[How do first codes of medical ethics inspire contemporary physicians?].

PubMed

Paprocka-Lipińska, Anna; Basińska, Krystyna

2014-02-01

First codes of medical ethics appeared between 18th and 19th century. Their formation was inspired by changes that happened in medicine, positive in general but with some negative setbacks. Those negative consequences revealed the need to codify all those ethical duties, which were formerly passed from generation to generation by the word of mouth and individual example by master physicians. 210 years has passed since the publication of "Medical Ethics" by Thomas Percival, yet essential ethical guidelines remain the same. Similarly, ethical codes published in Poland in 19 century can still be an inspiration to modem physicians.

The Nuremberg Code-A critique.

PubMed

Ghooi, Ravindra B

2011-04-01

The Nuremberg Code drafted at the end of the Doctor's trial in Nuremberg 1947 has been hailed as a landmark document in medical and research ethics. Close examination of this code reveals that it was based on the Guidelines for Human Experimentation of 1931. The resemblance between these documents is uncanny. It is unfortunate that the authors of the Nuremberg Code passed it off as their original work. There is evidence that the defendants at the trial did request that their actions be judged on the basis of the 1931 Guidelines, in force in Germany. The prosecutors, however, ignored the request and tried the defendants for crimes against humanity, and the judges included the Nuremberg Code as a part of the judgment. Six of ten principles in Nuremberg Code are derived from the 1931 Guidelines, and two of four newly inserted principles are open to misinterpretation. There is little doubt that the Code was prepared after studying the Guidelines, but no reference was made to the Guidelines, for reasons that are not known. Using the Guidelines as a base document without giving due credit is plagiarism; as per our understanding of ethics today, this would be considered unethical. The Nuremberg Code has fallen by the wayside; since unlike the Declaration of Helsinki, it is not regularly reviewed and updated. The regular updating of some ethics codes is evidence of the evolving nature of human ethics.

The Nuremberg Code–A critique

PubMed Central

Ghooi, Ravindra B.

2011-01-01

The Nuremberg Code drafted at the end of the Doctor’s trial in Nuremberg 1947 has been hailed as a landmark document in medical and research ethics. Close examination of this code reveals that it was based on the Guidelines for Human Experimentation of 1931. The resemblance between these documents is uncanny. It is unfortunate that the authors of the Nuremberg Code passed it off as their original work. There is evidence that the defendants at the trial did request that their actions be judged on the basis of the 1931 Guidelines, in force in Germany. The prosecutors, however, ignored the request and tried the defendants for crimes against humanity, and the judges included the Nuremberg Code as a part of the judgment. Six of ten principles in Nuremberg Code are derived from the 1931 Guidelines, and two of four newly inserted principles are open to misinterpretation. There is little doubt that the Code was prepared after studying the Guidelines, but no reference was made to the Guidelines, for reasons that are not known. Using the Guidelines as a base document without giving due credit is plagiarism; as per our understanding of ethics today, this would be considered unethical. The Nuremberg Code has fallen by the wayside; since unlike the Declaration of Helsinki, it is not regularly reviewed and updated. The regular updating of some ethics codes is evidence of the evolving nature of human ethics. PMID:21731859

An Analysis of Due Process Cases and Doctrines: Implications for School Districts

ERIC Educational Resources Information Center

Bleakney, William; Glass, Thomas

1977-01-01

Identifies criteria relating to procedural due process from current judicial opinions, rulings of state attorneys general, and state administrative codes; applies the criteria to an analysis of school policies; and suggests guidelines for public school districts in the assessment, implementation, and revision of policies relating to procedural due…

LEA in Private: A Privacy and Data Protection Framework for a Learning Analytics Toolbox

ERIC Educational Resources Information Center

Steiner, Christina M.; Kickmeier-Rust, Michael D.; Albert, Dietrich

2016-01-01

To find a balance between learning analytics research and individual privacy, learning analytics initiatives need to appropriately address ethical, privacy, and data protection issues. A range of general guidelines, model codes, and principles for handling ethical issues and for appropriate data and privacy protection are available, which may…

Implementation plans included in World Health Organisation guidelines.

PubMed

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

2016-05-20

The implementation of high-quality guidelines is essential to improve clinical practice and public health. The World Health Organisation (WHO) develops evidence-based public health and other guidelines that are used or adapted by countries around the world. Detailed implementation plans are often necessary for local policymakers to properly use the guidelines developed by WHO. This paper describes the plans for guideline implementation reported in WHO guidelines and indicates which of these plans are evidence-based. We conducted a content analysis of the implementation sections of WHO guidelines approved by the WHO guideline review committee between December 2007 and May 2015. The implementation techniques reported in each guideline were coded according to the Cochrane Collaboration's Effective Practice and Organisation of Care (EPOC) taxonomy and classified as passive, active or policy strategies. The frequencies of implementation techniques are reported. The WHO guidelines (n = 123) analysed mentioned implementation techniques 800 times, although most mentioned implementation techniques very briefly, if at all. Passive strategies (21 %, 167/800) and general policy strategies (62 %, 496/800) occurred most often. Evidence-based active implementation methods were generally neglected with no guideline mentioning reminders (computerised or paper) and only one mentioning a multifaceted approach. Many guidelines contained implementation sections that were identical to those used in older guidelines produced by the same WHO technical unit. The prevalence of passive and policy-based implementation techniques as opposed to evidence-based active techniques suggests that WHO guidelines should contain stronger guidance for implementation. This could include structured and increased detail on implementation considerations, accompanying or linked documents that provide information on what is needed to contextualise or adapt a guideline and specific options from among evidence-based implementation strategies.

How Principled Are Guidelines?

ERIC Educational Resources Information Center

Homan, Roger

1998-01-01

Explores and interprets factors related to the burgeoning of codes, criteria, and guidelines in recent years within three kinds of context: (1) higher degree and dissertation-award processes; (2) guidelines for teachers and university lecturers; and (3) codes for researchers in the social sciences. Discusses the intentions and unforeseen…

Follow the Code: Rules or Guidelines for Academic Deans' Behavior?

ERIC Educational Resources Information Center

Bray, Nathaniel J.

2012-01-01

In the popular movie series "Pirates of the Caribbean," there is a pirate code that influences how pirates behave in unclear situations, with a running joke about whether the code is either a set of rules or guidelines for behavior. Codes of conduct in any social group or organization can have much the same feel; they can provide clarity and…

Design and Implementation of a Pretty Printer for the Functional Specification Language SPEC

DTIC Science & Technology

1988-06-01

language independent pretty printer using Kodiyak and attribute grammars. These general guidelines are a direct result of the insight gained from the...outlined. The final subject in this chapter is the general and specific rules for the pretty printer. A user of the pretty printer code needs only a working...an extension of a context-free grammar whose generated language includes syntax and semantics. A context-free grammar (CFG) is a four tuple G (N,T, P ,S

Stroke

MedlinePlus

... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ...

Varicose Veins

MedlinePlus

... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ...

28 CFR Appendix A to Part 58 - Guidelines for Reviewing Applications for Compensation and Reimbursement of Expenses Filed Under...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Administration DEPARTMENT OF JUSTICE (CONTINUED) REGULATIONS RELATING TO THE BANKRUPTCY REFORM ACTS OF 1978 AND... Reimbursement of Expenses Filed Under 11 U.S.C. 330 (a) General Information. (1) The Bankruptcy Reform Act of... thus reflect standards and procedures articulated in section 330 of the Code and Rule 2016 of the...

Find an Interventional Radiologist

MedlinePlus

... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ...

Society of Interventional Radiology

MedlinePlus

... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ...

Hereditary Hemorrhagic Telangiectasia - HHT

MedlinePlus

... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ...

The origins of informed consent: the International Scientific Commission on Medical War Crimes, and the Nuremburg code.

PubMed

Weindling, P

2001-01-01

The Nuremberg Code has generally been seen as arising from the Nuremberg Medical Trial. This paper examines developments prior to the Trial, involving the physiologist Andrew Conway Ivy and an inter-Allied Scientific Commission on Medical War Crimes. The paper traces the formulation of the concept of a medical war crime by the physiologist John West Thompson, as part of the background to Ivy's code on human experiments of 1 August 1946. It evaluates subsequent responses by the American Medical Association, and by other war crimes experts, notably Leo Alexander, who developed Ivy's conceptual framework. Ivy's interaction with the judges at Nuremberg alerted them to the importance of formulating ethical guidelines for clinical research.

Chronic pelvic pain (pelvic congestion syndrome)

MedlinePlus

... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ... GUIDELINES, CLINICAL TOPIC ACKNOWLEDGEMENTS MACRA MATTERS HEALTH POLICY, ECONOMICS, CODING REIMBURSEMENT AND APPEALS TOOLKITS UFE AWARENESS TOOLKIT ...

Code of ethics for the national pharmaceutical system: Codifying and compilation

PubMed Central

Salari, Pooneh; Namazi, Hamidreza; Abdollahi, Mohammad; Khansari, Fatemeh; Nikfar, Shekoufeh; Larijani, Bagher; Araminia, Behin

2013-01-01

Pharmacists as one of health-care providers face ethical issues in terms of pharmaceutical care, relationship with patients and cooperation with the health-care team. Other than pharmacy, there are pharmaceutical companies in various fields of manufacturing, importing or distributing that have their own ethical issues. Therefore, pharmacy practice is vulnerable to ethical challenges and needs special code of conducts. On feeling the need, based on a shared project between experts of the ethics from relevant research centers, all the needs were fully recognized and then specified code of conduct for each was written. The code of conduct was subject to comments of all experts involved in the pharmaceutical sector and thus criticized in several meetings. The prepared code of conduct is comprised of professional code of ethics for pharmacists, ethics guideline for pharmaceutical manufacturers, ethics guideline for pharmaceutical importers, ethics guideline for pharmaceutical distributors, and ethics guideline for policy makers. The document was compiled based on the principles of bioethics and professionalism. The compiling the code of ethics for the national pharmaceutical system is the first step in implementing ethics in pharmacy practice and further attempts into teaching the professionalism and the ethical code as the necessary and complementary effort are highly recommended. PMID:24174954

NASA's Technical Handbook for Avoiding On-Orbit ESD Anomalies Due to Internal Charging Effects

NASA Technical Reports Server (NTRS)

Whittlesey, Albert; Garrett, Henry B.

1996-01-01

This paper describes NASA-HDBK-4002, "Avoiding Problems Caused by Spacecraft On-Orbit Internal Charging Effects". The handbook includes a description of internal charging and why it is of concern to spacecraft designers. It also suggests how to determine when a project needs to consider internal spacecraft charging, it contains an electron penetration depth chart, rationale for a critical electron flux criterion, a worst-case geosynchronous electron plasma spectrum, general design guidelines, quantitative design guidelines, and a typical materials characteristics list. Appendices include a listing of some environment codes, electron transport codes, a discussion of geostationary electron plasma environments, a brief description of electron beam and other materials tests, and transient susceptibility tests. The handbook will be in the web page, hftp://standards.nasa.gov. A prior document, NASA TP2361 "Design Guidelines for Assessing and controlling Spacecraft Charging Effects", 1984, is in use to describe mitigation techniques for the effects of surface charging of satellites in space plasma environments. HDBK-4002 is meant to complement 2361 and together, the pair of documents describe both cause and mitigation designs for problems caused by energetic space plasmas.

General practitioners’ justifications for therapeutic inertia in cardiovascular prevention: an empirically grounded typology

PubMed Central

Lebeau, Jean-Pierre; Cadwallader, Jean-Sébastien; Vaillant-Roussel, Hélène; Pouchain, Denis; Yaouanc, Virginie; Aubin-Auger, Isabelle; Mercier, Alain; Rusch, Emmanuel; Remmen, Roy; Vermeire, Etienne; Hendrickx, Kristin

2016-01-01

Objective To construct a typology of general practitioners’ (GPs) responses regarding their justification of therapeutic inertia in cardiovascular primary prevention for high-risk patients with hypertension. Design Empirically grounded construction of typology. Types were defined by attributes derived from the qualitative analysis of GPs’ reported reasons for inaction. Participants 256 GPs randomised in the intervention group of a cluster randomised controlled trial. Setting GPs members of 23 French Regional Colleges of Teachers in General Practice, included in the EffectS of a multifaceted intervention on CArdiovascular risk factors in high-risk hyPErtensive patients (ESCAPE) trial. Data collection and analysis The database consisted of 2638 written responses given by the GPs to an open-ended question asking for the reasons why drug treatment was not changed as suggested by the national guidelines. All answers were coded using constant comparison analysis. A matrix analysis of codes per GP allowed the construction of a response typology, where types were defined by codes as attributes. Initial coding and definition of types were performed independently by two teams. Results Initial coding resulted in a list of 69 codes in the final codebook, representing 4764 coded references in the question responses. A typology including seven types was constructed. 100 GPs were allocated to one and only one of these types, while 25 GPs did not provide enough data to allow classification. Types (numbers of GPs allocated) were: ‘optimists’ (28), ‘negotiators’ (20), ‘checkers’ (15), ‘contextualisers’ (13), ‘cautious’ (11), ‘rounders’ (8) and ‘scientists’ (5). For the 36 GPs that provided 50 or more coded references, analysis of the code evolution over time and across patients showed a consistent belonging to the initial type for any given GP. Conclusion This typology could provide GPs with some insight into their general ways of considering changes in the treatment/management of cardiovascular risk factors and guide design of specific physician-centred interventions to reduce inappropriate inaction. Trial registration number NCT00348855. PMID:27178974

Guidelines for pressure vessel safety assessment

NASA Astrophysics Data System (ADS)

Yukawa, S.

1990-04-01

A technical overview and information on metallic pressure containment vessels and tanks is given. The intent is to provide Occupational Safety and Health Administration (OSHA) personnel and other persons with information to assist in the evaluation of the safety of operating pressure vessels and low pressure storage tanks. The scope is limited to general industrial application vessels and tanks constructed of carbon or low alloy steels and used at temperatures between -75 and 315 C (-100 and 600 F). Information on design codes, materials, fabrication processes, inspection and testing applicable to the vessels and tanks are presented. The majority of the vessels and tanks are made to the rules and requirements of ASME Code Section VIII or API Standard 620. The causes of deterioration and damage in operation are described and methods and capabilities of detecting serious damage and cracking are discussed. Guidelines and recommendations formulated by various groups to inspect for the damages being found and to mitigate the causes and effects of the problems are presented.

The diagnosis related groups enhanced electronic medical record.

PubMed

Müller, Marcel Lucas; Bürkle, Thomas; Irps, Sebastian; Roeder, Norbert; Prokosch, Hans-Ulrich

2003-07-01

The introduction of Diagnosis Related Groups as a basis for hospital payment in Germany announced essential changes in the hospital reimbursement practice. A hospital's economical survival will depend vitally on the accuracy and completeness of the documentation of DRG relevant data like diagnosis and procedure codes. In order to enhance physicians' coding compliance, an easy-to-use interface integrating coding tasks seamlessly into clinical routine had to be developed. A generic approach should access coding and clinical guidelines from different information sources. Within the Electronic Medical Record (EMR) a user interface ('DRG Control Center') for all DRG relevant clinical and administrative data has been built. A comprehensive DRG-related web site gives online access to DRG grouping software and an electronic coding expert. Both components are linked together using an application supporting bi-directional communication. Other web based services like a guideline search engine can be integrated as well. With the proposed method, the clinician gains quick access to context sensitive clinical guidelines for appropriate treatment of his/her patient and administrative guidelines for the adequate coding of the diagnoses and procedures. This paper describes the design and current implementation and discusses our experiences.

The Landscape of long non-coding RNA classification

PubMed Central

St Laurent, Georges; Wahlestedt, Claes; Kapranov, Philipp

2015-01-01

Advances in the depth and quality of transcriptome sequencing have revealed many new classes of long non-coding RNAs (lncRNAs). lncRNA classification has mushroomed to accommodate these new findings, even though the real dimensions and complexity of the non-coding transcriptome remain unknown. Although evidence of functionality of specific lncRNAs continues to accumulate, conflicting, confusing, and overlapping terminology has fostered ambiguity and lack of clarity in the field in general. The lack of fundamental conceptual un-ambiguous classification framework results in a number of challenges in the annotation and interpretation of non-coding transcriptome data. It also might undermine integration of the new genomic methods and datasets in an effort to unravel function of lncRNA. Here, we review existing lncRNA classifications, nomenclature, and terminology. Then we describe the conceptual guidelines that have emerged for their classification and functional annotation based on expanding and more comprehensive use of large systems biology-based datasets. PMID:25869999

Quality, not just quantity: Lessons learned from HIV testing in Salvador, Brazil

PubMed Central

MacCarthy, Sarah; Rasanathan, Jennifer J. K.; Dourado, Ines; Gruskin, Sofia

2015-01-01

Studies have demonstrated that an early HIV diagnosis is a critical first step toward continued engagement in care. We examined HIV testing experiences in Salvador, Brazil, to understand how a focus on quality services can inform service provision more generally in the post–2015 global health agenda. Seventeen semi-structured interviews were conducted with HIV-positive pregnant women in Salvador, a large urban centre of northeast Brazil. Interviews were transcribed, translated, and coded for analysis. Deductive codes confirmed factors identified in the literature review. Inductive codes highlighted new factors emerging from the initial coding. ‘Quality’ was defined according to global and national guidelines as HIV testing with informed and voluntary consent, counselling, and confidentiality (3Cs). No pregnant woman experienced all elements of the 3Cs. Three women did not experience any informed and voluntary consent, counselling, or confidentiality. Few women provided consent overall and none received pre-test counselling. Post-test counselling and confidentiality of services were more consistently provided. This study suggests that testing in Salvador—the third-largest city in the country—is not of the quality called for by global and national guidelines, despite the fact that HIV testing is being routinely provided for HIV-positive pregnant women in Brazil. Going forward, additional clarity around the 3Cs is necessary to improve how the quality, not just the quantity, of HIV services is measured. PMID:24881693

Ethics in clinical research: the Indian perspective.

PubMed

Sanmukhani, J; Tripathi, C B

2011-03-01

Ethics in clinical research focuses largely on identifying and implementing the acceptable conditions for exposure of some individuals to risks and burdens for the benefit of society at large. Ethical guidelines for clinical research were formulated only after discovery of inhumane behaviour with participants during research experiments. The Nuremberg Code was the first international code laying ethical principles for clinical research. With increasing research all over, World Health Organization formulated guidelines in the form of Declaration of Helsinki in 1964. The US laid down its guidelines for ethical principles in the Belmont Report after discovery of the Tuskegee's Syphilis study. The Indian Council of Medical Research has laid down the 'Ethical Guidelines for Biomedical Research on Human Subjects' in the year 2000 which were revised in 2006. It gives twelve general principles to be followed by all biomedical researchers working in the country. The Ethics Committee stands as the bridge between the researcher and the ethical guidelines of the country. The basic responsibility of the Ethics Committee is to ensure an independent, competent and timely review of all ethical aspects of the project proposals received in order to safeguard the dignity, rights, safety and well-being of all actual or potential research participants. A well-documented informed consent process is the hallmark of any ethical research work. Informed consent respects individual's autonomy, to participate or not to participate in research. Concepts of vulnerable populations, therapeutic misconception and post trial access hold special importance in ethical conduct of research, especially in developing countries like India, where most of the research participants are uneducated and economically backward.

Informed consent in human subject research: a comparison of current international and Nigerian guidelines.

PubMed

Fadare, Joseph O; Porteri, Corinna

2010-03-01

Informed consent is a basic requirement for the conduct of ethical research involving human subjects. Currently, the Helsinki Declaration of the World Medical Association and the International Ethical Guidelines for Biomedical Research of the Council for International Organizations of Medical Sciences (CIOMS) are widely accepted as international codes regulating human subject research and the informed consent sections of these documents are quite important. Debates on the applicability of these guidelines in different socio-cultural settings are ongoing and many workers have advocated the need for national or regional guidelines. Nigeria, a developing country, has recently adopted its national guideline regulating human subject research: the National Health Research Ethics Committee (NHREC) code. A content analysis of the three guidelines was done to see if the Nigerian guidelines confer any additional protection for research subjects. The concept of a Community Advisory Committee in the Nigerian guideline is a novel one that emphasizes research as a community burden and should promote a form of "research friendship" to foster the welfare of research participants. There is also the need for a regular update of the NHREC code so as to address some issues that were not considered in its current version.

Development of the First Guideline for Professional Conduct in Medical Practice in Iran.

PubMed

Saeedi Tehrani, Saeedeh; Nayeri, Fatemeh; Parsapoor, Alireza; Jafarian, Ali; Labaf, Ali; Mirzazadeh, Azim; Emadi Kouchak, Hamid; Shahi, Farhad; Ghasemzadeh, Nazafarin; Asghari, Fariba

2017-01-01

Professional behavior is first learned at the university. One of the necessary considerations in maintaining the professional environment of the university is establishing a set of codes for the behavior of physicians and medical students. This paper describes the process of developing the professional code of conduct in Tehran University of Medical Sciences, Tehran, Iran. A review of Iranian and international literature was performed to develop the first draft of the guideline. In sessions of group discussion by the authors, the articles of the draft were evaluated for relevancy, clarity, and lack of repetition. The draft was sent for evaluation to all participants, including the medical faculty members, residents, and medical students, four times and necessary corrections were made according to the comments received. The final guideline included 76 behavior codes in 6 categories, including altruism, honor and integrity, responsibility, respect, justice, and excellence. The codes of the guideline cover the physicians' commitments in the physician-patient, physician-colleague, and instructor-student relationships in order to improve the quality of the services. The Islamic and Iranian culture were taken into consideration in developing the guideline. Accordance with the administrative and educational conditions of the universities was ensured in developing the guideline and its acceptance was ensured through extensive surveys. Thus, it is expected that this guideline will be very effective in enhancing professional commitment in medical universities.

Talking about psychosocial problems: an observational study on changes in doctor-patient communication in general practice between 1977 and 2008.

PubMed

Butalid, Ligaya; Bensing, Jozien M; Verhaak, Peter F M

2014-03-01

To examine whether GPs' communication styles have changed since the introduction and implementation of clinical guidelines for psychosocial problems in Dutch general practice in the 1990s. From a database of 5184 consultations videotaped between 1977 and 2008, 512 consultations assessed by GPs as 'completely psychosocial' were coded with RIAS (Roter Interaction Analysis System). The 121 consultations prior to and 391 consultations after implementation of guidelines were analyzed whether communication styles have changed over time. We found that GPs were more likely to consider consultations to be mainly (17%) or completely (12%) psychosocial after the implementation of guidelines. They gave more biomedical and psychosocial information and advice in the second period compared to the first period. We also found that empathy decreased over time (frequency of empathic statements by GPs changed from 2.9-3.2 to 1.4-1.6 between periods). Communication in psychosocial consultations has changed; GPs have become more focused on task-oriented communication (asking questions, giving information and advice) and less on showing empathy. GPs face the challenge of integrating an evidence-based approach of applying guidelines that promote active symptom exploration with understanding patients' personal contexts and giving room to their emotions. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Assessment of Self-Regulatory Code Violations in Brazilian Television Beer Advertisements*

PubMed Central

Vendrame, Alan; Pinsky, Ilana; Souza E Silva, Rebeca; Babor, Thomas

2010-01-01

Objective: Research suggests that alcoholic beverage advertisements may have an adverse effect on teenagers and young adults, owing to their vulnerability to suggestive message content. This study was designed to evaluate perceived violations of the content guidelines of the Brazilian alcohol marketing self-regulation code, based on ratings of the five most popular beer advertisements broadcast on television in the summer of 2005–2006 and during the 2006 FIFA (Fédération Internationale de Football Association) World Cup games. Method: Five beer advertisements were selected from a previous study showing that they were perceived to be highly appealing to a sample of Brazilian teenagers. These advertisements were evaluated by a sample of Brazilian high school students using a rating procedure designed to measure the content of alcohol advertisements covered in industry self-regulation codes. Results: All five advertisements were found to violate multiple guidelines of the Brazilian code of marketing self-regulation. The advertisement with the greatest number of violations was Antarctica's “Male Repellent,” which was perceived to violate 11 of the 16 guidelines in the code. Two advertisements had nine violations, and one had eight. The guidelines most likely to be violated by these advertisements were Guideline 1, which is aimed at protecting children and teenagers, and Guideline 2, which prohibits content encouraging excessive and irresponsible alcoholic beverage consumption. Conclusions: The five beer advertisements rated as most appealing to Brazilian teenagers were perceived by a sample of the same population to have violated numerous principles of the Brazilian self-regulation code governing the marketing of alcoholic beverages. Because of these numerous perceived code violations, it now seems important for regulatory authorities to submit industry marketing content to more systematic evaluation by young people and public health experts and for researchers to focus more on the ways in which alcohol advertising influences early onset of drinking and excessive alcohol consumption. PMID:20409439

Assessment of self-regulatory code violations in Brazilian television beer advertisements.

PubMed

Vendrame, Alan; Pinsky, Ilana; e Silva, Rebeca Souza; Babor, Thomas

2010-05-01

Research suggests that alcoholic beverage advertisements may have an adverse effect on teenagers and young adults, owing to their vulnerability to suggestive message content. This study was designed to evaluate perceived violations of the content guidelines of the Brazilian alcohol marketing self-regulation code, based on ratings of the five most popular beer advertisements broadcast on television in the summer of 2005-2006 and during the 2006 FIFA (Federation Internationale de Football Association) World Cup games. Five beer advertisements were selected from a previous study showing that they were perceived to be highly appealing to a sample of Brazilian teenagers. These advertisements were evaluated by a sample of Brazilian high school students using a rating procedure designed to measure the content of alcohol advertisements covered in industry self-regulation codes. All five advertisements were found to violate multiple guidelines of the Brazilian code of marketing self-regulation. The advertisement with the greatest number of violations was Antarctica's "Male Repellent," which was perceived to violate 11 of the 16 guidelines in the code. Two advertisements had nine violations, and one had eight. The guidelines most likely to be violated by these advertisements were Guideline 1, which is aimed at protecting children and teenagers, and Guideline 2, which prohibits content encouraging excessive and irresponsible alcoholic beverage consumption. The five beer advertisements rated as most appealing to Brazilian teenagers were perceived by a sample of the same population to have violated numerous principles of the Brazilian self-regulation code governing the marketing of alcoholic beverages. Because of these numerous perceived code violations, it now seems important for regulatory authorities to submit industry marketing content to more systematic evaluation by young people and public health experts and for researchers to focus more on the ways in which alcohol advertising influences early onset of drinking and excessive alcohol consumption.

Minimum Standards for Student Conduct and Discipline, Including Suggested Guidelines and Model Codes. Oregon Administrative Rules 21-050 -- 21-085.

ERIC Educational Resources Information Center

Parnell, Dale

The guidelines and codes in this booklet were written to assist teachers and administrators strengthen their positions in times of legal and social confusion and in the face of challenges to administrative and staff authority. Model codes are provided for student (1) assembly, (2) dress and grooming, (3) motor vehicles, (4) search and seizure, (5)…

Regulatory changes that affect coding for immunotherapy.

PubMed

Atwater, J Spencer

2006-02-01

During the past decade, a variety of federal regulations have had a significant impact on the way allergen immunotherapy is reimbursed and how Current Procedural Terminology (CPT) codes are used for this purpose. As mandated by the US Congress, the Centers for Medicare and Medicaid Services (CMS) through the Office of the Inspector General (OIG) targeted immunotherapy codes for scrutiny, because they are some of the most frequently used codes. To examine how federal regulations have affected reimbursement for allergy immunotherapy and other allergy services. A review was performed of the OIG survey of allergy immunotherapy and the OIG recommendations on CPT coding compliance guidelines. A preliminary survey found problems with medical appropriateness of allergen immunotherapy. For this reason, the OIG performed a more comprehensive study of 301 physicians using code 95165 to analyze by medical record and billing data whether the new billing rules were being correctly used and found that only 44% of physicians were following the new definition of a billable dose. In the early 1990s, the federal government served notice of its intent to more aggressively identify and prosecute health care providers who improperly billed and collected for medical services. Through the adoption of the 1991 US Sentencing Commission Guidelines, the government sought to enhance compliance by mandating lesser criminal penalties for violating organizations that nevertheless maintained and operated "effective compliance plans." In 2002, the OIG audited health care providers and recouped dollar 14.4 billion in improper payments by Medicare. Between January and June 2003, Medicare excluded 1,241 individual providers and health care entities due to fraudulent billing practices. Federal regulations have significantly affected reimbursement for allergy immunotherapy and other allergy services. Allergists need to be aware of these changes and implement the new recommendations into their practices.

Codes That Support Smart Growth Development

EPA Pesticide Factsheets

Provides examples of local zoning codes that support smart growth development, categorized by: unified development code, form-based code, transit-oriented development, design guidelines, street design standards, and zoning overlay.

General practitioners' justifications for therapeutic inertia in cardiovascular prevention: an empirically grounded typology.

PubMed

Lebeau, Jean-Pierre; Cadwallader, Jean-Sébastien; Vaillant-Roussel, Hélène; Pouchain, Denis; Yaouanc, Virginie; Aubin-Auger, Isabelle; Mercier, Alain; Rusch, Emmanuel; Remmen, Roy; Vermeire, Etienne; Hendrickx, Kristin

2016-05-13

To construct a typology of general practitioners' (GPs) responses regarding their justification of therapeutic inertia in cardiovascular primary prevention for high-risk patients with hypertension. Empirically grounded construction of typology. Types were defined by attributes derived from the qualitative analysis of GPs' reported reasons for inaction. 256 GPs randomised in the intervention group of a cluster randomised controlled trial. GPs members of 23 French Regional Colleges of Teachers in General Practice, included in the EffectS of a multifaceted intervention on CArdiovascular risk factors in high-risk hyPErtensive patients (ESCAPE) trial. The database consisted of 2638 written responses given by the GPs to an open-ended question asking for the reasons why drug treatment was not changed as suggested by the national guidelines. All answers were coded using constant comparison analysis. A matrix analysis of codes per GP allowed the construction of a response typology, where types were defined by codes as attributes. Initial coding and definition of types were performed independently by two teams. Initial coding resulted in a list of 69 codes in the final codebook, representing 4764 coded references in the question responses. A typology including seven types was constructed. 100 GPs were allocated to one and only one of these types, while 25 GPs did not provide enough data to allow classification. Types (numbers of GPs allocated) were: 'optimists' (28), 'negotiators' (20), 'checkers' (15), 'contextualisers' (13), 'cautious' (11), 'rounders' (8) and 'scientists' (5). For the 36 GPs that provided 50 or more coded references, analysis of the code evolution over time and across patients showed a consistent belonging to the initial type for any given GP. This typology could provide GPs with some insight into their general ways of considering changes in the treatment/management of cardiovascular risk factors and guide design of specific physician-centred interventions to reduce inappropriate inaction. NCT00348855. 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/

National Electrical Code in Power Engineering Course for Electrical Engineering Curriculum

ERIC Educational Resources Information Center

Azizur, Rahman M. M.

2011-01-01

In order to ensure the safety of their inhabitants and properties, the residential, industrial and business installations require complying with NEC (national electrical code) for electrical systems. Electrical design engineers and technicians rely heavily on these very important design guidelines. However, these design guidelines are not formally…

General practitioners' perspectives on management of early-stage chronic kidney disease: a focus group study.

