal process and provides guidelines for professionals. (JAC)

Sedation assisted by an endoscopist (SAE) for complex endoscopic procedures. Is it time to change the current guidelines?

PubMed

Hernán Ocaña, Pablo

2018-04-01

Currently, sedation in endoscopic procedures is considered a necessary condition and a criterion of quality in digestive endoscopy. The role of SAE in conventional endoscopic procedures is clearly established in clinical guidelines, but this is not so clear in complex endoscopic procedures, such as ERCP. In recent years, numerous studies have been published, with results similar to those noticed in this article, endorsing the safety, efficacy and efficiency of SAE, when performed by properly trained staff.

[Is there any progress in the blood glucose lowering therapy of type 2 diabetes?].

PubMed

Winkler, Gábor

2014-08-03

Principles of glycemic treatment of type 2 diabetes are well outlined for a long time, however, emphasis of therapeutic strategies and treatment guidelines are continuously changing partially due to the continuous expansion of the available antihyperglycemic drugs. This article overviews the modifications of the drug selection arising from the broadening of the pathogenetic knowledge and recent therapeutic guidelines. It presents the role of the patient-centered approach in the therapeutic choice, highlights occasional contradictions between recent international and national guidelines and financing rules in Hungary. While consideration of the different antidiabetics by the same criteria and the choice of the most appropriate drug characterize international practice, prescription of certain compounds is often restricted by financial rules in Hungary.

Safety and efficacy of extended-release guaifenesin/pseudoephedrine hydrochloride for adjunctive symptom relief of acute respiratory infections.

PubMed

Kikano, George

2009-05-01

Acute bacterial respiratory infections (ABRIs) require treatment with antibiotics. Although antibiotics may address the underlying pathogenic factors, over-the-counter (OTC) agents can play an adjuvant role in relieving mucus-related symptoms. This complimentary role contributes to the healing process and is supported by current clinical guidelines.

The Physician's Role in Prevention. Adolescent Alcoholism: Recognizing, Intervening, and Treating Series No. 2.

ERIC Educational Resources Information Center

Fisher, Joseph V.; Krol, Ronald A.

This document is one of seven publications contained in a series of materials for physicians on recognizing, intervening with, and treating adolescent alcoholism. The materials in this unit of study offer guidelines to help physicians make responsible and informed decisions about their roles with adolescent patients. Materials are presented which…

Small mammals of the Bitterroot National Forest: Ecological significance and guidelines for management

Treesearch

Dean E. Pearson

2000-01-01

Small mammal literature was reviewed to assess the ecological role of small mammals on the Bitterroot National Forest of western Montana. Small mammals fulfill numerous important roles in forest ecosystems by supporting a wide range of predators, dispersing seeds and mycorrhizal spores, altering vegetation through herbivory and seed predation, and preying on insects....

Barriers to the implementation of practice guidelines in managing patients with nonvariceal upper gastrointestinal bleeding: A qualitative approach

PubMed Central

Hayes, Sean M; Murray, Suzanne; Dupuis, Martin; Dawes, Martin; Hawes, Ian A; Barkun, Alan N

2010-01-01

BACKGROUND/OBJECTIVE: Guidelines for the management of patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) are inconsistently applied by health care providers, potentially resulting in suboptimal care and patient outcomes. A needs assessment was performed to assess health care providers’ barriers to the implementation of these guidelines in Canada. METHODS: Semistructured telephone interviews were conducted by trained research personnel with 22 selectively sampled health care professionals actively treating and managing NVUGIB patients, including emergency room physicians (ER), intensivists (ICU), gastroenterologists (GI), gastroenterology nurses and hospital administrators. Participants were chosen from a representative sample of six Canadian community- and academic-based hospitals that participated in a national Canadian audit on the management of NVUGIB. RESULTS: Participants reported substantive gaps in the implementation of NVUGIB guidelines that included the following: lack of knowledge of the specifics of the NVUGIB guidelines (ER, ICU, nurses); limited belief in the value of guidelines, especially in areas where evidence is lacking (ER, ICU); limited belief in the value of available tools to support implementation of guidelines (GI); lack of knowledge of the roles and responsibilities of health care professions and disciplines, and lack of effective collaboration skills (ER, ICU and GI); variability of knowledge and skills of health care professionals within professions (eg, variability of nurses’ knowledge and skills in endoscopic procedures); and perceived overuse of intravenous proton pump inhibitor treatment, with limited concern regarding cost or side effect implications (all participants). CONCLUSIONS: In the present study population, ER, ICU and nurses did not adhere to NVUGIB guidelines because they were neither aware of nor familiar with them, whereas the GI lack of adherence to NVUGIB guidelines was influenced more by attitudinal and contextual barriers. These findings can guide the design of multifaceted educational and behavioural interventions when attempting to effectively disseminate existing guidelines, and for guideline implementation into practice. PMID:20485702

[Trends in breast cancer treatment in the elderly at a breast cancer outpatient clinic: guidelines followed better].

PubMed

Hamaker, Marije E; Schreurs, W Hermien; van Slooten, Henk Jan; Uppelschoten, Jeroen M; Smorenburg, Carolien H

2009-01-01

To investigate the treatment of resectable breast cancer in elderly patients at Alkmaar Medical Centre, Alkmaar, the Netherlands, before and after the introduction of a multidisciplinary breast cancer consultation (MDC) with the breast cancer team in February 2006. Retrospective. The treatment of patients aged 70 and over with newly diagnosed stage I and II resectable breast cancer was monitored during the period 2002-2007. A total of 84% of the 232 studied patients were treated surgically. Adjuvant treatment with radiotherapy, hormone therapy and chemotherapy was given to 88, 91 and 5 patients, respectively. The percentage of patients who underwent first-line surgery decreased significantly, mainly because fewer patients aged 80 or over received surgery. The number of patients given radiotherapy in accordance with guidelines increased, while for hormonal therapy the number remained more or less the same. Recording of decisions that involved deviation from treatment guidelines improved in the study period. In 2002-2007, the breast cancer team became more aware of treatment guidelines and deviations from guidelines were better accounted for. In the elderly, the guidelines for adjuvant radiotherapy were followed better, but there was a remarkable decrease in primary surgical treatment of patients, particularly in patients aged 80 and over. Comorbidity and patients' preferences played an important role in this.

Clinical Guidelines and Implementation into Daily Dental Practice.

PubMed

Guncu, Guliz Nigar; Nemli, Secil Karakoca; Carrilho, Eunice; Yamalık, Nermin; Volodina, Elena; Melo, Paulo; Margvelashvili, Vladimer; Rossi, Alessandra

2018-01-31

The purpose of this study is to assess the extent of the familiarity, attitude and perceptions of dental professionals regarding clinical dental guidelines and their implementation into daily dental practice. For this purpose, a questionnaire which was developed by the members of the World Dental Federation, European Regional Organization Working Group - 'Relation Between Dental Practitioner and Universities', was implemented by the National Dental Associations of six European Regional Organization-zone countries (Georgian Stomatological Association - Georgia, Associazione Nazionale Dentisti Italiani - Italy, Portuguese Dental Association - Portugal, Russian Dental Association - Russia, Swiss Dental Association - Switzerland, and Turkish Dental Association - Turkey. The questionnaire was filled by a total of 910 dental professionals who are members of one of these national dental associations and who voluntarily wanted to participate to this survey. Most of the survey participants were familiar with clinical dental guidelines (68%), claimed that they implemented them into daily practice (61.7%), and generally acknowledged their benefits (81.8%). Many participants believed that clinical dental guidelines could help to improve the clinical treatment plan (50.6 %) and the accuracy of diagnosis (39.4%); which increased with age and years of practice (p < 0.05). The most frequently perceived barrier to the effective implementation of clinical dental guidelines was expressed as 'lack of awareness', while participants suggested a role for national dental associations in spreading clinical dental guidelines. A better understanding of the perceptions and attitudes of dentists towards clinical dental guidelines and the potential impact of factors affecting such perceptions and attitudes may be of particular importance for attempts aiming at overcoming the barriers for effective implementation of clinical dental guidelines into daily practice. Despite a significant familiarity and a common positive attitude, dental professionals are likely to have different perceptions towards clinical dental guidelines, especially regarding their effective implementation into daily practice, benefits and barriers.

[Gender: new methodological approaches in guideline development].

PubMed

Weinbrenner, Susanne; Lönnfors, Sanna; Babitsch, Birgit

2010-01-01

Gender and diversity have a strong impact on health and illness as evidenced by sex and gender differences in the onset and progression of diseases as well as in diagnosis, therapy, and therapeutic outcome. The number of sex/gender-specific studies in medicine has increased steadily in recent years, indicating sex (biological) and gender (social) differences in numerous diseases. Despite this evidence, however, sex/gender differences are rarely considered in medical practice or in health systems, suggesting a delay in transferring such research into evidence-based medical treatment. Similarly, quality improvement guidelines in medical care do not systematically integrate the sex/gender perspective. Against this backdrop, this paper seeks to enumerate the necessary components of a guideline development and evaluation process that systematically integrates sex/gender differences in addition to providing a sex/gender-based methodological approach. The latter is illustrated by a pilot study in which four international guidelines on depression were selected. The sex/gender appropriateness of these guidelines was analysed using two methods: first, sex/gender-relevant words were counted; and second, relevant sex/gender differences were summarised based on a systematic literature review and then compared with the information given in the guidelines. The findings of the pilot study revealed that although strong evidence exists on sex/gender differences in depression, such research was rarely implemented in the guidelines. Given the scope and potential of guidelines to improve the quality of health care, it is essential that they consider the crucial role of sex/gender differences. To date, sex/gender differences have been insufficiently addressed in guideline development and evaluation when they should be an integral component of the process. Copyright © 2010. Published by Elsevier GmbH.

Proposal for establishing structure and process in the development of implicit chiropractic standards of care and practice guidelines.

PubMed

Hansen, D T; Adams, A H; Meeker, W C; Phillips, R B

1992-09-01

With the advent of health care's "era of accountability", the chiropractic profession is now faced with generating implicit standards and guidelines for care or having it done for us by outside agencies. Already we see chiropractic groups in individual states and provinces being pressured into naive efforts of guideline development. Current knowledge and experience are available through recent health care literature that clearly defines the structure and process of guideline development and offers suggestions on how to measure outcomes of those processes. In addition, the United States Congress has directed a new federal agency to oversee this activity and monitor outcomes of quality improvement programs. The time has come for the chiropractic profession to define its exact role in health care delivery and develop implicit standards of care and practice guidelines. This sentinel effort should be managed by a commissioned body of empaneled experts that generally represent the academic and clinical chiropractic profession. A protocol for selection of these panelists and the panel chairperson needs to be developed and memorialized. Appropriate methodology (with definitions) needs to be developed for the process of standards/guideline development. Adherence to the accepted structure and process of guideline development will ensure the continuity of this dynamic process in the coming generations. This proposal offers a preliminary definition of the structure and process, including a "seed" policy statement and decision flow chart, specific to guideline development. Once the structure and process of guideline development for chiropractic are defined, the profession can then present this product to federal and state agencies, private sector health care purchasers, patient advocacy groups and other stakeholders of chiropractic care.(ABSTRACT TRUNCATED AT 250 WORDS)

International variations in clinical practice guidelines for palliative sedation: a systematic review.