PubMed

van Dipten, Carola; van Berkel, Saskia; de Grauw, Wim J C; Scherpbier-de Haan, Nynke D; Brongers, Bouke; van Spaendonck, Karel; Wetzels, Jack F M; Assendelft, Willem J J; Dees, Marianne K

2018-06-06

Guideline adherence in chronic kidney disease management is low, despite guideline implementation initiatives. Knowing general practitioners' (GPs') perspectives of management of early-stage chronic kidney disease (CKD) and the applicability of the national interdisciplinary guideline could support strategies to improve quality of care. Qualitative focus group study with 27 GPs in the Netherlands. Three analysts open-coded and comparatively analysed the data. Mind-mapping sessions were performed after data-saturation. Five themes emerged: defining CKD, knowledge and awareness, patient-physician interaction, organisation of CKD care and value of the guideline. A key finding was the abstractness of the CKD concept. The GPs expressed various perspectives about defining CKD and interpreting estimated glomerular filtration rates. Views about clinical relevance influenced the decision-making, although factual knowledge seems lacking. Striving to inform well enough without creating anxiety and to explain suitably for the intellectual ability of the patient caused tension in the patient-physician interaction. Integration with cardiovascular disease-management programmes was mentioned as a way of implementing CKD care in the future. The guideline was perceived as a rough guide rather than a leading document. CKD is perceived as an abstract rather than a clinical concept. Abstractness plays a role in all formulated themes. Management of CKD patients in primary care is complex and is influenced by physician-bound considerations related to individual knowledge and perception of the importance of CKD. Strategies are needed to improve GPs' understanding of the concept of CKD by education, a holistic approach to guidelines, and integration of CKD care into cardiovascular programmes. Not applicable.

Involving migrants in the development of guidelines for communication in cross-cultural general practice consultations: a participatory learning and action research project

PubMed Central

O'Reilly-de Brún, Mary; MacFarlane, Anne; de Brún, Tomas; Okonkwo, Ekaterina; Bonsenge Bokanga, Jean Samuel; Manuela De Almeida Silva, Maria; Ogbebor, Florence; Mierzejewska, Aga; Nnadi, Lovina; van den Muijsenbergh, Maria; van Weel-Baumgarten, Evelyn; van Weel, Chris

2015-01-01

Objective The aim of this research was to involve migrants and other key stakeholders in a participatory dialogue to develop a guideline for enhancing communication in cross-cultural general practice consultations. In this paper, we focus on findings about the use of formal versus informal interpreters because dialogues about these issues emerged as central to the identification of recommendations for best practice. Design This qualitative case study involved a Participatory Learning and Action (PLA) research methodology. Participants The sample comprised 80 stakeholders: 51 from migrant communities; 15 general practitioners (GPs) and general practice staff; 7 established migrants as peer researchers; 5 formal, trained interpreters; and 2 service planners from the national health authority. Setting Galway, Ireland. Results There was 100% consensus across stakeholder groups that while informal interpreters have uses for migrants and general practice staff, they are not considered acceptable as best practice. There was also 100% consensus that formal interpreters who are trained and working as per a professional code of practice are acceptable as best practice. Conclusions Policymakers and service planners need to work in partnership with service providers and migrants to progress the implementation of professional, trained interpreters as a routine way of working in general practice. PMID:26391628

An Analysis of State Alternate Assessment Participation Guidelines

ERIC Educational Resources Information Center

Musson, Jane E.; Thomas, Megan K.; Towles-Reeves, Elizabeth; Kearns, Jacqueline F.

2010-01-01

The purpose of this study was to examine all states' participation guidelines for alternate assessments based on alternate achievement standards (AA-AAS) and to analyze these guidelines for common and contrasting themes. State alternate assessment participation guidelines were found for all 50 states. Participation guidelines were coded, and 12…

Informed consent in human experimentation before the Nuremberg code.

PubMed

Vollmann, J; Winau, R

1996-12-07

The issue of ethics with respect to medical experimentation in Germany during the 1930s and 1940s was crucial at the Nuremberg trials and related trials of doctors and public health officials. Those involved in horrible crimes attempted to excuse themselves by arguing that there were no explicit rules governing medical research on human beings in Germany during the period and that research practices in Germany were not different from those in allied countries. In this context the Nuremberg code of 1947 is generally regarded as the first document to set out ethical regulations in human experimentation based on informed consent. New research, however, indicates that ethical issues of informed consent in guidelines for human experimentation were recognised as early as the nineteenth century. These guidelines shed light on the still contentious issue of when the concepts of autonomy, informed consent, and therapeutic and non-therapeutic research first emerged. This issue assumes renewed importance in the context of current attempts to assess liability and responsibility for the abuse of people in various experiments conducted since the second world war in the United States, Canada, Russia, and other nations.

Code of Ethics in a Multicultural Company and its Legal Context

NASA Astrophysics Data System (ADS)

Odlerová, Eva; Ďurišová, Jaroslava; Šramel, Bystrík

2012-12-01

The entry of foreign investors and simultaneous expansion of different national cultures, religions, rules, moral and ethical standards is bringing up problems of cooperation and coexistence of different nationalities, ethnicities and cultures. Working in an international environment therefore requires adaptation to a variety of economic, political, legal, technical, social, cultural and historical conditions. One possible solution is to define a code of ethics, guidelines which find enough common moral principles, which can become the basis for the adoption of general ethical standards, while respecting national, cultural differences and practices. In this article, the authors pay attention not only to the analysis of the common ethical rules in a multicultural company, but also to the legal aspects of codes of ethics. Each code of ethics is a set of standards, which, like the legal norms, regulate the behaviour of individuals. These standards, however, must simultaneously meet certain statutory criteria that define the boundaries of regulation of employee’s behaviour.

Computation of Acoustic Waves Through Sliding-Zone Interfaces Using an Euler/Navier-Stokes Code

NASA Technical Reports Server (NTRS)

Rumsey, Christopher L.

1996-01-01

The effect of a patched sliding-zone interface on the transmission of acoustic waves is examined for two- and three-dimensional model problems. A simple but general interpolation scheme at the patched boundary passes acoustic waves without distortion, provided that a sufficiently small time step is taken. A guideline is provided for the maximum permissible time step or zone speed that gives an acceptable error introduced by the sliding-zone interface.

Internationalizing professional codes in engineering.

PubMed

Harris, Charles E

2004-07-01

Professional engineering societies which are based in the United States, such as the American Society of Mechanical Engineers (ASME, now ASME International) are recognizing that their codes of ethics must apply to engineers working throughout the world. An examination of the ethical code of the ASME International shows that its provisions pose many problems of application, especially in societies outside the United States. In applying the codes effectively in the international environment, two principal issues must be addressed. First, some Culture Transcending Guidelines must be identified and justified. Nine such guidelines are identified Second, some methods for applying the codes to particular situations must be identified Three such methods are specification, balancing, and finding a creative middle way.

An implementation framework for the feedback of individual research results and incidental findings in research.

PubMed

Thorogood, Adrian; Joly, Yann; Knoppers, Bartha Maria; Nilsson, Tommy; Metrakos, Peter; Lazaris, Anthoula; Salman, Ayat

2014-12-23

This article outlines procedures for the feedback of individual research data to participants. This feedback framework was developed in the context of a personalized medicine research project in Canada. Researchers in this domain have an ethical obligation to return individual research results and/or material incidental findings that are clinically significant, valid and actionable to participants. Communication of individual research data must proceed in an ethical and efficient manner. Feedback involves three procedural steps: assessing the health relevance of a finding, re-identifying the affected participant, and communicating the finding. Re-identification requires researchers to break the code in place to protect participant identities. Coding systems replace personal identifiers with a numerical code. Double coding systems provide added privacy protection by separating research data from personal identifying data with a third "linkage" database. A trusted and independent intermediary, the "keyholder", controls access to this linkage database. Procedural guidelines for the return of individual research results and incidental findings are lacking. This article outlines a procedural framework for the three steps of feedback: assessment, re-identification, and communication. This framework clarifies the roles of the researcher, Research Ethics Board, and keyholder in the process. The framework also addresses challenges posed by coding systems. Breaking the code involves privacy risks and should only be carried out in clearly defined circumstances. Where a double coding system is used, the keyholder plays an important role in balancing the benefits of individual feedback with the privacy risks of re-identification. Feedback policies should explicitly outline procedures for the assessment of findings, and the re-identification and contact of participants. The responsibilities of researchers, the Research Ethics Board, and the keyholder must be clearly defined. We provide general guidelines for keyholders involved in feedback. We also recommend that Research Ethics Boards should not be directly involved in the assessment of individual findings. Hospitals should instead establish formal, interdisciplinary clinical advisory committees to help researchers determine whether or not an uncertain finding should be returned.

Ground Operations Aerospace Language (GOAL). Volume 4: Interpretive code translator

NASA Technical Reports Server (NTRS)

1973-01-01

This specification identifies and describes the principal functions and elements of the Interpretive Code Translator which has been developed for use with the GOAL Compiler. This translator enables the user to convert a compliled GOAL program to a highly general binary format which is designed to enable interpretive execution. The translator program provides user controls which are designed to enable the selection of various output types and formats. These controls provide a means for accommodating many of the implementation options which are discussed in the Interpretive Code Guideline document. The technical design approach is given. The relationship between the translator and the GOAL compiler is explained and the principal functions performed by the Translator are described. Specific constraints regarding the use of the Translator are discussed. The control options are described. These options enable the user to select outputs to be generated by the translator and to control vrious aspects of the translation processing.

Dose Modeling Evaluations and Technical Support Document For the Authorized Limits Request for the DOE-Owned Property Outside the Limited Area, Paducah Gaseous Diffusion Plant Paducah, Kentucky

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

Boerner, A. J.; Maldonado, D. G.; Hansen, Tom

2012-09-01

Environmental assessments and remediation activities are being conducted by the U.S. Department of Energy (DOE) at the Paducah Gaseous Diffusion Plant (PGDP), Paducah, Kentucky. The Oak Ridge Institute for Science and Education (ORISE), a DOE prime contractor, was contracted by the DOE Portsmouth/Paducah Project Office (DOE-PPPO) to conduct radiation dose modeling analyses and derive single radionuclide soil guidelines (soil guidelines) in support of the derivation of Authorized Limits (ALs) for 'DOE-Owned Property Outside the Limited Area' ('Property') at the PGDP. The ORISE evaluation specifically included the area identified by DOE restricted area postings (public use access restrictions) and areas licensedmore » by DOE to the West Kentucky Wildlife Management Area (WKWMA). The licensed areas are available without restriction to the general public for a variety of (primarily) recreational uses. Relevant receptors impacting current and reasonably anticipated future use activities were evaluated. In support of soil guideline derivation, a Conceptual Site Model (CSM) was developed. The CSM listed radiation and contamination sources, release mechanisms, transport media, representative exposure pathways from residual radioactivity, and a total of three receptors (under present and future use scenarios). Plausible receptors included a Resident Farmer, Recreational User, and Wildlife Worker. single radionuclide soil guidelines (outputs specified by the software modeling code) were generated for three receptors and thirteen targeted radionuclides. These soil guidelines were based on satisfying the project dose constraints. For comparison, soil guidelines applicable to the basic radiation public dose limit of 100 mrem/yr were generated. Single radionuclide soil guidelines from the most limiting (restrictive) receptor based on a target dose constraint of 25 mrem/yr were then rounded and identified as the derived soil guidelines. An additional evaluation using the derived soil guidelines as inputs into the code was also performed to determine the maximum (peak) dose for all receptors. This report contains the technical basis in support of the DOE?s derivation of ALs for the 'Property.' A complete description of the methodology, including an assessment of the input parameters, model inputs, and results is provided in this report. This report also provides initial recommendations on applying the derived soil guidelines.« less

Predicting Regulatory Compliance in Beer Advertising on Facebook.

PubMed

Noel, Jonathan K; Babor, Thomas F

2017-11-01

The prevalence of alcohol advertising has been growing on social media platforms. The purpose of this study was to evaluate alcohol advertising on Facebook for regulatory compliance and thematic content. A total of 50 Budweiser and Bud Light ads posted on Facebook within 1 month of the 2015 NFL Super Bowl were evaluated for compliance with a self-regulated alcohol advertising code and for thematic content. An exploratory sensitivity/specificity analysis was conducted to determine if thematic content could predict code violations. The code violation rate was 82%, with violations prevalent in guidelines prohibiting the association of alcohol with success (Guideline 5) and health benefits (Guideline 3). Overall, 21 thematic content areas were identified. Displaying the product (62%) and adventure/sensation seeking (52%) were the most prevalent. There was perfect specificity (100%) for 10 content areas for detecting any code violation (animals, negative emotions, positive emotions, games/contests/promotions, female characters, minorities, party, sexuality, night-time, sunrise) and high specificity (>80%) for 10 content areas for detecting violations of guidelines intended to protect minors (animals, negative emotions, famous people, friendship, games/contests/promotions, minorities, responsibility messages, sexuality, sunrise, video games). The high prevalence of code violations indicates a failure of self-regulation to prevent potentially harmful content from appearing in alcohol advertising, including explicit code violations (e.g. sexuality). Routine violations indicate an unwillingness to restrict advertising content for public health purposes, and statutory restrictions may be necessary to sufficiently deter alcohol producers from repeatedly violating marketing codes. Violations of a self-regulated alcohol advertising code are prevalent in a sample of beer ads published on Facebook near the US National Football League's Super Bowl. Overall, 16 thematic content areas demonstrated high specificity for code violations. Alcohol advertising codes should be updated to expressly prohibit the use of such content. © The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Transfers of proven oil and gas properties from individuals to controlled corporations

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

Cash, L.S.; Dickens, T.L.

1985-12-01

Code Section 613A(c) (10) sets forth an exception, for transfers by individuals to their controlled corporations, to the general rule of section 613A(c)(9) denying percentage depletion to transferees of proven oil and gas properties. The proposed regulations attempt to provide guidelines to help taxpayers comply, and, although these regulations are not all-inclusive, they should be helpful to taxpayers who must rely on these provisions to prevent the loss of deductions for percentage depletion. Because of some apparent ambiguities in this area of the Internal Revenue Code and Treasury's inability to flesh out these ambiguities in its proposed regulations, affected taxpayersmore » should be cautious. 2 tables.« less

ASVCP quality assurance guidelines: control of preanalytical, analytical, and postanalytical factors for urinalysis, cytology, and clinical chemistry in veterinary laboratories.

PubMed

Gunn-Christie, Rebekah G; Flatland, Bente; Friedrichs, Kristen R; Szladovits, Balazs; Harr, Kendal E; Ruotsalo, Kristiina; Knoll, Joyce S; Wamsley, Heather L; Freeman, Kathy P

2012-03-01

In December 2009, the American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards committee published the updated and peer-reviewed ASVCP Quality Assurance Guidelines on the Society's website. These guidelines are intended for use by veterinary diagnostic laboratories and veterinary research laboratories that are not covered by the US Food and Drug Administration Good Laboratory Practice standards (Code of Federal Regulations Title 21, Chapter 58). The guidelines have been divided into 3 reports: (1) general analytical factors for veterinary laboratory performance and comparisons; (2) hematology, hemostasis, and crossmatching; and (3) clinical chemistry, cytology, and urinalysis. This particular report is one of 3 reports and documents recommendations for control of preanalytical, analytical, and postanalytical factors related to urinalysis, cytology, and clinical chemistry in veterinary laboratories and is adapted from sections 1.1 and 2.2 (clinical chemistry), 1.3 and 2.5 (urinalysis), 1.4 and 2.6 (cytology), and 3 (postanalytical factors important in veterinary clinical pathology) of these guidelines. These guidelines are not intended to be all-inclusive; rather, they provide minimal guidelines for quality assurance and quality control for veterinary laboratory testing and a basis for laboratories to assess their current practices, determine areas for improvement, and guide continuing professional development and education efforts. © 2012 American Society for Veterinary Clinical Pathology.

ASVCP quality assurance guidelines: control of preanalytical and analytical factors for hematology for mammalian and nonmammalian species, hemostasis, and crossmatching in veterinary laboratories.

PubMed

Vap, Linda M; Harr, Kendal E; Arnold, Jill E; Freeman, Kathleen P; Getzy, Karen; Lester, Sally; Friedrichs, Kristen R

2012-03-01

In December 2009, the American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards committee published the updated and peer-reviewed ASVCP Quality Assurance Guidelines on the Society's website. These guidelines are intended for use by veterinary diagnostic laboratories and veterinary research laboratories that are not covered by the US Food and Drug Administration Good Laboratory Practice standards (Code of Federal Regulations Title 21, Chapter 58). The guidelines have been divided into 3 reports: (1) general analytical factors for veterinary laboratory performance and comparisons; (2) hematology, hemostasis, and crossmatching; and (3) clinical chemistry, cytology, and urinalysis. This particular report is one of 3 reports and provides recommendations for control of preanalytical and analytical factors related to hematology for mammalian and nonmammalian species, hemostasis testing, and crossmatching and is adapted from sections 1.1 and 2.3 (mammalian hematology), 1.2 and 2.4 (nonmammalian hematology), 1.5 and 2.7 (hemostasis testing), and 1.6 and 2.8 (crossmatching) of the complete guidelines. These guidelines are not intended to be all-inclusive; rather, they provide minimal guidelines for quality assurance and quality control for veterinary laboratory testing and a basis for laboratories to assess their current practices, determine areas for improvement, and guide continuing professional development and education efforts. © 2012 American Society for Veterinary Clinical Pathology.

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

Dr. George L Mesina

Our ultimate goal is to create and maintain RELAP5-3D as the best software tool available to analyze nuclear power plants. This begins with writing excellent programming and requires thorough testing. This document covers development of RELAP5-3D software, the behavior of the RELAP5-3D program that must be maintained, and code testing. RELAP5-3D must perform in a manner consistent with previous code versions with backward compatibility for the sake of the users. Thus file operations, code termination, input and output must remain consistent in form and content while adding appropriate new files, input and output as new features are developed. As computermore » hardware, operating systems, and other software change, RELAP5-3D must adapt and maintain performance. The code must be thoroughly tested to ensure that it continues to perform robustly on the supported platforms. The coding must be written in a consistent manner that makes the program easy to read to reduce the time and cost of development, maintenance and error resolution. The programming guidelines presented her are intended to institutionalize a consistent way of writing FORTRAN code for the RELAP5-3D computer program that will minimize errors and rework. A common format and organization of program units creates a unifying look and feel to the code. This in turn increases readability and reduces time required for maintenance, development and debugging. It also aids new programmers in reading and understanding the program. Therefore, when undertaking development of the RELAP5-3D computer program, the programmer must write computer code that follows these guidelines. This set of programming guidelines creates a framework of good programming practices, such as initialization, structured programming, and vector-friendly coding. It sets out formatting rules for lines of code, such as indentation, capitalization, spacing, etc. It creates limits on program units, such as subprograms, functions, and modules. It establishes documentation guidance on internal comments. The guidelines apply to both existing and new subprograms. They are written for both FORTRAN 77 and FORTRAN 95. The guidelines are not so rigorous as to inhibit a programmer’s unique style, but do restrict the variations in acceptable coding to create sufficient commonality that new readers will find the coding in each new subroutine familiar. It is recognized that this is a “living” document and must be updated as languages, compilers, and computer hardware and software evolve.« less

The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels.

PubMed

Neumann, Ignacio; Brignardello-Petersen, Romina; Wiercioch, Wojtek; Carrasco-Labra, Alonso; Cuello, Carlos; Akl, Elie; Mustafa, Reem A; Al-Hazzani, Waleed; Etxeandia-Ikobaltzeta, Itziar; Rojas, Maria Ximena; Falavigna, Maicon; Santesso, Nancy; Brozek, Jan; Iorio, Alfonso; Alonso-Coello, Pablo; Schünemann, Holger J

2016-07-15

Judgments underlying guideline recommendations are seldom recorded and presented in a systematic fashion. The GRADE Evidence-to-Decision Framework (EtD) offers a transparent way to record and report guideline developers' judgments. In this paper, we report the experiences with the EtD frameworks in 15 real guideline panels. Following the guideline panel meetings, we asked methodologists participating in the panel to provide feedback regarding the EtD framework. They were instructed to consider their own experience and the feedback collected from the rest of the panel. Two investigators independently summarized the responses and jointly interpreted the data using pre-specified domains as coding system. We asked methodologists to review the results and provide further input to improve the structure of the EtDs iteratively. The EtD framework was well received, and the comments were generally positive. Methodologists felt that in a real guideline panel, the EtD framework helps structuring a complex process through relatively simple steps in an explicit and transparent way. However, some sections (e.g., "values and preferences" and "balance between benefits and harms") required further development and clarification that were considered in the current version of the EtD framework. The use of an EtD framework in guideline development offers a structured and explicit way to record and report the judgments and discussion of guideline panels during the formulation of recommendations. In addition, it facilitates the formulation of recommendations, assessment of their strength, and identifying gaps in research.

Impact of documentation errors on accuracy of cause of death coding in an educational hospital in Southern Iran.

PubMed

Haghighi, Mohammad Hosein Hayavi; Dehghani, Mohammad; Teshnizi, Saeid Hoseini; Mahmoodi, Hamid

2014-01-01

Accurate cause of death coding leads to organised and usable death information but there are some factors that influence documentation on death certificates and therefore affect the coding. We reviewed the role of documentation errors on the accuracy of death coding at Shahid Mohammadi Hospital (SMH), Bandar Abbas, Iran. We studied the death certificates of all deceased patients in SMH from October 2010 to March 2011. Researchers determined and coded the underlying cause of death on the death certificates according to the guidelines issued by the World Health Organization in Volume 2 of the International Statistical Classification of Diseases and Health Related Problems-10th revision (ICD-10). Necessary ICD coding rules (such as the General Principle, Rules 1-3, the modification rules and other instructions about death coding) were applied to select the underlying cause of death on each certificate. Demographic details and documentation errors were then extracted. Data were analysed with descriptive statistics and chi square tests. The accuracy rate of causes of death coding was 51.7%, demonstrating a statistically significant relationship (p=.001) with major errors but not such a relationship with minor errors. Factors that result in poor quality of Cause of Death coding in SMH are lack of coder training, documentation errors and the undesirable structure of death certificates.

Open-source framework for documentation of scientific software written on MATLAB-compatible programming languages

NASA Astrophysics Data System (ADS)

Konnik, Mikhail V.; Welsh, James

2012-09-01

Numerical simulators for adaptive optics systems have become an essential tool for the research and development of the future advanced astronomical instruments. However, growing software code of the numerical simulator makes it difficult to continue to support the code itself. The problem of adequate documentation of the astronomical software for adaptive optics simulators may complicate the development since the documentation must contain up-to-date schemes and mathematical descriptions implemented in the software code. Although most modern programming environments like MATLAB or Octave have in-built documentation abilities, they are often insufficient for the description of a typical adaptive optics simulator code. This paper describes a general cross-platform framework for the documentation of scientific software using open-source tools such as LATEX, mercurial, Doxygen, and Perl. Using the Perl script that translates M-files MATLAB comments into C-like, one can use Doxygen to generate and update the documentation for the scientific source code. The documentation generated by this framework contains the current code description with mathematical formulas, images, and bibliographical references. A detailed description of the framework components is presented as well as the guidelines for the framework deployment. Examples of the code documentation for the scripts and functions of a MATLAB-based adaptive optics simulator are provided.

Understanding Mixed Code and Classroom Code-Switching: Myths and Realities

ERIC Educational Resources Information Center

Li, David C. S.

2008-01-01

Background: Cantonese-English mixed code is ubiquitous in Hong Kong society, and yet using mixed code is widely perceived as improper. This paper presents evidence of mixed code being socially constructed as bad language behavior. In the education domain, an EDB guideline bans mixed code in the classroom. Teachers are encouraged to stick to…

Association between Health Information Technology and Case Mix Index.

PubMed

Park, Young-Taek; Lee, Junsang; Lee, Jinhyung

2017-10-01

Health information technology (IT) can assist healthcare providers in ordering medication and adhering to guidelines while improving communication among providers and the quality of care. However, the relationship between health IT and Case Mix Index (CMI) has not been thoroughly investigated; therefore, this study aimed to clarify this relationship. To examine the effect of health IT on CMI, a generalized estimation equation (GEE) was applied to two years of California hospital data. We found that IT was positively associated with CMI, indicating that increased IT adoption could lead to a higher CMI or billing though DRG up-coding. This implies that hospitals' revenue could increase around $40,000 by increasing IT investment by 10%. The positive association between IT and CMI implies that IT adoption itself could lead to higher patient billings. Generally, a higher CMI in a hospital indicates that the hospital provides expensive services with higher coding and therefore receives more money from patients. Therefore, measures to prevent upcoding through IT systems should be implemented.

78 FR 69793 - Voluntary Remedial Actions and Guidelines for Voluntary Recall Notices

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-21

... (Commission, CPSC, or we) proposes an interpretive rule to set forth principles and guidelines for the content... setting forth the Commission's principles and guidelines regarding the content of voluntary recall notices..., ``Principles and Guidelines for Voluntary Recall Notices,'' in part 1115 of title 16 of the Code of Federal...

76 FR 18238 - Wind Turbine Guidelines Advisory Committee; Announcement of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

...] Wind Turbine Guidelines Advisory Committee; Announcement of Public Meeting AGENCY: Fish and Wildlife... (Service), will host a Wind Turbine Guidelines Advisory Committee (Committee) meeting on April 27, 2011... Turbine Guidelines Advisory Committee. [FR Doc. 2011-7788 Filed 3-31-11; 8:45 am] BILLING CODE 4310-55-P ...

Diagnostic strategies for urinary tract infections in French general practice.

PubMed

Kinouani, S; de Lary de Latour, H; Joseph, J-P; Letrilliart, L

2017-10-01

We aimed to describe the diagnostic management procedures for detection of urinary tract infections in general practice and their correlated factors. We analyzed data from the ECOGEN study on urinary tract infections, collected in France between November 2011 and April 2012. This national cross-sectional study was carried out in general practices. Data was coded according to the International Classification of Primary Care. A total of 340 consultations or home visits were held for urinary tract infections. The five most frequent diagnostic procedures were (in descending order) clinical examination (67.6%), urine cytobacteriological examination (UCBE) (47.9%), urine dipstick test (15.6%), blood test (8.5%), and imaging (6.5%). No urine dipstick test or UCBE was performed in 43% of cases. Factors correlated with diagnostic procedures were age and gender of patients, annual number of consultations held by family physicians, and duration of consultation. Family physicians did not comply with guidelines on diagnostic management for detection of urinary tract infections. We hypothesized that this non-compliance could be due to the family physicians' environment and characteristics, and to clinical practice guidelines. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Does a higher 'quality points' score mean better care in stroke? An audit of general practice medical records.

PubMed

Williams, Peter Huw; de Lusignan, Simon

2006-01-01

The Royal College of Physicians (RCP) have produced guidelines for stroke management in primary care; this guidance is taken to be the gold standard for the care of people with stroke. UK general practitioners now have a quality-based contract which includes a Quality and Outcomes Framework (QOF). This consists of financially remunerated 'quality points' for specific disease areas, including stroke. Achievement of these quality points is measured by extracting a limited list of computer codes from practice computer systems. To investigate whether a high stroke quality score is associated with adherence to RCP guidelines. Examination of computer and written medical records of all patients with a diagnosis of stroke. Two general practices, one in southwest London, one in Surrey, with a combined practice population of over 20 000. Both practices had a similar age-sex profile and prevalence of stroke. One practice scored 93.5% (29/31) of the available stroke quality points. The other practice achieved 73.4% (22.75/31), and only did better in one stroke quality target. However, the practice scoring fewer quality points had much better adherence to RCP guidance: 96% of patients were assessed in secondary care compared with 79% (P=0.001); 64% of stroke patients were seen the same day, compared with 44%; 56% received rehabilitation compared with 37%. Higher quality points did not reflect better adherence to RCP guidance. This audit highlights a gap between relatively simplistic measures of quality in the QOF, dependent on the recording of a narrow range of computer codes, and the actual standard of care being delivered. Research is needed to see whether this finding is generalisable and how the Quality and Outcomes Framework might be better aligned with delivering best practice.

Patient reported outcomes (PROs) in clinical trials: is 'in-trial' guidance lacking? a systematic review.

PubMed

Kyte, Derek G; Draper, Heather; Ives, Jonathan; Liles, Clive; Gheorghe, Adrian; Calvert, Melanie

2013-01-01

Patient reported outcomes (PROs) are increasingly assessed in clinical trials, and guidelines are available to inform the design and reporting of such trials. However, researchers involved in PRO data collection report that specific guidance on 'in-trial' activity (recruitment, data collection and data inputting) and the management of 'concerning' PRO data (i.e., data which raises concern for the well-being of the trial participant) appears to be lacking. The purpose of this review was to determine the extent and nature of published guidelines addressing these areas. Systematic review of 1,362 articles identified 18 eligible papers containing 'in-trial' guidelines. Two independent authors undertook a qualitative content analysis of the selected papers. Guidelines presented in each of the articles were coded according to an a priori defined coding frame, which demonstrated reliability (pooled Kappa 0.86-0.97), and validity (<2% residual category coding). The majority of guidelines present were concerned with 'pre-trial' activities (72%), for example, outcome measure selection and study design issues, or 'post-trial' activities (16%) such as data analysis, reporting and interpretation. 'In-trial' guidelines represented 9.2% of all guidance across the papers reviewed, with content primarily focused on compliance, quality control, proxy assessment and reporting of data collection. There were no guidelines surrounding the management of concerning PRO data. The findings highlight there are minimal in-trial guidelines in publication regarding PRO data collection and management in clinical trials. No guidance appears to exist for researchers involved with the handling of concerning PRO data. Guidelines are needed, which support researchers to manage all PRO data appropriately and which facilitate unbiased data collection.

Patient Reported Outcomes (PROs) in Clinical Trials: Is ‘In-Trial’ Guidance Lacking? A Systematic Review

PubMed Central

Kyte, Derek G.; Draper, Heather; Ives, Jonathan; Liles, Clive; Gheorghe, Adrian; Calvert, Melanie

2013-01-01

Background Patient reported outcomes (PROs) are increasingly assessed in clinical trials, and guidelines are available to inform the design and reporting of such trials. However, researchers involved in PRO data collection report that specific guidance on ‘in-trial’ activity (recruitment, data collection and data inputting) and the management of ‘concerning’ PRO data (i.e., data which raises concern for the well-being of the trial participant) appears to be lacking. The purpose of this review was to determine the extent and nature of published guidelines addressing these areas. Methods and Findings Systematic review of 1,362 articles identified 18 eligible papers containing ‘in-trial’ guidelines. Two independent authors undertook a qualitative content analysis of the selected papers. Guidelines presented in each of the articles were coded according to an a priori defined coding frame, which demonstrated reliability (pooled Kappa 0.86–0.97), and validity (<2% residual category coding). The majority of guidelines present were concerned with ‘pre-trial’ activities (72%), for example, outcome measure selection and study design issues, or ‘post-trial’ activities (16%) such as data analysis, reporting and interpretation. ‘In-trial’ guidelines represented 9.2% of all guidance across the papers reviewed, with content primarily focused on compliance, quality control, proxy assessment and reporting of data collection. There were no guidelines surrounding the management of concerning PRO data. Conclusions The findings highlight there are minimal in-trial guidelines in publication regarding PRO data collection and management in clinical trials. No guidance appears to exist for researchers involved with the handling of concerning PRO data. Guidelines are needed, which support researchers to manage all PRO data appropriately and which facilitate unbiased data collection. PMID:23560103

Evaluating the uptake of Canada's new physical activity and sedentary behavior guidelines on service organizations' websites.

PubMed

Gainforth, Heather L; Berry, Tanya; Faulkner, Guy; Rhodes, Ryan E; Spence, John C; Tremblay, Mark S; Latimer-Cheung, Amy E

2013-06-01

New evidence-based physical activity and sedentary behavior guidelines for Canadians were launched in 2011. As a consequence, service organizations that promote physical activity directly to the public needed to change their promotion materials to reflect the new guidelines. Little is known about the rate at which service organizations adopt and integrate new evidence-based guidelines and determinants of guideline adoption. In this natural observational study, we evaluated the rate of online adoption of the new guidelines among key service organizations that promote physical activity and examined participation in a booster webinar as a supplemental dissemination strategy. One hundred fifty nine service organization websites were coded by one of six raters prior to the release of the new guidelines as well as at 3, 6, and 9 months after the release. Online adoption of the guidelines increased during the coding period with 51 % of organizations posting the guidelines or related information on their websites. Organizations' engagement in a webinar was associated with their adoption of the guidelines. The release of new Canadian Physical Activity and Sedentary Behaviour Guidelines led to increased guideline adoption on service organizations' websites. However, adoption was not universal. In order for the uptake of the new guidelines to be successful, further efforts need to be taken to ensure that service organizations present physical activity guidelines on their websites. Comprehensive, active dissemination strategies tailored to address organizational barriers are needed to ensure online guideline adoption.

National Utilization of Partial Nephrectomy Pre- and Post- AUA Guidelines: Is This as Good as It Gets?

PubMed

Sorokin, Igor; Feustel, Paul J; O'Malley, Rebecca L

2017-10-01

The purpose of the study was to compare utilization and predictors of partial nephrectomy (PN) in the pre- and post-guideline eras. American Board of Urology certification/recertification operative logs were reviewed from 2003 to 2014. Nephrectomy cases were extracted using Current Procedural Terminology codes. The cases were then stratified according to pre-guidelines (2003-October 2009) and post-guidelines (November 2009-2014). Multivariable logistic regression was used to evaluate patient, surgeon, and practice characteristics as predictors of PN. A general linear model with regression analysis was used to evaluate the change in PN over time relative to the incidence of renal cell carcinoma (RCC). We identified 20,402 and 20,729 nephrectomies in the pre- and post-guidelines eras, respectively. In multivariable analysis, the post-guidelines group was more likely to undergo PN (odds ratio, 1.87; P < .001). The pre- as well as post-guidelines groups had a higher likelihood of undergoing PN with an open approach, higher-volume surgeons, and younger patient age (P < .05). Surgeon subspecialty and US region were no longer significant factors after guidelines publication. Number of PN normalized to the incidence of RCC continued to increase over time (0.14%/y; R 2  = 0.77; P < .001). Partial nephrectomy in the post-guidelines era is no longer confined to urological subspecialists or certain densely populated US regions. Although rates of PN continue to increase relative to the recently decreasing overall incidence of RCC, the slope has leveled off somewhat. This is likely related to clinical intricacies of the best treatment modality and technologic advances rather than changes related to guidelines publication. Published by Elsevier Inc.

Guidelines for psychological evaluations in child protection matters.

PubMed

2013-01-01

The problems of abused and neglected children are epidemic in our society (U.S. Department of Health and Human Services, Administration on Children, Youth, and Families, 2008) and create issues that psychologists may be called upon to address. Psychologists are positioned to contribute significantly to decision making in child protection matters. Psychological data and expertise may provide sources of information and a perspective not otherwise available to courts regarding the functioning of parties, and thus may increase the fairness of decisions by the court, state agency, or other party. such matters. These guidelines are a revision of the 1999 "Guidelines for Psychological Evaluations in Child Protection Matters" (American Psychological Association [APA], 1999). These guidelines are informed by APA's "Ethical Principles of Psychologists and Code of Conduct" ("APA Ethics Code"; APA, 2002a, 2010).

Sponsorship in non-commercial clinical trials: definitions, challenges and the role of Good Clinical Practices guidelines.

PubMed

Ravinetto, Raffaella; De Nys, Katelijne; Boelaert, Marleen; Diro, Ermias; Meintjes, Graeme; Adoke, Yeka; Tagbor, Harry; Casteels, Minne

2015-12-30

Non-commercial clinical research plays an increasingly essential role for global health. Multiple partners join in international consortia that operate under the limited timeframe of a specific funding period. One organisation (the sponsor) designs and carries out the trial in collaboration with research partners, and is ultimately responsible for the trial's scientific, ethical, regulatory and legal aspects, while another organization, generally in the North (the funder), provides the external funding and sets funding conditions. Even if external funding mechanisms are key for most non-commercial research, the dependence on an external funder's policies may heavily influence the choices of a sponsor. In addition, the competition for accessing the available external funds is great, and non-commercial sponsors may not be in a position to discuss or refuse standard conditions set by a funder. To see whether the current definitions adequately address the intricacies of sponsorship in externally-funded trials, we looked at how a "sponsor" of clinical trials is defined in selected international guidelines, with particular focus on international Good Clinical Practices codes, and in selected European and African regulations/legislations. Our limited analysis suggests that the sponsors definition from the 1995 WHO Good Clinical Practices code has been integrated as such into many legislations, guidelines and regulations, and that it is not adequate to cover today's reality of funding arrangements in global health, where the legal responsibility and the funding source are de facto split. In agreement with other groups, we suggest that the international Good Clinical Practices codes should be updated to reflect the reality of non-commercial clinical research. In particular, they should explicitly include the distinction between commercial and non-commercial sponsors, and provide guidance to non-commercial sponsors for negotiating with external funding agencies and other research counterparts. Non-commercial sponsors of clinical trials should surely invest in the development of adequate legal, administrative and management skills. By acknowledging their role and specificities, and by providing them with adapted guidance, the international Good Clinical Practices codes would provide valuable guidance and support to non-commercial clinical research, whose relevance for global health is increasingly evident.

Conceptual and statistical issues in couples observational research: Rationale and methods for design decisions.

PubMed

Baucom, Brian R W; Leo, Karena; Adamo, Colin; Georgiou, Panayiotis; Baucom, Katherine J W

2017-12-01

Observational behavioral coding methods are widely used for the study of relational phenomena. There are numerous guidelines for the development and implementation of these methods that include principles for creating new and adapting existing coding systems as well as principles for creating coding teams. While these principles have been successfully implemented in research on relational phenomena, the ever expanding array of phenomena being investigated with observational methods calls for a similar expansion of these principles. Specifically, guidelines are needed for decisions that arise in current areas of emphasis in couple research including observational investigation of related outcomes (e.g., relationship distress and psychological symptoms), the study of change in behavior over time, and the study of group similarities and differences in the enactment and perception of behavior. This article describes conceptual and statistical considerations involved in these 3 areas of research and presents principle- and empirically based rationale for design decisions related to these issues. A unifying principle underlying these guidelines is the need for careful consideration of fit between theory, research questions, selection of coding systems, and creation of coding teams. Implications of (mis)fit for the advancement of theory are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Effectiveness of Traumatic Brain Injury Management Guideline Introduction in Hungary.

PubMed

Sorinola, Abayomi; Buki, Andras; Sandor, Janos; Czeiter, Endre

2018-01-01

To describe the impact of the Traumatic Brain Injury management guideline introduction in Hungary. Hospital discharge records (HDR) including age, gender, codes of interventions applied, ICD codes of diagnosed disorders of patients admitted between 01/01/2004 and 31/12/2010 with the diagnosis of intracranial injury (S06 by ICD10) from every inpatient institution in Hungary were collected from the database of National Health Insurance Fund (NHIF). The Case Fatality Ratios (CFR) for one week, one month and six months were calculated for the periods before and after the guideline introduction. The change of CFRs was applied as indicators for change of clinical quality elicited by the guideline. The centers together at one week, one month and six months had pre-guideline introduction CFRs of 23.4%, 37.7% and 47.5% and post-guideline introduction CFRs of 22.1%, 39.1%, and 50.0% respectively. The secondary institutions together at one week, one month and six months had pre-guideline introduction CFRs of 21.5%, 34.8% and 46.3% and post-guideline introduction CFRs of 21.9%, 37.0%, and 48.9% respectively. None of the CFRs showed significant change. The effectiveness of TBI management guideline adaptation in Hungary is poor. Without supportive financing and external auditing system, guideline introduction alone cannot achieve standard clinical practice and a reduction in CFR.

Unsupervised Extraction of Diagnosis Codes from EMRs Using Knowledge-Based and Extractive Text Summarization Techniques

PubMed Central

Kavuluru, Ramakanth; Han, Sifei; Harris, Daniel

2017-01-01

Diagnosis codes are extracted from medical records for billing and reimbursement and for secondary uses such as quality control and cohort identification. In the US, these codes come from the standard terminology ICD-9-CM derived from the international classification of diseases (ICD). ICD-9 codes are generally extracted by trained human coders by reading all artifacts available in a patient’s medical record following specific coding guidelines. To assist coders in this manual process, this paper proposes an unsupervised ensemble approach to automatically extract ICD-9 diagnosis codes from textual narratives included in electronic medical records (EMRs). Earlier attempts on automatic extraction focused on individual documents such as radiology reports and discharge summaries. Here we use a more realistic dataset and extract ICD-9 codes from EMRs of 1000 inpatient visits at the University of Kentucky Medical Center. Using named entity recognition (NER), graph-based concept-mapping of medical concepts, and extractive text summarization techniques, we achieve an example based average recall of 0.42 with average precision 0.47; compared with a baseline of using only NER, we notice a 12% improvement in recall with the graph-based approach and a 7% improvement in precision using the extractive text summarization approach. Although diagnosis codes are complex concepts often expressed in text with significant long range non-local dependencies, our present work shows the potential of unsupervised methods in extracting a portion of codes. As such, our findings are especially relevant for code extraction tasks where obtaining large amounts of training data is difficult. PMID:28748227

(I Can't Get No) Saturation: A simulation and guidelines for sample sizes in qualitative research.

PubMed

van Rijnsoever, Frank J

2017-01-01

I explore the sample size in qualitative research that is required to reach theoretical saturation. I conceptualize a population as consisting of sub-populations that contain different types of information sources that hold a number of codes. Theoretical saturation is reached after all the codes in the population have been observed once in the sample. I delineate three different scenarios to sample information sources: "random chance," which is based on probability sampling, "minimal information," which yields at least one new code per sampling step, and "maximum information," which yields the largest number of new codes per sampling step. Next, I use simulations to assess the minimum sample size for each scenario for systematically varying hypothetical populations. I show that theoretical saturation is more dependent on the mean probability of observing codes than on the number of codes in a population. Moreover, the minimal and maximal information scenarios are significantly more efficient than random chance, but yield fewer repetitions per code to validate the findings. I formulate guidelines for purposive sampling and recommend that researchers follow a minimum information scenario.

Quantitative data analysis to determine best food cooling practices in U.S. restaurants.

PubMed

Schaffner, Donald W; Brown, Laura Green; Ripley, Danny; Reimann, Dave; Koktavy, Nicole; Blade, Henry; Nicholas, David

2015-04-01

Data collected by the Centers for Disease Control and Prevention (CDC) show that improper cooling practices contributed to more than 500 foodborne illness outbreaks associated with restaurants or delis in the United States between 1998 and 2008. CDC's Environmental Health Specialists Network (EHS-Net) personnel collected data in approximately 50 randomly selected restaurants in nine EHS-Net sites in 2009 to 2010 and measured the temperatures of cooling food at the beginning and the end of the observation period. Those beginning and ending points were used to estimate cooling rates. The most common cooling method was refrigeration, used in 48% of cooling steps. Other cooling methods included ice baths (19%), room-temperature cooling (17%), ice-wand cooling (7%), and adding ice or frozen food to the cooling food as an ingredient (2%). Sixty-five percent of cooling observations had an estimated cooling rate that was compliant with the 2009 Food and Drug Administration Food Code guideline (cooling to 41 °F [5 °C] in 6 h). Large cuts of meat and stews had the slowest overall estimated cooling rate, approximately equal to that specified in the Food Code guideline. Pasta and noodles were the fastest cooling foods, with a cooling time of just over 2 h. Foods not being actively monitored by food workers were more than twice as likely to cool more slowly than recommended in the Food Code guideline. Food stored at a depth greater than 7.6 cm (3 in.) was twice as likely to cool more slowly than specified in the Food Code guideline. Unventilated cooling foods were almost twice as likely to cool more slowly than specified in the Food Code guideline. Our data suggest that several best cooling practices can contribute to a proper cooling process. Inspectors unable to assess the full cooling process should consider assessing specific cooling practices as an alternative. Future research could validate our estimation method and study the effect of specific practices on the full cooling process.

What Should I Do?

ERIC Educational Resources Information Center

Shelton, Charles

1993-01-01

Suggests that codes of ethics developed by educators and youth ministers can provide guidelines for dealing with social and personal dilemmas. Offers basic ethical guidelines for youth workers and suggests ways of implementing the principles in action. (MAB)

Assessing the Viability of Social Media for Disseminating Evidence-Based Nutrition Practice Guideline Through Content Analysis of Twitter Messages and Health Professional Interviews: An Observational Study

PubMed Central

Kenne, Deric; Wolfram, Taylor M; Abram, Jenica K; Fleming, Michael

2016-01-01

Background Given the high penetration of social media use, social media has been proposed as a method for the dissemination of information to health professionals and patients. This study explored the potential for social media dissemination of the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline (EBNPG) for Heart Failure (HF). Objectives The objectives were to (1) describe the existing social media content on HF, including message content, source, and target audience, and (2) describe the attitude of physicians and registered dietitian nutritionists (RDNs) who care for outpatient HF patients toward the use of social media as a method to obtain information for themselves and to share this information with patients. Methods The methods were divided into 2 parts. Part 1 involved conducting a content analysis of tweets related to HF, which were downloaded from Twitonomy and assigned codes for message content (19 codes), source (9 codes), and target audience (9 codes); code frequency was described. A comparison in the popularity of tweets (those marked as favorites or retweeted) based on applied codes was made using t tests. Part 2 involved conducting phone interviews with RDNs and physicians to describe health professionals’ attitude toward the use of social media to communicate general health information and information specifically related to the HF EBNPG. Interviews were transcribed and coded; exemplar quotes representing frequent themes are presented. Results The sample included 294 original tweets with the hashtag “#heartfailure.” The most frequent message content codes were “HF awareness” (166/294, 56.5%) and “patient support” (97/294, 33.0%). The most frequent source codes were “professional, government, patient advocacy organization, or charity” (112/277, 40.4%) and “patient or family” (105/277, 37.9%). The most frequent target audience codes were “unable to identify” (111/277, 40.1%) and “other” (55/277, 19.9%). Significant differences were found in the popularity of tweets with (mean 1, SD 1.3 favorites) or without (mean 0.7, SD 1.3 favorites), the content code being “HF research” (P=.049). Tweets with the source code “professional, government, patient advocacy organizations, or charities” were significantly more likely to be marked as a favorite and retweeted than those without this source code (mean 1.2, SD 1.4 vs mean 0.8, SD 1.2, P=.03) and (mean 1.5, SD 1.8 vs mean 0.9, SD 2.0, P=.03). Interview participants believed that social media was a useful way to gather professional information. They did not believe that social media was useful for communicating with patients due to privacy concerns and the fact that the information had to be kept general rather than be tailored for a specific patient and the belief that their patients did not use social media or technology. Conclusions Existing Twitter content related to HF comes from a combination of patients and evidence-based organizations; however, there is little nutrition content. That gap may present an opportunity for EBNPG dissemination. Health professionals use social media to gather information for themselves but are skeptical of its value when communicating with patients, particularly due to privacy concerns and misconceptions about the characteristics of social media users. PMID:27847349

Assessing the Viability of Social Media for Disseminating Evidence-Based Nutrition Practice Guideline Through Content Analysis of Twitter Messages and Health Professional Interviews: An Observational Study.

PubMed

Hand, Rosa K; Kenne, Deric; Wolfram, Taylor M; Abram, Jenica K; Fleming, Michael

2016-11-15

Given the high penetration of social media use, social media has been proposed as a method for the dissemination of information to health professionals and patients. This study explored the potential for social media dissemination of the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline (EBNPG) for Heart Failure (HF). The objectives were to (1) describe the existing social media content on HF, including message content, source, and target audience, and (2) describe the attitude of physicians and registered dietitian nutritionists (RDNs) who care for outpatient HF patients toward the use of social media as a method to obtain information for themselves and to share this information with patients. The methods were divided into 2 parts. Part 1 involved conducting a content analysis of tweets related to HF, which were downloaded from Twitonomy and assigned codes for message content (19 codes), source (9 codes), and target audience (9 codes); code frequency was described. A comparison in the popularity of tweets (those marked as favorites or retweeted) based on applied codes was made using t tests. Part 2 involved conducting phone interviews with RDNs and physicians to describe health professionals' attitude toward the use of social media to communicate general health information and information specifically related to the HF EBNPG. Interviews were transcribed and coded; exemplar quotes representing frequent themes are presented. The sample included 294 original tweets with the hashtag "#heartfailure." The most frequent message content codes were "HF awareness" (166/294, 56.5%) and "patient support" (97/294, 33.0%). The most frequent source codes were "professional, government, patient advocacy organization, or charity" (112/277, 40.4%) and "patient or family" (105/277, 37.9%). The most frequent target audience codes were "unable to identify" (111/277, 40.1%) and "other" (55/277, 19.9%). Significant differences were found in the popularity of tweets with (mean 1, SD 1.3 favorites) or without (mean 0.7, SD 1.3 favorites), the content code being "HF research" (P=.049). Tweets with the source code "professional, government, patient advocacy organizations, or charities" were significantly more likely to be marked as a favorite and retweeted than those without this source code (mean 1.2, SD 1.4 vs mean 0.8, SD 1.2, P=.03) and (mean 1.5, SD 1.8 vs mean 0.9, SD 2.0, P=.03). Interview participants believed that social media was a useful way to gather professional information. They did not believe that social media was useful for communicating with patients due to privacy concerns and the fact that the information had to be kept general rather than be tailored for a specific patient and the belief that their patients did not use social media or technology. Existing Twitter content related to HF comes from a combination of patients and evidence-based organizations; however, there is little nutrition content. That gap may present an opportunity for EBNPG dissemination. Health professionals use social media to gather information for themselves but are skeptical of its value when communicating with patients, particularly due to privacy concerns and misconceptions about the characteristics of social media users. ©Rosa K Hand, Deric Kenne, Taylor M Wolfram, Jenica K Abram, Michael Fleming. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.11.2016.

[10 Years of Quality Management: Perception and Importance from GPs' Point of View].

PubMed

Kühlein, T; Madlo-Thiess, F; Wambach, V; Schaffer, S

2018-03-01

Quality management (QM) became mandatory for the ambulatory sector of the German health care system 10 years ago. The aim of this study was to find out how general practitioners (GPs) perceived the introduction of this measure, how they see it today and what they expect of the future concerning QM. In a qualitative study, interviews following a semi-structured guideline with GPs were conducted. Following transcription, interviews were coded in triangulation, first inductively, then deductively until saturation was reached. Main topics and code families were agreed on after discussion. There was consensus on the necessity of standardization of basic processes like hygiene. However, the application of QM to an activity that emphasizes personal relationships and communication was seen as barely possible. GPs stated that they reduced QM to a tolerable and for them reasonable minimum. GPs mostly refused certification. The next 10 years were seen with pessimism in terms of more bureaucratic guidelines. The statutory introduction of QM was an attack on medical professionalism. Instead of passive resistance and reduction of QM to a minimum, engaged independent quality work might help to regain the trust of society we seem to have lost and restore the professional autonomy we need for our work. Eigentümer und Copyright ©Georg Thieme Verlag KG 2018.

Contributions to a Brazilian Code of Conduct for Fieldwork in Geology: an approach based on Geoconservation and Geoethics.

PubMed

Mansur, Kátia L; Ponciano, Luiza C M O; Castro, Aline R S F DE

2017-05-01

When considering the numerous events that have prohibited the development of scientific projects or caused destruction of outcrops, it is clear that there is rapidly increasing necessity to define a Brazilian Code of Conduct for geological fieldwork. In general, this destruction is attributed to lack of knowledge as to the relevance of geological sites. The aim of this Code of Conduct is to guide geologists to adopt good practices during geoscience activities. Proposed guidelines are based on Codes of Conduct from other countries, mainly Scotland and England, on situations described in papers and on the personal experience of the authors. In this paper 29 points are suggested, in order to guarantee that fieldwork is conducted in accordance with geoethics, geoconservation and sustainability values. The proposal is structured in three parts: (1) Behavior and practices in respect to local traditions and providing information to the population; (2) Measures to minimize degradation on outcrops; and (3) Safety. The proposal seeks to broaden the debate on the need for responsible behavior during fieldwork, in order to promote respect for geodiversity. Through this code, Brazilian geoscientists will be able to contribute to the conservation of geological heritage and of outcrops with special educational relevance.

42 CFR 137.328 - Must a construction project proposal incorporate provisions of Federal construction guidelines...

Code of Federal Regulations, 2014 CFR

2014-10-01

..., the Self-Governance Tribe and the Secretary must agree upon and specify appropriate building codes and...-Governance Tribe in the preparation of its construction project proposal. If Tribal construction codes and standards (including national, regional, State, or Tribal building codes or construction industry standards...

42 CFR 137.328 - Must a construction project proposal incorporate provisions of Federal construction guidelines...

Code of Federal Regulations, 2012 CFR

2012-10-01

..., the Self-Governance Tribe and the Secretary must agree upon and specify appropriate building codes and...-Governance Tribe in the preparation of its construction project proposal. If Tribal construction codes and standards (including national, regional, State, or Tribal building codes or construction industry standards...

42 CFR 137.328 - Must a construction project proposal incorporate provisions of Federal construction guidelines...

Code of Federal Regulations, 2013 CFR

2013-10-01

..., the Self-Governance Tribe and the Secretary must agree upon and specify appropriate building codes and...-Governance Tribe in the preparation of its construction project proposal. If Tribal construction codes and standards (including national, regional, State, or Tribal building codes or construction industry standards...

42 CFR 137.328 - Must a construction project proposal incorporate provisions of Federal construction guidelines...

Code of Federal Regulations, 2011 CFR

2011-10-01

..., the Self-Governance Tribe and the Secretary must agree upon and specify appropriate building codes and...-Governance Tribe in the preparation of its construction project proposal. If Tribal construction codes and standards (including national, regional, State, or Tribal building codes or construction industry standards...

42 CFR 137.328 - Must a construction project proposal incorporate provisions of Federal construction guidelines...

Code of Federal Regulations, 2010 CFR

2010-10-01

..., the Self-Governance Tribe and the Secretary must agree upon and specify appropriate building codes and...-Governance Tribe in the preparation of its construction project proposal. If Tribal construction codes and standards (including national, regional, State, or Tribal building codes or construction industry standards...

76 FR 26194 - Metarhizium anisopliae Strain F52; Exemption From the Requirement of a Tolerance

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

... sensitization--guinea pig (Harmonized Guideline 870.2600; MRID No. 448447-15). An acceptable dermal... pesticide manufacturer. Potentially affected entities may include, but are not limited to: Crop production (NAICS code 111). Animal production (NAICS code 112). Food manufacturing (NAICS code 311). Pesticide...

Structural design, analysis, and code evaluation of an odd-shaped pressure vessel

NASA Astrophysics Data System (ADS)

Rezvani, M. A.; Ziada, H. H.

1992-12-01

An effort to design, analyze, and evaluate a rectangular pressure vessel is described. Normally pressure vessels are designed in circular or spherical shapes to prevent stress concentrations. In this case, because of operational limitations, the choice of vessels was limited to a rectangular pressure box with a removable cover plate. The American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel Code is used as a guideline for pressure containments whose width or depth exceeds 15.24 cm (6.0 in.) and where pressures will exceed 103.4 KPa (15.0 lbf/in(sup 2)). This evaluation used Section 8 of this Code, hereafter referred to as the Code. The dimensions and working pressure of the subject vessel fall within the pressure vessel category of the Code. The Code design guidelines and rules do not directly apply to this vessel. Therefore, finite-element methodology was used to analyze the pressure vessel, and the Code then was used in qualifying the vessel to be stamped to the Code. Section 8, Division 1 of the Code was used for evaluation. This action was justified by selecting a material for which fatigue damage would not be a concern. The stress analysis results were then checked against the Code, and the thicknesses adjusted to satisfy Code requirements. Although not directly applicable, the Code design formulas for rectangular vessels were also considered and presented.

A case report of embryo donation: ethical and clinical implications for psychologists.

PubMed

Rizk, Marianne; Pawlak, Stacey

2016-10-01

Third-party reproduction is a growing field, and an increasing body of literature considers the ethics of embryo donation. Due to the psychosocial complexities that generally accompany the donation and/or use of donor embryos, psychologists can play a pivotal role in these specialised fertility cases. While laws in the USA are in place to regulate the medical procedures involved in embryo donation, only unenforceable guidelines exist for psychologists specialising in fertility cases. The presentation of this case study aims to: (1) clarify the ethical concerns that fertility psychologists should consider in similar situations by assessing whether American Society of Reproductive Medicine (ASRM) and the American Psychological Association (APA) guidelines compete or complement one another within this case of embryo donation and (2) consider the interests, obligations and rights of all parties involved. Several principles, standards and guidelines that must be considered are described. Overall, the APA Ethics Code and the ASRM Guidelines appear to complement one another for most aspects of this case. Fertility psychologists should consider the clinical implications of the interests, rights and duties of all involved parties, including themselves. 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/

Supporting the Uptake of Nursing Guidelines: what you really need to know to move nursing guidelines into practice.

PubMed

Matthew-Maich, Nancy; Ploeg, Jenny; Dobbins, Maureen; Jack, Susan

2013-05-01

There is a current push to use best practice guidelines (BPGs) in health care to enhance client care and outcomes. Even though intensive resources have been invested internationally to develop BPGs, a gap in knowledge exists about how to consistently and efficiently move them into practice. Constructivist grounded theory was used to explore the complex processes of a breastfeeding BPG implementation and uptake in three acute care hospitals. Interviews (n = 120) with 112 participants representing clients, nurses, lactation consultants, midwives, physicians, managers, administrators, and nurse educators as well as document and field note analysis informed this study. Data were analyzed using constant comparison and coding steps outlined by Charmaz: initial coding, selective (focused) coding, then theoretical coding. Triangulation of data types and sources were used as well as theoretical sampling. Data were collected from 2009 to 2010. Two sites showed BPG uptake while one did not. Factors present in the uptake sites included, ongoing passionate frontline leaders, the use of multifaceted strategies, and processes that occurred at organizational, leadership, individual and social levels. Particularly noteworthy was the transformation of individual nurses to believing in and using the BPG. Impacts occurred at client, nurse, unit, inter-professional, organizational and system levels. A conceptual framework: Supporting the Uptake of Nursing Guidelines, was developed that reveals essential processes used to facilitate BPG uptake into nursing practice and a process of nurse transformation to believing in and using the BPG. © Sigma Theta Tau International.

ICD-9-CM and ICD-10-CM mapping of the AAST Emergency General Surgery disease severity grading systems: Conceptual approach, limitations, and recommendations for the future.

PubMed

Utter, Garth H; Miller, Preston R; Mowery, Nathan T; Tominaga, Gail T; Gunter, Oliver; Osler, Turner M; Ciesla, David J; Agarwal, Suresh K; Inaba, Kenji; Aboutanos, Michel B; Brown, Carlos V R; Ross, Steven E; Crandall, Marie L; Shafi, Shahid

2015-05-01

The American Association for the Surgery of Trauma (AAST) recently established a grading system for uniform reporting of anatomic severity of several emergency general surgery (EGS) diseases. There are five grades of severity for each disease, ranging from I (lowest severity) to V (highest severity). However, the grading process requires manual chart review. We sought to evaluate whether International Classification of Diseases, 9th and 10th Revisions, Clinical Modification (ICD-9-CM, ICD-10-CM) codes might allow estimation of AAST grades for EGS diseases. The Patient Assessment and Outcomes Committee of the AAST reviewed all available ICD-9-CM and ICD-10-CM diagnosis codes relevant to 16 EGS diseases with available AAST grades. We then matched grades for each EGS disease with one or more ICD codes. We used the Official Coding Guidelines for ICD-9-CM and ICD-10-CM and the American Hospital Association's "Coding Clinic for ICD-9-CM" for coding guidance. The ICD codes did not allow for matching all five AAST grades of severity for each of the 16 diseases. With ICD-9-CM, six diseases mapped into four categories of severity (instead of five), another six diseases into three categories of severity, and four diseases into only two categories of severity. With ICD-10-CM, five diseases mapped into four categories of severity, seven diseases into three categories, and four diseases into two categories. Two diseases mapped into discontinuous categories of grades (two in ICD-9-CM and one in ICD-10-CM). Although resolution is limited, ICD-9-CM and ICD-10-CM diagnosis codes might have some utility in roughly approximating the severity of the AAST grades in the absence of more precise information. These ICD mappings should be validated and refined before widespread use to characterize EGS disease severity. In the long-term, it may be desirable to develop alternatives to ICD-9-CM and ICD-10-CM codes for routine collection of disease severity characteristics.

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

Ischaemic stroke management at Al-Shifa Hospital in the Gaza Strip: a clinical audit.

PubMed

Abukaresh, Amir; Al-Abadlah, Rami; Böttcher, Bettina; El-Essi, Khamis

2018-02-21

In the 2014 Palestinian annual health report, cerebrovascular accident was ranked as the third leading cause of death in the occupied Palestinian territory. Cerebrovascular accident is also one the most common causes of disability worldwide. Good management decreases mortality and morbidity. The aim of this study was to assess the current management of patients with ischaemic stroke at the Al-Shifa Hospital and to compare this with international guidelines. For this clinical audit, we used simple random sampling to select files of patients admitted with the diagnosis of ischaemic stroke to the Al-Shifa Hospital. Data collection sheets were completed, and clinical practice was compared with the 2013 American Stroke Association guidelines. Between January and June, 2016, 254 patients were admitted with ischaemic stroke, haemorrhagic stroke, or transient ischaemic attack. We selected 55 patient files. The International Classification of Diseases coding for cerebral infarction in patient files was relatively good, with 92% of files correctly coded. However, we found a substantial weakness in the documentation of duration, progression of symptoms (documented in 20% of files only), and physiotherapy assessment. Most essential acute investigations were done on time (for all [100%] patients needing blood count, renal function tests, and CT scan and for 42 [76%] patients needing ECG). However, thrombolytic drugs were not used because they were not available. Long-term antiplatelet therapy was provided properly to 51 (92%) patients discharged from hospital. However, the initial doses of antiplatelet therapy were generally lower than the international recommendations. Findings also showed a marked inconformity of blood pressure management, especially with respect to the treatment decision and the choice of antihypertensive drug. No local guidelines exist. Furthermore, the lack of availability of thrombolysis medication and the poor deviation in blood pressure management show a lack of evidence-based practice. These findings point to the urgent need for the development of local, evidence-based guidelines. None. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Pupil Nondiscrimination Guidelines for Athletics. Implementing Section 118.13 of the Wisconsin Statutes and PI 9 of the Wisconsin Administrative Code. Revised.

ERIC Educational Resources Information Center

Wisconsin Interscholastic Athletic Association.

This guide is designed to assist schools in fully implementing Wisconsin's pupil nondiscrimination guidelines which provide equal educational opportunity for all of its students. The guidelines focus on discrimination problems in interscholastic athletics and are based on sex equity. Following a foreword and acknowledgements, the document is…

(I Can’t Get No) Saturation: A simulation and guidelines for sample sizes in qualitative research

PubMed Central

2017-01-01

I explore the sample size in qualitative research that is required to reach theoretical saturation. I conceptualize a population as consisting of sub-populations that contain different types of information sources that hold a number of codes. Theoretical saturation is reached after all the codes in the population have been observed once in the sample. I delineate three different scenarios to sample information sources: “random chance,” which is based on probability sampling, “minimal information,” which yields at least one new code per sampling step, and “maximum information,” which yields the largest number of new codes per sampling step. Next, I use simulations to assess the minimum sample size for each scenario for systematically varying hypothetical populations. I show that theoretical saturation is more dependent on the mean probability of observing codes than on the number of codes in a population. Moreover, the minimal and maximal information scenarios are significantly more efficient than random chance, but yield fewer repetitions per code to validate the findings. I formulate guidelines for purposive sampling and recommend that researchers follow a minimum information scenario. PMID:28746358

The re-identification risk of Canadians from longitudinal demographics

PubMed Central

2011-01-01

Background The public is less willing to allow their personal health information to be disclosed for research purposes if they do not trust researchers and how researchers manage their data. However, the public is more comfortable with their data being used for research if the risk of re-identification is low. There are few studies on the risk of re-identification of Canadians from their basic demographics, and no studies on their risk from their longitudinal data. Our objective was to estimate the risk of re-identification from the basic cross-sectional and longitudinal demographics of Canadians. Methods Uniqueness is a common measure of re-identification risk. Demographic data on a 25% random sample of the population of Montreal were analyzed to estimate population uniqueness on postal code, date of birth, and gender as well as their generalizations, for periods ranging from 1 year to 11 years. Results Almost 98% of the population was unique on full postal code, date of birth and gender: these three variables are effectively a unique identifier for Montrealers. Uniqueness increased for longitudinal data. Considerable generalization was required to reach acceptably low uniqueness levels, especially for longitudinal data. Detailed guidelines and disclosure policies on how to ensure that the re-identification risk is low are provided. Conclusions A large percentage of Montreal residents are unique on basic demographics. For non-longitudinal data sets, the three character postal code, gender, and month/year of birth represent sufficiently low re-identification risk. Data custodians need to generalize their demographic information further for longitudinal data sets. PMID:21696636

NAEYC Code of Ethical Conduct. Revised = Codigo de Conducta Etica. Revisada

ERIC Educational Resources Information Center

National Association of Elementary School Principals (NAESP), 2005

2005-01-01

This document presents a code of ethics for early childhood educators that offers guidelines for responsible behavior and sets forth a common basis for resolving ethical dilemmas encountered in early education. It represents the English and Spanish versions of the revised code. Its contents were approved by the NAEYC Governing Board in April 2005…

INTERIM RADON-RESISTANT CONTRUCTION GUIDELINES FOR USE IN FLORIDA, 1989

EPA Science Inventory

The report gives results of a project to investigate, analyze, and develop radon-resistant construction guidelines that are consistent with other building codes and that could be applied to Florida. Literature search resulted in information on radon remediation techniques, new c...