PubMed

Abarshi, Ebun; Rietjens, Judith; Robijn, Lenzo; Caraceni, Augusto; Payne, Sheila; Deliens, Luc; Van den Block, Lieve

2017-09-01

Palliative sedation is a highly debated medical practice, particularly regarding its proper use in end-of-life care. Worldwide, guidelines are used to standardise care and regulate this practice. In this review, we identify and compare national/regional clinical practice guidelines on palliative sedation against the European Association for Palliative Care (EAPC) palliative sedation Framework and assess the developmental quality of these guidelines using the Appraisal Guideline Research and Evaluation (AGREE II) instrument. Using the PRISMA criteria, we searched multiple databases (PubMed, CancerLit, CINAHL, Cochrane Library, NHS Evidence and Google Scholar) for relevant guidelines, and selected those written in English, Dutch and Italian; published between January 2000 and March 2016. Of 264 hits, 13 guidelines-Belgium, Canada (3), Ireland, Italy, Japan, the Netherlands, Norway, Spain, Europe, and USA (2) were selected. 8 contained at least 9/10 recommendations published in the EAPC Framework; 9 recommended 'pre-emptive discussion of the potential role of sedation in end-of-life care'; 9 recommended 'nutrition/hydration while performing sedation' and 8 acknowledged the need to 'care for the medical team'. There were striking differences in terminologies used and in life expectancy preceding the practice. Selected guidelines were conceptually similar, comparing closely to the EAPC Framework recommendations, albeit with notable variations. Based on AGREE II, 3 guidelines achieved top scores and could therefore be recommended for use in this context. Also, domains 'scope and purpose' and 'editorial independence' ranked highest and lowest, respectively-underscoring the importance of good reportage at the developmental stage. 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/.

KSC00pp0329

NASA Image and Video Library

2000-03-10

FIRST teams and their robots work to go through the right motions at the FIRST competition. Students from all over the country are at the KSC Visitor Complex for the FIRST (For Inspiration and Recognition of Science and Technology) Southeast Regional competition March 9-11 in the Rocket Garden. Teams of high school students are testing the limits of their imagination using robots they have designed, with the support of business and engineering professionals and corporate sponsors, to compete in a technological battle against other schools' robots. Of the 30 high school teams competing, 16 are Florida teams co-sponsored by NASA and KSC contractors. Local high schools participating are Astronaut, Bayside, Cocoa Beach, Eau Gallie, Melbourne, Melbourne Central Catholic, Palm Bay, Rockledge, Satellite, and Titusville

KSC-00pp0329

NASA Image and Video Library

2000-03-10

FIRST teams and their robots work to go through the right motions at the FIRST competition. Students from all over the country are at the KSC Visitor Complex for the FIRST (For Inspiration and Recognition of Science and Technology) Southeast Regional competition March 9-11 in the Rocket Garden. Teams of high school students are testing the limits of their imagination using robots they have designed, with the support of business and engineering professionals and corporate sponsors, to compete in a technological battle against other schools' robots. Of the 30 high school teams competing, 16 are Florida teams co-sponsored by NASA and KSC contractors. Local high schools participating are Astronaut, Bayside, Cocoa Beach, Eau Gallie, Melbourne, Melbourne Central Catholic, Palm Bay, Rockledge, Satellite, and Titusville

Laser femtoseconde, filamentation, nuage et orage

NASA Astrophysics Data System (ADS)

Courvoisier, F.; Boutou, V.; Kasparian, J.; Salmon, E.; Méjean, G.; Yu, J.; Wolf, J.-P.

2005-06-01

Les applications telles que le contrôle de foudre grâce aux filaments autoguidés générés par un laser femtoseconde nécessitent de propager un tel filament à travers des aérosols de gouttes d'eau. Nous montrons qu'un filament survit à son interaction avec une goutte de diamètre comparable au sien (95 μ m), ainsi qu'à des nuages d'épaisseur optique 3,2, soit 5% de transmission. Cette transmission est permise par la présence d'un “bain de photons” autour du filament. Ce bain forme un réservoir contenant une part importante de l'énergie du faisceau, en équilibre avec le filament, et favorisant son alimentation.

Stakeholder involvement: how to do it right: article 9 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Cluzeau, Françoise; Wedzicha, Jadwiga A; Kelson, Marcia; Corn, Judy; Kunz, Regina; Walsh, John; Schünemann, Holger J

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 with input from appropriate stakeholders. This is the ninth of a series of 14 articles that were prepared by an international panel to advise guideline developers in respiratory and other diseases on approaches for guideline development. We updated a review of the literature on stakeholder involvement, focusing on six key questions. In this review we addressed the following questions. (1) What are "stakeholders"? (2) Why involve stakeholders in guidelines? (3) At what stage should stakeholders contribute to guidelines? (4) What are the potential barriers to integrating stakeholder involvement? (5) How can stakeholders be involved effectively? (6) Should anyone be excluded from the process? We searched PubMed and other databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct our own systematic reviews. Our conclusions are based on available evidence, the experience of guideline developers, and workshop discussions. Stakeholders are all those who have a legitimate interest in a guideline. They include healthcare professionals, patients and caregivers, public and private funding bodies, managers, employers, and manufacturers. Their engagement is justified for several reasons, including limitations of evidence, principles of transparency and democracy, ownership, and potential policy implications. They have a role to play at different points of guideline development, but their involvement can be complex. To be successful, stakeholder engagement needs to be inclusive, equitable, and adequately resourced.

The revised Canadian Guidelines for the Economic Evaluation of Pharmaceuticals.

PubMed

Glennie, J L; Torrance, G W; Baladi, J F; Berka, C; Hubbard, E; Menon, D; Otten, N; Rivière, M

1999-05-01

The first edition of the Guidelines for Economic Evaluation of Pharmaceuticals: Canada was published in November 1994. At that time, the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) was assigned the task of maintaining and regularly updating the Canadian Guidelines. Since their introduction, a great deal of experience has been gained with the practical application of the guidelines. Their role has also evolved over time, from being a framework for pharmacoeconomic research to the point where a wide variety of decision-makers use economic evaluations based on the principles set out in the guidelines as a means of facilitating their formulary decisions. In addition, methodologies in certain areas (and the body of related research literature in general) have developed considerably over time. Given these changes in the science and the experience gained, CCOHTA convened a multi-disciplinary committee to address the need for revisions to the guidelines. The underlying principles of the review process were to keep the guidance nature of the document, to focus on the needs of 'doers' (so as to meet the information needs of 'users') and to provide information and advice in areas of controversy, with sound direction in areas of general agreement. The purpose of this review is three-fold: (i) to outline the process which lead to the revision of the Canadian Guidelines; (ii) to describe the major changes made to the second edition of this document; and (iii) to consider the 'next steps' as they relate to the impact of such guidelines and the measurement of outcomes related to economic assessments of pharmaceuticals in general.

Research Reporting Guidelines in Dentistry: A Survey of Editors.

PubMed

Sarkis-Onofre, Rafael; Cenci, Maximiliano Sérgio; Moher, David; Pereira-Cenci, Tatiana

2017-01-01

The use of reporting guidelines has an important role in the development of health research, improving the quality and precision of the publications. This study evaluated how dental journals use reporting guidelines. All editors of dental journals registered on the 2013 Journal Citation Reports list (n=81) were invited to participate. The data were collected by a self-reported web-based questionnaire. Information about the profile of journal/editor and on the use of reporting guidelines by journals was gathered. Information/recommendations about the use of reporting guidelines were collected from the websites of all journals. Data were descriptively analyzed and frequencies were summarized. Thirty-four (42%) editors completed the questionnaire. Most journals are members of Committee on Publication Ethics (64.7%) and/or follow the International Committee of Medical Journal Editors recommendations (20.6%), while 26.5% are not members of any editorial group. Most editors are unfamiliar with the EQUATOR Network (55.9%), do not work full time (85.3%) and 88.2% have some income/payment. Most of them received educational training for this position (55.9%). The CONSORT Statement was endorsed by 61.8% of journals. Information from websites showed that 44.4% journals do not recommend any reporting guideline, 51.9% mention CONSORT Statement in the website and 28.4% only recommend the use of CONSORT Statement. There is clearly room for improving the use of reporting guidelines in dental journals. Broadening the understanding and the endorsement/adherence/implementation of reporting guidelines by journals may promote quality and transparence of published dental research.

Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015.

PubMed

Zagari, Rocco Maurizio; Romano, Marco; Ojetti, Veronica; Stockbrugger, Reinhold; Gullini, Sergio; Annibale, Bruno; Farinati, Fabio; Ierardi, Enzo; Maconi, Giovanni; Rugge, Massimo; Calabrese, Carlo; Di Mario, Francesco; Luzza, Francesco; Pretolani, Stefano; Savio, Antonella; Gasbarrini, Giovanni; Caselli, Michele

2015-11-01

Knowledge on the role of Helicobacter pylori (HP) infection is continually evolving, and treatment is becoming more challenging due to increasing bacterial resistance. Since the management of HP infection is changing, an update of the national Italian guidelines delivered in 2007 was needed. In the III Working Group Consensus Report 2015, a panel of 17 experts from several Italian regions reviewed current evidence on different topics relating to HP infection. Four working groups examined the following topics: (1) "open questions" on HP diagnosis and treatment (focusing on dyspepsia, gastro-oesophageal reflux disease, non-steroidal anti-inflammatory drugs or aspirin use and extra-gastric diseases); (2) non-invasive and invasive diagnostic tests; (3) treatment of HP infection; (4) role of HP in the prevention of gastric cancer. Statements and recommendations were discussed and a consensus reached in a final plenary session held in February 2015 in Bologna. Recommendations are based on the best current evidence to help physicians manage HP infection in Italy. The guidelines have been endorsed by the Italian Society of Gastroenterology and the Italian Society of Digestive Endoscopy. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Is “Processed” a Four-Letter Word? The Role of Processed Foods in Achieving Dietary Guidelines and Nutrient Recommendations123

PubMed Central

Dwyer, Johanna T.; Fulgoni, Victor L.; Clemens, Roger A.; Schmidt, David B.

2012-01-01

This paper, based on the symposium “Is ‘Processed’ a Four-Letter Word? The Role of Processed Foods in Achieving Dietary Guidelines and Nutrient Recommendations in the U.S.” describes ongoing efforts and challenges at the nutrition–food science interface and public health; addresses misinformation about processed foods by showing that processed fruits and vegetables made important dietary contributions (e.g., fiber, folate, potassium, vitamins A and C) to nutrient intake among NHANES 2003–2006 participants, that major sources of vitamins (except vitamin K) were provided by enrichment and fortification and that enrichment and fortification helped decrease the percentage of the population below the Estimated Average Requirement for vitamin A, thiamin, folate, and iron; describes how negative consumer perceptions and consumer confusion about processed foods led to the development of science-based information on food processing and technology that aligns with health objectives; and examines challenges and opportunities faced by food scientists who must balance consumer preferences, federal regulations, and issues surrounding food safety, cost, unintended consequences, and sustainability when developing healthful foods that align with dietary guidelines. PMID:22797990

A Clinical Practice Guideline for the Management of Acute Spinal Cord Injury: Introduction, Rationale, and Scope.

PubMed

Fehlings, Michael G; Tetreault, Lindsay A; Wilson, Jefferson R; Kwon, Brian K; Burns, Anthony S; Martin, Allan R; Hawryluk, Gregory; Harrop, James S

2017-09-01

Acute spinal cord injury (SCI) is a traumatic event that results in disturbances to normal sensory, motor, or autonomic function and ultimately affects a patient's physical, psychological, and social well-being. The management of patients with SCI has drastically evolved over the past century as a result of increasing knowledge on injury mechanisms, disease pathophysiology, and the role of surgery. There still, however, remain controversial areas surrounding available management strategies for the treatment of SCI, including the use of corticosteroids such as methylprednisolone sodium succinate, the optimal timing of surgical intervention, the type and timing of anticoagulation prophylaxis, the role of magnetic resonance imaging, and the type and timing of rehabilitation. This lack of consensus has prevented the standardization of care across treatment centers and among the various disciplines that encounter patients with SCI. The objective of this guideline is to form evidence-based recommendations for these areas of controversy and outline how to best manage patients with SCI. The ultimate goal of these guidelines is to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care and encouraging clinicians to make evidence-informed decisions.

Employee health.

PubMed

2015-09-01

The National Institute for Health and Care Excellence has produced a new guideline looking at improving the health and wellbeing of employees, with a particular focus on organisational culture and context, and the role of line managers.

Current management of gender identity disorder in childhood and adolescence: guidelines, barriers and areas of controversy.

PubMed

Shumer, Daniel E; Spack, Norman P

2013-02-01

The approach to gender identity disorder (GID) in childhood and adolescence has been rapidly evolving and is in a state of flux. In an effort to form management recommendations on the basis of the available literature, The Endocrine Society published clinical practice guidelines in 2009. The guidelines recommend against sex role change in prepubertal children, but they recommend the use of gonadotropin-releasing hormone (GnRH) agonists to suppress puberty in adolescence, and the use of cross-sex hormones starting around age 16 for eligible patients. In actual practice, the approach to GID is quite variable due to continued lack of consensus and specific barriers to treatment that are unique to GID. Recent literature has focused on the mental health approach to prepubertal children with GID and short-term outcomes using pubertal suppression and cross-sex steroids in adolescents with GID. This review will describe the literature published since the release of The Endocrine Society guidelines regarding the management of GID in both children and adolescents.

Implementation of the 2013 American College of Cardiology/American Heart Association Blood Cholesterol Guideline Including Data From the Improved Reduction of Outcomes: Vytorin Efficacy International Trial

PubMed Central

Ziaeian, Boback; Dinkler, John; Watson, Karol

2015-01-01

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in developed countries. The management of blood cholesterol through use of 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors (statins) in at-risk patients is a pillar of medical therapy for the primary and secondary prevention of cardiovascular disease. The recent 2013 American College of Cardiology/American Heart Association guideline on managing blood cholesterol provides an important framework for the effective implementation of risk-reduction strategies. The guideline identifies four cohorts of patients with proven benefits from statin therapy and streamlines the dosing and monitoring recommendations based on evidence from published, randomized controlled trials. Primary care physicians and cardiologists play key roles in identifying populations at elevated ASCVD risk. In providing a practical management overview of the current blood cholesterol guideline, we facilitate more informed discussions on treatment options between healthcare providers and their patients. PMID:26198559

76 FR 44574 - Yavapai County Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... and Community Self-Determination Act (Pub. L. 110- 343) and in compliance with the Federal Advisory... Act, roles of members, guidelines for Title II, and the Federal Advisory Committee Act. DATES: The...

76 FR 13124 - Yavapai County Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-10

... and Community Self-Determination Act (Pub. L. 110- 343) and in compliance with the Federal Advisory... Act, roles of members, guidelines for Title II, and the Federal Advisory Committee Act. DATES: The...

Developing a cultural model of caregiving obligations for elderly Chinese wives.

PubMed

Holroyd, Eleanor

2005-06-01

This article addresses the dilemmas of elderly Chinese women as spousal caregivers in Hong Kong in the 1990s. An in-depth ethnographic approach was used to draw on a convenience sample of 20 elderly wives who were caregivers from Hong Kong. At the conceptual level, the discussion highlights how caregiving is rooted in complex, culturally-based models of contemporary practices, sociohistoric patterns, and gender-specific obligations. The key themes identified were marital duty-bound roles and responsibilities, reciprocity and burden, public guidelines and upholding reputations as Chinese wives, monetary restrictions, affection as an emotional force to sustain caregiving, effects of the caregiving role, and the creation of self-identity through caregiving. The model proposed for interpreting elderly Chinese wives' caregiving obligations highlights the tension-filled links between Confucianism and government guidelines, early and ongoing socializing experiences, and self-identity.

Improving collaboration between primary care and mental health services.

PubMed

Kates, Nick; Arroll, Bruce; Currie, Elizabeth; Hanlon, Charlotte; Gask, Linda; Klasen, Henrikje; Meadows, Graham; Rukundo, Godfrey; Sunderji, Nadiya; Ruud, Torleif; Williams, Mark

2018-06-20

Previous guidelines and planning documents have identified the key role primary care providers play in delivering mental health care, including the recommendation from the WHO that meeting the mental health needs of the population in many low and middle income countries will only be achieved through greater integration of mental health services within general medical settings. This position paper aims to build upon this work and present a global framework for enhancing mental health care delivered within primary care. This paper synthesizes previous guidelines, empirical data from the literature and experiences of the authors in varied clinical settings to identify core principles and the key elements of successful collaboration, and organizes these into practical guidelines that can be adapted to any setting. The paper proposes a three-step approach. The first is mental health services that any primary care provider can deliver with or without the presence of a mental health professional. Second is practical ways that effective collaboration can enhance this care. The third looks at wider system changes required to support these new roles and how better collaboration can lead to new responses to respond to challenges facing all mental health systems. This simple framework can be applied in any jurisdiction or country to enhance the detection, treatment, and prevention of mental health problems, reinforcing the role of the primary care provider in delivering care and showing how collaborative care can lead to better outcomes for people with mental health and addiction problems.

Keeping Youth Drug Free: A Guide for Parents, Grandparents, Elders, Mentors, and Other Caregivers.

ERIC Educational Resources Information Center

Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Center for Substance Abuse Prevention.

Research indicates that parents, grandparents, elders, foster parents, youth leaders, coaches, and other role models can play a major role in helping young people avoid substance abuse. This booklet provides caregivers with guidelines for communicating with youth about these potential problems. It is geared to the parents or guardians of 7-to-13…

The Role of Business in the Schools. The Best of ERIC on Educational Management Number 102.

ERIC Educational Resources Information Center

ERIC Clearinghouse on Educational Management, Eugene, OR.

Annotations of ERIC literature on the role of business in the schools are presented in this document. The following 10 items are reviewed: "What Reform Talk Does: Creating New Inequalities in Education," by Michael W. Apple; "Guidelines for Business Involvement in the Schools," by the Association for Supervision and Curriculum Development;…

Thoughtful nursing practice: reflections on nurse delegation decision-making.

PubMed

McInnis, Leigh Ann; Parsons, Lynn C

2009-12-01

This article discusses delegation challenges and legal and regulatory oversight associated with delegation in the clinical practice setting. The authors address moral and legal attributes of the roles and responsibilities of health care providers regarding delegating health care interventions. The article also explores guiding principles and rules of delegation within professional standards, national practice guidelines, and state nurse practice acts. Nurse experts provide thoughtful reflection on nursing models and the role of delegation, emphasizing the critical role of delegation in extending the role of the health care professional in patient care services.

Who's responsible for the care of women during and after a pregnancy affected by gestational diabetes?

PubMed

Wilkinson, Shelley A; Lim, Siew S; Upham, Susan; Pennington, Andrew; O'Reilly, Sharleen L; Asproloupos, Dino; McIntyre, H David; Dunbar, James A

2014-08-04

Despite its increasing incidence and high conferred risk to women and their children, gestational diabetes mellitus (GDM) is managed inconsistently during and after pregnancy due to an absence of a systemic approach to managing these women. New guidelines for GDM testing and diagnosis are based on stronger evidence, but raise concerns about increased workloads and confusion in a landscape of multiple, conflicting guidelines. Postnatal care and long-term preventive measures are particularly fragmented, with no professional group taking responsibility for this crucial role. Clearer guidelines and assistance from existing frameworks, such as the National Gestational Diabetes Register, could enable general practitioners to take ownership of the management of women at risk of type 2 diabetes following GDM, applying the principles of chronic disease management long term.

TAM receptor knockout mice are susceptible to retinal autoimmune induction.

PubMed

Ye, Fei; Li, Qiutang; Ke, Yan; Lu, Qingjun; Han, Lixia; Kaplan, Henry J; Shao, Hui; Lu, Qingxian

2011-06-16

TAM receptors are expressed mainly by dendritic cells and macrophages in the immune system, and mice lacking TAM receptors develop systemic autoimmune diseases because of inefficient negative control of the cytokine signaling in those cells. This study aims to test the susceptibility of the TAM triple knockout (tko) mice to the retina-specific autoantigen to develop experimental autoimmune uveoretinitis (EAU). TAM tko mice that were or were not immunized with interphotoreceptor retinoid-binding protein (IRBP) peptides were evaluated for retinal infiltration of the macrophages and CD3(+) T cells by immunohistochemistry, spontaneous activation of CD4(+) T cells, and memory T cells by flow cytometry and proliferation of IRBP-specific CD4(+) T cells by [(3)H]thymidine incorporation assay. Ocular inflammation induced by IRBP peptide immunization and specific T cell transfer were observed clinically by funduscopy and confirmed by histology. Tko mice were found to have less naive, but more activated, memory T cells, among which were exhibited high sensitivity to ocular IRBP autoantigens. Immunization with a low dose of IRBP and adoptive transfer of small numbers of IRBP-specific T cells from immunized tko mice caused the infiltration of lymphocytes, including CD3(+) T cells, into the tko retina. Mice without TAM receptor spontaneously develop IRBP-specific CD4(+) T cells and are more susceptible to retinal autoantigen immunization. This TAM knockout mouse line provides an animal model with which to study the role of antigen-presenting cells in the development of T cell-mediated uveitis.

Dietary Guidelines for Chinese Residents (2016): comments and comparisons

PubMed Central

Wang, Shan-shan; Lay, Sovichea; Yu, Hai-ning; Shen, Sheng-rong

2016-01-01

A high quality diet is believed to play a functional role in promoting the healthy growth of mankind and preventing many kinds of chronic degenerative diseases, including cancer, cardiovascular disease, diabetes, and obesity. Adherence to a high quality diet has been strongly associated with a lower risk of mortality. To help promote healthy lifestyles and physical strength, the Chinese government has produced a new revised version of the Dietary Guidelines for Chinese Residents (2016) and the Chinese Food Pagoda, as guidance for dietary intake among its population. Similarly, the Japanese government has produced the Japanese Food Guide Spinning Top Model, and the US government has recently published revised dietary recommendations in its 2015–2020 eighth edition of Dietary Guidelines for Americans. The evidence from all respective cohort studies involved in producing these guidelines shows a reduced risk of many chronic diseases and mortality if the guidelines are followed. All scientific findings support encouraging the general population to consume a broad variety of food on the basis of nutrient and food intakes in order to prevent deficiency diseases and a surplus of energy and nutrients, and recommend daily physical activity for health promotion. PMID:27604857

Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline.

PubMed

Polkowski, M; Larghi, A; Weynand, B; Boustière, C; Giovannini, M; Pujol, B; Dumonceau, J-M

2012-02-01

This article is the second of a two-part publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling, including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided Trucut biopsy. The first part (the Clinical Guideline) focused on the results obtained with EUS-guided sampling, and the role of this technique in patient management, and made recommendations on circumstances that warrant its use. The current Technical Guideline discusses issues related to learning, techniques, and complications of EUS-guided sampling, and to processing of specimens. Technical issues related to maximizing the diagnostic yield (e.g., rapid on-site cytopathological evaluation, needle diameter, microcore isolation for histopathological examination, and adequate number of needle passes) are discussed and recommendations are made for various settings, including solid and cystic pancreatic lesions, submucosal tumors, and lymph nodes. The target readership for the Clinical Guideline mostly includes gastroenterologists, oncologists, internists, and surgeons while the Technical Guideline should be most useful to endoscopists who perform EUS-guided sampling. A two-page executive summary of evidence statements and recommendations is provided. © Georg Thieme Verlag KG Stuttgart · New York.

Dietary Guidelines for Chinese Residents (2016): comments and comparisons.