Quantitative Data Analysis To Determine Best Food Cooling Practices in U.S. Restaurants†

PubMed Central

Schaffner, Donald W.; Brown, Laura Green; Ripley, Danny; Reimann, Dave; Koktavy, Nicole; Blade, Henry; Nicholas, David

2017-01-01

Data collected by the Centers for Disease Control and Prevention (CDC) show that improper cooling practices contributed to more than 500 foodborne illness outbreaks associated with restaurants or delis in the United States between 1998 and 2008. CDC's Environmental Health Specialists Network (EHS-Net) personnel collected data in approximately 50 randomly selected restaurants in nine EHS-Net sites in 2009 to 2010 and measured the temperatures of cooling food at the beginning and the end of the observation period. Those beginning and ending points were used to estimate cooling rates. The most common cooling method was refrigeration, used in 48% of cooling steps. Other cooling methods included ice baths (19%), room-temperature cooling (17%), ice-wand cooling (7%), and adding ice or frozen food to the cooling food as an ingredient (2%). Sixty-five percent of cooling observations had an estimated cooling rate that was compliant with the 2009 Food and Drug Administration Food Code guideline (cooling to 41°F [5°C] in 6 h). Large cuts of meat and stews had the slowest overall estimated cooling rate, approximately equal to that specified in the Food Code guideline. Pasta and noodles were the fastest cooling foods, with a cooling time of just over 2 h. Foods not being actively monitored by food workers were more than twice as likely to cool more slowly than recommended in the Food Code guideline. Food stored at a depth greater than 7.6 cm (3 in.) was twice as likely to cool more slowly than specified in the Food Code guideline. Unventilated cooling foods were almost twice as likely to cool more slowly than specified in the Food Code guideline. Our data suggest that several best cooling practices can contribute to a proper cooling process. Inspectors unable to assess the full cooling process should consider assessing specific cooling practices as an alternative. Future research could validate our estimation method and study the effect of specific practices on the full cooling process. PMID:25836405

From policy to practice: implementation of physical activity and food policies in schools

PubMed Central

2013-01-01

Purpose Public policies targeting the school setting are increasingly being used to address childhood obesity; however, their effectiveness depends on their implementation. This study explores the factors which impeded or facilitated the implementation of publicly mandated school-based physical activity and nutrition guidelines in the province of British Columbia (BC), Canada. Methods Semi-structured interviews were conducted with 50 school informants (17 principals - 33 teacher/school informants) to examine the factors associated with the implementation of the mandated Daily Physical Activity (DPA) and Food and Beverage Sales in Schools (FBSS) guidelines. Coding used a constructivist grounded theory approach. The first five transcripts and every fifth transcript thereafter were coded by two independent coders with discrepancies reconciled by a third coder. Data was coded and analysed in the NVivo 9 software. Concept maps were developed and current theoretical perspectives were integrated in the later stages of analysis. Results The Diffusion of Innovations Model provided an organizing framework to present emergent themes. With the exception of triability (not relevant in the context of mandated guidelines/policies), the key attributes of the Diffusion of Innovations Model (relative advantage, compatibility, complexity, and observability) provided a robust framework for understanding themes associated with implementation of mandated guidelines. Specifically, implementation of the DPA and FBSS guidelines was facilitated by perceptions that they: were relatively advantageous compared to status quo; were compatible with school mandates and teaching philosophies; had observable positive impacts and impeded when perceived as complex to understand and implement. In addition, a number of contextual factors including availability of resources facilitated implementation. Conclusions The enactment of mandated policies/guidelines for schools is considered an essential step in improving physical activity and healthy eating. However, policy makers need to: monitor whether schools are able to implement the guidelines, support schools struggling with implementation, and document the impact of the guidelines on students’ behaviors. To facilitate the implementation of mandated guidelines/policies, the Diffusion of Innovations Model provides an organizational framework for planning interventions. Changing the school environment is a process which cannot be undertaken solely by passive means as we know that such approaches have not resulted in adequate implementation. PMID:23731803

From policy to practice: implementation of physical activity and food policies in schools.

PubMed

Mâsse, Louise C; Naiman, Daniel; Naylor, Patti-Jean

2013-06-03

Public policies targeting the school setting are increasingly being used to address childhood obesity; however, their effectiveness depends on their implementation. This study explores the factors which impeded or facilitated the implementation of publicly mandated school-based physical activity and nutrition guidelines in the province of British Columbia (BC), Canada. Semi-structured interviews were conducted with 50 school informants (17 principals - 33 teacher/school informants) to examine the factors associated with the implementation of the mandated Daily Physical Activity (DPA) and Food and Beverage Sales in Schools (FBSS) guidelines. Coding used a constructivist grounded theory approach. The first five transcripts and every fifth transcript thereafter were coded by two independent coders with discrepancies reconciled by a third coder. Data was coded and analysed in the NVivo 9 software. Concept maps were developed and current theoretical perspectives were integrated in the later stages of analysis. The Diffusion of Innovations Model provided an organizing framework to present emergent themes. With the exception of triability (not relevant in the context of mandated guidelines/policies), the key attributes of the Diffusion of Innovations Model (relative advantage, compatibility, complexity, and observability) provided a robust framework for understanding themes associated with implementation of mandated guidelines. Specifically, implementation of the DPA and FBSS guidelines was facilitated by perceptions that they: were relatively advantageous compared to status quo; were compatible with school mandates and teaching philosophies; had observable positive impacts and impeded when perceived as complex to understand and implement. In addition, a number of contextual factors including availability of resources facilitated implementation. The enactment of mandated policies/guidelines for schools is considered an essential step in improving physical activity and healthy eating. However, policy makers need to: monitor whether schools are able to implement the guidelines, support schools struggling with implementation, and document the impact of the guidelines on students' behaviors. To facilitate the implementation of mandated guidelines/policies, the Diffusion of Innovations Model provides an organizational framework for planning interventions. Changing the school environment is a process which cannot be undertaken solely by passive means as we know that such approaches have not resulted in adequate implementation.

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

Affirmative Action Guidelines.

ERIC Educational Resources Information Center

Barbarita, Juana

Clarifying guidelines are presented for use by California community college districts in interpreting Title 5 of the California Administrative Code, which requires the adoption of employee affirmative action plans, including goals and timetables to increase the number of ethnic minorities and women in district employment. Following material on the…

Magna Carta for Researchers

NASA Astrophysics Data System (ADS)

2006-12-01

Today, Janez Potočnik, European Commissioner for Science and Research received a statement of support for the European Charter for Researchers and the Code of Conduct for the Recruitment of Researchers from EIROforum. "The EIROforum partners warmly welcome this valuable initiative by the European Commission", said Prof. William G. Stirling, Director General of ESRF and present Chairman of EIROforum."This is an important step towards the implementation of the European Research Area." ESO PR Photo 47/06 ESO PR Photo 47a/06 Janez Potočnik, European Commissioner for Science and Research receives the statement of support from Bill Stirling, Director General of ESRF and present Chairman of EIROforum. The European Charter for Researchers addresses the roles, responsibilities and entitlements of researchers and their employers or funding organisations. It aims at ensuring that the relationship between these parties contributes to successful performance in the generation, transfer and sharing of knowledge, and to the career development of researchers. The Code of Conduct for the Recruitment of Researchers aims to improve recruitment, to make selection procedures fairer and more transparent and proposes different means of judging merit. Merit should not just be measured on the number of publications but on a wider range of evaluation criteria, such as teaching, supervision, teamwork, knowledge transfer, management and public awareness activities. ESO PR Photo 47/06 ESO PR Photo 47b/06 The signature of the statement of support last November. From left to right: Richard Wagner, Director of the ILL, David Southwood, Scientific Director of ESA, Robert Aymar, Director General of CERN, Bill Stirling, Director General of ESRF, Catherine Cesarsky, Director General of ESO, Francesco Romanelli, EFDA-JET leader and Silke Schumacher, Coordinator International Relations and Communication of the EMBL. In their statement, signed at the EIROforum Assembly on 15 November 2006, the seven EIROforum organisations support the general principles contained in the Charter and the Code, and will endeavour individually, where appropriate, to implement recommendations that have not yet been undertaken, or which could be improved within their own organisations. The two documents were carefully studied by the organisations' human resources experts, who noted the high level of compliance with the guidelines of the Charter and the Code in the EIROforum organisations, where most of the recommendations are implemented and part of internal practice. The implementation of the recommendations of the Charter and the Code of Conduct will be done in full compliance with the relevant intergovernmental conventions and agreements, staff rules and regulations, applicable to each of the EIROforum organisations.

An Empirical Evaluation of the US Beer Institute’s Self-Regulation Code Governing the Content of Beer Advertising

PubMed Central

Xuan, Ziming; Damon, Donna; Noel, Jonathan

2013-01-01

Objectives. We evaluated advertising code violations using the US Beer Institute guidelines for responsible advertising. Methods. We applied the Delphi rating technique to all beer ads (n = 289) broadcast in national markets between 1999 and 2008 during the National Collegiate Athletic Association basketball tournament games. Fifteen public health professionals completed ratings using quantitative scales measuring the content of alcohol advertisements (e.g., perceived actor age, portrayal of excessive drinking) according to 1997 and 2006 versions of the Beer Institute Code. Results. Depending on the code version, exclusion criteria, and scoring method, expert raters found that between 35% and 74% of the ads had code violations. There were significant differences among producers in the frequency with which ads with violations were broadcast, but not in the proportions of unique ads with violations. Guidelines most likely to be violated included the association of beer drinking with social success and the use of content appealing to persons younger than 21 years. Conclusions. The alcohol industry’s current self-regulatory framework is ineffective at preventing content violations but could be improved by the use of new rating procedures designed to better detect content code violations. PMID:23947318

An empirical evaluation of the US Beer Institute's self-regulation code governing the content of beer advertising.

PubMed

Babor, Thomas F; Xuan, Ziming; Damon, Donna; Noel, Jonathan

2013-10-01

We evaluated advertising code violations using the US Beer Institute guidelines for responsible advertising. We applied the Delphi rating technique to all beer ads (n = 289) broadcast in national markets between 1999 and 2008 during the National Collegiate Athletic Association basketball tournament games. Fifteen public health professionals completed ratings using quantitative scales measuring the content of alcohol advertisements (e.g., perceived actor age, portrayal of excessive drinking) according to 1997 and 2006 versions of the Beer Institute Code. Depending on the code version, exclusion criteria, and scoring method, expert raters found that between 35% and 74% of the ads had code violations. There were significant differences among producers in the frequency with which ads with violations were broadcast, but not in the proportions of unique ads with violations. Guidelines most likely to be violated included the association of beer drinking with social success and the use of content appealing to persons younger than 21 years. The alcohol industry's current self-regulatory framework is ineffective at preventing content violations but could be improved by the use of new rating procedures designed to better detect content code violations.

Patient Self-Defined Goals: Essentials of Person-Centered Care for Serious Illness.

PubMed

Schellinger, Sandra Ellen; Anderson, Eric Worden; Frazer, Monica Schmitz; Cain, Cindy Lynn

2018-01-01

This research, a descriptive qualitative analysis of self-defined serious illness goals, expands the knowledge of what goals are important beyond the physical-making existing disease-specific guidelines more holistic. Integration of goals of care discussions and documentation is standard for quality palliative care but not consistently executed into general and specialty practice. Over 14 months, lay health-care workers (care guides) provided monthly supportive visits for 160 patients with advanced heart failure, cancer, and dementia expected to die in 2 to 3 years. Care guides explored what was most important to patients and documented their self-defined goals on a medical record flow sheet. Using definitions of an expanded set of whole-person domains adapted from the National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care, 999 goals and their associated plans were deductively coded and examined. Four themes were identified-medical, nonmedical, multiple, and global. Forty percent of goals were coded into the medical domain; 40% were coded to nonmedical domains-social (9%), ethical (7%), family (6%), financial/legal (5%), psychological (5%), housing (3%), legacy/bereavement (3%), spiritual (1%), and end-of-life care (1%). Sixteen percent of the goals were complex and reflected a mix of medical and nonmedical domains, "multiple" goals. The remaining goals (4%) were too global to attribute to an NCP domain. Self-defined serious illness goals express experiences beyond physical health and extend into all aspects of whole person. It is feasible to elicit and record serious illness goals. This approach to goals can support meaningful person-centered care, decision-making, and planning that accords with individual preferences of late life.

77 FR 54663 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-05

...This final rule adopts the standard for a national unique health plan identifier (HPID) and establishes requirements for the implementation of the HPID. In addition, it adopts a data element that will serve as an other entity identifier (OEID), or an identifier for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. This final rule also specifies the circumstances under which an organization covered health care provider must require certain noncovered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier (NPI). Lastly, this final rule changes the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD- 10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, 2014.

Research ethics and lessons from Hwanggate: what can we learn from the Korean cloning fraud?

PubMed

Saunders, R; Savulescu, J

2008-03-01

In this review of the Korean cloning scandal involving Woo-Suk Hwang, the nature of the disaster is documented and reasons why it occurred are suggested. The general problems it raises for scientific research are highlighted and six possible ways of improving practice are offered in the light of this case: (1) better education of science students; (2) independent monitoring and validation; (3) guidelines for tissue donation for research; (4) fostering of debate about ethically contentious research in science journals; (5) development of an international code of ethical research practice; (6) fostering of public involvement in ethical review and debate through the web.

Clean air program : design guidelines for bus transit systems using compressed natural gas as an alternative fuel

DOT National Transportation Integrated Search

1996-06-01

This report documents design guidelines for the safe use of Compressed Natural Gas (CNG). The report is designed to provide guidance, information on safe industry practices, applicable national codes and standards, and reference data that transit age...

10 CFR 1023.9 - General guidelines.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false General guidelines. 1023.9 Section 1023.9 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) CONTRACT APPEALS Overview: Organization, Functions and Authorities § 1023.9 General guidelines. (a) The principles of this Overview shall apply to all Board functions...

Building Codes and Regulations.

ERIC Educational Resources Information Center

Fisher, John L.

The hazard of fire is of great concern to libraries due to combustible books and new plastics used in construction and interiors. Building codes and standards can offer architects and planners guidelines to follow but these standards should be closely monitored, updated, and researched for fire prevention. (DS)

Ask a SEER Registrar - SEER Registrars

Cancer.gov

First submit questions to your central registry as required and they will submit them to SEER. Use the form on this page to submit questions to SEER staff about coding cancer cases or SEER's reporting guideline materials. Coding and abstracting answers are on SEER Inquiry System website.

Guidelines for Developing Computer Based Resource Units. Revised.

ERIC Educational Resources Information Center

State Univ. of New York, Buffalo. Coll. at Buffalo. Educational Research and Development Complex.

Presented for use with normal and handicapped children are guidelines for the development of computer based resource units organized into two operations: one of which is the production of software which includes the writing of instructional objectives, content, activities, materials, and measuring devices; and the other the coding of the software…

A high temperature fatigue life prediction computer code based on the total strain version of StrainRange Partitioning (SRP)

NASA Technical Reports Server (NTRS)

Mcgaw, Michael A.; Saltsman, James F.

1993-01-01

A recently developed high-temperature fatigue life prediction computer code is presented and an example of its usage given. The code discussed is based on the Total Strain version of Strainrange Partitioning (TS-SRP). Included in this code are procedures for characterizing the creep-fatigue durability behavior of an alloy according to TS-SRP guidelines and predicting cyclic life for complex cycle types for both isothermal and thermomechanical conditions. A reasonably extensive materials properties database is included with the code.

43 CFR 4.100 - General rules and guidelines.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false General rules and guidelines. 4.100... rules and guidelines. (a) Effective date and applicability—(1) Effective date and general applicability..., in which event the period shall run to the end of the next business day. (e) General guidelines—(1...

The appraisal of clinical guidelines in dentistry.

PubMed

Glenny, Anne-Marie; Worthington, Helen V; Clarkson, Jan E; Esposito, Marco

2009-01-01

To appraise the reported processes involved in the development of published dental guidelines. Electronic databases were searched to identify guidelines making recommendations for any health professional within dentistry. All included guidelines were appraised using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. A total of 105 guidelines met the inclusion criteria. The appraised guidelines showed lack of rigour in their development (median score 14.3%; range 0% to 100%). Only 10 (9.5%) were coded as 'strongly recommend' by at least two assessors. If recommendations within clinical guidelines are to be relied upon, the methods used in their development must be explicit and free from bias. When using the AGREE checklist to make decisions on whether or not to implement individual sets of guidelines, the findings of the present assessment reinforce the need for more than two assessors to be included in the appraisal of each set of guidelines.

A Brief Report on the Ethical and Legal Guides For Technology Use in Marriage and Family Therapy.

PubMed

Pennington, Michael; Patton, Rikki; Ray, Amber; Katafiasz, Heather

2017-10-01

Marriage and family therapists (MFTs) use ethical codes and state licensure laws/rules as guidelines for best clinical practice. It is important that professional codes reflect the potential exponential use of technology in therapy. However, current standards regarding technology use lack clarity. To explore this gap, a summative content analysis was conducted on state licensure laws/rules and professional ethical codes to find themes and subthemes among the many aspects of therapy in which technology can be utilized. Findings from the content analysis indicated that while there have been efforts by both state and professional organizations to incorporate guidance for technology use in therapy, a clear and comprehensive "roadmap" is still missing. Future scholarship is needed that develops clearer guidelines for therapists. © 2017 American Association for Marriage and Family Therapy.

Alcohol industry self-regulation: who is it really protecting?

PubMed

Noel, Jonathan; Lazzarini, Zita; Robaina, Katherine; Vendrame, Alan

2017-01-01

Self-regulation has been promoted by the alcohol industry as a sufficient means of regulating alcohol marketing activities. However, evidence suggests that the guidelines of self-regulated alcohol marketing codes are violated routinely, resulting in excessive alcohol marketing exposure to youth and the use of content that is potentially harmful to youth and other vulnerable populations. If the alcohol industry does not adhere to its own regulations the purpose and design of these codes should be questioned. Indeed, implementation of alcohol marketing self-regulation in Brazil, the United Kingdom and the United States was likely to delay statutory regulation rather than to promote public health. Moreover, current self-regulation codes suffer from vague language that may allow the industry to circumvent the guidelines, loopholes that may obstruct the implementation of the codes, lax exposure guidelines that can allow excessive youth exposure, even if properly followed, and a standard of review that may be inappropriate for protecting vulnerable populations. Greater public health benefits may be realized if legislative restrictions were applied to alcohol marketing, and strict statutory alcohol marketing regulations have been implemented and defended successfully in the European Union, with European courts declaring that restrictions on alcohol marketing are proportional to the benefits to public health. In contrast, attempts to restrict alcohol marketing activities in the United States have occurred through private litigation and have been unsuccessful. None the less, repeated violations of industry codes may provide legislators with sufficient justification to pass new legislation and for such legislation to withstand constitutional review in the United States and elsewhere. © 2016 Society for the Study of Addiction.

A mirror code for protein-cholesterol interactions in the two leaflets of biological membranes

NASA Astrophysics Data System (ADS)

Fantini, Jacques; di Scala, Coralie; Evans, Luke S.; Williamson, Philip T. F.; Barrantes, Francisco J.

2016-02-01

Cholesterol controls the activity of a wide range of membrane receptors through specific interactions and identifying cholesterol recognition motifs is therefore critical for understanding signaling receptor function. The membrane-spanning domains of the paradigm neurotransmitter receptor for acetylcholine (AChR) display a series of cholesterol consensus domains (referred to as “CARC”). Here we use a combination of molecular modeling, lipid monolayer/mutational approaches and NMR spectroscopy to study the binding of cholesterol to a synthetic CARC peptide. The CARC-cholesterol interaction is of high affinity, lipid-specific, concentration-dependent, and sensitive to single-point mutations. The CARC motif is generally located in the outer membrane leaflet and its reverse sequence CRAC in the inner one. Their simultaneous presence within the same transmembrane domain obeys a “mirror code” controlling protein-cholesterol interactions in the outer and inner membrane leaflets. Deciphering this code enabled us to elaborate guidelines for the detection of cholesterol-binding motifs in any membrane protein. Several representative examples of neurotransmitter receptors and ABC transporters with the dual CARC/CRAC motifs are presented. The biological significance and potential clinical applications of the mirror code are discussed.

Euthanasia and death with dignity in Japanese law.

PubMed

Kai, Katsunori

2010-12-01

In Japan, there are no acts and, specific provisions or official guidelines on euthanasia, but recently, as I will mention below, an official guideline on "death with dignity" has been made. Nevertheless in fact, this guideline provides only a few rules of process on terminal care. Therefore the problems of euthanasia and "death with dignity" are mainly left to the legal interpretation by literatures and judicial precedents of homicide (Article 199 of the Criminal Code; where there is no distinction between murder and manslaughter) and of homicide with consent (Article 202 of the Criminal Code). Furthermore, there are several cases on euthanasia or "death with dignity" as well as borderline cases in Japan. In this paper I will present the situation of the latest discussions on euthanasia and "death with dignity" in Japan from the viewpoint of medical law. Especially, "death with dignity" is seriously discussed in Japan, therefore I focus on it.

Discovery of functional elements in 12 Drosophila genomes using evolutionary signatures

PubMed Central

Stark, Alexander; Lin, Michael F.; Kheradpour, Pouya; Pedersen, Jakob S.; Parts, Leopold; Carlson, Joseph W.; Crosby, Madeline A.; Rasmussen, Matthew D.; Roy, Sushmita; Deoras, Ameya N.; Ruby, J. Graham; Brennecke, Julius; Hodges, Emily; Hinrichs, Angie S.; Caspi, Anat; Paten, Benedict; Park, Seung-Won; Han, Mira V.; Maeder, Morgan L.; Polansky, Benjamin J.; Robson, Bryanne E.; Aerts, Stein; van Helden, Jacques; Hassan, Bassem; Gilbert, Donald G.; Eastman, Deborah A.; Rice, Michael; Weir, Michael; Hahn, Matthew W.; Park, Yongkyu; Dewey, Colin N.; Pachter, Lior; Kent, W. James; Haussler, David; Lai, Eric C.; Bartel, David P.; Hannon, Gregory J.; Kaufman, Thomas C.; Eisen, Michael B.; Clark, Andrew G.; Smith, Douglas; Celniker, Susan E.; Gelbart, William M.; Kellis, Manolis

2008-01-01

Sequencing of multiple related species followed by comparative genomics analysis constitutes a powerful approach for the systematic understanding of any genome. Here, we use the genomes of 12 Drosophila species for the de novo discovery of functional elements in the fly. Each type of functional element shows characteristic patterns of change, or ‘evolutionary signatures’, dictated by its precise selective constraints. Such signatures enable recognition of new protein-coding genes and exons, spurious and incorrect gene annotations, and numerous unusual gene structures, including abundant stop-codon readthrough. Similarly, we predict non-protein-coding RNA genes and structures, and new microRNA (miRNA) genes. We provide evidence of miRNA processing and functionality from both hairpin arms and both DNA strands. We identify several classes of pre- and post-transcriptional regulatory motifs, and predict individual motif instances with high confidence. We also study how discovery power scales with the divergence and number of species compared, and we provide general guidelines for comparative studies. PMID:17994088

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2011 CFR

2011-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2012 CFR

2012-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2014 CFR

2014-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2013 CFR

2013-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2010 CFR

2010-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

40 CFR 52.1824 - Review of new sources and modifications.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) North Dakota § 52.1824... the language contained in the North Dakota Administrative Code on the use of the EPA “Guideline on Air Quality Models” as supplemented by the “North Dakota Guideline for Air Quality Modeling Analysis”.In a...

40 CFR 52.1824 - Review of new sources and modifications.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) North Dakota § 52.1824... the language contained in the North Dakota Administrative Code on the use of the EPA “Guideline on Air Quality Models” as supplemented by the “North Dakota Guideline for Air Quality Modeling Analysis”.In a...

40 CFR 52.1824 - Review of new sources and modifications.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) North Dakota § 52.1824... the language contained in the North Dakota Administrative Code on the use of the EPA “Guideline on Air Quality Models” as supplemented by the “North Dakota Guideline for Air Quality Modeling Analysis”.In a...

28 CFR 2.80 - Guidelines for D.C. Code offenders.

Code of Federal Regulations, 2011 CFR

2011-07-01

... for criminal behavior of a violent or sexual nature, a decision above the guidelines may be warranted... committed +2 C. Current offense involved high level violence (other than the behaviors described above) +1...) Current offense means any criminal behavior that is either: (i) Reflected in the offense of conviction, or...

28 CFR 2.80 - Guidelines for D.C. Code offenders.

Code of Federal Regulations, 2010 CFR

2010-07-01

... for criminal behavior of a violent or sexual nature, a decision above the guidelines may be warranted... committed +2 C. Current offense involved high level violence (other than the behaviors described above) +1...) Current offense means any criminal behavior that is either: (i) Reflected in the offense of conviction, or...

Guideline for the Comprehensive Campus Master Plan System.

ERIC Educational Resources Information Center

State Univ. System of Florida, Tallahassee.

This document is a guideline for institutions in the Florida State University System to use as they comply with state mandates requiring them to develop campus master plans and land management plans. It supplements the minimum criteria in the state's Administrative Code. For each element the guide offers description of its purpose, data…

Applying EALTA Guidelines as Baseline for the Foreign Language Proficiency Test in Turkey: The Case of YDS

ERIC Educational Resources Information Center

Kavakli, Nurdan; Arslan, Sezen

2017-01-01

Within the scope of educational testing and assessment, setting standards and creating guidelines as a code of practice provide more prolific and sustainable outcomes. In this sense, internationally accepted and regionally accredited principles are suggested for standardization in language testing and assessment practices. Herein, ILTA guidelines…

28 CFR 2.80 - Guidelines for D.C. Code offenders.

Code of Federal Regulations, 2013 CFR

2013-07-01

... violence or sexual offenses and who has not participated in available programming to address a potential for criminal behavior of a violent or sexual nature, a decision above the guidelines may be warranted...) Obstruction of justice through violence or threats of violence; (viii) Any offense involving sexual abuse of a...

28 CFR 2.80 - Guidelines for D.C. Code offenders.

Code of Federal Regulations, 2014 CFR

2014-07-01

... violence or sexual offenses and who has not participated in available programming to address a potential for criminal behavior of a violent or sexual nature, a decision above the guidelines may be warranted...) Obstruction of justice through violence or threats of violence; (viii) Any offense involving sexual abuse of a...

28 CFR 2.80 - Guidelines for D.C. Code offenders.

Code of Federal Regulations, 2012 CFR

2012-07-01

... violence or sexual offenses and who has not participated in available programming to address a potential for criminal behavior of a violent or sexual nature, a decision above the guidelines may be warranted...) Obstruction of justice through violence or threats of violence; (viii) Any offense involving sexual abuse of a...

A Normative Code of Conduct for Admissions Officers

ERIC Educational Resources Information Center

Hodum, Robert L.

2012-01-01

The increasing competition for the desired quantity and quality of college students, along with the rise of for-profit institutions, has amplified the scrutiny of behavior and ethics among college admissions professionals and has increased the need for meaningful ethical guidelines and codes of conduct. Many other areas of responsibility within…

An Analysis of the Effect of Knowledge Management on the Execution of Simplified Acquisition Procedures

DTIC Science & Technology

2012-12-27

of Work UCC Uniform Commercial Code USD(AT&L) Under Secretary of Defense for Acquisition, Technology, and Logistics WBS Work Breakdown Structure...intensive career field. The FAR, the DFARS, and other federal agency supplements of the FAR, the Uniform Commercial Code ( UCC ), installation guidelines

Peak Performance for Healthy Schools

ERIC Educational Resources Information Center

McKale, Chuck; Townsend, Scott

2012-01-01

Far from the limelight of LEED, Energy Star or Green Globes certifications are the energy codes developed and updated by the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) and the International Code Council (ICC) through the support of the Department of Energy (DOE) as minimum guidelines for building envelope,…

Utilization of genetic tests: analysis of gene-specific billing in Medicare claims data.

PubMed

Lynch, Julie A; Berse, Brygida; Dotson, W David; Khoury, Muin J; Coomer, Nicole; Kautter, John

2017-08-01

We examined the utilization of precision medicine tests among Medicare beneficiaries through analysis of gene-specific tier 1 and 2 billing codes developed by the American Medical Association in 2012. We conducted a retrospective cross-sectional study. The primary source of data was 2013 Medicare 100% fee-for-service claims. We identified claims billed for each laboratory test, the number of patients tested, expenditures, and the diagnostic codes indicated for testing. We analyzed variations in testing by patient demographics and region of the country. Pharmacogenetic tests were billed most frequently, accounting for 48% of the expenditures for new codes. The most common indications for testing were breast cancer, long-term use of medications, and disorders of lipid metabolism. There was underutilization of guideline-recommended tumor mutation tests (e.g., epidermal growth factor receptor) and substantial overutilization of a test discouraged by guidelines (methylenetetrahydrofolate reductase). Methodology-based tier 2 codes represented 15% of all claims billed with the new codes. The highest rate of testing per beneficiary was in Mississippi and the lowest rate was in Alaska. Gene-specific billing codes significantly improved our ability to conduct population-level research of precision medicine. Analysis of these data in conjunction with clinical records should be conducted to validate findings.Genet Med advance online publication 26 January 2017.

Coupling computer-interpretable guidelines with a drug-database through a web-based system – The PRESGUID project

PubMed Central

Dufour, Jean-Charles; Fieschi, Dominique; Fieschi, Marius

2004-01-01

Background Clinical Practice Guidelines (CPGs) available today are not extensively used due to lack of proper integration into clinical settings, knowledge-related information resources, and lack of decision support at the point of care in a particular clinical context. Objective The PRESGUID project (PREScription and GUIDelines) aims to improve the assistance provided by guidelines. The project proposes an online service enabling physicians to consult computerized CPGs linked to drug databases for easier integration into the healthcare process. Methods Computable CPGs are structured as decision trees and coded in XML format. Recommendations related to drug classes are tagged with ATC codes. We use a mapping module to enhance computerized guidelines coupling with a drug database, which contains detailed information about each usable specific medication. In this way, therapeutic recommendations are backed up with current and up-to-date information from the database. Results Two authoritative CPGs, originally diffused as static textual documents, have been implemented to validate the computerization process and to illustrate the usefulness of the resulting automated CPGs and their coupling with a drug database. We discuss the advantages of this approach for practitioners and the implications for both guideline developers and drug database providers. Other CPGs will be implemented and evaluated in real conditions by clinicians working in different health institutions. PMID:15053828

A new method for evaluating compliance with industry self-regulation codes governing the content of alcohol advertising.