PubMed

Wang, Shan-Shan; Lay, Sovichea; Yu, Hai-Ning; Shen, Sheng-Rong

2016-09-01

A high quality diet is believed to play a functional role in promoting the healthy growth of mankind and preventing many kinds of chronic degenerative diseases, including cancer, cardiovascular disease, diabetes, and obesity. Adherence to a high quality diet has been strongly associated with a lower risk of mortality. To help promote healthy lifestyles and physical strength, the Chinese government has produced a new revised version of the Dietary Guidelines for Chinese Residents (2016) and the Chinese Food Pagoda, as guidance for dietary intake among its population. Similarly, the Japanese government has produced the Japanese Food Guide Spinning Top Model, and the US government has recently published revised dietary recommendations in its 2015-2020 eighth edition of Dietary Guidelines for Americans. The evidence from all respective cohort studies involved in producing these guidelines shows a reduced risk of many chronic diseases and mortality if the guidelines are followed. All scientific findings support encouraging the general population to consume a broad variety of food on the basis of nutrient and food intakes in order to prevent deficiency diseases and a surplus of energy and nutrients, and recommend daily physical activity for health promotion.

Summary and critique of the new NIH guidelines for recombinant DNA research.

PubMed

Szybalski, W

1979-03-01

New NIH Guidelines for research involving recombinant DNA (R-DNA) molecules were issued on December 15, 1978. These are composed of four main parts, the first defining R-DNA and specifying prohibitions and exemptions, the second describing physical and biological containment, the third assigning the containment levels for many R-DNA experiments, and the fourth detailing the roles and responsibilities of the investigator, research institutions and NIH. Although the new Guidelines reduce restrictions, principally on those R-DNA experiments that use Escherichia coli K-12 host-vector systems, and exempt from the Guidelines several classes of experiments on prokaryotes that naturally exchange their DNA, most of their provisions are unjustified by the present assessment of the absence of any practical risks; many totally innocuous experiments are unnecessarily restricted and even virtually prohibited mainly because no host-vector systems were officially certified. The term Guidelines is a misnomer since they are mandatory regulations, even without any statutory basis. They impose large but unnecessary bureaucratic burdens on scientists, research institutions, research committees and NIH, and represent unwarranted censorship of basic research, which is antithetical to the creativity of human thought, thus posing serious dangers to the traditional freedom of inquiry.

Guidelines for the management of people with foot health problems related to rheumatoid arthritis: a survey of their use in podiatry practice.

PubMed

Williams, Anita E; Graham, Andrea S; Davies, Samantha; Bowen, Catherine J

2013-06-18

In the last decade there has been a significant expansion in the body of knowledge on the effects of rheumatoid arthritis (RA) on the foot and the management of these problems. Aligned with this has been the development of specialist clinical roles for podiatrists. However, despite being recommended by national guidelines, specialist podiatrists are scarce. In order to inform non-specialist podiatrists of the appropriate interventions for these foot problems, management guidelines have been developed and disseminated by a group of specialist podiatrists. The aim of this survey was to investigate the use of these guidelines in clinical practice. Following ethical approval an online questionnaire survey was carried out. The questions were formulated from a focus group and comprised fixed response and open response questions. The survey underwent cognitive testing with two podiatrists before being finalised. An inductive approach using thematic analysis was used with the qualitative data. 245 questionnaires were completed (128-non-specialist working in the private sector, 101 non-specialists working in the NHS and 16 specialist podiatrists). Overall, 97% of the non-specialists (n = 222) had not heard of the guidelines. The non-specialists identified other influences on their management of people with RA, such as their undergraduate training and professional body branch meetings. Three main themes emerged from the qualitative data: (i) the benefits of the foot health management guidelines, (ii) the barriers to the use of guidelines generally and (iii) the features of useable clinical guidelines. This study has revealed some crucial information about podiatrists' level of engagement with the foot health management guidelines and the use of guidelines in general. Specifically, the non-specialist podiatrists were less likely to use the foot health management guidelines than the specialist podiatrists. The positive aspects were that for the specialist practitioners, the guidelines helped them to identify their professional development needs and for the few non-specialists that did use them, they enabled appropriate referral to the rheumatology team for foot health management. The barriers to their use included a lack of understanding of the risk associated with managing people with RA and that guidelines can be too long and detailed for use in clinical practice. Suggestions are made for improving the implementation of foot health guidelines.

What helps or hinders midwives to implement physical activity guidelines for obese pregnant women? A questionnaire survey using the Theoretical Domains Framework.

PubMed

McParlin, Catherine; Bell, Ruth; Robson, Stephen C; Muirhead, Colin R; Araújo-Soares, Vera

2017-06-01

to investigate barriers and facilitators to physical activity (PA) guideline implementation for midwives when advising obese pregnant women. a cross-sectional, self-completion, anonymous questionnaire was designed using the Theoretical Domains Framework. this framework was developed to evaluate the implementation of guidelines by health care professionals. A total of 40 questions were included. These were informed by previous research on pregnant women's and midwives views, knowledge and attitudes to PA, and supported by national evidence based guidelines. Demographic information and free text comments were also collected. three diverse NHS Trusts in the North East of England. all midwives employed by two hospital Trusts and the community midwives from the third Trust (n=375) were invited to participate. mean domain scores were calculated. Factor and regression analysis were performed to describe which theoretical domains may be influencing practice. Free text comments were analysed thematically. 192 (53%) questionnaires were returned. Mean domain scores were highest for social professional role and knowledge, and lowest for skills, beliefs about capabilities and behaviour regulation. Regression analysis indicated that skills and memory/attention/decision domains had a statistically significant influence on midwives discussing PA with obese pregnant women and advising them accordingly. Midwives comments indicated that they felt it was part of their role to discuss PA with all pregnant women but felt they lacked the skills and resources to do so effectively. midwives seem to have the necessary knowledge about the need/importance of PA advice for obese women and believe it is part of their role, but perceive they lack necessary skills and resources, and do not plan or prioritise the discussion regarding PA with obese pregnant woman. designing interventions that improve skills, promote routine enquiry regarding PA and provide resources (eg. information, referral pathways) may help improve midwives' PA advice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Medical curricula and preventing childhood obesity: pooling the resources of medical students and primary care to inform curricula.

PubMed

Wylie, Ann; Furmedge, Daniel S; Appleton, Amber; Toop, Helen; Coats, Tom

2009-03-01

The study aimed to firstly provide a small self-selecting group of medical students with the opportunity to explore current approaches and opportunities addressing the prevention of childhood obesity and, secondly, to consider what aspects could be part of the taught curriculum. Medical students in their third and fourth year were invited to self-design special study modules (SSMs) exploring interventions and processes addressing the growing concern about childhood obesity. One student looked at the role of the primary care teams, two looked at community-based opportunities to improve physical activity in urban areas where there is significant deprivation and one student explored the complex role of the media as a social determinant of dietary patterns and sedentary behaviour. Primary care health professionals questioned their role in regard to raising the topic of obesity in the consultation and had limited awareness of current NICE guidelines and local interventions for referral. Local authority physical activity programmes have an important role in preventing and tackling obesity and although the media are regulated, there is limited impact on reducing obesity. Conversely, the influence of the media is complex and enables medical students and teachers to be aware of some of the social determinants influencing health-related behaviour. About a third of UK GP practices have some role in medical undergraduate education. It will therefore be inevitable that students will encounter GPs working with prevention and management of childhood obesity, however limited, and this will increasingly be part of the teaching agenda, whether formal and planned or opportunistic. Curricula could include being familiar with the evidence that informs NICE guidelines, observing these guidelines being implemented and their limitations, awareness of local schemes for referral to prevent or treat obesity and the influence of wider determinants on diet and physical activity behaviour, including the media.

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.

Results of an Integrative Analysis: A Call for Contextualizing HIV and AIDS Clinical Practice Guidelines to Support Evidence-Based Practice.

PubMed

Edwards, Nancy; Kahwa, Eulalia; Hoogeveen, Katie

2017-12-01

Practice guidelines aim to improve the standard of care for people living with HIV/AIDS. Successfully implementing guidelines requires tailoring them to populations served and to social and organizational influences on care. To examine dimensions of context, which nurses and midwives described as having a significant impact on their care of patients living with HIV/AIDS in Kenya, Uganda, South Africa, and Jamaica and to determine whether HIV/AIDS guidelines include adaptations congruent with these dimensions of context. Two sets of data were used. The first came from a qualitative study. In-depth interviews were conducted with purposively selected nurses, midwives, and nurse managers from 21 districts in four study countries. A coding framework was iteratively developed and themes inductively identified. Context dimensions were derived from these themes. A second data set of published guidelines for HIV/AIDS care was then assembled. Guidelines were identified through Google and PubMed searches. Using a deductive integrative analysis approach, text related to context dimensions was extracted from guidelines and categorized into problem and strategy statements. Ninety-six individuals participated in qualitative interviews. Four discrete dimensions of context were identified: health workforce adequacy, workplace exposure risk, workplace consequences for nurses living with HIV/AIDS, and the intersection of work and family life. Guidelines most often acknowledged health human resource constraints and presented mitigation strategies to offset them, and least often discussed workplace consequences and the intersections of family and work life. Guidelines should more consistently acknowledge diverse implementation contexts, propose how recommendations can be adapted to these realities, and suggest what role frontline healthcare providers have in realizing the structural changes necessary for healthier work environments and better patient care. Guideline recommendations should include more explicit advice on adapting their recommendations to different care conditions. © 2017 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.

Guidelines on nuclear medicine imaging in neuroblastoma.

PubMed

Bar-Sever, Zvi; Biassoni, Lorenzo; Shulkin, Barry; Kong, Grace; Hofman, Michael S; Lopci, Egesta; Manea, Irina; Koziorowski, Jacek; Castellani, Rita; Boubaker, Ariane; Lambert, Bieke; Pfluger, Thomas; Nadel, Helen; Sharp, Susan; Giammarile, Francesco

2018-06-25

Nuclear medicine has a central role in the diagnosis, staging, response assessment and long-term follow-up of neuroblastoma, the most common solid extracranial tumour in children. These EANM guidelines include updated information on 123 I-mIBG, the most common study in nuclear medicine for the evaluation of neuroblastoma, and on PET/CT imaging with 18 F-FDG, 18 F-DOPA and 68 Ga-DOTA peptides. These PET/CT studies are increasingly employed in clinical practice. Indications, advantages and limitations are presented along with recommendations on study protocols, interpretation of findings and reporting results.

The Role of Clothing in Achieving Acceptability of Environmental Temperatures between 65 F and 85 F (18 C and 30 C),

DTIC Science & Technology

1978-02-01

hands thermal comfort may not be achievable to allow for sedentary office work at temperatures below that level. The present summertime guidelines of...It seems clear that the trend, since the 1920’s, to lighter weight and less clothing will have to be reversed completely in the winter if thermal ... comfort is to be achieved at the present Federal Energy Agency guidelines of 68 to 70 F for winter thermostat settings, and because of the problem of the

Developing an eLearning tool formalizing in YAWL the guidelines used in a transfusion medicine service.

PubMed

Russo, Paola; Piazza, Miriam; Leonardi, Giorgio; Roncoroni, Layla; Russo, Carlo; Spadaro, Salvatore; Quaglini, Silvana

2012-01-01

The blood transfusion is a complex activity subject to a high risk of eventually fatal errors. The development and application of computer-based systems could help reducing the error rate, playing a fundamental role in the improvement of the quality of care. This poster presents an under development eLearning tool formalizing the guidelines of the transfusion process. This system, implemented in YAWL (Yet Another Workflow Language), will be used to train the personnel in order to improve the efficiency of care and to reduce errors.

[Reflections on a pedagogical praxis based on educational references and guidelines for nursing training].

PubMed

Timoteo, Rosalba Pessoa de Souza; Liberalino, Francisca Nazaré

2003-01-01

This text aims at supplying elements for reflection on Nursing education, considering the introduction of national curricular guidelines and the need for the creation of political-pedagogical projects in undergraduate programs. By taking as a reference some constituent factors of the pedagogical praxis, it searches to raise critical thinking on this field, on the bases and the plan for pedagogical action, as well as the relationship between theory and practice and the roles of the individuals involved in a teaching-learning process.

Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation

PubMed Central

2012-01-01

Background Facilitation is emerging as an important strategy in the uptake of evidence. However, it is not entirely clear from a practical perspective how facilitation occurs to help move research evidence into nursing practice. The Canadian Partnership Against Cancer, also known as the 'Partnership,' is a Pan-Canadian initiative supporting knowledge translation activity for improved care through guideline use. In this case-series study, five self-identified groups volunteered to use a systematic methodology to adapt existing clinical practice guidelines for Canadian use. With 'Partnership' support, local and external facilitators provided assistance for groups to begin the process by adapting the guidelines and planning for implementation. Methods To gain a more comprehensive understanding of the nature of facilitation, we conducted a mixed-methods study. Specifically, we examined the role and skills of individuals actively engaged in facilitation as well as the actual facilitation activities occurring within the 'Partnership.' The study was driven by and builds upon a focused literature review published in 2010 that examined facilitation as a role and process in achieving evidence-based practice in nursing. An audit tool outlining 46 discrete facilitation activities based on results of this review was used to examine the facilitation noted in the documents (emails, meeting minutes, field notes) of three nursing-related cases participating in the 'Partnership' case-series study. To further examine the concept, six facilitators were interviewed about their practical experiences. The case-audit data were analyzed through a simple content analysis and triangulated with participant responses from the focus group interview to understand what occurred as these cases undertook guideline adaptation. Results The analysis of the three cases revealed that almost all of the 46 discrete, practical facilitation activities from the literature were evidenced. Additionally, case documents exposed five other facilitation-related activities, and a combination of external and local facilitation was apparent. Individuals who were involved in the case or group adapting the guideline(s) also performed facilitation activities, both formally and informally, in conjunction with or in addition to appointed external and local facilitators. Conclusions Facilitation of evidence-based practice is a multifaceted process and a team effort. Communication and relationship-building are key components. The practical aspects of facilitation explicated in this study validate what has been previously noted in the literature and expand what is known about facilitation process and activity. PMID:22309743

Daylighting Makes a Difference.

ERIC Educational Resources Information Center

Heschong, Lisa; Knecht, Carey

2002-01-01

Examined the role of daylight in student achievement in three schools and found a uniformly positive and statistically significant correlation between the presence of more daylight and better student test scores. Offers guidelines on designing daylit classrooms. (EV)

Childhood Injuries--Causes, Preventive Theories and Case Studies.

ERIC Educational Resources Information Center

Fisher, Leslie

1988-01-01

Provides a priori historical experiences and illustrations of several roles played by health practitioners in applied injury prevention. Reviews various models and assesses their strengths and weaknesses. Suggests guidelines for program management. (Author/CW)

Guidelines on CV networking information flow optimization for Texas.

DOT National Transportation Integrated Search

2017-03-01

Recognizing the fundamental role of information flow in future transportation applications, the research team investigated the quality and security of information flow in the connected vehicle (CV) environment. The research team identified key challe...

76 FR 7531 - Yavapai County Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-10

...) and in compliance with the Federal Advisory Committee Act. The purpose of the meeting is to orientate new committee members to the Secural Rural Schools Act, roles of members, guidelines for Title II, and...

Chemical response to groundwater extraction southeast of Mexico City

NASA Astrophysics Data System (ADS)

Huizar-Alvarez, R.; Carrillo-Rivera, J. J.; Ángeles-Serrano, G.; Hergt, T.; Cardona, A.

An alternative procedure of pumping test data interpretation is used through a joint analysis of the standard time-drawdown curve and simultaneous field measurements of total dissolved solids (TDS); additional support is also provided by the temperature of extracted groundwater and the chemical composition of extracted water. The overall information was applied to characterise the groundwater flow system and its sources, the hydraulic conditions of the aquifer and hydraulic response of extraction boreholes. The analysis of this information suggests the presence of: (i) a local flow system that circulates at shallow depth through basalt units interstratified with fine grained sediments and pyroclastics; these materials contain water with TDS of 127-600 mg/L and Na of 24-178 mg/L, and temperature of 18-19.5 °C (ii) intermediate flow in granular material under reducing conditions by the oxidation of organic matter in aquitard sediments; this water has TDS and Na values of 203-940 and 30-370 mg/L, respectively, and temperatures of about 20-22 °C (iii) regional flow through volcanic rocks and limestone, with TDS content of 300-700 mg/L, Na of 80-230 mg/L and temperature of 23.0-24.8 °C. The hydraulic response and the chemical composition of the water produced by some boreholes are affected by the seepage inflow from sewage effluents, the input from an overlying aquitard unit and the inducement of regional flow. The conception of the flow regime thus obtained allowed the recognition of hydraulic conditions which were more consistent with the hydrogeological setting, than if only a time vs. drawdown test analysis would have been carried out. L'interprétation simultanée de pompages d'essais, des données de température et résidu sec (RS) de L'eau souterraine pompée, mesurées simultanément sur le terrain et la composition chimique de L'eau pompée comme un aide additionnelle, est utilisée comme une différent procédure pour interpréter les pompages d'essais. La procédure a été appliquée pour caractériser le système d'écoulement souterraine et sa source, les conditions hydrauliques de l'aquifère et la réponse hydraulique des puits considéré. L'analyse de cette information suggérer la présence des systèmes d'écoulement suivantes. (i) local avec18 et 19.5 °C de température, RS de 127-600 mg/L, et Na de 24-178 mg/L, (ii) intermédiaire avec une température de 20 á 22 °C, le RS de 203-940 mg/L et Na 30-370 mg/L, (iii) régional avec 300 à 700 mg/L de RS et 80 à 230 mg/L de Na, une température de 23 à 24.8 °C. Dans le premier cas, l'eau traverse des roches basaltiques, dans le deuxième, des sédiments clastiques avec matière organique de l'aquitard, dans le troisième, des roches volcaniques et calcaires. La chimie de l'eau des quelques puits et sa réponse hydraulique met en évidence l'influence de l'eau de L'aquitard, des effluents de surface et écoulement régional. La conception du régime d'écoulement obtenu, a permis reconnaître les conditions hydrauliques des puits plus correspondantes au contexte hydrogéologique, que si uniquement les données rabattement vs temps auraient été analysé La interpretación conjunta de la gráfica de prueba de bombeo, valores de temperatura y sólidos totales disueltos (STD) del agua subterránea extraída, medidos simultáneamente en campo y la composición química del agua extraída como apoyo adicional; se utilizó como un procedimiento alternativo para interpretar los datos de pruebas de bombeo. Toda esa información fue aplicada para caracterizar el sistema de flujo subterráneo y el origen de éste, las condiciones hidráulicas del acuífero y la respuesta hidráulica de los pozos de extracción. El análisis de la información indica la presencia de: (i) flujo local con temperatura de 18-19.5 °C, STD de 127-600, y Na de 24-178 mg/L (ii) flujo intermedio con temperatura de 20-22 °C, los STD y Na son de (203-940 y 30-370 mg/L), respectivamente; (iii) regional con STD de 300-700 y Na de 80-230 mg/L, y temperatura de 23-24.8 °C. En el primer caso el agua circula a través de rocas basálticas, en el segundo viaja por material granular y materia orgánica en sedimentos del acuitado. El flujo regional circula por material volcánico y rocas calizas. La respuesta hidráulica y la composición química del agua extraída por algunos pozos, es afectada por infiltración de efluentes de agua residual, entrada de agua del acuitardo sobreyacente y la inducción de flujo regional. La concepción del régimen de flujo obtenida, permitió reconocer a las condiciones hidráulicas de los pozos, más correspondientes con el contexto hidrogeológico, que sí únicamente se hubieran analizado los datos de abatimiento vs tiempo.

[Lessons learned from the implementation of Dutch national healthcare guidelines on childhood obesity].

PubMed

Schalkwijk, A A H; Nijpels, G; Bot, S D M; Chin A Paw, M J M; Renders, C M; Elders, P J M

2016-01-01

To describe the implementation and feasibility of the national healthcare guidelines on childhood obesity in a region with a high prevalence of overweight and obesity in children. Descriptive, implementation study. The implementation of the guidelines took place in the borough Amsterdam West. In total, 17 general practitioners (GP) from the Academic General Practice Network (ANH) of the VU University Medical Center, Amsterdam, participated in the study, along with 19 child healthcare practitioners and 3 paediatricians. A number of measures were taken to promote implementation. Feasibility was evaluated using both qualitative and quantitative methods. The participating healthcare providers found the training in application of the guidelines and case study discussions useful. GPs found that their role as central caregiver was not feasible. All participants expressed a preference for child healthcare practitioners as the central caregiver. A total of 327 obese children were invited to attend the GP's surgery; only 65 of them participated in the study and only 28 children were monitored for a whole year. Collaboration agreements between involved healthcare providers were rarely fulfilled. Implementation of the national healthcare guidelines on childhood obesity in the current form appears not to be feasible in Amsterdam West, despite the many implementation-enhancing measures that were applied. It is questionable whether the national healthcare guidelines on childhood obesity in its current form can contribute to addressing the societal problem of overweight and obesity in children.

Assessing the impact of the U.S. Endangered Species Act recovery planning guidelines on managing threats for listed species.

PubMed

Troyer, Caitlin M; Gerber, Leah R

2015-10-01

The Endangered Species Act (ESA) of the United States was enacted in 1973 to prevent the extinction of species. Recovery plans, required by 1988 amendments to the ESA, play an important role in organizing these efforts to protect and recover species. To improve the use of science in the recovery planning process, the Society for Conservation Biology (SCB) commissioned an independent review of endangered species recovery planning in 1999. From these findings, the SCB made key recommendations for how management agencies could improve the recovery planning process, after which the U.S. Fish and Wildlife Service and the National Marine Fisheries Service redrafted their recovery planning guidelines. One important recommendation called for recovery plans to make threats a primary focus, including organizing and prioritizing recovery tasks for threat abatement. We sought to determine the extent to which results from the SCB study were incorporated into these new guidelines and whether the SCB recommendations regarding threats manifested in recovery plans written under the new guidelines. Recovery planning guidelines generally incorporated the SCB recommendations, including those for managing threats. However, although recent recovery plans have improved in their treatment of threats, many fail to adequately incorporate threat monitoring. This failure suggests that developing clear guidelines for monitoring should be an important priority in improving ESA recovery planning. © 2015 Society for Conservation Biology.

[Spanish Adaptation of the 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice].

PubMed

Royo-Bordonada, Miguel Angel; Armario, Pedro; Lobos Bejarano, José María; Pedro-Botet, Juan; Villar Álvarez, Fernando; Elosua, Roberto; Brotons Cuixart, Carlos; Cortés, Olga; Serrano, Benilde; Camafort Babkowski, Miguel; Gil Núñez, Antonio; Pérez, Antonio; Maiques, Antonio; de Santiago Nocito, Ana; Castro, Almudena; Alegría, Eduardo; Baeza, Ciro; Herranz, María; Sans, Susana; Campos, Pilar

2016-11-24

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than 10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

Diabetes Technology-Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline.

PubMed

Peters, Anne L; Ahmann, Andrew J; Battelino, Tadej; Evert, Alison; Hirsch, Irl B; Murad, M Hassan; Winter, William E; Wolpert, Howard

2016-11-01

To formulate clinical practice guidelines for the use of continuous glucose monitoring and continuous subcutaneous insulin infusion in adults with diabetes. The participants include an Endocrine Society-appointed Task Force of seven experts, a methodologist, and a medical writer. The American Association for Clinical Chemistry, the American Association of Diabetes Educators, and the European Society of Endocrinology co-sponsored this guideline. The Task Force developed this evidence-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned one systematic review and used the best available evidence from other published systematic reviews and individual studies. One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, the American Association for Clinical Chemistry, the American Association of Diabetes Educators, and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Continuous subcutaneous insulin infusion and continuous glucose monitoring have an important role in the treatment of diabetes. Data from randomized controlled trials are limited on the use of medical devices, but existing studies support the use of diabetes technology for a wide variety of indications. This guideline presents a review of the literature and practice recommendations for appropriate device use.