PubMed

Babor, Thomas F; Xuan, Ziming; Damon, Donna

2013-10-01

This study evaluated the use of a modified Delphi technique in combination with a previously developed alcohol advertising rating procedure to detect content violations in the U.S. Beer Institute Code. A related aim was to estimate the minimum number of raters needed to obtain reliable evaluations of code violations in television commercials. Six alcohol ads selected for their likelihood of having code violations were rated by community and expert participants (N = 286). Quantitative rating scales were used to measure the content of alcohol advertisements based on alcohol industry self-regulatory guidelines. The community group participants represented vulnerability characteristics that industry codes were designed to protect (e.g., age <21); experts represented various health-related professions, including public health, human development, alcohol research, and mental health. Alcohol ads were rated on 2 occasions separated by 1 month. After completing Time 1 ratings, participants were randomized to receive feedback from 1 group or the other. Findings indicate that (i) ratings at Time 2 had generally reduced variance, suggesting greater consensus after feedback, (ii) feedback from the expert group was more influential than that of the community group in developing group consensus, (iii) the expert group found significantly fewer violations than the community group, (iv) experts representing different professional backgrounds did not differ among themselves in the number of violations identified, and (v) a rating panel composed of at least 15 raters is sufficient to obtain reliable estimates of code violations. The Delphi technique facilitates consensus development around code violations in alcohol ad content and may enhance the ability of regulatory agencies to monitor the content of alcoholic beverage advertising when combined with psychometric-based rating procedures. Copyright © 2013 by the Research Society on Alcoholism.

A New Method for Evaluating Compliance with Industry Self-regulation Codes Governing the Content of Alcohol Advertising

PubMed Central

Babor, Thomas F.; Xuan, Ziming; Damon, Donna

2013-01-01

Background This study evaluated the use of a modified Delphi technique in combination with a previously developed alcohol advertising rating procedure to detect content violations in the US Beer Institute code. A related aim was to estimate the minimum number of raters needed to obtain reliable evaluations of code violations in television commercials. Methods Six alcohol ads selected for their likelihood of having code violations were rated by community and expert participants (N=286). Quantitative rating scales were used to measure the content of alcohol advertisements based on alcohol industry self-regulatory guidelines. The community group participants represented vulnerability characteristics that industry codes were designed to protect (e.g., age < 21); experts represented various health-related professions, including public health, human development, alcohol research and mental health. Alcohol ads were rated on two occasions separated by one month. After completing Time 1 ratings, participants were randomized to receive feedback from one group or the other. Results Findings indicate that (1) ratings at Time 2 had generally reduced variance, suggesting greater consensus after feedback, (2) feedback from the expert group was more influential than that of the community group in developing group consensus, (3) the expert group found significantly fewer violations than the community group, (4) experts representing different professional backgrounds did not differ among themselves in the number of violations identified; (5) a rating panel composed of at least 15 raters is sufficient to obtain reliable estimates of code violations. Conclusions The Delphi Technique facilitates consensus development around code violations in alcohol ad content and may enhance the ability of regulatory agencies to monitor the content of alcoholic beverage advertising when combined with psychometric-based rating procedures. PMID:23682927

Bounds on Block Error Probability for Multilevel Concatenated Codes

NASA Technical Reports Server (NTRS)

Lin, Shu; Moorthy, Hari T.; Stojanovic, Diana

1996-01-01

Maximum likelihood decoding of long block codes is not feasable due to large complexity. Some classes of codes are shown to be decomposable into multilevel concatenated codes (MLCC). For these codes, multistage decoding provides good trade-off between performance and complexity. In this paper, we derive an upper bound on the probability of block error for MLCC. We use this bound to evaluate difference in performance for different decompositions of some codes. Examples given show that a significant reduction in complexity can be achieved when increasing number of stages of decoding. Resulting performance degradation varies for different decompositions. A guideline is given for finding good m-level decompositions.

Making our offices universally accessible: guidelines for physicians

PubMed Central

Jones, K E; Tamari, I E

1997-01-01

OBJECTIVE: To develop recommendations for office-based physicians who wish to make their offices accessible to all patients. OPTIONS: Include taking steps to make offices more accessible, or not; offices may be accessible to varying degrees. OUTCOMES: Outcomes of accessibility involve patient-care, economic, ethical and legal issues. Stakeholders in these outcomes include patients, physicians, government and society. EVIDENCE: Data were obtained from a series of searches of MEDLINE, CINAHL and Healthstar (previously Health) databases for articles on disability and family medicine, primary (health) care and family practice, and on access and offices, and health services accessibility, and from a telephone survey of 50 stakeholders. VALUES: A high value was placed on services to persons with disabilities and on stakeholder input. Universal accessibility was valued as an overall goal; improved accessibility was also highly valued. BENEFITS, HARMS AND COSTS: Benefits to patients include improved access to care as guaranteed by the Canada Health Act and in keeping with provincial Human Rights Codes. Benefits to physicians include contact with a broader patient population and freedom from fear of litigation. Costs of improved accessibility vary depending on individual circumstances and on whether an office is being built or renovated; some improvement costs are minimal. RECOMMENDATIONS: All physicians should take measures to improve practice accessibility. Improved access should be considered in each of the following areas: transportation and entrance to the facility, entrance to the office, waiting rooms, rest rooms, examination rooms, general building features and other features. VALIDATION: No similar guidelines exist. To assess the content validity of these guidelines, the authors had a draft document reviewed by 18 stakeholders. All specific recommendations met the minimum criterion of adherence to current legislation, including national and provincial building codes. The specific recommendations are endorsed by the Canadian Paraplegic Association (national and Ontario offices), the DisAbled Women's Network (Ontario) and the Centre for Independent Living (Toronto). SPONSORS: Development of these guidelines was supported in part by the Department of Family and Community Medicine, Toronto Hospital, Toronto, Ont. PMID:9068570

A Case Study for Probabilistic Methods Validation (MSFC Center Director's Discretionary Fund, Project No. 94-26)

NASA Technical Reports Server (NTRS)

Price J. M.; Ortega, R.

1998-01-01

Probabilistic method is not a universally accepted approach for the design and analysis of aerospace structures. The validity of this approach must be demonstrated to encourage its acceptance as it viable design and analysis tool to estimate structural reliability. The objective of this Study is to develop a well characterized finite population of similar aerospace structures that can be used to (1) validate probabilistic codes, (2) demonstrate the basic principles behind probabilistic methods, (3) formulate general guidelines for characterization of material drivers (such as elastic modulus) when limited data is available, and (4) investigate how the drivers affect the results of sensitivity analysis at the component/failure mode level.

Measure Guideline: Ventilation Guidance for Residential High-Performance New Construction - Multifamily

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

Lstiburek, Joseph

2017-01-01

The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamilymore » units that satisfies the requirements of ASHRAE 62.2-2016.« less

Measure Guideline: Ventilation Guidance for Residential High-Performance New Construction - Multifamily

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

Lstiburek, Joseph

The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamilymore » units that satisfies the requirements of ASHRAE 62.2-2016.« less

Assessing Fidelity to Suicide Reporting Guidelines in Canadian News Media: The Death of Robin Williams.

PubMed

Creed, Michael; Whitley, Rob

2017-05-01

Mindset is a short recently-published booklet funded by the Mental Health Commission of Canada outlining evidence-based guidelines and best practices for journalists writing about mental health and suicide. Our study aimed to assess fidelity to Mindset recommendations in Canadian newspaper reports of a recent celebrity suicide. A secondary aim is to identify common themes discussed in these newspaper articles. Articles about Robin Williams' suicide from major Canadian newspapers were gathered and coded for presence or absence of each of the 14 recommendations in the "Covering Suicide" section of Mindset. A threshold of 80% was set to test for high fidelity to the guidelines. A qualitative content analysis of the articles was also undertaken to discern common themes and social issues discussed in the articles. Fifty-five per cent of articles surpassed the 80% threshold for high fidelity, while 85% applied at least 70% of the recommendations. The recommendation most commonly overlooked was "Do tell others considering suicide how they can get help," which was absent in 73% of articles. The most common themes discussed were those of addictions and stigma. The news articles generally follow the evidence-based guidelines regarding the reporting of suicide set out in Mindset. This is a welcome development. Future research should continue to examine reporting of suicide to assess for further improvements, while also examining the wider impact of Mindset on the reporting of mental illness per se.

Assessing Fidelity to Suicide Reporting Guidelines in Canadian News Media: The Death of Robin Williams

PubMed Central

Creed, Michael

2016-01-01

Objective: Mindset is a short recently-published booklet funded by the Mental Health Commission of Canada outlining evidence-based guidelines and best practices for journalists writing about mental health and suicide. Our study aimed to assess fidelity to Mindset recommendations in Canadian newspaper reports of a recent celebrity suicide. A secondary aim is to identify common themes discussed in these newspaper articles. Methods: Articles about Robin Williams’ suicide from major Canadian newspapers were gathered and coded for presence or absence of each of the 14 recommendations in the “Covering Suicide” section of Mindset. A threshold of 80% was set to test for high fidelity to the guidelines. A qualitative content analysis of the articles was also undertaken to discern common themes and social issues discussed in the articles. Results: Fifty-five per cent of articles surpassed the 80% threshold for high fidelity, while 85% applied at least 70% of the recommendations. The recommendation most commonly overlooked was “Do tell others considering suicide how they can get help,” which was absent in 73% of articles. The most common themes discussed were those of addictions and stigma. Conclusions: The news articles generally follow the evidence-based guidelines regarding the reporting of suicide set out in Mindset. This is a welcome development. Future research should continue to examine reporting of suicide to assess for further improvements, while also examining the wider impact of Mindset on the reporting of mental illness per se. PMID:27600531

Who's keeping the code? Compliance with the international code for the marketing of breast-milk substitutes in Greater Glasgow.

PubMed

McInnes, Rhona J; Wright, Charlotte; Haq, Shogufta; McGranachan, Margaret

2007-07-01

To evaluate compliance with the World Health Organization's International Code of Marketing of Breast-milk Substitutes in primary care, after the introduction of strict local infant feeding guidelines. An audit form was sent to all community-based health professionals with an infant feeding remit. Walking tours were conducted in a random sample of community care facilities. Greater Glasgow Primary Care Division. (1) Primary-care staff with an infant feeding remit; (2) community health-care facilities. Contact with manufacturers of breast-milk substitutes (BMS) and BMS company personnel, free samples or incentives, and advertising of BMS. Contact with company personnel was minimal, usually unsolicited and was mainly to provide product information. Free samples of BMS or feeding equipment were rare but childcare or parenting literature was more prevalent. Staff voiced concerns about the lack of relevant information for bottle-feeding mothers and the need to support the mother's feeding choice. One-third of facilities were still displaying materials non-compliant with the Code, with the most common materials being weight conversion charts and posters. Contact between personnel from primary care and BMS companies was minimal and generally unsolicited. The presence of materials from BMS companies in health-care premises was more common. Due to the high level of bottle-feeding in Glasgow, primary-care staff stated a need for information about BMS.

Characterizing and Modeling the Cost of Rework in a Library of Reusable Software Components

NASA Technical Reports Server (NTRS)

Basili, Victor R.; Condon, Steven E.; ElEmam, Khaled; Hendrick, Robert B.; Melo, Walcelio

1997-01-01

In this paper we characterize and model the cost of rework in a Component Factory (CF) organization. A CF is responsible for developing and packaging reusable software components. Data was collected on corrective maintenance activities for the Generalized Support Software reuse asset library located at the Flight Dynamics Division of NASA's GSFC. We then constructed a predictive model of the cost of rework using the C4.5 system for generating a logical classification model. The predictor variables for the model are measures of internal software product attributes. The model demonstrates good prediction accuracy, and can be used by managers to allocate resources for corrective maintenance activities. Furthermore, we used the model to generate proscriptive coding guidelines to improve programming, practices so that the cost of rework can be reduced in the future. The general approach we have used is applicable to other environments.

Receiving Gifts from Commercial Companies. Part 1: The Need for General Institutional Guidelines. Part 2: Example of General Institutional Guidelines.

ERIC Educational Resources Information Center

Harrison, R. Van

1994-01-01

General institutional guidelines for gifts from commercial companies are needed, in light of national trends. Commercially supported continuing medical education, those concerning personal gifts to physicians, and conflict of interest and research are areas to be considered. (SK)

Applying clinical guidelines in general practice: a qualitative study of potential complications.

PubMed

Austad, Bjarne; Hetlevik, Irene; Mjølstad, Bente Prytz; Helvik, Anne-Sofie

2016-07-22

Clinical guidelines for single diseases often pose problems in general practice work with multimorbid patients. However, little research focuses on how general practice is affected by the demand to follow multiple guidelines. This study explored Norwegian general practitioners' (GPs') experiences with and reflections upon the consequences for general practice of applying multiple guidelines. Qualitative focus group study carried out in Mid-Norway. The study involved a purposeful sample of 25 Norwegian GPs from four pre-existing groups. Interviews were audio-recorded, transcribed and analyzed using systematic text condensation, i.e. applying a phenomenological approach. The GPs' responses clustered around two major topics: 1) Complications for the GPs of applying multiple guidelines; and, 2) Complications for their patients when GPs apply multiple guidelines. For the GPs, applying multiple guidelines created a highly problematic situation as they felt obliged to implement guidelines that were not suited to their patients: too often, the map and the terrain did not match. They also experienced greater insecurity regarding their own practice which, they admitted, resulted in an increased tendency to practice 'defensive medicine'. For their patients, the GPs experienced that applying multiple guidelines increased the risk of polypharmacy, excessive non-pharmacological recommendations, a tendency toward medicalization and, for some, a reduction in quality of life. The GPs experienced negative consequences when obliged to apply a variety of single disease guidelines to multimorbid patients, including increased risk of polypharmacy and overtreatment. We believe patient-centered care and the GPs' courage to non-comply when necessary may aid in reducing these risks. Health care authorities and guideline developers need to be aware of the potential negative effects of applying a single disease focus in general practice, where multimorbidity is highly prevalent.

Insights from a User-Centered Approach to Computerized Guidelines for Chronic Disease

ERIC Educational Resources Information Center

Shaten, Barbara Jessica

2011-01-01

For more than two decades, the medical informatics community has worked towards representing evidence-based guidelines in computer code, intended to be executed at the point of care. The purpose is to close the gap between evidence of best medical practices and the care that patients receive. Most informatics work has taken a…

The Pupil Nondiscrimination Guidelines for Athletics. Implementing Section 118.13 of the Wisconsin Statutes and PI 9 of the Wisconsin Administrative Code.

ERIC Educational Resources Information Center

Wisconsin Interscholastic Athletic Association.

These guidelines explaining state pupil nondiscrimination requirements in interscholastic athletics are the result of a collaboration between the Wisconsin Department of Public Instruction and the Wisconsin Interscholastic Athletic Association (WIAA). The guide is designed to help schools fully implement Wisconsin's pupil nondiscrimination…

A Developmental Approach to the Teaching of Ethical Decision Making.

ERIC Educational Resources Information Center

Neukrug, Edward S.

1996-01-01

Examines the newly adopted code of ethics, reviews some ethical decision-making models, and hypothesizes how the maturity of a student might mediate the effective use of codes and of decision-making models. Provides a model for human service educators that integrates ethical guidelines and ethical decision-making models. (RJM)

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.

Using read codes to identify patients with irritable bowel syndrome in general practice: a database study

PubMed Central

2013-01-01

Background Estimates of the prevalence of irritable bowel syndrome (IBS) vary widely, and a large proportion of patients report having consulted their general practitioner (GP). In patients with new onset gastrointestinal symptoms in primary care it might be possible to predict those at risk of persistent symptoms. However, one of the difficulties is identifying patients within primary care. GPs use a variety of Read Codes to describe patients presenting with IBS. Furthermore, in a qualitative study, exploring GPs’ attitudes and approaches to defining patients with IBS, GPs appeared reluctant to add the IBS Read Code to the patient record until more serious conditions were ruled out. Consequently, symptom codes such as 'abdominal pain’, 'diarrhoea’ or 'constipation’ are used. The aim of the current study was to investigate the prevalence of recorded consultations for IBS and to explore the symptom profile of patients with IBS using data from the Salford Integrated Record (SIR). Methods This was a database study using the SIR, a local patient sharing record system integrating primary, community and secondary care information. Records were obtained for a cohort of patients with gastrointestinal disorders from January 2002 to December 2011. Prevalence rates, symptom recording, medication prescribing and referral patterns were compared for three patient groups (IBS, abdominal pain (AP) and Inflammatory Bowel Disease (IBD)). Results The prevalence of IBS (age standardised rate: 616 per year per 100,000 population) was much lower than expected compared with that reported in the literature. The majority of patients (69%) had no gastrointestinal symptoms recorded in the year prior to their IBS. However a proportion of these (22%) were likely to have been prescribed NICE guideline recommended medications for IBS in that year. The findings for AP and IBD were similar. Conclusions Using Read Codes to identify patients with IBS may lead to a large underestimate of the community prevalence. The IBS diagnostic Read Code was rarely applied in practice. There are similarities with many other medically unexplained symptoms which are typically difficult to diagnose in clinical practice. PMID:24295337

Using read codes to identify patients with irritable bowel syndrome in general practice: a database study.

PubMed

Harkness, Elaine F; Grant, Laura; O'Brien, Sarah J; Chew-Graham, Carolyn A; Thompson, David G

2013-12-02

Estimates of the prevalence of irritable bowel syndrome (IBS) vary widely, and a large proportion of patients report having consulted their general practitioner (GP). In patients with new onset gastrointestinal symptoms in primary care it might be possible to predict those at risk of persistent symptoms. However, one of the difficulties is identifying patients within primary care. GPs use a variety of Read Codes to describe patients presenting with IBS. Furthermore, in a qualitative study, exploring GPs' attitudes and approaches to defining patients with IBS, GPs appeared reluctant to add the IBS Read Code to the patient record until more serious conditions were ruled out. Consequently, symptom codes such as 'abdominal pain', 'diarrhoea' or 'constipation' are used. The aim of the current study was to investigate the prevalence of recorded consultations for IBS and to explore the symptom profile of patients with IBS using data from the Salford Integrated Record (SIR). This was a database study using the SIR, a local patient sharing record system integrating primary, community and secondary care information. Records were obtained for a cohort of patients with gastrointestinal disorders from January 2002 to December 2011. Prevalence rates, symptom recording, medication prescribing and referral patterns were compared for three patient groups (IBS, abdominal pain (AP) and Inflammatory Bowel Disease (IBD)). The prevalence of IBS (age standardised rate: 616 per year per 100,000 population) was much lower than expected compared with that reported in the literature. The majority of patients (69%) had no gastrointestinal symptoms recorded in the year prior to their IBS. However a proportion of these (22%) were likely to have been prescribed NICE guideline recommended medications for IBS in that year. The findings for AP and IBD were similar. Using Read Codes to identify patients with IBS may lead to a large underestimate of the community prevalence. The IBS diagnostic Read Code was rarely applied in practice. There are similarities with many other medically unexplained symptoms which are typically difficult to diagnose in clinical practice.

How much is '5-a-day'? A qualitative investigation into consumer understanding of fruit and vegetable intake guidelines.

PubMed

Rooney, C; McKinley, M C; Appleton, K M; Young, I S; McGrath, A J; Draffin, C R; Hamill, L L; Woodside, J V

2017-02-01

Despite the known health benefits of fruit and vegetables (FV), population intakes remain low. One potential contributing factor may be a lack of understanding surrounding recommended intakes. The present study aimed to explore the understanding of FV intake guidelines among a sample of low FV consumers. Six semi-structured focus groups were held with low FV consumers (n = 28, age range 19-55 years). Focus groups were recorded digitally, transcribed verbatim and analysed thematically using nvivo (QSR International, Melbourne, Australia) to manage the coded data. Participants also completed a short questionnaire assessing knowledge on FV intake guidelines. Descriptive statistics were used to analyse responses. The discussions highlighted that, although participants were aware of FV intake guidelines, they lacked clarity with regard to the meaning of the '5-a-day' message, including what foods are included in the guideline, as well as what constitutes a portion of FV. There was also a sense of confusion surrounding the concept of achieving variety with regard to FV intake. The sample highlighted a lack of previous education on FV portion sizes and put forward suggestions for improving knowledge, including increased information on food packaging and through health campaigns. Questionnaire findings were generally congruent with the qualitative findings, showing high awareness of the '5-a-day' message but a lack of knowledge surrounding FV portion sizes. Future public health campaigns should consider how best to address the gaps in knowledge identified in the present study, and incorporate evaluations that will allow the impact of future initiatives on knowledge, and ultimately behaviour, to be investigated. © 2016 The British Dietetic Association Ltd.

Guidelines for Coding and Entering Ground-Water Data into the Ground-Water Site Inventory Data Base, Version 4.6, U.S. Geological Survey, Washington Water Science Center

DTIC Science & Technology

2006-01-01

collected, code both. Code Type of Analysis Code Type of Analysis A Physical properties I Common ions/trace elements B Common ions J Sanitary analysis and...1) A ground-water site is coded as if it is a single point, not a geographic area or property . (2) Latitude and longitude should be determined at a...terrace from an adjacent upland on one side, and a lowland coast or valley on the other. Due to the effects of erosion, the terrace surface may not be as

Hydrogen Fuel Cell Engines and Related Technologies

NASA Astrophysics Data System (ADS)

2001-12-01

The Hydrogen Fuel Cell Engines and Related Technologies report documents the first training course ever developed and made available to the transportation community and general public on the use hydrogen fuel cells in transportation. The course is designed to train a new generation of technicians in gaining a more complete understanding of the concepts, procedures, and technologies involved with hydrogen fuel cell use in transportation purposes. The manual contains 11 modules (chapters). The first eight modules cover (1) hydrogen properties, use and safety; and (2) fuel cell technology and its systems, fuel cell engine design and safety, and design and maintenance of a heavy duty fuel cell bus engine. The different types of fuel cells and hybrid electric vehicles are presented, however, the system descriptions and maintenance procedures focus on proton-exchange-membrane (PEM) fuel cells with respect to heavy duty transit applications. Modules 9 and 10 are intended to provide a better understanding of the acts, codes, regulations and guidelines concerning the use of hydrogen, as well as the safety guidelines for both hydrogen maintenance and fueling facilities. Module 11 presents a glossary and conversions.

The extent and nature of alcohol advertising on Australian television.

PubMed

Pettigrew, Simone; Roberts, Michele; Pescud, Melanie; Chapman, Kathy; Quester, Pascale; Miller, Caroline

2012-09-01

Current alcohol guidelines in Australia recommend minimising alcohol consumption, especially among minors. This study investigated (i) the extent to which children and the general population are exposed to television advertisements that endorse alcohol consumption and (ii) the themes used in these advertisements. A content analysis was conducted on alcohol advertisements aired over two months in major Australian cities. The advertisements were coded according to the products that were promoted, the themes that were employed, and the time of exposure. Advertising placement expenditure was also captured. In total, 2810 alcohol advertisements were aired, representing one in 10 beverage advertisements. Advertisement placement expenditure for alcohol products in the five cities over the two months was $15.8 million. Around half of all alcohol advertisements appeared during children's popular viewing times. The most common themes used were humour, friendship/mateship and value for money. Children and adults are regularly exposed to advertisements that depict alcohol consumption as fun, social and inexpensive. Such messages may reinforce existing alcohol-related cultural norms that prevent many Australians from meeting current intake guidelines. © 2012 Australasian Professional Society on Alcohol and other Drugs.

Ethical Guidelines for Counselors when Working with Clients with Terminal Illness Requesting Physician Aid in Dying

ERIC Educational Resources Information Center

Kurt, Layla J.; Piazza, Nick J.

2012-01-01

In 2005, the American Counseling Association (ACA) introduced a new ethical standard for counselors working with clients with terminal illness who are considering hastened death options. The authors' purpose is to inform counselors of the Death With Dignity Act and explore relevant ethical guidelines in the "ACA Code of Ethics" (ACA, 2005).

Image Processing Language. Phase 1

DTIC Science & Technology

1988-05-01

their entirety. Nonetheless, they can serve as guidelines to which the construction of a useful and comprehensive imaging algebra might aspire. 3. TIH... guidelines to which the construction of a useful and comprehensive imaging algebra might aspire. * It was recognized that any structure which encompasses...Bernstein Polynomial Approximation Best Plane Fit ( BPF , Sobel, Roberts, Prewitt, Gradient) Boundary Finder Boundary Segmenter Chain Code Angle

Enhancing health care professionals' and trainees' knowledge of physical activity guidelines for adults with and without SCI.

PubMed

Shirazipour, Celina H; Tomasone, Jennifer R; Martin Ginis, Kathleen A

2018-01-11

Health care providers (HCPs) are preferred sources of physical activity (PA) information; however, minimal research has explored HCPs' knowledge of spinal cord injury (SCI) PA guidelines, and no research has examined HCP trainees' PA guideline knowledge. The current study explored HCPs' and trainees' initial knowledge of PA guidelines for both adults with SCI and the general population, and the utility of an event-based intervention for improving this knowledge. Participants (HCPs n = 129; trainees n = 573) reported guideline knowledge for both sets of guidelines (SCI and general population) immediately after, one-month, and six-months following the intervention. Frequencies determined guideline knowledge at each timepoint, while chi-squared tests examined differences in knowledge of both guidelines, as well as knowledge differences in the short- and long-term. Results demonstrated that HCPs and trainees lack knowledge of PA guidelines, particularly guidelines for adults with SCI. The results further suggest that a single event-based intervention is not effective for improving long-term guideline knowledge. Suggestions are made for future research with the aim of improving interventions that target HCP and HCP trainees' long-term guideline knowledge for adults with SCI and the general population.

Ethical Guidelines for Structural Interventions to Small-Scale Historic Stone Masonry Buildings.

PubMed

Hurol, Yonca; Yüceer, Hülya; Başarır, Hacer

2015-12-01

Structural interventions to historic stone masonry buildings require that both structural and heritage values be considered simultaneously. The absence of one of these value systems in implementation can be regarded as an unethical professional action. The research objective of this article is to prepare a guideline for ensuring ethical structural interventions to small-scale stone historic masonry buildings in the conservation areas of Northern Cyprus. The methodology covers an analysis of internationally accepted conservation documents and national laws related to the conservation of historic buildings, an analysis of building codes, especially Turkish building codes, which have been used in Northern Cyprus, and an analysis of the structural interventions introduced to a significant historic building in a semi-intact state in the walled city of Famagusta. This guideline covers issues related to whether buildings are intact or ruined, the presence of earthquake risk, the types of structural decisions in an architectural conservation project, and the values to consider during the decision making phase.

Field Programmable Gate Array Failure Rate Estimation Guidelines for Launch Vehicle Fault Tree Models

NASA Technical Reports Server (NTRS)

Al Hassan, Mohammad; Novack, Steven D.; Hatfield, Glen S.; Britton, Paul

2017-01-01

Today's launch vehicles complex electronic and avionic systems heavily utilize the Field Programmable Gate Array (FPGA) integrated circuit (IC). FPGAs are prevalent ICs in communication protocols such as MIL-STD-1553B, and in control signal commands such as in solenoid/servo valves actuations. This paper will demonstrate guidelines to estimate FPGA failure rates for a launch vehicle, the guidelines will account for hardware, firmware, and radiation induced failures. The hardware contribution of the approach accounts for physical failures of the IC, FPGA memory and clock. The firmware portion will provide guidelines on the high level FPGA programming language and ways to account for software/code reliability growth. The radiation portion will provide guidelines on environment susceptibility as well as guidelines on tailoring other launch vehicle programs historical data to a specific launch vehicle.

Foods Served in Child Care Facilities Participating in the Child and Adult Care Food Program: Menu Match and Agreement with the New Meal Patterns and Best Practices.

PubMed

Dave, Jayna M; Cullen, Karen W

2018-06-01

To assess the agreement of posted menus with foods served to 3- to 5-year-old children attending federal Child and Adult Care Food Program (CACFP)-enrolled facilities, and the degree to which the facilities met the new meal patterns and best practices. On-site observations and menu coding. Nine early care and education centers. Agreement of posted menus with foods served, and comparison of foods served and consumed with the new CACFP meal guidelines and best practices. Data were compiled for each meal (breakfast, lunch, and snacks). Frequencies and percentages of agreement with the posted menu (coded matches, substitutions, additions, and omissions) were calculated for each food component in the CACFP menu guidelines. Menu total match was created by summing the menu match plus acceptable substitutions. Menus were compared with the new CACFP meal guidelines and best practices. The match between the posted menus and foods actually served to children at breakfast, lunch, and snack was high when the acceptable menu substitutions were considered (approximately 94% to 100% total match). Comparing the menus with the new meal guidelines and best practices, the 1 guideline that was fully implemented was serving only unflavored, low-fat, or 1% milk; fruit and vegetable guidelines were partially met; fruit juice was not served often, nor were legumes; the guideline for 1 whole grain-rich serving/d was not met; and regular beef and full-fat cheese products were commonly served. Early care and education centers enrolled in CACFP provided meals that met the current CACFP guidelines. Some menu improvements are needed for the centers to meet the new guidelines and best practices. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

[Guideline compliance in hip fracture: results of an external quality-assurance program in North Rhine Westphalia: 2003-2005].

PubMed

Schulze Raestrup, U; Grams, A; Smektala, R

2008-02-01

Whereas the Scottish guidelines are audited annually, nobody evaluates guideline compliance in Germany. Thus, can external quality assurance data pursuant to section 137 of the German Social Code Book V be suitable for auditing guideline compliance? From North Rhine Westphalia, a total of 48,831 cases of femoral fractures near the hip joint were evaluated. Compliance with the guidelines was determined based on preoperative hospital stay, thrombosis, and antibiotic prophylaxis. Guideline rationale was reviewed in terms of mortality and thromboembolism rate. Sixty-four percent of the interventions were performed in a timely manner. Thrombosis prophylaxis was given in 99% of cases. Antibiotics were given as a single shot. There was no connection between mortality and thromboembolism rates or time to surgery. Guideline compliance is similar in German and Scotland. The external quality assurance data are suitable for evaluating guideline compliance. The literature recommends a short time to surgery. Given the short observation period, it was not possible to demonstrate any improvement in outcomes.

Attorney General forces Infectious Diseases Society of America to redo Lyme guidelines due to flawed development process.

PubMed

Johnson, L; Stricker, R B

2009-05-01

Lyme disease is one of the most controversial illnesses in the history of medicine. In 2006 the Connecticut Attorney General launched an antitrust investigation into the Lyme guidelines development process of the Infectious Diseases Society of America (IDSA). In a recent settlement with IDSA, the Attorney General noted important commercial conflicts of interest and suppression of scientific evidence that had tainted the guidelines process. This paper explores two broad ethical themes that influenced the IDSA investigation. The first is the growing problem of conflicts of interest among guidelines developers, and the second is the increasing centralisation of medical decisions by insurance companies, which use treatment guidelines as a means of controlling the practices of individual doctors and denying treatment for patients. The implications of the first-ever antitrust investigation of medical guidelines and the proposed model to remediate the tainted IDSA guidelines process are also discussed.

Identifying and prioritizing lower value services from Dutch specialist guidelines and a comparison with the UK do-not-do list.

PubMed

Wammes, Joost Johan Godert; van den Akker-van Marle, M Elske; Verkerk, Eva W; van Dulmen, Simone A; Westert, Gert P; van Asselt, Antoinette D I; Kool, R B

2016-11-25

The term 'lower value services' concerns healthcare that is of little or no value to the patient and consequently should not be provided routinely, or not be provided at all. De-adoption of lower value care may occur through explicit recommendations in clinical guidelines. The present study aimed to generate a comprehensive list of lower value services for the Netherlands that assesses the type of care and associated medical conditions. The list was compared with the NICE do-not-do list (United Kingdom). Finally, the feasibility of prioritizing the list was studied to identify conditions where de-adoption is warranted. Dutch clinical guidelines (published from 2010 to 2015) were searched for lower value services. The lower value services identified were categorized by type of care (diagnostics, treatment with and without medication), type of lower value service (not routinely provided or not provided at all), and ICD10 codes (international classification of diseases). The list was prioritized per ICD10 code, based on the number of lower value services per ICD10 code, prevalence, and burden of disease. A total of 1366 lower value services were found in the 193 Dutch guidelines included in our study. Of the lower value services, 30% covered diagnostics, 29% related to surgical and medical treatment without drugs primarily, and 39% related to drug treatment. The majority (77%) of all lower value services was on care that should not be offered at all, whereas the other 23% recommended on care that should not be offered routinely. ICD10 chapters that included most lower value services were neoplasms and diseases of the nervous system. Dutch guidelines appear to contain more lower value services than UK guidelines. The prioritization processes revealed several conditions, including back pain, chronic obstructive pulmonary disease, and ischemic heart diseases, where lower value services most likely occur and de-adoption is warranted. In this study, a comprehensive list of lower value services for Dutch hospital care was developed. A feasible method for prioritizing lower value services was established. Identifying and prioritizing lower value services is the first of several necessary steps in reducing them.