Death knocks, professional practice, and the public good: the media experience of suicide reporting in New Zealand.

PubMed

Collings, Sunny C; Kemp, Christopher G

2010-07-01

Health, government, and media organizations around the world have responded to research demonstrating the imitative effects of suicide coverage in the news media by developing guidelines to foster responsible reporting. Implementation of these guidelines has encountered some resistance, and little is known about the media perspective on suicide coverage and its effects on guideline use. This qualitative study provides an in-depth appreciation of this perspective by investigating the experiences of journalists covering suicide in New Zealand. Fifteen newspaper, television and radio journalists were interviewed between December 2008 and March 2009 and transcripts were analyzed using a grounded hermeneutic editing approach. Five themes were identified: public responsibility, media framing of suicide, professional practice, personal experience of suicide reporting, and restricted reporting. Participants asserted the role of the media in the protection of the public good. Though this stance aligns them with the goals of health policymakers, it is derived from a set of professional mores at odds with the perceived paternalism of suicide reporting guidelines. Participants were stakeholders in the issue of suicide coverage. We conclude that policymakers must engage with the news media and acknowledge the competing imperatives that provide the context for the application of suicide reporting guidelines by individual journalists. Collaborative guideline development will be vital to effective implementation. Copyright 2010 Elsevier Ltd. All rights reserved.

A Novel Approach to Improving Utilization of Laboratory Testing.

PubMed

Zhou, Yaolin; Procop, Gary W; Riley, Jacquelyn D

2018-02-01

- The incorporation of best practice guidelines into one's institution is a challenging goal of utilization management, and the successful adoption of such guidelines depends on institutional context. Laboratorians who have access to key clinical data are well positioned to understand existing local practices and promote more appropriate laboratory testing. - To apply a novel approach to utilization management by reviewing international clinical guidelines and current institutional practices to create a reliable mechanism to improve detection and reduce unnecessary tests in our patient population. - We targeted a frequently ordered genetic test for HFE-related hereditary hemochromatosis, a disorder of low penetrance. After reviewing international practice guidelines, we evaluated 918 HFE tests and found that all patients with new diagnoses had transferrin saturation levels that were significantly higher than those of patients with nonrisk genotypes (72% versus 42%; P < .001). - Our "one-button" order that restricts HFE genetic tests to patients with transferrin saturation greater than 45% is consistent with published practice guidelines and detected 100% of new patients with HFE-related hereditary hemochromatosis. - Our proposed algorithm differs from previously published approaches in that it incorporates both clinical practice guidelines and local physician practices, yet requires no additional hands-on effort from pathologists or clinicians. This novel approach to utilization management embraces the role of pathologists as leaders in promoting high-quality patient care in local health care systems.

Canadian clinical practice guidelines for acute and chronic rhinosinusitis

PubMed Central

2011-01-01

This document provides healthcare practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS) and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in guidelines development, and do not address the particulars of the Canadian healthcare environment. Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg, increased use of corticosteroids). The role of bacteria in the persistence of chronic infections, and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused. Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on readability rather than completeness, yet covers relevant information, offers summaries of areas where considerable evidence exists, and provides recommendations with an assessment of strength of the evidence base and degree of endorsement by the multidisciplinary expert group preparing the document. These guidelines have been copublished in both Allergy, Asthma & Clinical Immunology and the Journal of Otolaryngology-Head and Neck Surgery. PMID:21310056

Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults With Cancer: An American Society of Clinical Oncology Guideline Adaptation

PubMed Central

Andersen, Barbara L.; DeRubeis, Robert J.; Berman, Barry S.; Gruman, Jessie; Champion, Victoria L.; Massie, Mary Jane; Holland, Jimmie C.; Partridge, Ann H.; Bak, Kate; Somerfield, Mark R.; Rowland, Julia H.

2014-01-01

Purpose A Pan-Canadian Practice Guideline on Screening, Assessment, and Care of Psychosocial Distress (Depression, Anxiety) in Adults With Cancer was identified for adaptation. Methods American Society of Clinical Oncology (ASCO) has a policy and set of procedures for adapting clinical practice guidelines developed by other organizations. The guideline was reviewed for developmental rigor and content applicability. Results On the basis of content review of the pan-Canadian guideline, the ASCO panel agreed that, in general, the recommendations were clear, thorough, based on the most relevant scientific evidence, and presented options that will be acceptable to patients. However, for some topics addressed in the pan-Canadian guideline, the ASCO panel formulated a set of adapted recommendations based on local context and practice beliefs of the ad hoc panel members. It is recommended that all patients with cancer be evaluated for symptoms of depression and anxiety at periodic times across the trajectory of care. Assessment should be performed using validated, published measures and procedures. Depending on levels of symptoms and supplementary information, differing treatment pathways are recommended. Failure to identify and treat anxiety and depression increases the risk for poor quality of life and potential disease-related morbidity and mortality. This guideline adaptation is part of a larger survivorship guideline series. Conclusion Although clinicians may not be able to prevent some of the chronic or late medical effects of cancer, they have a vital role in mitigating the negative emotional and behavioral sequelae. Recognizing and treating effectively those who manifest symptoms of anxiety or depression will reduce the human cost of cancer. PMID:24733793

Intention to use sport concussion guidelines among community-level coaches and sports trainers.

PubMed

Newton, Joshua D; White, Peta E; Ewing, Michael T; Makdissi, Michael; Davis, Gavin A; Donaldson, Alex; Sullivan, S John; Seward, Hugh; Finch, Caroline F

2014-09-01

Sporting bodies have developed guidelines for managing community-level players with suspected concussion in response to international consensus statements on concussion in sport. The purpose of this study was to examine the factors that influence the intended use of concussion guidelines among community-level coaches and sports trainers from two popular football codes in Australia: Australian football and rugby league. Cross-sectional survey. The survey, based on an extended theory of planned behaviour model, was completed by 183 Australian football coaches, 121 Australian football sports trainers, 171 rugby league coaches, and 142 rugby league sports trainers. Personal norms and self-efficacy were significant predictors of intention to use concussion guidelines, although the relationship between self-efficacy and intention was stronger among Australian football coaches than rugby league coaches. Analysis of the salient beliefs that underpin self-efficacy found that coaches, irrespective of football code, felt less familiar (χ(2)=25.70, p<0.001) and less experienced (χ(2)=31.56, p<0.001) than sports trainers in using the concussion guidelines. At the same time, Australian football personnel, irrespective of their team role, felt that they had insufficient time (χ(2)=8.04, p<0.01) and resources (χ(2)=12.31, p<0.001) to implement the concussion guidelines relative to rugby league personnel. Programmes aimed at increasing the intended use of sport concussion guidelines should focus on enhancing self-efficacy and leveraging personal norms. Increasing coaches' familiarity and experience in using the concussion guidelines would also be warranted, as would finding ways to overcome the perceived time and resource constraints identified among Australian football personnel. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Commentary on recent therapeutic guidelines for osteoarthritis.

PubMed

Cutolo, Maurizio; Berenbaum, Francis; Hochberg, Marc; Punzi, Leonardo; Reginster, Jean-Yves

2015-06-01

Despite availability of international evidence-based guidelines for osteoarthritis (OA) management, agreement on the different treatment modalities is lacking. A symposium of European and US OA experts was held within the framework of the Annual European Congress of Rheumatology to discuss and compare guidelines and recommendations for the treatment of knee OA and to reach a consensus for management, particularly for areas in which there is no clear consensus: non-pharmacological therapy; efficacy and safety of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs); intra-articular (i.a.) hyaluronates (HA); and the role of chondroitin sulfate (CS) and/or glucosamine sulfate (GS). All guidelines reviewed agree that knee OA is a progressive disease of the joint whose management requires non-pharmacological and pharmacological approaches. Discrepancies between guidelines are few and mostly reflect heterogeneity of expert panels involved, geographical differences in the availability of pharmacotherapies, and heterogeneity of the studies included. Panels chosen for guideline development should include experts with real clinical experience in drug use and patient management. Implementation of agreed guidelines can be thwarted by drug availability and reimbursement plans, resulting in optimal OA treatment being jeopardized, HA and symptomatic slow-acting drugs for osteoarthritis (SySADOAs) being clear examples of drugs whose availability and prescription can greatly vary geographically. In addition, primary care providers, often responsible for OA management (at least in early disease), may not adhere to clinical care guidelines, particularly for non-pharmacological OA treatment. Harmonization of the recommendations for knee OA treatment is challenging but feasible, as shown by the step-by-step therapeutic algorithm developed by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). More easily disseminated and implemented guidance for OA treatment in the primary care setting is key to improved management of OA. Copyright © 2015 Elsevier Inc. All rights reserved.

Direct simulation of groundwater transit-time distributions using the reservoir theory

NASA Astrophysics Data System (ADS)

Etcheverry, David; Perrochet, Pierre

Groundwater transit times are of interest for the management of water resources, assessment of pollution from non-point sources, and quantitative dating of groundwaters by the use of environmental isotopes. The age of water is the time water has spent in an aquifer since it has entered the system, whereas the transit time is the age of water as it exits the system. Water at the outlet of an aquifer is a mixture of water elements with different transit times, as a consequence of the different flow-line lengths. In this paper, transit-time distributions are calculated by coupling two existing methods, the reservoir theory and a recent age-simulation method. Based on the derivation of the cumulative age distribution over the whole domain, the approach accounts for the whole hydrogeological framework. The method is tested using an analytical example and its applicability illustrated for a regional layered aquifer. Results show the asymmetry and multimodality of the transit-time distribution even in advection-only conditions, due to the aquifer geometry and to the velocity-field heterogeneity. Résumé Les temps de transit des eaux souterraines sont intéressants à connaître pour gérer l'évaluation des ressources en eau dans le cas de pollution à partir de sources non ponctuelles, et aussi pour dater quantitativement les eaux souterraines au moyen des isotopes du milieu. L'âge de l'eau est le temps qu'elle a passé dans un aquifère depuis qu'elle est entrée dans le système, alors que le temps de transit est l'âge de l'eau au moment où elle quitte le système. L'eau à la sortie d'un aquifère est un mélange d'eaux possédant différents temps de transit, du fait des longueurs différentes des lignes de courant suivies. Dans ce papier, les distributions des temps de transit sont calculées en couplant deux méthodes, la théorie du réservoir et une méthode récente de simulation des âges. Basée sur la dérivation de la distribution cumulées des âges sur tout le domaine, l'approche prend en compte le cadre hydrogéologique dans son ensemble. La méthode est testée sur un exemple analytique et son applicabilité est illustrée pour un aquifère stratifié régional. Les résultats montrent l'asymétrie et la plurimodalité de la distribution des temps de transit même dans des conditions uniquement d'advection, à cause de la géométrie de l'aquifère et de l'hétérogénéité du champ des vitesses. Resumen El estudio de los tiempos de tránsito del agua subterránea es muy útil para (1) la gestión de los recursos de agua frente a la contaminación por focos no puntuales, y (2) la datación de aguas mediante isótopos ambientales. La edad de un agua subterránea es el tiempo que ésta ha permanecido en el acuífero contada desde el momento de su entrada, mientras que el tiempo de tránsito corresponde a la edad del agua en el momento en que abandona el sistema. En el punto de descarga en realidad se encuentra una mezcla de aguas con distintos tiempos de tránsito, debido a la yuxtaposición de líneas de flujo con diferentes recorridos. En este artículo se calculan las distribuciones de tiempos de tránsito mediante el acoplamiento de dos métodos ya existentes: la teoría de embalse y un método reciente de simulación de edades. El método se basa en la derivación de la distribución acumulada de edades, y es aplicable en todo el dominio hidrogeológico. El método se ha probado en un ejemplo analítico, y su aplicabilidad se muestra para un acuífero estratificado. Como resultado se obtiene que, aun en el caso de flujo exclusivamente advectivo, la distribución de tiempos de tránsito es asimétrica y multimodal debido a la geometría del acuífero y a la heterogeneidad del campo de velocidades.