10 CFR 1047.5 - Exercise of arrest authority-general guidelines.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Exercise of arrest authority-general guidelines. 1047.5 Section 1047.5 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS General Provisions § 1047.5 Exercise of arrest authority—general...

10 CFR 1047.5 - Exercise of arrest authority-general guidelines.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Exercise of arrest authority-general guidelines. 1047.5 Section 1047.5 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS General Provisions § 1047.5 Exercise of arrest authority—general...

10 CFR 1047.5 - Exercise of arrest authority-general guidelines.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Exercise of arrest authority-general guidelines. 1047.5 Section 1047.5 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS General Provisions § 1047.5 Exercise of arrest authority—general...

10 CFR 1047.5 - Exercise of arrest authority-general guidelines.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Exercise of arrest authority-general guidelines. 1047.5 Section 1047.5 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS General Provisions § 1047.5 Exercise of arrest authority—general...

10 CFR 1047.5 - Exercise of arrest authority-general guidelines.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Exercise of arrest authority-general guidelines. 1047.5 Section 1047.5 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS General Provisions § 1047.5 Exercise of arrest authority—general...

Facilities Guidelines for Fine Arts Programs.

ERIC Educational Resources Information Center

Maryland State Dept. of Education, Baltimore.

This manual of facility guidelines examines the planning process and design features and considerations for public school fine arts programs in Maryland. Planning concepts and trends are highlighted followed by planning guidelines for dance, music, theater, visual arts, general education, and performance spaces. General design considerations…

28 CFR 513.32 - Guidelines for disclosure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Guidelines for disclosure. 513.32 Section 513.32 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE GENERAL MANAGEMENT AND ADMINISTRATION ACCESS TO RECORDS Release of Information General Provisions and Procedures § 513.32 Guidelines for...

Current issues in billing and coding in interventional pain medicine.

PubMed

Manchikanti, L

2000-10-01

Interventional pain management is a dynamic field with changes occurring on a daily basis, not only with technology but also with regulations that have a substantial financial impact on practices. Regulations are imposed not only by the federal government and other regulatory agencies, and also by a multitude of other payors, state governments and medical boards. Documentation of medical necessity with coding that correlates with multiple components of the patient's medical record, operative report, and billing statement is extremely important. Numerous changes which have occurred in the practice of interventional pain management in the new millennium continue to impact the financial viability of interventional pain practices along with patient access to these services. Thus, while complying with regulations of billing, coding and proper, effective, and ethical practice of pain management, it is also essential for physicians to understand financial aspects and the impact of various practice patterns. This article provides guidelines which are meant to provide practical considerations for billing and coding of interventional techniques in the management of chronic pain based on the current state of the art and science of interventional pain management. Hence, these guidelines do not constitute inflexible treatment, coding, billing or documentation recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis taking into account an individual patient's medical condition, personal needs, and preferences, along with physician's experience and in a similar manner, billing and coding practices will be developed. Based on an individual patient's needs, treatment, billing and coding, different from what is outlined here is not only warranted but essential.

A Systematic Approach for Quantitative Analysis of Multidisciplinary Design Optimization Framework

NASA Astrophysics Data System (ADS)

Kim, Sangho; Park, Jungkeun; Lee, Jeong-Oog; Lee, Jae-Woo

An efficient Multidisciplinary Design and Optimization (MDO) framework for an aerospace engineering system should use and integrate distributed resources such as various analysis codes, optimization codes, Computer Aided Design (CAD) tools, Data Base Management Systems (DBMS), etc. in a heterogeneous environment, and need to provide user-friendly graphical user interfaces. In this paper, we propose a systematic approach for determining a reference MDO framework and for evaluating MDO frameworks. The proposed approach incorporates two well-known methods, Analytic Hierarchy Process (AHP) and Quality Function Deployment (QFD), in order to provide a quantitative analysis of the qualitative criteria of MDO frameworks. Identification and hierarchy of the framework requirements and the corresponding solutions for the reference MDO frameworks, the general one and the aircraft oriented one were carefully investigated. The reference frameworks were also quantitatively identified using AHP and QFD. An assessment of three in-house frameworks was then performed. The results produced clear and useful guidelines for improvement of the in-house MDO frameworks and showed the feasibility of the proposed approach for evaluating an MDO framework without a human interference.

Medicare Cancer Screening in the Context of Clinical Guidelines: 2000 to 2012.

PubMed

Maroongroge, Sean; Yu, James B

2018-04-01

Cancer screening is a ubiquitous and controversial public health issue, particularly in the elderly population. Despite extensive evidence-based guidelines for screening, it is unclear how cancer screening has changed in the Medicare population over time. We characterize trends in cancer screening for the most common cancer types in the Medicare fee-for-service (FFS) program in the context of conflicting guidelines from 2000 to 2012. We performed a descriptive analysis of retrospective claims data from the Medicare FFS program based on billing codes. Our data include all claims for Medicare part B beneficiaries who received breast, colorectal (CRC), or prostate cancer screening from 2000 to 2012 based on billing codes. We utilize a Monte Carlo permutation method to detect changes in screening trends. In total, 231,416,732 screening tests were analyzed from 2000 to 2012, representing an average of 436.8 tests per 1000 beneficiaries per year. Mammography rates declined 7.4%, with digital mammography extensively replacing film. CRC cancer screening rates declined overall. As a percentage of all CRC screening tests, colonoscopy grew from 32% to 71%. Prostate screening rates increased 16% from 2000 to 2007, and then declined to 7% less than its 2000 rate by 2012. Both the aggressiveness of screening guidelines and screening rates for the Medicare FFS population peaked and then declined from 2000 to 2012. However, guideline publications did not consistently precede utilization trend shifts. Technology adoption, practical and financial concerns, and patient preferences may have also contributed to the observed trends. Further research should be performed on the impact of multiple, conflicting guidelines in cancer screening.

The wound/burn guidelines - 1: Wounds in general.

PubMed

Inoue, Yuji; Hasegawa, Minoru; Maekawa, Takeo; Le Pavoux, Andres; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Ito, Takaaki; Isei, Taiki; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ohtsuka, Mikio; Ogawa, Fumihide; Kadono, Takafumi; Kodera, Masanari; Kawakami, Tamihiro; Kawaguchi, Masakazu; Kukino, Ryuichi; Kono, Takeshi; Sakai, Keisuke; Takahara, Masakazu; Tanioka, Miki; Nakanishi, Takeshi; Nakamura, Yasuhiro; Hashimoto, Akira; Hayashi, Masahiro; Fujimoto, Manabu; Fujiwara, Hiroshi; Matsuo, Koma; Madokoro, Naoki; Yamasaki, Osamu; Yoshino, Yuichiro; Tachibana, Takao; Ihn, Hironobu

2016-04-01

The Japanese Dermatological Association determined to prepare the Wound/Burn Guidelines focusing on treatments, catering to needs for the clinical practice of dermatology. Among these guidelines, "Wounds in General" was intended to explain knowledge necessary "to heal wounds" without specifying particular disorders. © 2016 Japanese Dermatological Association.

Antihypertensive prescribing--a survey of general practice supervisors and registrars.

PubMed

Eastman, Peter

2008-11-01

Hypertension is a common problem in general practice. Prescribing guidelines vary, but generally favour thiazide diuretics as first line treatment for uncomplicated essential hypertension. This study looks at antihypertensive prescribing habits of primary care practitioners and their knowledge of prescribing guideline recommendations. General practitioner supervisors and registrars from the Sydney Institute of General Practice Education and Training completed an online survey between April and July 2007. In response to a clinical vignette, participants indicated which agent they would use as first line therapy. In addition, they described what they knew about existing prescribing guidelines for essential hypertension. One hundred and thirty-eight surveys were sent and 31 were returned completed. Angiotensin converting enzyme inhibitors were favoured as first line agents. Most believed current guidelines recommend more than one class of antihypertensive agent as appropriate for the initiation of single agent therapy. Angiotensin converting enzyme inhibitors were nominated most often as first line treatments recommended by guidelines. The study is limited by a small sample size, a low response rate and the fact that participants all came from a similar location. Prescribing habits in the study group were not consistent with two out of three Australian guidelines on management of hypertension. Further research may allow generalisation to the wider Australian general practice community and indicate underlying reasons for this inconsistency. Hypertension management is an important educational topic for general practice registrars and GPs.

Barriers Against Implementing Blunt Abdominal Trauma Guidelines in a Hospital: A Qualitative Study.

PubMed

Zaboli, Rouhollah; Tofighi, Shahram; Aghighi, Ali; Shokouh, Seyyed Javad Hosaini; Naraghi, Nader; Goodarzi, Hassan

2016-08-01

Clinical practice guidelines are structured recommendations that help physicians and patients to make proper decisions when dealing with a specific clinical condition. Because blunt abdominal trauma causes a various range of mild, single-system, and multisystem injuries, early detection will help to reduce mortality and resulting disability. Emergency treatment should be initiated based on CPGs. This study aimed to determine the variables affecting implementing blunt abdominal trauma CPGs in an Iranian hospital. This study was conducted as a qualitative and phenomenology study in the Family Hospital in Tehran (Iran) in 2015. The research population included eight experts and key people in the area of blunt abdominal trauma clinical practice guidelines. Sampling was based on purposive and nonrandom methods. A semistructured interview was done for the data collection. A framework method was applied for the data analysis by using Atlas.ti software. After framework analyzing and various reviewing and deleting and combining the codes from 251 codes obtained, 15 families and five super families were extracted, including technical knowledge barriers, economical barriers, barriers related to deployment and monitoring, political will barriers, and managing barriers. Structural reform is needed for eliminating the defects available in the healthcare system. As with most of the codes, subconcepts and concepts are classified into the field of human resources; it seems that the education and knowledge will be more important than other resources such as capital and equipment.

An Australian perspective on developing standards and ensuring compliance.

PubMed

Thornber, Peter M

2010-01-01

Australia is a federation of states and territories, each with their own parliament and animal-welfare laws. Australian animal-welfare legislation imposes a "duty of care" on people responsible for the care and well-being of animals under their management. In the livestock sector, this responsibility is mirrored by the ongoing development of standards, guidelines, and codes of practice to assist people to understand their responsibilities and to meet expectations concerning animal welfare. The Australian Animal Welfare Strategy (AAWS) is the national animal-welfare policy blueprint for sustainable improvements in animal welfare, and one of its key goals is to achieve greater consistency in the development, implementation, and enforcement of animal-welfare standards. Standards, guidelines, and model codes also inform the development of contemporary, evidence-based quality assurance programs for individual livestock industries and provide the basis for competency-based training programs for animal handlers. Australian standards have been developed for pigs and land transport of livestock, and work is progressing on national standards for cattle, sheep, horses, zoo animals, dogs, and cats. Other achievements include the development of requirements for the care and use of animals in research and teaching, guidelines for the welfare of aquatic animals, and codes of practice for the humane killing of pest animals. State and territory governments are developing a framework for consistent regulation and compliance in consultation with industries and welfare organizations.

Generalized Bezout's Theorem and its applications in coding theory

NASA Technical Reports Server (NTRS)

Berg, Gene A.; Feng, Gui-Liang; Rao, T. R. N.

1996-01-01

This paper presents a generalized Bezout theorem which can be used to determine a tighter lower bound of the number of distinct points of intersection of two or more curves for a large class of plane curves. A new approach to determine a lower bound on the minimum distance (and also the generalized Hamming weights) for algebraic-geometric codes defined from a class of plane curves is introduced, based on the generalized Bezout theorem. Examples of more efficient linear codes are constructed using the generalized Bezout theorem and the new approach. For d = 4, the linear codes constructed by the new construction are better than or equal to the known linear codes. For d greater than 5, these new codes are better than the known codes. The Klein code over GF(2(sup 3)) is also constructed.

10 CFR 436.102 - General operations plan format and content.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false General operations plan format and content. 436.102... PROGRAMS Guidelines for General Operations Plans § 436.102 General operations plan format and content. (a... effective date of these guidelines, a general operations 10-year plan which shall consist of two parts, an...

American Association for Dental Schools Curricular Guidelines for Microscopic Anatomy (General and Oral).

ERIC Educational Resources Information Center

Susi, Frank; Mundell, Robert

1980-01-01

Guidelines developed by the Section on Anatomical Sciences of the American Association for Dental Schools are presented. These guidelines were drawn up as an effort to provide a general criterion-referenced standard against which a school can measure its course content in histology. (MLW)

42 CFR 81.22 - General guidelines for use of NIOSH-IREP.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES GUIDELINES FOR DETERMINING PROBABILITY OF CAUSATION... Probability of Causation § 81.22 General guidelines for use of NIOSH-IREP. DOL will use procedures specified in the NIOSH-IREP Operating Guide to calculate probability of causation estimates under EEOICPA. The...

IS THERE A DOWNSIDE TO CUSTOMIZING CARE? IMPLICATIONS OF GENERAL AND PATIENT-SPECIFIC TREATMENT STRATEGIES

PubMed Central

Johnson, Paul E.; O’Connor, Patrick J.

2009-01-01

The use of general clinical guidelines versus customization of patient care presents a dilemma for clinicians managing chronic illness. We propose that the performance of customized strategies for the management of chronic illness depends on accurate patient categorization, and inaccurate categorization can lead to worse performance than that achievable using a general clinical guideline. This paper is based on an analysis of a basic utility model differentiating outcomes between the use of general management strategies and customized strategies. Results of the analysis have four implications regarding the design and use of clinical guidelines and customization of care: (1) the balance between the applications of more general strategies versus customization depends on the specificity and accuracy of the strategies; (2) adoption of clinical guidelines may be stifled as the complexity of guidelines increases to account for growing evidence; (3) clinical inertia (i.e. the failure to intensify an indicated treatment) can be a rational response to strategy specificity and the probability of misapplication; and, (4) current clinical guidelines and other decision-support tools may be improved if they accommodate the need for customization of strategies for some patients while providing support for proper categorization of patients. PMID:20367722

The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature

PubMed Central

Liu, Xinliang; Kolber, Morey J.

2016-01-01

Background Low back pain (LBP) is common and associated healthcare costs are significant. While clinical practice guidelines have been established in an attempt to reduce costs and healthcare utilization, it is unclear if adherence to physical therapy guidelines for those with LBP is efficacious. Therefore, the purpose of this study was to assess current evidence and evaluate the impact of physical therapy guideline adherence on subsequent healthcare costs and utilization for patients with LBP. Methods An electronic search was conducted in PubMed, CINAHL (EBSCO Host), AMED (Ovid), and PEDro. Studies included in this review were published in peer reviewed journals and the primary mode of treatment was administered by a physical therapist. Also, the definition of adherence was clearly defined based on claims data and at least one measure of cost or utilization reported. Quality assessment was evaluated via a modified Downs and Black checklist. Due to the conceptual heterogeneity in variable measurements, data were qualitatively synthesized and stratified by reported utilization and cost measures. Results A total of 256 results were identified and after omitting duplicates, 4 articles were retained, which were all retrospective in nature. Quality scores ranged between 19 and 21 points out of a possible 26 on the modified Downs and Black checklist. All identified studies used the same definition of guideline adherence, which focused on billing active codes and minimizing use of passive codes. The results demonstrated trends that, with a few exceptions, suggested those patients with LBP that were treated with an adherent guideline program demonstrated decreased healthcare utilization and an overall healthcare savings. Conclusion Preliminary evidence suggests that adherence to established clinical practice guidelines may assist with decreasing healthcare utilization and costs. Additional research based on prospective randomized controlled trials are needed to provide high quality evidence regarding the impact of guideline adherence among patients with LBP. PMID:27285608

Derivation of strontium-90 and cesium-137 residual radioactive material guidelines for the Laboratory for Energy-Related Health Research, University of California, Davis

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

Nimmagadda, M.; Yu, C.

1993-04-01

Residual radioactive material guidelines for strontium-90 and cesium-137 were derived for the Laboratory for Energy-Related Health Research (LEHR) site in Davis, California. The guideline derivation was based on a dose limit of 100 mrem/yr. The US Department of Energy (DOE) residual radioactive material guideline computer code, RESRAD, was used in this evaluation; this code implements the methodology described in the DOE manual for implementing residual radioactive material guidelines. Three potential site utilization scenarios were considered with the assumption that, for a period of 1,000 years following remedial action, the site will be utilized without radiological restrictions. The defined scenarios varymore » with regard to use of the site, time spent at the site, and sources of food consumed. The results of the evaluation indicate that the basic dose limit of 100 mrem/yr will not be exceeded within 1,000 years for either strontium-90 or cesium-137, provided that the soil concentrations of these radionuclides at the LEHR site do not exceed the following levels: 71,000 pCi/g for strontium-90 and 91 pCi/g for cesium-137 for Scenario A (researcher: the expected scenario); 160,000 pCi/g for strontium-90 and 220 pCi/g for cesium-137 for Scenario B (recreationist: a plausible scenario); and 37 pCi/g for strontium-90 and 32 pCi/g for cesium-137 for Scenario C (resident farmer ingesting food produced in the contaminated area: a plausible scenario). The derived guidelines are single-radionuclide guidelines and are linearly proportional to the dose limit used in the calculations. In setting the actual strontium-90 and cesium-137 guidelines for the LEHR site, DOE will apply the as low as reasonably achievable (ALARA) policy to the decision-making process, along with other factors such as whether a particular scenario is reasonable and appropriate.« less

Measure Guideline: Combustion Safety for Natural Draft Appliances Using Indoor Air

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

Brand, L.

2014-04-01

This measure guideline covers how to assess and carry out the combustion safety procedures for appliances and heating equipment that uses indoor air for combustion in low-rise residential buildings. Only appliances installed in the living space, or in an area freely communicating with the living space, vented alone or in tandem with another appliance are considered here. A separate measure guideline addresses combustion appliances located either within the living space in enclosed closets or side rooms or outside the living space in an adjacent area like an attic or garage that use outdoor air for combustion. This document is formore » inspectors, auditors, and technicians working in homes where energy upgrades are being conducted whether or not air infiltration control is included in the package of measures being applied. In the indoor combustion air case, guidelines summarized here are based on language provided in several of the codes to establish minimum requirements for the space using simplified prescriptive measures. In addition, building performance testing procedures are provided by testing agencies. The codes in combination with the test procedures offer comprehensive combustion safety coverage to address safety concerns, allowing inexperienced residential energy retrofit inspectors to effectively address combustion safety issues and allow energy retrofits to proceed.« less

SQA of finite element method (FEM) codes used for analyses of pit storage/transport packages

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

Russel, E.

1997-11-01

This report contains viewgraphs on the software quality assurance of finite element method codes used for analyses of pit storage and transport projects. This methodology utilizes the ISO 9000-3: Guideline for application of 9001 to the development, supply, and maintenance of software, for establishing well-defined software engineering processes to consistently maintain high quality management approaches.

Are physical activity studies in Hispanics meeting reporting guidelines for continuous monitoring technology? A systematic review.

PubMed

Layne, Charles S; Parker, Nathan H; Soltero, Erica G; Rosales Chavez, José; O'Connor, Daniel P; Gallagher, Martina R; Lee, Rebecca E

2015-09-18

Continuous monitoring technologies such as accelerometers and pedometers are the gold standard for physical activity (PA) measurement. However, inconsistencies in use, analysis, and reporting limit the understanding of dose-response relationships involving PA and the ability to make comparisons across studies and population subgroups. These issues are particularly detrimental to the study of PA across different ethnicities with different PA habits. This systematic review examined the inclusion of published guidelines involving data collection, processing, and reporting among articles using accelerometers or pedometers in Hispanic or Latino populations. English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) articles published between 2000 and 2013 using accelerometers or pedometers to measure PA among Hispanics or Latinos were identified through systematic literature searches. Of the 253 abstracts which were initially reviewed, 57 met eligibility criteria (44 accelerometer, 13 pedometer). Articles were coded and reviewed to evaluate compliance with recommended guidelines (N = 20), and the percentage of accelerometer and pedometer articles following each guideline were computed and reported. On average, 57.1 % of accelerometer and 62.2 % of pedometer articles reported each recommended guideline for data collection. Device manufacturer and model were reported most frequently, and provision of instructions for device wear in Spanish was reported least frequently. On average, 29.6 % of accelerometer articles reported each guideline for data processing. Definitions of an acceptable day for inclusion in analyses were reported most frequently, and definitions of an acceptable hour for inclusion in analyses were reported least frequently. On average, 18.8 % of accelerometer and 85.7 % of pedometer articles included each guideline for data reporting. Accelerometer articles most frequently included average number of valid days and least frequently included percentage of wear time. Inclusion of standard collection and reporting procedures in studies using continuous monitoring devices in Hispanic or Latino population is generally low. Lack of reporting consistency in continuous monitoring studies limits researchers' ability to compare studies or draw meaningful conclusions concerning amounts, quality, and benefits of PA among Hispanic or Latino populations. Reporting data collection, computation, and decision-making standards should be required. Improved interpretability would allow practitioners and researchers to apply scientific findings to promote PA.

10 CFR 960.3 - Implementation guidelines.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

10 CFR 960.3 - Implementation guidelines.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

10 CFR 960.3 - Implementation guidelines.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

10 CFR 960.3 - Implementation guidelines.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

10 CFR 960.3 - Implementation guidelines.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...

Best Practices for Reduction of Uncertainty in CFD Results

NASA Technical Reports Server (NTRS)

Mendenhall, Michael R.; Childs, Robert E.; Morrison, Joseph H.

2003-01-01

This paper describes a proposed best-practices system that will present expert knowledge in the use of CFD. The best-practices system will include specific guidelines to assist the user in problem definition, input preparation, grid generation, code selection, parameter specification, and results interpretation. The goal of the system is to assist all CFD users in obtaining high quality CFD solutions with reduced uncertainty and at lower cost for a wide range of flow problems. The best-practices system will be implemented as a software product which includes an expert system made up of knowledge databases of expert information with specific guidelines for individual codes and algorithms. The process of acquiring expert knowledge is discussed, and help from the CFD community is solicited. Benefits and challenges associated with this project are examined.

An iPhone Application Intervention to Promote Surveillance Among Women with a BRCA Mutation: Pre-intervention Data.

PubMed

Cohen, Stephanie A; Scherr, Courtney Lynam; Nixon, Dawn M

2018-04-01

Women with BRCA mutations, at significantly increased risk for breast and ovarian cancer, do not consistently adhere to management guidelines due to lack of awareness and challenges tracking appointments. We developed an iPhone application (app) to help BRCA carriers manage their surveillance. We explored baseline awareness and adherence to surveillance guidelines and analytic data from 21 months of app use. Descriptive statistics were calculated on responses (N = 86) to a survey about surveillance awareness and practices. The majority were aware of breast surveillance guidelines, but only one third were aware of ovarian surveillance guidelines. In practice, the majority reported a clinical breast exam within 6 months, just over half reported a mammogram and breast MRI in the last year, and under half reported ovarian surveillance in the last year. Nearly 50% reported difficulty remembering appointments. Although only 69 received access codes, 284 unique users attempted to enter the app, which was visible in the iTunes store but only available to those with a study code. Evaluation of analytic data demonstrated user engagement with study participants accessing the app 427 times over the 21-month time period (range 2-57; mean = 6.28). Results indicate participants were more likely to know screening guidelines than practice them. There was interest in the app and users were engaged, suggesting app value. We will send a follow-up survey after 18 months of app use for additional evaluation and feedback.

Safety Precautions for Science.

ERIC Educational Resources Information Center

Folks, John; And Others

Safety information is discussed and outlined in this guide. Areas include: (1) general laboratory safety rules; (2) general rules and guidelines for animals in the elementary classroom; (3) general guidelines for the physical sciences; (4) general rules for using animals in investigations, with specifics on the care and handling of mammals,…

Development of DCGLs by using both probabilistic and deterministic analyses in RESRAD (onsite) and RESRAD-OFFSITE codes.

PubMed

Kamboj, Sunita; Yu, Charley; Johnson, Robert

2013-05-01

The Derived Concentration Guideline Levels for two building areas previously used in waste processing and storage at Argonne National Laboratory were developed using both probabilistic and deterministic radiological environmental pathway analysis. Four scenarios were considered. The two current uses considered were on-site industrial use and off-site residential use with farming. The two future uses (i.e., after an institutional control period of 100 y) were on-site recreational use and on-site residential use with farming. The RESRAD-OFFSITE code was used for the current-use off-site residential/farming scenario and RESRAD (onsite) was used for the other three scenarios. Contaminants of concern were identified from the past operations conducted in the buildings and the actual characterization done at the site. Derived Concentration Guideline Levels were developed for all four scenarios using deterministic and probabilistic approaches, which include both "peak-of-the-means" and "mean-of-the-peaks" analyses. The future-use on-site residential/farming scenario resulted in the most restrictive Derived Concentration Guideline Levels for most radionuclides.

iPhone apps for smoking cessation: a content analysis.

PubMed

Abroms, Lorien C; Padmanabhan, Nalini; Thaweethai, Lalida; Phillips, Todd

2011-03-01

With the proliferation of smartphones such as the iPhone, mobile phones are being used in novel ways to promote smoking cessation. This study set out to examine the content of the 47 iPhone applications (apps) for smoking cessation that were distributed through the online iTunes store, as of June 24, 2009. Each app was independently coded by two reviewers for its (1) approach to smoking cessation and (2) adherence to the U.S. Public Health Service's 2008 Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Each app was also coded for its (3) frequency of downloads. Apps identified for smoking cessation were found to have low levels of adherence to key guidelines in the index. Few, if any, apps recommended or linked the user to proven treatments such as pharmacotherapy, counseling, and/or a quitline. iPhone apps for smoking cessation rarely adhere to established guidelines for smoking cessation. It is recommended that current apps be revised and future apps be developed around evidence-based practices for smoking cessation. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

iPhone Apps for Smoking Cessation

PubMed Central

Abroms, Lorien C.; Padmanabhan, Nalini; Thaweethai, Lalida; Phillips, Todd

2012-01-01

Background With the proliferation of smartphones such as the iPhone, mobile phones are being used in novel ways to promote smoking cessation. Purpose This study set out to examine the content of the 47 iPhone applications (apps) for smoking cessation that were distributed through the online iTunes store, as of June 24, 2009. Methods Each app was independently coded by two reviewers for their (1) approach to smoking cessation and their (2) adherence to the U.S. Public Health Service’s 2008 Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Apps were also coded for their (3) frequency of downloads. Results Apps identified for smoking cessation were found to have low levels of adherence to key guidelines in the index. Few, if any, apps recommended or linked the user to proven treatments such as pharmacotherapy, counseling, and/or a quitline. Conclusions iPhone apps for smoking cessation rarely adhere to established guidelines for smoking cessation. It is recommended that current apps be revised and future apps be developed around evidence-based practices for smoking cessation. PMID:21335258

Location identifiers

DOT National Transportation Integrated Search

1997-01-30

This order lists the location identifiers authorized by the Federal Aviation Administration, Department of the Navy, and Transport Canada. It lists United States airspace fixes and procedure codes. The order also includes guidelines for requesting id...

Quality in the pharmaceutical industry - A literature review.

PubMed

Haleem, Reham M; Salem, Maissa Y; Fatahallah, Faten A; Abdelfattah, Laila E

2015-10-01

The aim of this study is to:a.Highlight the most important guidelines and practices of quality in the pharmaceutical industry.b.Organize such guidelines and practices to create a guide to pave the way for other researchers who would like to dig deeper into these guidelines and practices. A review was conducted of 102 publications; 56 publications were concerned with the pharmaceutical quality directly while 46 publications were concerned with the general quality practices. The content of those sources was analyzed and the following themes were identified:a.Research theme 1: Guidelines of the pharmaceutical quality.b.Research theme 2: General practices recently applied in the pharmaceutical industry. The following guidelines were identified and reviewed: WHO guidelines, FDA guidelines, EU guidelines and ICH guidelines in the research theme I. In research theme II; the following topics were identified and reviewed: quality risk management, quality by design, corrective actions and preventive actions, process capability analysis, Six Sigma, process analytical technology, lean manufacturing, total quality management, ISO series and HACCP. Upon reviewing the previously highlighted guidelines and the practices that are widely applied in the pharmaceutical industry, it was noticed that there is an abundant number of papers and articles that explain the general guidelines and practices but the literature lack those describing application; case studies of the pharmaceutical factories applying those guidelines and significance of those guidelines and practices. It is recommended that the literature would invest more in the area of application and significance of guidelines and practices. New case studies should be done to prove the feasibility of such practices.

Generalized serial search code acquisition - The equivalent circular state diagram approach

NASA Technical Reports Server (NTRS)

Polydoros, A.; Simon, M. K.

1984-01-01

A transform-domain method for deriving the generating function of the acquisition process resulting from an arbitrary serial search strategy is presented. The method relies on equivalent circular state diagrams, uses Mason's formula from flow-graph theory, and employs a minimum number of required parameters. The transform-domain approach is briefly described and the concept of equivalent circular state diagrams is introduced and exploited to derive the generating function and resulting mean acquisition time for three particular cases of interest, the continuous/center Z search, the broken/center Z search, and the expanding window search. An optimization of the latter technique is performed whereby the number of partial windows which minimizes the mean acquisition time is determined. The numerical results satisfy certain intuitive predictions and provide useful design guidelines for such systems.

Interactive Finite Elements for General Engine Dynamics Analysis

NASA Technical Reports Server (NTRS)

Adams, M. L.; Padovan, J.; Fertis, D. G.

1984-01-01

General nonlinear finite element codes were adapted for the purpose of analyzing the dynamics of gas turbine engines. In particular, this adaptation required the development of a squeeze-film damper element software package and its implantation into a representative current generation code. The ADINA code was selected because of prior use of it and familiarity with its internal structure and logic. This objective was met and the results indicate that such use of general purpose codes is viable alternative to specialized codes for general dynamics analysis of engines.

Quantum Kronecker sum-product low-density parity-check codes with finite rate

NASA Astrophysics Data System (ADS)

Kovalev, Alexey A.; Pryadko, Leonid P.

2013-07-01

We introduce an ansatz for quantum codes which gives the hypergraph-product (generalized toric) codes by Tillich and Zémor and generalized bicycle codes by MacKay as limiting cases. The construction allows for both the lower and the upper bounds on the minimum distance; they scale as a square root of the block length. Many thus defined codes have a finite rate and limited-weight stabilizer generators, an analog of classical low-density parity-check (LDPC) codes. Compared to the hypergraph-product codes, hyperbicycle codes generally have a wider range of parameters; in particular, they can have a higher rate while preserving the estimated error threshold.

Washing and changing uniforms: is guidance being adhered to?

PubMed

Potter, Yvonne Camilla; Justham, David

To allay public apprehension regarding the risk of nurses' uniforms transmitting healthcare-associated infections (HCAI), national and local guidelines have been issued to control use, laundry and storage. This paper aims to measure the knowledge of registered nurses (RNs) and healthcare assistants (HCAs) working within a rural NHS foundation Trust and their adherence to the local infection prevention and control (IPC) standard regarding uniforms through a Trust-wide audit. Stratified random sampling selected 597 nursing staff and 399 responded (67%) by completing a short questionnaire based on the local standard. Responses were coded and transferred to SPSS (v. 17) for analysis. The audit found that nursing staff generally adhere to the guidelines, changing their uniforms daily and immediately upon accidental soiling, and wearing plastic aprons where indicated. At home, staff normally machine-wash and then iron their uniforms at the hottest setting. Nevertheless, few observe the local direction to place their newly-laundered uniforms in protective covers. This paper recommends a re-audit to compare compliance rates with baseline figures and further research into the reasons why compliance is lacking to sanction interventions for improvement, such as providing relevant staff education and re-introducing appropriate changing facilities.

Code of Practice on Animals in Schools.

ERIC Educational Resources Information Center

Science and Children, 1980

1980-01-01

Provides guidelines prepared by the National Science Teachers Association for the use and care of invertebrate and vertebrate animals in the classroom. Suggestions are made for conducting experimental and observational studies. (CS)

Proceedings of the First NASA Formal Methods Symposium

NASA Technical Reports Server (NTRS)

Denney, Ewen (Editor); Giannakopoulou, Dimitra (Editor); Pasareanu, Corina S. (Editor)

2009-01-01

Topics covered include: Model Checking - My 27-Year Quest to Overcome the State Explosion Problem; Applying Formal Methods to NASA Projects: Transition from Research to Practice; TLA+: Whence, Wherefore, and Whither; Formal Methods Applications in Air Transportation; Theorem Proving in Intel Hardware Design; Building a Formal Model of a Human-Interactive System: Insights into the Integration of Formal Methods and Human Factors Engineering; Model Checking for Autonomic Systems Specified with ASSL; A Game-Theoretic Approach to Branching Time Abstract-Check-Refine Process; Software Model Checking Without Source Code; Generalized Abstract Symbolic Summaries; A Comparative Study of Randomized Constraint Solvers for Random-Symbolic Testing; Component-Oriented Behavior Extraction for Autonomic System Design; Automated Verification of Design Patterns with LePUS3; A Module Language for Typing by Contracts; From Goal-Oriented Requirements to Event-B Specifications; Introduction of Virtualization Technology to Multi-Process Model Checking; Comparing Techniques for Certified Static Analysis; Towards a Framework for Generating Tests to Satisfy Complex Code Coverage in Java Pathfinder; jFuzz: A Concolic Whitebox Fuzzer for Java; Machine-Checkable Timed CSP; Stochastic Formal Correctness of Numerical Algorithms; Deductive Verification of Cryptographic Software; Coloured Petri Net Refinement Specification and Correctness Proof with Coq; Modeling Guidelines for Code Generation in the Railway Signaling Context; Tactical Synthesis Of Efficient Global Search Algorithms; Towards Co-Engineering Communicating Autonomous Cyber-Physical Systems; and Formal Methods for Automated Diagnosis of Autosub 6000.

Knowledge base methodology: Methodology for first Engineering Script Language (ESL) knowledge base

NASA Technical Reports Server (NTRS)

Peeris, Kumar; Izygon, Michel E.

1992-01-01

The primary goal of reusing software components is that software can be developed faster, cheaper and with higher quality. Though, reuse is not automatic and can not just happen. It has to be carefully engineered. For example a component needs to be easily understandable in order to be reused, and it has also to be malleable enough to fit into different applications. In fact the software development process is deeply affected when reuse is being applied. During component development, a serious effort has to be directed toward making these components as reusable. This implies defining reuse coding style guidelines and applying then to any new component to create as well as to any old component to modify. These guidelines should point out the favorable reuse features and may apply to naming conventions, module size and cohesion, internal documentation, etc. During application development, effort is shifted from writing new code toward finding and eventually modifying existing pieces of code, then assembling them together. We see here that reuse is not free, and therefore has to be carefully managed.

An empirical evaluation of supervised learning approaches in assigning diagnosis codes to electronic medical records

PubMed Central

Kavuluru, Ramakanth; Rios, Anthony; Lu, Yuan

2015-01-01

Background Diagnosis codes are assigned to medical records in healthcare facilities by trained coders by reviewing all physician authored documents associated with a patient's visit. This is a necessary and complex task involving coders adhering to coding guidelines and coding all assignable codes. With the popularity of electronic medical records (EMRs), computational approaches to code assignment have been proposed in the recent years. However, most efforts have focused on single and often short clinical narratives, while realistic scenarios warrant full EMR level analysis for code assignment. Objective We evaluate supervised learning approaches to automatically assign international classification of diseases (ninth revision) - clinical modification (ICD-9-CM) codes to EMRs by experimenting with a large realistic EMR dataset. The overall goal is to identify methods that offer superior performance in this task when considering such datasets. Methods We use a dataset of 71,463 EMRs corresponding to in-patient visits with discharge date falling in a two year period (2011–2012) from the University of Kentucky (UKY) Medical Center. We curate a smaller subset of this dataset and also use a third gold standard dataset of radiology reports. We conduct experiments using different problem transformation approaches with feature and data selection components and employing suitable label calibration and ranking methods with novel features involving code co-occurrence frequencies and latent code associations. Results Over all codes with at least 50 training examples we obtain a micro F-score of 0.48. On the set of codes that occur at least in 1% of the two year dataset, we achieve a micro F-score of 0.54. For the smaller radiology report dataset, the classifier chaining approach yields best results. For the smaller subset of the UKY dataset, feature selection, data selection, and label calibration offer best performance. Conclusions We show that datasets at different scale (size of the EMRs, number of distinct codes) and with different characteristics warrant different learning approaches. For shorter narratives pertaining to a particular medical subdomain (e.g., radiology, pathology), classifier chaining is ideal given the codes are highly related with each other. For realistic in-patient full EMRs, feature and data selection methods offer high performance for smaller datasets. However, for large EMR datasets, we observe that the binary relevance approach with learning-to-rank based code reranking offers the best performance. Regardless of the training dataset size, for general EMRs, label calibration to select the optimal number of labels is an indispensable final step. PMID:26054428

An empirical evaluation of supervised learning approaches in assigning diagnosis codes to electronic medical records.

PubMed

Kavuluru, Ramakanth; Rios, Anthony; Lu, Yuan

2015-10-01

Diagnosis codes are assigned to medical records in healthcare facilities by trained coders by reviewing all physician authored documents associated with a patient's visit. This is a necessary and complex task involving coders adhering to coding guidelines and coding all assignable codes. With the popularity of electronic medical records (EMRs), computational approaches to code assignment have been proposed in the recent years. However, most efforts have focused on single and often short clinical narratives, while realistic scenarios warrant full EMR level analysis for code assignment. We evaluate supervised learning approaches to automatically assign international classification of diseases (ninth revision) - clinical modification (ICD-9-CM) codes to EMRs by experimenting with a large realistic EMR dataset. The overall goal is to identify methods that offer superior performance in this task when considering such datasets. We use a dataset of 71,463 EMRs corresponding to in-patient visits with discharge date falling in a two year period (2011-2012) from the University of Kentucky (UKY) Medical Center. We curate a smaller subset of this dataset and also use a third gold standard dataset of radiology reports. We conduct experiments using different problem transformation approaches with feature and data selection components and employing suitable label calibration and ranking methods with novel features involving code co-occurrence frequencies and latent code associations. Over all codes with at least 50 training examples we obtain a micro F-score of 0.48. On the set of codes that occur at least in 1% of the two year dataset, we achieve a micro F-score of 0.54. For the smaller radiology report dataset, the classifier chaining approach yields best results. For the smaller subset of the UKY dataset, feature selection, data selection, and label calibration offer best performance. We show that datasets at different scale (size of the EMRs, number of distinct codes) and with different characteristics warrant different learning approaches. For shorter narratives pertaining to a particular medical subdomain (e.g., radiology, pathology), classifier chaining is ideal given the codes are highly related with each other. For realistic in-patient full EMRs, feature and data selection methods offer high performance for smaller datasets. However, for large EMR datasets, we observe that the binary relevance approach with learning-to-rank based code reranking offers the best performance. Regardless of the training dataset size, for general EMRs, label calibration to select the optimal number of labels is an indispensable final step. Copyright © 2015 Elsevier B.V. All rights reserved.

Prudent use guidelines: a review of existing veterinary guidelines.

PubMed

Teale, C J; Moulin, G

2012-04-01

The World Organisation for Animal Health (OIE) TerrestrialAnimal Health Code considers the prudent use of antimicrobial agents in veterinary medicine to comprise a series of practical measures and recommendations which confer benefits to animal and public health while preserving and maintaining the therapeutic efficacy of antimicrobials. This paper reviews some of the main veterinary prudent use guidelines which have been published in English and the responsibilities of those involved at all levels in the administration of antimicrobials to animals, including national regulatory authorities. The OIE guidelines are considered comprehensive and cover all of those levels, from regulatory authorities to veterinarians and food producers. Guidelines produced by national authorities, professional veterinary associations or farming associations and which are targeted at particular individuals, for example veterinarians or food animal producers, will, obviously, restrict their coverage to those aspects considered relevant for their target audience.

Barriers Against Implementing Blunt Abdominal Trauma Guidelines in a Hospital: A Qualitative Study

PubMed Central

Zaboli, Rouhollah; Tofighi, Shahram; Aghighi, Ali; Shokouh, Seyyed Javad Hosaini; Naraghi, Nader; Goodarzi, Hassan

2016-01-01

Introduction Clinical practice guidelines are structured recommendations that help physicians and patients to make proper decisions when dealing with a specific clinical condition. Because blunt abdominal trauma causes a various range of mild, single-system, and multisystem injuries, early detection will help to reduce mortality and resulting disability. Emergency treatment should be initiated based on CPGs. This study aimed to determine the variables affecting implementing blunt abdominal trauma CPGs in an Iranian hospital. Methods This study was conducted as a qualitative and phenomenology study in the Family Hospital in Tehran (Iran) in 2015. The research population included eight experts and key people in the area of blunt abdominal trauma clinical practice guidelines. Sampling was based on purposive and nonrandom methods. A semistructured interview was done for the data collection. A framework method was applied for the data analysis by using Atlas.ti software. Results After framework analyzing and various reviewing and deleting and combining the codes from 251 codes obtained, 15 families and five super families were extracted, including technical knowledge barriers, economical barriers, barriers related to deployment and monitoring, political will barriers, and managing barriers. Conclusion Structural reform is needed for eliminating the defects available in the healthcare system. As with most of the codes, subconcepts and concepts are classified into the field of human resources; it seems that the education and knowledge will be more important than other resources such as capital and equipment. PMID:27757191

Health facility challenges to the provision of Option B+ in western Kenya: a qualitative study

PubMed Central

Akama, Eliud; Bukusi, Elizabeth A; Musoke, Pamela; Nalwa, Wafula Z; Odeny, Thomas A; Onono, Maricianah; Spangler, Sydney A; Turan, Janet M; Wanga, Iris; Abuogi, Lisa L

2017-01-01

Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes. PMID:28207061

Health facility challenges to the provision of Option B+ in western Kenya: a qualitative study.

PubMed

Helova, Anna; Akama, Eliud; Bukusi, Elizabeth A; Musoke, Pamela; Nalwa, Wafula Z; Odeny, Thomas A; Onono, Maricianah; Spangler, Sydney A; Turan, Janet M; Wanga, Iris; Abuogi, Lisa L

2017-03-01

Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes.

Qualitative Improvement Methods Through Analysis of Inquiry Contents for Cancer Registration

PubMed

Boo, Yoo-Kyung; Lim, Hyun-Sook; Kim, Jung-Eun; Kim, Kyoung-Beom; Won, Young-Joo

2017-06-25

Background: In Korea, the national cancer database was constructed after the initiation of the national cancer registration project in 1980, and the annual national cancer registration report has been published every year since 2005. Consequently, data management must begin even at the stage of data collection in order to ensure quality. Objectives: To determine the suitability of cancer registries’ inquiry tools through the inquiry analysis of the Korea Central Cancer Registry (KCCR), and identify the needs to improve the quality of cancer registration. Methods: Results of 721 inquiries to the KCCR from 2000 to 2014 were analyzed by inquiry year, question type, and medical institution characteristics. Using Stata version 14.1, descriptive analysis was performed to identify general participant characteristics, and chi-square analysis was applied to investigate significant differences in distribution characteristics by factors affecting the quality of cancer registration data. Results: The number of inquiries increased in 2005–2009. During this period, there were various changes, including the addition of cancer registration items such as brain tumors and guideline updates. Of the inquirers, 65.3% worked at hospitals in metropolitan cities and 60.89% of hospitals had 601–1000 beds. Tertiary hospitals had the highest number of inquiries (64.91%), and the highest number of questions by type were 353 (48.96%) for histological codes, 92 (12.76%) for primary sites, and 76 (10.54%) for reportable. Conclusions: A cancer registration inquiry system is an effective method when not confident about codes during cancer registration, or when confronting cancer cases in which previous clinical knowledge or information on the cancer registration guidelines are insufficient. Creative Commons Attribution License

Legal requirements and guidelines for the control of harmful laser generated particles, vapours and gases

NASA Astrophysics Data System (ADS)

Horsey, John

2015-07-01

This paper is a review of the Health and Safety laws and guidelines relating to laser generated emissions into the workplace and outside environment with emphasis on the differences between legal requirements and guideline advice. The types and nature of contaminants released by various laser processes (i.e. cutting, coding, engraving, marking etc) are discussed, together with the best methods for controlling them to within legal exposure limits. A brief description of the main extract air filtration techniques, including the principles of particulate removal and the action of activated carbon for gas/vapour/odour filtration, is given.

Video-assisted feedback in general practice internships using German general practitioner's guidelines

PubMed Central

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. Teaching method: First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient – student – consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. Feasibility: The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept. The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. Conclusion: This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out. PMID:23255963

Video-assisted feedback in general practice internships using German general practitioner's guidelines.

PubMed

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient - student - consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The Following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept.The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out.

Personalized Guideline-Based Treatment Recommendations Using Natural Language Processing Techniques.

PubMed

Becker, Matthias; Böckmann, Britta

2017-01-01

Clinical guidelines and clinical pathways are accepted and proven instruments for quality assurance and process optimization. Today, electronic representation of clinical guidelines exists as unstructured text, but is not well-integrated with patient-specific information from electronic health records. Consequently, generic content of the clinical guidelines is accessible, but it is not possible to visualize the position of the patient on the clinical pathway, decision support cannot be provided by personalized guidelines for the next treatment step. The Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) provides common reference terminology as well as the semantic link for combining the pathways and the patient-specific information. This paper proposes a model-based approach to support the development of guideline-compliant pathways combined with patient-specific structured and unstructured information using SNOMED CT. To identify SNOMED CT concepts, a software was developed to extract SNOMED CT codes out of structured and unstructured German data to map these with clinical pathways annotated in accordance with the systematized nomenclature.

Quality in the pharmaceutical industry – A literature review

PubMed Central

Haleem, Reham M.; Salem, Maissa Y.; Fatahallah, Faten A.; Abdelfattah, Laila E.

2013-01-01

Objectives The aim of this study is to:a.Highlight the most important guidelines and practices of quality in the pharmaceutical industry.b.Organize such guidelines and practices to create a guide to pave the way for other researchers who would like to dig deeper into these guidelines and practices. Design A review was conducted of 102 publications; 56 publications were concerned with the pharmaceutical quality directly while 46 publications were concerned with the general quality practices. The content of those sources was analyzed and the following themes were identified:a.Research theme 1: Guidelines of the pharmaceutical quality.b.Research theme 2: General practices recently applied in the pharmaceutical industry. Main outcome measures The following guidelines were identified and reviewed: WHO guidelines, FDA guidelines, EU guidelines and ICH guidelines in the research theme I. In research theme II; the following topics were identified and reviewed: quality risk management, quality by design, corrective actions and preventive actions, process capability analysis, Six Sigma, process analytical technology, lean manufacturing, total quality management, ISO series and HACCP. Results Upon reviewing the previously highlighted guidelines and the practices that are widely applied in the pharmaceutical industry, it was noticed that there is an abundant number of papers and articles that explain the general guidelines and practices but the literature lack those describing application; case studies of the pharmaceutical factories applying those guidelines and significance of those guidelines and practices. Conclusions It is recommended that the literature would invest more in the area of application and significance of guidelines and practices. New case studies should be done to prove the feasibility of such practices. PMID:26594110

[Stroke prevention in atrial fibrillation in Germany. Situational analysis of treatment reality based on retrospective data].

PubMed

Mergenthaler, Ulrike; Kostev, Karel; Moosmang, Sven; Thate-Waschke, Inga-Marion; Haas, Sylvia

2017-12-01

Guideline-based, risk-adjusted therapy with anticoagulants reduce thromboembolic stroke risk in patients with atrial fibrillation (AF). This study analyzed use of oral anticoagulation in German AF-patients. Access to anonymized patient records was made via IMS Health Disease Analyzer database (sample size: 113,619 patients with ICD-10 Code I48.-; observation period: 11/2010-10/2013). Results were subsequently extrapolated to all general practitioners' (GPs) and cardiological practices in Germany. In 2011 12-month AF-prevalence was extrapolated to 2.1 million patients (first diagnosed: n = 537.548). In 2012 AF-prevalence gone up to 2.2 million cases (first diagnosed: n = 537.548) and in 2013 to 2.8 million (first diagnosed: n = 636.571). Commonly prescribed oral anticoagulants (OAC) were vitamin K antagonists (VKA). Unstable INR setting, private health insurance, hospital admission, heart failure or hypertension increased probability of change from VKA to non-vitamin K antagonist oral anticoagulants (NOAC). 17.3-36.5% of patients with CHA 2 DS 2 -VASc-score ≥ 2 did not receive any thromboembolism prophylaxis; 38.5% with CHA 2 DS 2 -VASc-score = 0 received unnecessarily OACs. For 2013 a potential of 29.749 ischemic strokes in GP practices was calculated, which possibly can be avoided by thromboembolism prophylaxis according to guidelines. Risk-based anticoagulation showed requirements for optimization. Use of OACs, according to guideline recommendations, would minimize bleeding risks, reduce ischemic strokes and could release resources.

Indoor air quality and the law in Singapore.

PubMed

Chan, P

1999-12-01

With the greater use of air-conditioned offices in Singapore, achieving good indoor air quality has become an important issue. The laws that impose duties upon designers and contractors with respect to the design and construction of air-conditioning and mechanical ventilation (ACMV) systems are set out in the Building Control Regulations and the Singapore Standard Code of Practice for Mechanical Ventilation and Air-conditioning in Buildings (hereinafter "SS CP 13:1980"). ACMV maintenance is governed by the Environmental Public Health Act, the Building and Common Property (Maintenance and Management) Act, and the Land Titles (Strata) Act, as well as by lease or tenancy agreements. Designers, contractors, developers, building owners and management corporations may also be liable to the workers, occupants and other premises users for indoor air quality (IAQ)-related injuries under the general principles of contract and tort. Recently, the Guidelines for Good Indoor Air Quality in Office Premises was issued by the Ministry of Environment to complement SS CP 13:1980 toward improving the indoor air quality of air-conditioned office premises. Although the Guidelines have no statutory effect, they may be adopted as contractual requirements in construction, lease and maintenance contracts. They may also be used to determine the relevant standard of duty of care required to discharge tortious liability. This paper looks at the existing laws and rules affecting the design, construction and maintenance of air-conditioned offices in light of Part III of the Ministry's Guidelines.

City Reach Code Technical Support Document

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

Athalye, Rahul A.; Chen, Yan; Zhang, Jian

This report describes and analyzes a set of energy efficiency measures that will save 20% energy over ASHRAE Standard 90.1-2013. The measures will be used to formulate a Reach Code for cities aiming to go beyond national model energy codes. A coalition of U.S. cities together with other stakeholders wanted to facilitate the development of voluntary guidelines and standards that can be implemented in stages at the city level to improve building energy efficiency. The coalition's efforts are being supported by the U.S. Department of Energy via Pacific Northwest National Laboratory (PNNL) and in collaboration with the New Buildings Institute.

Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial.

PubMed

Riis, Allan; Jensen, Cathrine Elgaard; Bro, Flemming; Maindal, Helle Terkildsen; Petersen, Karin Dam; Jensen, Martin Bach

2013-10-20

Evidence-based clinical practice guidelines may improve treatment quality, but the uptake of guideline recommendations is often incomplete and slow. Recently new low back pain guidelines are being launched in Denmark. The guidelines are considered to reduce personal and public costs. The aim of this study is to evaluate whether a complex, multifaceted implementation strategy of the low back pain guidelines will reduce secondary care referral and improve patient outcomes compared to the usual simple implementation strategy. In a two-armed cluster randomised trial, 100 general practices (clusters) and 2,700 patients aged 18 to 65 years from the North Denmark region will be included. Practices are randomly allocated 1:1 to a simple or a complex implementation strategy. Intervention practices will receive a complex implementation strategy, including guideline facilitator visits, stratification tools, and quality reports on low back pain treatment. Primary outcome is referral to secondary care. Secondary outcomes are pain, physical function, health-related quality of life, patient satisfaction with care and treatment outcome, employment status, and sick leave. Primary and secondary outcomes pertain to the patient level. Assessments of outcomes are blinded and follow the intention-to-treat principle. Additionally, a process assessment will evaluate the degree to which the intervention elements will be delivered as planned, as well as measure changes in beliefs and behaviours among general practitioners and patients. This study provides knowledge concerning the process and effect of an intervention to implement low back pain guidelines in general practice, and will provide insight on essential elements to include in future implementation strategies in general practice. Registered as NCT01699256 on ClinicalTrials.gov.

10 CFR 960.4-1 - System guideline.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false System guideline. 960.4-1 Section 960.4-1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Postclosure Guidelines § 960.4-1 System guideline. (a) Qualifying Condition. The geologic setting...

10 CFR 960.4-1 - System guideline.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false System guideline. 960.4-1 Section 960.4-1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Postclosure Guidelines § 960.4-1 System guideline. (a) Qualifying Condition. The geologic setting...

10 CFR 960.4-1 - System guideline.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false System guideline. 960.4-1 Section 960.4-1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Postclosure Guidelines § 960.4-1 System guideline. (a) Qualifying Condition. The geologic setting...

10 CFR 960.5-1 - System guidelines.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false System guidelines. 960.5-1 Section 960.5-1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines § 960.5-1 System guidelines. (a) Qualifying conditions—(1) Preclosure...

10 CFR 960.5-1 - System guidelines.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false System guidelines. 960.5-1 Section 960.5-1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines § 960.5-1 System guidelines. (a) Qualifying conditions—(1) Preclosure...

10 CFR 960.5-1 - System guidelines.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false System guidelines. 960.5-1 Section 960.5-1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines § 960.5-1 System guidelines. (a) Qualifying conditions—(1) Preclosure...

10 CFR 960.4-1 - System guideline.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false System guideline. 960.4-1 Section 960.4-1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Postclosure Guidelines § 960.4-1 System guideline. (a) Qualifying Condition. The geologic setting...

40 CFR 799.11 - Availability of test guidelines.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 31 2010-07-01 2010-07-01 true Availability of test guidelines. 799.11... General Provisions § 799.11 Availability of test guidelines. (a) The TSCA and FIFRA guidelines for the...-487-4650). (b) The OECD guidelines for the various study plans are available from the following...

Reporting Guidelines: Optimal Use in Preventive Medicine and Public Health

PubMed Central

Popham, Karyn; Calo, William A.; Carpentier, Melissa Y.; Chen, Naomi E.; Kamrudin, Samira A.; Le, Yen-Chi L.; Skala, Katherine A.; Thornton, Logan R.; Mullen, Patricia Dolan

2012-01-01

Numerous reporting guidelines are available to help authors write higher quality manuscripts more efficiently. Almost 200 are listed on the EQUATOR (Enhancing the Quality and Transparency of Health Research) Network’s website and they vary in authority, usability, and breadth, making it difficult to decide which one(s) to use. This paper provides consistent information about guidelines for preventive medicine and public health and a framework and sequential approach for selecting them. EQUATOR guidelines were reviewed for relevance to target audiences; selected guidelines were classified as “core” (frequently recommended) or specialized, and the latter were grouped by their focus. Core and specialized guidelines were coded for indicators of authority (simultaneous publication in multiple journals, rationale, scientific background supporting each element, expertise of designers, permanent website/named group), usability (presence of checklists and examples of good reporting), and breadth (manuscript sections covered). Discrepancies were resolved by consensus. Selected guidelines are presented in four tables arranged to facilitate selection: core guidelines, all of which pertain to major research designs; guidelines for additional study designs, topical guidelines, and guidelines for particular manuscript sections. A flow diagram provides an overview. The framework and sequential approach will enable authors as well as editors, peer reviewers, researchers, and systematic reviewers to make optimal use of available guidelines to improve the transparency, clarity, and rigor of manuscripts and research protocols and the efficiency of conducing systematic reviews and meta-analyses. PMID:22992369

[Need for clinical guidelines for chronic periodontitis in general and specialized Belgian practice].

PubMed

Cosyn, Jan; Thevissen, Eric; Reners, Michèle; Rompen, Eric; Klinge, Björn; De Bruyn, Hugo

2008-01-01

As the prevalence of periodontitis is more than 40 % in the adult Belgian population, periodontists are clearly understaffed to treat this disease in all patients. Therefore, it seems logic that mild forms of chronic periodontitis are treated by the general practitioner especially because Belgium lacks dental hygienists. Important prerequisites for organizing periodontal care as such relate to the general practitioner who should use the same techniques, have comparable communicative skills to motivate patients and create a similar amount of time for periodontal treatment as the specialist. After all, the patient has the right to qualitative treatment regardless of the level of education of the care provider. In order to guarantee this in general practice as much as possible, there is a need for clinical guidelines developed by specialists. These guidelines should not only support the general practitioner in treating disease; above all, they should assist the dentist in periodontal diagnosis. Hitherto, periodontal screening by general dentists seems to be infrequently performed even though reimbursement of the Dutch Periodontal Screening Index is implemented in the Belgian healthcare security system. In this manuscript possible explanations for this phenomenon are discussed. Apart from the need for guidelines in general practice, guidelines for surgical treatment seem compulsory to uniform treatment protocols in specialized practice. Extreme variation in the recommendation of surgery among Belgian specialists calls for consensus statements.

Towers of generalized divisible quantum codes

NASA Astrophysics Data System (ADS)

Haah, Jeongwan

2018-04-01

A divisible binary classical code is one in which every code word has weight divisible by a fixed integer. If the divisor is 2ν for a positive integer ν , then one can construct a Calderbank-Shor-Steane (CSS) code, where X -stabilizer space is the divisible classical code, that admits a transversal gate in the ν th level of Clifford hierarchy. We consider a generalization of the divisibility by allowing a coefficient vector of odd integers with which every code word has zero dot product modulo the divisor. In this generalized sense, we construct a CSS code with divisor 2ν +1 and code distance d from any CSS code of code distance d and divisor 2ν where the transversal X is a nontrivial logical operator. The encoding rate of the new code is approximately d times smaller than that of the old code. In particular, for large d and ν ≥2 , our construction yields a CSS code of parameters [[O (dν -1) ,Ω (d ) ,d ] ] admitting a transversal gate at the ν th level of Clifford hierarchy. For our construction we introduce a conversion from magic state distillation protocols based on Clifford measurements to those based on codes with transversal T gates. Our tower contains, as a subclass, generalized triply even CSS codes that have appeared in so-called gauge fixing or code switching methods.

A context-adaptable approach to clinical guidelines.

PubMed

Terenziani, Paolo; Montani, Stefania; Bottrighi, Alessio; Torchio, Mauro; Molino, Gianpaolo; Correndo, Gianluca

2004-01-01

One of the most relevant obstacles to the use and dissemination of clinical guidelines is the gap between the generality of guidelines (as defined, e.g., by physicians' committees) and the peculiarities of the specific context of application. In particular, general guidelines do not take into account the fact that the tools needed for laboratory and instrumental investigations might be unavailable at a given hospital. Moreover, computer-based guideline managers must also be integrated with the Hospital Information System (HIS), and usually different DBMS are adopted by different hospitals. The GLARE (Guideline Acquisition, Representation and Execution) system addresses these issues by providing a facility for automatic resource-based adaptation of guidelines to the specific context of application, and by providing a modular architecture in which only limited and well-localised changes are needed to integrate the system with the HIS at hand.

Autonomy, responsibility and the Italian Code of Deontology for Nurses.

PubMed

Barazzetti, Gaia; Radaelli, Stefania; Sala, Roberta

2007-01-01

This article is a first assessment of the Italian Code of deontology for nurses (revised in 1999) on the basis of data collected from focus groups with nurses taking part in the Ethical Codes in Nursing (ECN) project. We illustrate the professional context in which the Code was introduced and explain why the 1999 revision was necessary in the light of changes affecting the Italian nursing profession. The most remarkable findings concern professional autonomy and responsibility, and how the Code is thought of as a set of guidelines for nursing practice. We discuss these issues, underlining that the 1999 Code represents a valuable instrument for ethical reflection and examination, a stimulus for putting the moral sense of the nursing profession into action, and that it represents a new era for professional nursing practice in Italy. The results of the analysis also deserve further qualitative study and future consideration.

Generalized type II hybrid ARQ scheme using punctured convolutional coding

NASA Astrophysics Data System (ADS)

Kallel, Samir; Haccoun, David

1990-11-01

A method is presented to construct rate-compatible convolutional (RCC) codes from known high-rate punctured convolutional codes, obtained from best-rate 1/2 codes. The construction method is rather simple and straightforward, and still yields good codes. Moreover, low-rate codes can be obtained without any limit on the lowest achievable code rate. Based on the RCC codes, a generalized type-II hybrid ARQ scheme, which combines the benefits of the modified type-II hybrid ARQ strategy of Hagenauer (1988) with the code-combining ARQ strategy of Chase (1985), is proposed and analyzed. With the proposed generalized type-II hybrid ARQ strategy, the throughput increases as the starting coding rate increases, and as the channel degrades, it tends to merge with the throughput of rate 1/2 type-II hybrid ARQ schemes with code combining, thus allowing the system to be flexible and adaptive to channel conditions, even under wide noise variations and severe degradations.

The weight hierarchies and chain condition of a class of codes from varieties over finite fields

NASA Technical Reports Server (NTRS)

Wu, Xinen; Feng, Gui-Liang; Rao, T. R. N.

1996-01-01

The generalized Hamming weights of linear codes were first introduced by Wei. These are fundamental parameters related to the minimal overlap structures of the subcodes and very useful in several fields. It was found that the chain condition of a linear code is convenient in studying the generalized Hamming weights of the product codes. In this paper we consider a class of codes defined over some varieties in projective spaces over finite fields, whose generalized Hamming weights can be determined by studying the orbits of subspaces of the projective spaces under the actions of classical groups over finite fields, i.e., the symplectic groups, the unitary groups and orthogonal groups. We give the weight hierarchies and generalized weight spectra of the codes from Hermitian varieties and prove that the codes satisfy the chain condition.

Factors influencing adherence to guidelines for screening mammography among women aged 40 years and older.

PubMed

Rahman, Saleh M M; Dignan, Mark B; Shelton, Brent J

2003-01-01

To explore patterns of adherence to guidelines for screening mammography among participants in the Colorado Mammography Project (CMAP) surveillance database. An algorithm was developed to assess factors associated with adherence to mammography screening guidelines. Of the 27,778 women ranging from 40-90 years of age included in the analysis, 41.4% were adherent with mammography screening guidelines. According to the model tested in this study, race/ethnicity (Black vs White, OR=0.76, 95% CI=0.64-0.91); educational attainment (high school vs 55,000 dollars vs <15,000 dollars, OR 1.14, 95% CI=1.03-1.26) were statistically significant predictors of adherence to guidelines. A significant interaction between age and family history of breast cancer (BC) was also found. Younger females with a family history of BC were less likely to be adherent than their counterparts without a family history (OR=0.93, 95% CI=0.90-0.96). In general, elderly women were more likely to be adherent compared with the youngest group in this cohort (OR=1.21, 95% CI=1.11-1.33). Inclusion or exclusion of women aged 70 years and older did not change the outcome of the analysis. Adherence with screening mammography guidelines was found to be associated with women's personal characteristics including race/ethnicity, age, and family history of BC. In addition, socioeconomic status, as measured by educational level and community economic status, are important predictors of adherence. Efforts to increase adherence may need to be specific to race/ethnic group and age, but the effect of age is mediated by family history of BC and vice versa.