The Role of Patient Safety in the Device Purchasing Process

DTIC Science & Technology

2005-05-01

Juliana J. Brixey, Danielle Paige, James P. Turley Abstract To examine how patient safety considerations are incorporated into medical device...Despite the general awareness of patient safety, its importance, and its role in medical device comparisons and purchasing decisions, this study...into the medical device purchasing process. We presently have a set of guidelines in development to help hospitals better emphasize patient safety

Promoting Positive Peer Interactions in the Preschool Classroom: The Role and the Responsibility of the Teacher in Supporting Children's Sociodramatic Play

ERIC Educational Resources Information Center

Stanton-Chapman, Tina L.

2015-01-01

Teachers play an important role in expanding and supporting children's play and interactions with peers. This manuscript provides specific guidelines for interventions teachers can use to promote successful peer interactions in preschool settings. The strategies discussed include: (a) preparing the physical environment for play (e.g., toy…

Striking the Balance: The Role of English and German in a Multilingual English-Medium Degree Programme in German Higher Education

ERIC Educational Resources Information Center

Earls, Clive W.

2014-01-01

In 2002, English-medium degree programmes (EMDPs) became a permanent feature of German higher education (HE). While this action marked an important step towards government-supported institutionalisation of English in Germany, no formal strategy or guidelines governing the role of English in HE have been developed. To date, research in this area in…

Oncology nurses' perceptions of barriers to discussion of fertility preservation with patients with cancer.

PubMed

King, Lindsey; Quinn, Gwendolyn P; Vadaparampil, Susan T; Gwede, Clement K; Miree, Cheryl A; Wilson, Crystal; Clayton, Heather; Perrin, Karen

2008-06-01

Infertility is a common result of cancer treatment; however, opportunities exist for patients to preserve fertility prior to treatment. Recent evidence suggests that healthcare providers, including nurses, do not consistently discuss fertility preservation (FP) with patients. This qualitative, cross-sectional pilot study used a focus group and in-depth interviews to explore knowledge, attitudes, and practice behaviors related to nurses' discussion of FP with patients with cancer. Results indicate that only half of the nurses discuss FP methods with patients, even though most believe that having discussions with patients about fertility is part of their role. Factors associated with the discussion of FP among nurses included (a) knowledge (FP procedures, fertility institutes and clinics, resources for patients, and practice guidelines), (b) attitudes (difficulty finding facilities, time constraints, role, comfort level, ethical issues, financial considerations, and patient characteristics), and (c) behaviors (patient initiation, physician behaviors, patient characteristics, and timing). Discussion should be stimulated among nurses about the role of nurses in the FP discussion, and educational interventions and practice guidelines should be developed that are aimed at oncology nurses to help facilitate discussions with patients.

Genetic testing of aetiology of intellectual disability in a dedicated physical healthcare outpatient clinic for adults with intellectual disability.

PubMed

Wallace, R A

2016-02-01

No guidelines exist for assessment of aetiology of intellectual disability in adults with intellectual disability by adult physicians, although robust guidelines exist for paediatric populations. It was speculated that the paediatric guidelines would also be suitable for adults. In rural/regional setting with limited clinical genetics, to perform a quality assurance evaluation on genetics assessment of aetiology of developmental disability in adults attending a dedicated healthcare clinic for adults with intellectual disability, compared results with paediatric standards, speculates if these seem appropriate for adults and speculates on a role for clinical genetics services. Retrospective chart audit of eligible patients looking at genetic clinical assessment, tests selected (molecular karyotype, G banding, metabolics), and yields of positive results. The results were compared with the recommended paediatric guidelines. Of 117 eligible adult patients, ideal genetic history was incomplete for 40% of patients without Down syndrome because of physician cause and lack of information. The number of abnormal genetic results increased from 46% to 66%, mainly from the molecular karyotype, though not all may have been clinically relevant. The improved yield from this test was similar to that in paediatric studies. Use of G banding and metabolic testing could be refined. Improvement can be made in clinical genetic assessment, but results generally support use of molecular karyotyping as first tier testing of cause of unknown intellectual disability in adults, as in the case for paediatric populations. The study highlights a necessary complementary role for clinical geneticists to interpret abnormal results. © 2016 Royal Australasian College of Physicians.

Guidelines of the previous consensus conference and recent developments.

PubMed

Beck, I T

1997-09-01

This article reviews the major changes that have occurred since the last Canadian consensus conference on gastroesophageal reflux disease (GERD), which was held four years ago. There were developments in the understanding of the pathophysiology of this disease and improvements in the methods of its investigation and management. Esophageal and extraesophageal complications have also been better defined. Since 1992 new knowledge on nitric oxide has been gained and several new inflammatory cytokines have been developed. Improved understanding of the mechanism of the hypersensitive esophagus helped to explain the presence of clinical symptoms with normal endoscopic findings. This also improved interpretation of the role of 24 h pH monitoring and 24 h pH with motility recording. There is better understanding of the role of H2 receptor antagonists and prokinetics and an increasing confidence in the long term safety of proton pump inhibitors (PPIs). The most important changes occurred in surgery with the introduction of laparoscopic fundoplication. Patients with Barrett's esophagus who are too ill for esophagectomy may now be enrolled in surveillance because it is possible to deal with dysplasia and small cancers with photodynamic therapy. As an introductory lecture to the consensus conference, this article also deals with the subject of health economics and discusses the necessity and the dangers involved in devising treatment guidelines. It indicates that guidelines change with advancing knowledge, and emphasizes that physicians' primary duty is toward their patients. Therefore, guidelines devised here should be adjusted to the individual needs of patients. Organizational aspects of the present conference are also described.

Understanding sexually transmitted infection screening and management in Indiana community health centers.

PubMed

Navale, Shalini M; Meyerson, Beth E; Ohmit, Anita; Gillespie, Anthony

2014-11-01

The role of community health centers (CHCs) in preventive health care is central to health reform, yet little is known about how CHCs identify and manage sexually transmitted infections (STIs). A survey of Indiana CHCs from April to May 2013 measured reported STI services, clinic expectations for STI testing and management, barriers to screening and management, and partner services. Reported practices were compared with current Centers for Disease Control and Prevention (CDC) guidelines for STI testing in clinical settings. Although most CHCs reported screening for syphilis (75.0%), chlamydia, and gonorrhea (85.7%), screening generally did not reflect CDC guidelines. Chlamydia and gonorrhea testing was provided primarily at patient request or when symptomatic by 67.9% of CHCs. Syphilis testing at 67.9% of CHCs reflected CDC guidelines for adults 65 years or younger and at 53.6% for first-trimester pregnant women. Chlamydia and gonorrhea screening reflected CDC guidelines for 17.9% of CHCs for gay/bisexual men and 60.9% for first-trimester pregnant women. One-third (35%) of CHCs reported not knowing the expectation for screening pregnant women and gay/bisexual men. It is likely that CHCs are not aware of patient sexual health risks because standard of care screening was observed only for gonorrhea and chlamydia during the first trimester and for syphilis testing when symptoms were present. As CHCs increase their role in preventive care with the implementation of the Affordable Care Act, focus must be upon clinician awareness of patient sexual health and training to identify and manage STIs in their patient populations.

Push hard, push fast, if you’re downtown: a citation review of urban-centrism in American and European basic life support guidelines

PubMed Central

2013-01-01

Bystander cardiopulmonary resuscitation (CPR) improves out-of-hospital cardiac arrest (OHCA) survival. In settings with prolonged ambulance response times, skilled bystanders may be even more crucial. In 2010, American Heart Association (AHA) and European Resuscitation Council (ERC) introduced compression-only CPR as an alternative to conventional bystander CPR under some circumstances. The purpose of this citation review and document analysis is to determine whether the evidentiary basis for 2010 AHA and ERC guidelines attends to settings with prolonged ambulance response times or no formal ambulance dispatch services. Primary and secondary citations referring to epidemiological research comparing adult OHCA survival based on the type of bystander CPR were included in the analysis. Details extracted from the citations included a study description and primary outcome measure, the geographic location in which the study occurred, EMS response times, the role of dispatchers, and main findings and summary statistics regarding rates of survival among patients receiving no CPR, conventional CPR or compression-only CPR. The inclusion criteria were met by 10 studies. 9 studies took place exclusively in urban settings. Ambulance dispatchers played an integral role in 7 studies. The cited studies suggest either no survival benefit or harm arising from compression-only CPR in settings with extended ambulance response times. The evidentiary basis for 2010 AHA and ERC bystander CPR guidelines does not attend to settings without rapid ambulance response times or dispatch services. Standardized bystander CPR guidelines may require adaptation or reconsideration in these settings. PMID:23601200

A qualitative examination of the perceptions of parents on the Canadian Sedentary Behaviour Guidelines for the early years.

PubMed

Carson, Valerie; Clark, Marianne; Berry, Tanya; Holt, Nicholas L; Latimer-Cheung, Amy E

2014-05-17

Minimizing sedentary behavior, in particular screen-based sedentary behavior, during the early years is important for healthy growth and development. Consequently, new Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years) were recently released. Researchers are unclear what messages should supplement the guidelines when disseminating them to parents and when using the guidelines in behaviour-change interventions to increase adoption. The objective of this study was to qualitatively examine parents' perceptions of the new Canadian Sedentary Behaviour Guidelines for the Early Years. Parents with a child ≤4 years who attended a child care centre were purposefully recruited from child care centres. A total of 7 semi-structured focus groups with 2 to 5 parents were conducted from August to November, 2013 by a trained and experienced moderator. Participants were asked a series of open-ended questions pertaining to the Sedentary Behaviour Guidelines information sheet. Initial themes were identified followed by further review and analysis. For the most part parents thought the guidelines were clear and did not disagree with the recommendations per se. However, some confusion arose around the value of some sedentary activities, such as reading and coloring, for social and cognitive development. Many parents described feeling guilty after reading the guidelines and perceived several barriers in meeting the daily recommendations. Common barriers included the need to balance multiple demands of family life, the prevalence and accessibility of screen technology, and the weather and built environment where families live. Parents expressed the importance of communicating the guidelines early enough for good habits to be established and the need for realistic strategies and ideas to help them meet the recommendations. Overall the findings indicate that gain-framed messages around the role of screen-based and non-screen-based sedentary behavior for children's cognitive and social development might be most effective for adoption of the guidelines. Furthermore, providing parents the guidelines early with resources for minimizing sedentary behavior should also be considered. Future research is needed in other demographic groups of parents to confirm these findings.

A qualitative examination of the perceptions of parents on the Canadian Sedentary Behaviour Guidelines for the early years

PubMed Central

2014-01-01

Background Minimizing sedentary behavior, in particular screen-based sedentary behavior, during the early years is important for healthy growth and development. Consequently, new Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0–4 years) were recently released. Researchers are unclear what messages should supplement the guidelines when disseminating them to parents and when using the guidelines in behaviour-change interventions to increase adoption. The objective of this study was to qualitatively examine parents’ perceptions of the new Canadian Sedentary Behaviour Guidelines for the Early Years. Methods Parents with a child ≤4 years who attended a child care centre were purposefully recruited from child care centres. A total of 7 semi-structured focus groups with 2 to 5 parents were conducted from August to November, 2013 by a trained and experienced moderator. Participants were asked a series of open-ended questions pertaining to the Sedentary Behaviour Guidelines information sheet. Initial themes were identified followed by further review and analysis. Results For the most part parents thought the guidelines were clear and did not disagree with the recommendations per se. However, some confusion arose around the value of some sedentary activities, such as reading and coloring, for social and cognitive development. Many parents described feeling guilty after reading the guidelines and perceived several barriers in meeting the daily recommendations. Common barriers included the need to balance multiple demands of family life, the prevalence and accessibility of screen technology, and the weather and built environment where families live. Parents expressed the importance of communicating the guidelines early enough for good habits to be established and the need for realistic strategies and ideas to help them meet the recommendations. Conclusions Overall the findings indicate that gain-framed messages around the role of screen-based and non-screen-based sedentary behavior for children’s cognitive and social development might be most effective for adoption of the guidelines. Furthermore, providing parents the guidelines early with resources for minimizing sedentary behavior should also be considered. Future research is needed in other demographic groups of parents to confirm these findings. PMID:24886305

PHYTOASSESSMENT OF ESTUARINE SEDIMENTS

EPA Science Inventory

Most sediment quality assessments and quality guidelines are based on the laboratory response of single animal species and benthic animal community composition. The role of plants in this hazard assessment process is poorly understood despite the fact that plant-dominated habitat...

Heads Up, Shoulders Straight, Stick and Twirl Together

ERIC Educational Resources Information Center

Warrick, James

1977-01-01

With so many roles to juggle and so many complex music problems to resolve, some marching band directors overlook simple rules of thumb to increase their bands' visual and musical impact. Here are some guidelines. (Author/RK)

Guinea Pig Guidelines.

ERIC Educational Resources Information Center

McQuillan, Patrick; Muncey, Donna

1991-01-01

When researchers want to scrutinize a school, the principal should get straight answers to questions concerning research focus and purpose, data collection methods, participants needed, school personnel's research roles, confidentiality protection, data analysis assistance, feedback, and participant access to findings. (MLH)

75 FR 44757 - Yavapai County Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-29

... and Community Self-Determination Act (Pub. L. 110- 343) and in compliance with the Federal Advisory... Act, roles of members, guidelines for Title II, and the Federal Advisory Committee Act. DATES: The... Designated Federal [[Page 44758

Probiotics, Prebiotics & Food allergy Prevention: Clinical Data in Children.

PubMed

Fiocchi, Alessandro; Pecora, Valentina; Dahdah, Lamia

2016-07-01

there are accruing evidences on the role of the intestinal microbiota in the development of allergic diseases among infants. Elaborating on this theoretical basis, studies did assess the possibilities to prevent allergic diseases in infancy through manipulation of the intestinal microbiota. We review here such studies. interventional studies led to conflicting conclusions on the possible role of probiotics and prebiotics in allergy prevention. Two metanalyses published in 2015 did reconcile all data. Guidelines have been predicated on such studies using the GRADE methodology. the guidelines for allergy prevention suggest for the first time the use of probiotics and prebiotics. The existing evidences stand for a use of such supplementation in particular for the prevention of eczema. As there is no evidence so far of superiority of one probiotic strand over the others, they should be considered as class and not as individual products.

Viral bronchiolitis.

PubMed

Florin, Todd A; Plint, Amy C; Zorc, Joseph J

2017-01-14

Viral bronchiolitis is a common clinical syndrome affecting infants and young children. Concern about its associated morbidity and cost has led to a large body of research that has been summarised in systematic reviews and integrated into clinical practice guidelines in several countries. The evidence and guideline recommendations consistently support a clinical diagnosis with the limited role for diagnostic testing for children presenting with the typical clinical syndrome of viral upper respiratory infection progressing to the lower respiratory tract. Management is largely supportive, focusing on maintaining oxygenation and hydration of the patient. Evidence suggests no benefit from bronchodilator or corticosteroid use in infants with a first episode of bronchiolitis. Evidence for other treatments such as hypertonic saline is evolving but not clearly defined yet. For infants with severe disease, the insufficient available data suggest a role for high-flow nasal cannula and continuous positive airway pressure use in a monitored setting to prevent respiratory failure. Copyright © 2017 Elsevier Ltd. All rights reserved.

An Analysis of Website Accessibility in Higher Education in Indonesia Based on WCAG 2.0 Guidelines

NASA Astrophysics Data System (ADS)

Arasid, W.; Abdullah, A. G.; Wahyudin, D.; Abdullah, C. U.; Widiaty, I.; Zakaria, D.; Amelia, N.; Juhana, A.

2018-02-01

Website accessibility is a simple way to access a website by everyone so that information on the website can be easily understood. This study aims to improve the accessibility of universities’ website to analyze website accessibility problems based on WCAG 2.0 guidelines. This study analyzed 13 universities’ websites in West Java, Indonesia by using TAW as an evaluation tool. The evaluation results were presented in a graph showing the error rate of each university’s website. The same errors that occurred in almost all websites were: non-text content, info and relationships, page title, link purpose, language of page, on input, labels and instructions, parsing, and name, role, value criteria. This study was expected to provide information to the university and to perform as guidelines for website accessibility improvements.

The role of traditional foods in food-based dietary guidelines - A South African case study on maas (cultured milk).

PubMed

Du Plooy, Z; Schönfeldt, H C; Hall, N

2018-01-01

With the revision of the South African food-based dietary guidelines (FBDGs) a new guideline specifically recommending the daily consumption of dairy products including maas (cultured milk) was introduced. This paper aims to evaluate the relevance of including maas as a traditional food product in the FBDGs. It was found that maas is a culturally relevant and traditional food product in South Africa. The nutrient profile of maas has changed notably over time since the first nutrient analysis was performed in 1995. The health benefits of maas, together with its popularity and its cultural relevance as part of the South African diet, make maas a suitable traditional food product to be included in the South African FBDGs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Implications of the new international sepsis guidelines for nursing care.

PubMed

Kleinpell, Ruth; Aitken, Leanne; Schorr, Christa A

2013-05-01

Sepsis is a serious worldwide health care condition that is associated with high mortality rates, despite improvements in the ability to manage infection. New guidelines for the management of sepsis were recently released that advocate for implementation of care based on evidence-based practice for both adult and pediatric patients. Critical care nurses are directly involved in the assessment of patients at risk for developing sepsis and in the treatment of patients with sepsis and can, therefore, affect outcomes for critically ill patients. Nurses' knowledge of the recommendations in the new guidelines can help to ensure that patients with sepsis receive therapies that are based on the latest scientific evidence. This article presents an overview of new evidence-based recommendations for the treatment of adult patients with sepsis, highlighting the role of critical care nurses.

Looking Inward: Philosophical and Methodological Perspectives on Phenomenological Self-Reflection.

PubMed

Pool, Natalie M

2018-07-01

Engaging in early and ongoing self-reflection during interpretive phenomenological research is critical for ensuring trustworthiness or rigor. However, the lack of guidelines and clarity about the role of self-reflection in this methodology creates both theoretical and procedural confusion. The purpose of this article is to describe key philosophical underpinnings, characteristics, and hallmarks of the process of self-reflection in interpretive phenomenological investigation and to provide a list of guidelines that facilitate this process. Excerpts from an interpretive phenomenological study are used to illustrate characteristics of quality self-reflection. The guidelines are intended to be particularly beneficial for novice researchers who may find self-reflective writing to be daunting and unclear. Facilitating use of self-reflection may strengthen both the interpretive phenomenological body of work as well as that of all qualitative research.

Improving implementation of the smoking cessation guidelines with pregnant women: How to support clinicians?

PubMed

Longman, Jo M; Adams, Catherine M; Johnston, Jennifer J; Passey, Megan E

2018-03-01

this study aimed to explore the enablers and barriers to implementation of the Australian smoking cessation in pregnancy guidelines. These guidelines direct clinicians to follow the 5As of cessation: Ask, Advise, Assess, Assist and Arrange follow-up. semi-structured interviews based on the Theoretical Domains Framework (TDF) elicited clinicians' views and experiences of implementing the guidelines. antenatal care in the NSW public health system. 27 maternity service managers, obstetricians and midwives. participants confirmed that implementation of the smoking cessation guidelines was sub-optimal. This was particularly the case with Assist and Arrange follow up at the initial visit, and with following any of the 5As at subsequent visits. Key barriers included systems which did not support implementation or monitoring, lack of knowledge, skills and training, perceived time restrictions, 'difficult conversations' and perceiving smoking as a social activity. Enablers included clinicians' knowledge of the harms of smoking in pregnancy, clinicians' skills in communicating with pregnant women, positive emotions, professional role and identity, the potential of training and of champions to influence practice, and systems that regulated behaviour. these findings will contribute to the development of a multifaceted intervention to support clinicians in implementing the guidelines. Building on existing strengths, antenatal care providers may be supported in implementing the guidelines by working with systems which remind and support implementation, the clear reframing of smoking as an addiction, knowledge and skills development and by realizing the potential of leadership to maximise the impact of reinforcement and social influence. Copyright © 2018 Elsevier Ltd. All rights reserved.

Appropriateness of Plasma Transfusion: A College of American Pathologists Q-Probes Study of Guidelines, Waste, and Serious Adverse Events.

PubMed

Alcorn, Kirsten; Ramsey, Glenn; Souers, Rhona; Lehman, Christopher M

2017-03-01

- Plasma transfusion guidelines support patient care and safety, management of product wastage, and compliance; yet, there is little information across multiple institutions about use of and adherence to plasma transfusion guidelines. - To survey multiple institutions regarding their plasma transfusion guidelines and compliance, plasma wastage rates, and incidence of transfusion reactions associated with plasma transfusion. - The College of American Pathologists Q-Probes model was used to collect data from 89 participating institutions. Each site was asked to provide data relevant to its most recent 40 adult patient plasma transfusion episodes, and complete a questionnaire regarding plasma transfusion guidelines, utilization and wastage of plasma, and transfusion reactions related to plasma transfusion. - The participating institutions reported a total of 3383 evaluable plasma transfusion episodes with transfusion of 9060 units of plasma. Compliance with institution-specific guidelines was seen in 3018 events (89%). Pretransfusion and posttransfusion coagulation testing was done in 3281 (97%) and 3043 (90%) of these episodes, respectively. Inappropriate criteria were noted for more than 100 transfusion episodes. Thirty-two plasma transfusion episodes (1%) were associated with a transfusion reaction. Serious and fatal reactions were reported. Median plasma wastage rate for the year preceding the study was 4.5%. - Most participating institutions are compliant with plasma transfusion guidelines based on published references, supported by appropriate testing. With transfusions for indications that lack evidence of efficacy and incidence of transfusion reactions, there is an ongoing role for transfusion service leaders to continue to update and monitor plasma transfusion practices.

Can 'Cascades' make guidelines global?

PubMed

Fried, Michael; Krabshuis, Justus

2008-10-01

Why are guidelines in medicine so important today? What role do they have? Why and how did the World Gastroenterology Organization (WGO) choose a global focus? What does this mean for guidelines? These are the underlying questions addressed by our article. We argue that the addition of 'Cascades' to guidelines will increase their impact in large parts of the world. By so doing, we hope to add a new dimension to the 'knowledge into action' debate. A number of illustrations shows how raised expectations and resource restrictions pose - or should pose - an enormous challenge for guideline makers. Furthermore, the emphasis on evidence also creates problems for guideline making. If resources are limited it is unlikely gold-standard technologies are available. We believe Cascades can help. A Cascade is a selection of two or more hierarchical diagnostic or therapeutic options, based on proven medical procedures, methods, tools or products for the same disease, condition or diagnosis, aiming to achieve the same outcome and ranked by available resources. The construction of such a cascade is a hazardous intellectual journey that goes, to some extent, against established practice. But lives can be saved by matching options for diagnosis and treatment to available resources. While the optimal strategy, defined through an evidence-based approach, should always be the goal, one must be aware of the resource limitations that confront our colleagues in certain parts of the world and we should endeavour to work with them in the guideline development process to develop strategies that are clinically sound yet economically feasible and dacceptable to their populace.

Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

PubMed

Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

2008-01-01

The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.