SuML: A Survey Markup Language for Generalized Survey Encoding

PubMed Central

Barclay, MW; Lober, WB; Karras, BT

2002-01-01

There is a need in clinical and research settings for a sophisticated, generalized, web based survey tool that supports complex logic, separation of content and presentation, and computable guidelines. There are many commercial and open source survey packages available that provide simple logic; few provide sophistication beyond “goto” statements; none support the use of guidelines. These tools are driven by databases, static web pages, and structured documents using markup languages such as eXtensible Markup Language (XML). We propose a generalized, guideline aware language and an implementation architecture using open source standards.

Concept Inventory Development Reveals Common Student Misconceptions about Microbiology †

PubMed Central

Briggs, Amy G.; Hughes, Lee E.; Brennan, Robert E.; Buchner, John; Horak, Rachel E. A.; Amburn, D. Sue Katz; McDonald, Ann H.; Primm, Todd P.; Smith, Ann C.; Stevens, Ann M.; Yung, Sunny B.; Paustian, Timothy D.

2017-01-01

Misconceptions, or alternative conceptions, are incorrect understandings that students have incorporated into their prior knowledge. The goal of this study was the identification of misconceptions in microbiology held by undergraduate students upon entry into an introductory, general microbiology course. This work was the first step in developing a microbiology concept inventory based on the American Society for Microbiology’s Recommended Curriculum Guidelines for Undergraduate Microbiology. Responses to true/false (T/F) questions accompanied by written explanations by undergraduate students at a diverse set of institutions were used to reveal misconceptions for fundamental microbiology concepts. These data were analyzed to identify the most difficult core concepts, misalignment between explanations and answer choices, and the most common misconceptions for each core concept. From across the core concepts, nineteen misconception themes found in at least 5% of the coded answers for a given question were identified. The top five misconceptions, with coded responses ranging from 19% to 43% of the explanations, are described, along with suggested classroom interventions. Identification of student misconceptions in microbiology provides a foundation upon which to understand students’ prior knowledge and to design appropriate tools for improving instruction in microbiology. PMID:29854046

User Guidelines and Best Practices for CASL VUQ Analysis Using Dakota

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

Adams, Brian M.; Coleman, Kayla; Hooper, Russell W.

2016-10-04

In general, Dakota is the Consortium for Advanced Simulation of Light Water Reactors (CASL) delivery vehicle for verification, validation, and uncertainty quantification (VUQ) algorithms. It permits ready application of the VUQ methods described above to simulation codes by CASL researchers, code developers, and application engineers. More specifically, the CASL VUQ Strategy [33] prescribes the use of Predictive Capability Maturity Model (PCMM) assessments [37]. PCMM is an expert elicitation tool designed to characterize and communicate completeness of the approaches used for computational model definition, verification, validation, and uncertainty quantification associated with an intended application. Exercising a computational model with the methodsmore » in Dakota will yield, in part, evidence for a predictive capability maturity model (PCMM) assessment. Table 1.1 summarizes some key predictive maturity related activities (see details in [33]), with examples of how Dakota fits in. This manual offers CASL partners a guide to conducting Dakota-based VUQ studies for CASL problems. It motivates various classes of Dakota methods and includes examples of their use on representative application problems. On reading, a CASL analyst should understand why and how to apply Dakota to a simulation problem.« less

Sector-specific issues and reporting methodologies supporting the General Guidelines for the voluntary reporting of greenhouse gases under Section 1605(b) of the Energy Policy Act of 1992. Volume 2: Part 4, Transportation sector; Part 5, Forestry sector; Part 6, Agricultural sector

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

Not Available

This volume, the second of two such volumes, contains sector-specific guidance in support of the General Guidelines for the voluntary reporting of greenhouse gas emissions and carbon sequestration. This voluntary reporting program was authorized by Congress in Section 1605(b) of the Energy Policy Act of 1992. The General Guidelines, bound separately from this volume, provide the overall rationale for the program, discuss in general how to analyze emissions and emission reduction/carbon sequestration projects, and address programmatic issues such as minimum reporting requirements, time parameters, international projects, confidentiality, and certification. Together, the General Guidelines and the guidance in these supporting documentsmore » will provide concepts and approaches needed to prepare the reporting forms. This second volume of sector-specific guidance covers the transportation sector, the forestry sector, and the agricultural sector.« less

10 CFR 1049.5 - Exercise of arrest authority-General guidelines.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Exercise of arrest authority-General guidelines. 1049.5 Section 1049.5 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS OF THE STRATEGIC PETROLEUM RESERVE § 1049.5 Exercise of arrest authority...

10 CFR 1049.5 - Exercise of arrest authority-General guidelines.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Exercise of arrest authority-General guidelines. 1049.5 Section 1049.5 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS OF THE STRATEGIC PETROLEUM RESERVE § 1049.5 Exercise of arrest authority...

10 CFR 1049.5 - Exercise of arrest authority-General guidelines.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Exercise of arrest authority-General guidelines. 1049.5 Section 1049.5 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS OF THE STRATEGIC PETROLEUM RESERVE § 1049.5 Exercise of arrest authority...

10 CFR 1049.5 - Exercise of arrest authority-General guidelines.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Exercise of arrest authority-General guidelines. 1049.5 Section 1049.5 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS OF THE STRATEGIC PETROLEUM RESERVE § 1049.5 Exercise of arrest authority...

10 CFR 1049.5 - Exercise of arrest authority-General guidelines.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Exercise of arrest authority-General guidelines. 1049.5 Section 1049.5 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS OF THE STRATEGIC PETROLEUM RESERVE § 1049.5 Exercise of arrest authority...

Moving Past Exploration and Adoption: Considering Priorities for Implementing Mobile Learning by Nurses.

PubMed

Mather, Carey; Cummings, Elizabeth

2017-01-01

Successful implementation of mobile technology for informal learning and continuing professional development within healthcare settings cannot be achieved or sustained, until end-users recognise that the benefits of using this innovation, outweigh the issues of non-use. At a systems level there is a need for standards, guidelines and codes of conduct to support deployment of mobile technology at an individual level. The aim of this research was to explore findings of a previous focus group study to elucidate priorities for action, provide evidence and focus impetus for advocating progression of the installation of standards and guidelines at an organisation level. The study confirms nurse supervisors' preparedness and readiness to employ mobile learning at point of care. However, successful implementation requires organisations engaging with, and embracing the evolving digital landscape, and supporting this new andragogy. Organisational level commitment will promote contemporary nursing practice, support the best clinical outcomes for patients, and provide educational support for nurses. Nurse leaders and professional bodies must drive and guide development of robust standards, guidelines, and codes of conduct to prioritise mobile learning as a component of digital professionalism within healthcare organisations.

Application Reuse Library for Software, Requirements, and Guidelines

NASA Technical Reports Server (NTRS)

Malin, Jane T.; Thronesbery, Carroll

1994-01-01

Better designs are needed for expert systems and other operations automation software, for more reliable, usable and effective human support. A prototype computer-aided Application Reuse Library shows feasibility of supporting concurrent development and improvement of advanced software by users, analysts, software developers, and human-computer interaction experts. Such a library expedites development of quality software, by providing working, documented examples, which support understanding, modification and reuse of requirements as well as code. It explicitly documents and implicitly embodies design guidelines, standards and conventions. The Application Reuse Library provides application modules with Demo-and-Tester elements. Developers and users can evaluate applicability of a library module and test modifications, by running it interactively. Sub-modules provide application code and displays and controls. The library supports software modification and reuse, by providing alternative versions of application and display functionality. Information about human support and display requirements is provided, so that modifications will conform to guidelines. The library supports entry of new application modules from developers throughout an organization. Example library modules include a timer, some buttons and special fonts, and a real-time data interface program. The library prototype is implemented in the object-oriented G2 environment for developing real-time expert systems.

Proceedings of the Joint Logistics Commanders Joint Policy Coordinating Group on Computer Resource Management; Computer Software Management Software Workshop, 2-5 April 1979.

DTIC Science & Technology

1979-08-21

Appendix s - Outline and Draft Material for Proposed Triservice Interim Guideline on Application of Software Acceptance Criteria....... 269 Appendix 9...AND DRAFT MATERIAL FOR PROPOSED TRISERVICE INTERIM GUIDELINE ON APPLICATION OF SOFTWARE ACCEPTANCE CRITERIA I I INTRODUCTION The purpose of this guide...contract item (CPCI) (code) 5. CPCI test plan 6. CPCI test procedures 7. CPCI test report 8. Handbooks and manuals. Al though additional material does

Liquid and gaseous oxygen safety review, volume 2

NASA Technical Reports Server (NTRS)

Lapin, A.

1972-01-01

Guidelines, codes, regulations and special procedures used in the design, installation, fabrication, testing and operations for protection against hazards involved with production, transportation, storage and system handling of oxygen are presented with a list of related references.

Work zone positive protection guidelines for Idaho.

DOT National Transportation Integrated Search

2014-12-01

The Code of Federal Regulation (CFR) Title 23 Part 630 Subpart K - Temporary Traffic Control (630.1102630.1110) rule states : that positive protection shall be considered where work zone conditions place workers at increased risk from motorized : ...

Assessment of Literature Related to Combustion Appliance Venting Systems

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

Rapp, V. H.; Less, B. D.; Singer, B. C.

In many residential building retrofit programs, air tightening to increase energy efficiency is often constrained by safety concerns with naturally vented combustion appliances. Tighter residential buildings more readily depressurize when exhaust equipment is operated, making combustion appliances more prone to backdraft or spill combustion exhaust into the living space. Several measures, such as installation guidelines, vent sizing codes, and combustion safety diagnostics, are in place with the intent to prevent backdrafting and combustion spillage, but the diagnostics conflict and the risk mitigation objective is inconsistent. This literature review summarizes the metrics and diagnostics used to assess combustion safety, documents theirmore » technical basis, and investigates their risk mitigations. It compiles information from the following: codes for combustion appliance venting and installation; standards and guidelines for combustion safety diagnostics; research evaluating combustion safety diagnostics; research investigating wind effects on building depressurization and venting; and software for simulating vent system performance.« less

A simple and inexpensive way to document simple husbandry in animal care facilities using QR code scanning.

PubMed

Green, Tyler; Smith, Terry; Hodges, Richard; Fry, W Mark

2017-12-01

Record keeping within research animal care facilities is a key part of the guidelines set forth by national regulatory bodies and mandated by federal laws. Research facilities must maintain records of animal health issues, procedures and usage. Facilities are also required to maintain records regarding regular husbandry such as general animal checks, feeding and watering. The level of record keeping has the potential to generate excessive amounts of paper which must be retained in a fashion as to be accessible. In addition it is preferable not to retain within administrative areas any paper records which may have been in contact with animal rooms. Here, we present a flexible, simple and inexpensive process for the generation and storage of electronic animal husbandry records using smartphone technology over a WiFi or cellular network.

7 CFR 622.5 - Guidelines.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... the Water Resources Council. Watershed projects are to be planned and carried out in a way that will...

7 CFR 622.5 - Guidelines.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... the Water Resources Council. Watershed projects are to be planned and carried out in a way that will...

7 CFR 622.5 - Guidelines.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... the Water Resources Council. Watershed projects are to be planned and carried out in a way that will...

7 CFR 622.5 - Guidelines.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... the Water Resources Council. Watershed projects are to be planned and carried out in a way that will...

36 CFR 910.67 - Square guidelines.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Square guidelines. 910.67 Section 910.67 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL... DEVELOPMENT AREA Glossary of Terms § 910.67 Square guidelines. Square Guidelines establish the Corporation's...

36 CFR 910.67 - Square guidelines.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false Square guidelines. 910.67 Section 910.67 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL... DEVELOPMENT AREA Glossary of Terms § 910.67 Square guidelines. Square Guidelines establish the Corporation's...

36 CFR 910.67 - Square guidelines.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false Square guidelines. 910.67 Section 910.67 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL... DEVELOPMENT AREA Glossary of Terms § 910.67 Square guidelines. Square Guidelines establish the Corporation's...

36 CFR 910.67 - Square guidelines.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false Square guidelines. 910.67 Section 910.67 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL... DEVELOPMENT AREA Glossary of Terms § 910.67 Square guidelines. Square Guidelines establish the Corporation's...

Variation in clinical coding lists in UK general practice: a barrier to consistent data entry?

PubMed

Tai, Tracy Waize; Anandarajah, Sobanna; Dhoul, Neil; de Lusignan, Simon

2007-01-01

Routinely collected general practice computer data are used for quality improvement; poor data quality including inconsistent coding can reduce their usefulness. To document the diversity of data entry systems currently in use in UK general practice and highlight possible implications for data quality. General practice volunteers provided screen shots of the clinical coding screen they would use to code a diagnosis or problem title in the clinical consultation. The six clinical conditions examined were: depression, cystitis, type 2 diabetes mellitus, sore throat, tired all the time, and myocardial infarction. We looked at the picking lists generated for these problem titles in EMIS, IPS, GPASS and iSOFT general practice clinical computer systems, using the Triset browser as a gold standard for comparison. A mean of 19.3 codes is offered in the picking list after entering a diagnosis or problem title. EMIS produced the longest picking lists and GPASS the shortest, with a mean number of choices of 35.2 and 12.7, respectively. Approximately three-quarters (73.5%) of codes are diagnoses, one-eighth (12.5%) symptom codes, and the remainder come from a range of Read chapters. There was no readily detectable consistent order in which codes were displayed. Velocity coding, whereby commonly-used codes are placed higher in the picking list, results in variation between practices even where they have the same brand of computer system. Current systems for clinical coding promote diversity rather than consistency of clinical coding. As the UK moves towards an integrated health IT system consistency of coding will become more important. A standardised, limited list of codes for primary care might help address this need.

Recommendations for the ethical use and design of artificial intelligent care providers.

PubMed

Luxton, David D

2014-09-01

This paper identifies and reviews ethical issues associated with artificial intelligent care providers (AICPs) in mental health care and other helping professions. Specific recommendations are made for the development of ethical codes, guidelines, and the design of AICPs. Current developments in the application of AICPs and associated technologies are reviewed and a foundational overview of applicable ethical principles in mental health care is provided. Emerging ethical issues regarding the use of AICPs are then reviewed in detail. Recommendations for ethical codes and guidelines as well as for the development of semi-autonomous and autonomous AICP systems are described. The benefits of AICPs and implications for the helping professions are discussed in order to weigh the pros and cons of their use. Existing ethics codes and practice guidelines do not presently consider the current or the future use of interactive artificial intelligent agents to assist and to potentially replace mental health care professionals. AICPs present new ethical issues that will have significant ramifications for the mental health care and other helping professions. Primary issues involve the therapeutic relationship, competence, liability, trust, privacy, and patient safety. Many of the same ethical and philosophical considerations are applicable to use and design of AICPs in medicine, nursing, social work, education, and ministry. The ethical and moral aspects regarding the use of AICP systems must be well thought-out today as this will help to guide the use and development of these systems in the future. Topics presented are relevant to end users, AI developers, and researchers, as well as policy makers and regulatory boards. Published by Elsevier B.V.

Sensemaking, stakeholder discord, and long-term risk communication at a US Superfund site.

PubMed

Hoover, Anna Goodman

2017-03-01

Risk communication can help reduce exposures to environmental contaminants, mitigate negative health outcomes, and inform community-based decisions about hazardous waste sites. While communication best practices have long guided such efforts, little research has examined unintended consequences arising from such guidelines. As rhetoric informs stakeholder sensemaking, the language used in and reinforced by these guidelines can challenge relationships and exacerbate stakeholder tensions. This study evaluates risk communication at a U.S. Superfund site to identify unintended consequences arising from current risk communication practices. This qualitative case study crystallizes data spanning 6 years from three sources: 1) local newspaper coverage of site-related topics; 2) focus-group transcripts from a multi-year project designed to support future visioning of site use; and 3) published blog entries authored by a local environmental activist. Constant comparative analysis provides the study's analytic foundation, with qualitative data analysis software QSR NVivo 8 supporting a three-step process: 1) provisional coding to identify broad topic categories within datasets, 2) coding occurrences of sensemaking constructs and emergent intra-dataset patterns, and 3) grouping related codes across datasets to examine the relationships among them. Existing risk communication practices at this Superfund site contribute to a dichotomous conceptualization of multiple and diverse stakeholders as members of one of only two categories: the government or the public. This conceptualization minimizes perceptions of capacity, encourages public commitment to stances aligned with a preferred group, and contributes to negative expectations that can become self-fulfilling prophecies. Findings indicate a need to re-examine and adapt risk communication guidelines to encourage more pluralistic understanding of the stakeholder landscape.

Assisted suicide: implications for nurses and nursing.

PubMed

Daly, B J; Berry, D; Fitzpatrick, J J; Drew, B; Montgomery, K

1997-01-01

Assisted suicide is an issue of great importance to nurses. This issue reflects our values and beliefs as a society, calls for a clear and precise response as a profession, and challenges individual nurses to think about their own moral views. The history of the debate and the compelling moral arguments on both sides attest to the complexity of the issue and also suggest that it will not soon be resolved. The current position of the profession, as expressed in the ANA Code for Nurses and a specific position statement, were reviewed. The dilemma faced by the individual nurse who perceives an obligation to adhere to the guidelines specified by his or her profession's code and yet whose conscience dictates an act in violation of this code has been discussed as an instance of conscientious objection. While this analysis has been necessarily brief, it was intended to illustrate the importance of being clear about one's personal moral views and equally clear about one's duty to fulfil the obligations stemming from the profession's public statements. It is essential that the profession continue to explore the moral issues involved in requests for assistance in dying and provide additional guidelines for practicing nurses, with sound rationale for the profession's position.

National evaluation of the benefits and risks of greater structuring and coding of the electronic health record: exploratory qualitative investigation.

PubMed

Morrison, Zoe; Fernando, Bernard; Kalra, Dipak; Cresswell, Kathrin; Sheikh, Aziz

2014-01-01

We aimed to explore stakeholder views, attitudes, needs, and expectations regarding likely benefits and risks resulting from increased structuring and coding of clinical information within electronic health records (EHRs). Qualitative investigation in primary and secondary care and research settings throughout the UK. Data were derived from interviews, expert discussion groups, observations, and relevant documents. Participants (n=70) included patients, healthcare professionals, health service commissioners, policy makers, managers, administrators, systems developers, researchers, and academics. Four main themes arose from our data: variations in documentation practice; patient care benefits; secondary uses of information; and informing and involving patients. We observed a lack of guidelines, co-ordination, and dissemination of best practice relating to the design and use of information structures. While we identified immediate benefits for direct care and secondary analysis, many healthcare professionals did not see the relevance of structured and/or coded data to clinical practice. The potential for structured information to increase patient understanding of their diagnosis and treatment contrasted with concerns regarding the appropriateness of coded information for patients. The design and development of EHRs requires the capture of narrative information to reflect patient/clinician communication and computable data for administration and research purposes. Increased structuring and/or coding of EHRs therefore offers both benefits and risks. Documentation standards within clinical guidelines are likely to encourage comprehensive, accurate processing of data. As data structures may impact upon clinician/patient interactions, new models of documentation may be necessary if EHRs are to be read and authored by patients.

National evaluation of the benefits and risks of greater structuring and coding of the electronic health record: exploratory qualitative investigation

PubMed Central

Morrison, Zoe; Fernando, Bernard; Kalra, Dipak; Cresswell, Kathrin; Sheikh, Aziz

2014-01-01

Objective We aimed to explore stakeholder views, attitudes, needs, and expectations regarding likely benefits and risks resulting from increased structuring and coding of clinical information within electronic health records (EHRs). Materials and methods Qualitative investigation in primary and secondary care and research settings throughout the UK. Data were derived from interviews, expert discussion groups, observations, and relevant documents. Participants (n=70) included patients, healthcare professionals, health service commissioners, policy makers, managers, administrators, systems developers, researchers, and academics. Results Four main themes arose from our data: variations in documentation practice; patient care benefits; secondary uses of information; and informing and involving patients. We observed a lack of guidelines, co-ordination, and dissemination of best practice relating to the design and use of information structures. While we identified immediate benefits for direct care and secondary analysis, many healthcare professionals did not see the relevance of structured and/or coded data to clinical practice. The potential for structured information to increase patient understanding of their diagnosis and treatment contrasted with concerns regarding the appropriateness of coded information for patients. Conclusions The design and development of EHRs requires the capture of narrative information to reflect patient/clinician communication and computable data for administration and research purposes. Increased structuring and/or coding of EHRs therefore offers both benefits and risks. Documentation standards within clinical guidelines are likely to encourage comprehensive, accurate processing of data. As data structures may impact upon clinician/patient interactions, new models of documentation may be necessary if EHRs are to be read and authored by patients. PMID:24186957

Recreation for All.

ERIC Educational Resources Information Center

Winston, Alan G., Ed.; Seekins, Nancy, Ed.

The manual is intended to provide guidelines for the planning and development of parks and recreation facilities which are accessbile to everyone. Separate chapters present guidelines for the following topics (sample subtopics in parentheses): general information (space relationships and wheelchair functions); general site conditions (soil…

[Vitamin D supplementation in the elderly: guidelines and practice].

PubMed

Chel, V G M; Elders, P J M; Tuijp, M L M; van den Berg, H H; van Drongelen, K I; Siedenburg, R C; Ooms, M E; Lips, P T A

2013-01-01

In 2008, the Health Council of the Netherlands published an advice on vitamin D supplementation for the elderly. Nevertheless, suspicion arose at the Ministry of Health, Welfare and Sport and the Netherlands Nutrition Centre that vitamin D supplementation in the elderly is still insufficient. We aimed to determine the extent to which general practitioners and elderly care physicians actually followed the advice of the Health Council. Questionnaire study. Brief questionnaires were sent to all elderly care physicians in the Netherlands. Some questions were also posed to general practitioners at a network meeting of the Academic Network of GP Practices of the VU University Medical Center in Amsterdam. More than two-thirds of the respondents, both elderly care physicians and general practitioners, are familiar with the guidelines of the Health Council of the Netherlands on vitamin D supplementation in the elderly, but about half do not prescribe vitamin D when the guideline advises to do so. When supplementation is prescribed, about half of the elderly care physicians and a fifth of the general practitioners uses an insufficient dose. The guidelines of the Health Council of the Netherlands on vitamin D supplementation in the elderly are not sufficiently followed by elderly care physicians and general practitioners. Awareness of and support for the vitamin D supplementation guidelines among health care providers is still limited.

Municipal Solid Waste Landfills: New Source Performance Standards (NSPS), Emission Guidelines (EG) and Compliance Times

EPA Pesticide Factsheets

learn about the NSPS for municipal solid waste landfills by reading the rule summary, rule history, code of federal regulations text, fact sheets, background information documents, related rules and compliance information.

[The 'Osteoporosis' guideline of the Dutch College of General Practitioners. The response from internal medicine].

PubMed

Duursma, S A

1999-07-31

The Dutch College of General Practitioners published well documented guidelines for the management of osteoporosis. It is however incorrect to use the Z-score for the elderly and the T-score for other age groups. The guidelines balance the patient's and the physician's interests and the financial consequences of osteoporosis. They demand certainty about recommending the GP's interventions and accept less certainty where the influence on the GP's activities is limited. The guidelines contain weighed judgements by and for GP's; it is questionable whether they are adequate regarding the interaction with the increasingly well informed patient.

User's manual for Axisymmetric Diffuser Duct (ADD) code. Volume 1: General ADD code description

NASA Technical Reports Server (NTRS)

Anderson, O. L.; Hankins, G. B., Jr.; Edwards, D. E.

1982-01-01

This User's Manual contains a complete description of the computer codes known as the AXISYMMETRIC DIFFUSER DUCT code or ADD code. It includes a list of references which describe the formulation of the ADD code and comparisons of calculation with experimental flows. The input/output and general use of the code is described in the first volume. The second volume contains a detailed description of the code including the global structure of the code, list of FORTRAN variables, and descriptions of the subroutines. The third volume contains a detailed description of the CODUCT code which generates coordinate systems for arbitrary axisymmetric ducts.

Summary of papers on current and anticipated uses of thermal-hydraulic codes

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

Caruso, R.

1997-07-01

The author reviews a range of recent papers which discuss possible uses and future development needs for thermal/hydraulic codes in the nuclear industry. From this review, eight common recommendations are extracted. They are: improve the user interface so that more people can use the code, so that models are easier and less expensive to prepare and maintain, and so that the results are scrutable; design the code so that it can easily be coupled to other codes, such as core physics, containment, fission product behaviour during severe accidents; improve the numerical methods to make the code more robust and especiallymore » faster running, particularly for low pressure transients; ensure that future code development includes assessment of code uncertainties as integral part of code verification and validation; provide extensive user guidelines or structure the code so that the `user effect` is minimized; include the capability to model multiple fluids (gas and liquid phase); design the code in a modular fashion so that new models can be added easily; provide the ability to include detailed or simplified component models; build on work previously done with other codes (RETRAN, RELAP, TRAC, CATHARE) and other code validation efforts (CSAU, CSNI SET and IET matrices).« less

The Council for International Organizations and Medical Sciences (CIOMS) guidelines on ethics of clinical trials.

PubMed

Macrae, Duncan J

2007-05-01

Numerous bodies from many countries, including governments, government regulatory departments, research organizations, medical professional bodies, and health care providers, have issued guidance or legislation on the ethical conduct of clinical trials. It is possible to trace the development of current guidelines back to the post-World War II Nuremburg war crimes trials, more specifically the "Doctors' Trial." From that trial emerged the Nuremburg Code, which set out basic principles to be observed when conducting research involving human subjects and which subsequently formed the basis for comprehensive international guidelines on medical research, such as the Declaration of Helsinki. Most recently, the Council for International Organizations and Medical Sciences (CIOMS) produced detailed guidelines (originally published in 1993 and updated in 2002) on the implementation of the principles outlined in the Declaration of Helsinki. The CIOMS guidelines set in an appropriate context the challenges of present-day clinical research, by addressing complex issues including HIV/AIDS research, availability of study treatments after a study ends, women as research subjects, safeguarding confidentiality, compensation for adverse events, as well guidelines on consent.

Lowering Salt in Your Diet

MedlinePlus

... salt than they need, according to the 2005 Dietary Guidelines for Americans. These guidelines are published every five ... Facts label that appears on food packaging. The Dietary Guidelines recommend that the general population consume no more ...

Comparison of Einstein-Boltzmann solvers for testing general relativity

NASA Astrophysics Data System (ADS)

Bellini, E.; Barreira, A.; Frusciante, N.; Hu, B.; Peirone, S.; Raveri, M.; Zumalacárregui, M.; Avilez-Lopez, A.; Ballardini, M.; Battye, R. A.; Bolliet, B.; Calabrese, E.; Dirian, Y.; Ferreira, P. G.; Finelli, F.; Huang, Z.; Ivanov, M. M.; Lesgourgues, J.; Li, B.; Lima, N. A.; Pace, F.; Paoletti, D.; Sawicki, I.; Silvestri, A.; Skordis, C.; Umiltà, C.; Vernizzi, F.

2018-01-01

We compare Einstein-Boltzmann solvers that include modifications to general relativity and find that, for a wide range of models and parameters, they agree to a high level of precision. We look at three general purpose codes that primarily model general scalar-tensor theories, three codes that model Jordan-Brans-Dicke (JBD) gravity, a code that models f (R ) gravity, a code that models covariant Galileons, a code that models Hořava-Lifschitz gravity, and two codes that model nonlocal models of gravity. Comparing predictions of the angular power spectrum of the cosmic microwave background and the power spectrum of dark matter for a suite of different models, we find agreement at the subpercent level. This means that this suite of Einstein-Boltzmann solvers is now sufficiently accurate for precision constraints on cosmological and gravitational parameters.

Modelling guidelines--terminology and guiding principles

NASA Astrophysics Data System (ADS)

Refsgaard, Jens Christian; Henriksen, Hans Jørgen

2004-01-01

Some scientists argue, with reference to Popper's scientific philosophical school, that models cannot be verified or validated. Other scientists and many practitioners nevertheless use these terms, but with very different meanings. As a result of an increasing number of examples of model malpractice and mistrust to the credibility of models, several modelling guidelines are being elaborated in recent years with the aim of improving the quality of modelling studies. This gap between the views and the lack of consensus experienced in the scientific community and the strongly perceived need for commonly agreed modelling guidelines is constraining the optimal use and benefits of models. This paper proposes a framework for quality assurance guidelines, including a consistent terminology and a foundation for a methodology bridging the gap between scientific philosophy and pragmatic modelling. A distinction is made between the conceptual model, the model code and the site-specific model. A conceptual model is subject to confirmation or falsification like scientific theories. A model code may be verified within given ranges of applicability and ranges of accuracy, but it can never be universally verified. Similarly, a model may be validated, but only with reference to site-specific applications and to pre-specified performance (accuracy) criteria. Thus, a model's validity will always be limited in terms of space, time, boundary conditions and types of application. This implies a continuous interaction between manager and modeller in order to establish suitable accuracy criteria and predictions associated with uncertainty analysis.

Views of Dental Providers on Primary Care Coordination at Chairside: A Pilot Study.

PubMed

Northridge, Mary E; Birenz, Shirley; Gomes, Danni M; Golembeski, Cynthia A; Greenblatt, Ariel Port; Shelley, Donna; Russell, Stefanie L

2016-06-01

There is a need for research to facilitate the widespread implementation, dissemination and sustained utilization of evidence-based primary care screening, monitoring and care coordination guidelines, thereby increasing the impact of dental hygienists' actions on patients' oral and general health. The aims of this formative study are to explore dental hygienists' and dentists' perspectives regarding the integration of primary care activities into routine dental care, and assess the needs of dental hygienists and dentists regarding primary care coordination activities and use of information technology to obtain clinical information at chairside. This qualitative study recruited 10 dental hygienists and 6 dentists from 10 New York City area dental offices with diverse patient mixes and volumes. A New York University faculty dental hygienist conducted semi-structured, in-depth interviews, which were digitally recorded and transcribed verbatim. Data analysis consisted of multilevel coding based on the Consolidated Framework for Implementation Research, resulting in emergent themes with accompanying categories. The dental hygienists and dentists interviewed as part of this study do not use evidence-based guidelines to screen their patients for primary care sensitive conditions. Overwhelmingly, dental providers believe that tobacco use and poor diet contribute to oral disease, and report using electronic devices at chairside to obtain web-based health information. Dental hygienists are well positioned to help facilitate greater integration of oral and general health care. Challenges include lack of evidence-based knowledge, coordination between dental hygienists and dentists, and systems-level support, with opportunities for improvement based upon a theory-driven framework. Copyright © 2016 The American Dental Hygienists’ Association.

Views of Dental Providers on Primary Care Coordination at Chairside: A Pilot Study

PubMed Central

Northridge, Mary E.; Birenz, Shirley; Gomes, Danni; Golembeski, Cynthia A.; Greenblatt, Ariel Port; Shelley, Donna; Russell, Stefanie L.

2016-01-01

Purpose There is a need for research to facilitate the widespread implementation, dissemination, and sustained utilization of evidence-based primary care screening, monitoring, and care coordination guidelines, thereby increasing the impact of dental hygienists’ actions on patients’ oral and general health. The aims of this formative study are to: (1) explore dental hygienists’ and dentists’ perspectives regarding the integration of primary care activities into routine dental care; and (2) assess the needs of dental hygienists and dentists regarding primary care coordination activities and use of information technology to obtain clinical information at chairside. Methods This qualitative study recruited ten hygienists and six dentists from ten New York City area dental offices with diverse patient mixes and volumes. A New York University faculty hygienist conducted semi-structured, in-depth interviews, which were digitally recorded and transcribed verbatim. Data analysis consisted of multilevel coding based on the Consolidated Framework for Implementation Research, resulting in emergent themes with accompanying categories. Results The dental hygienists and dentists interviewed as part of this study fail to use evidence-based guidelines to screen their patients for primary care sensitive conditions. Overwhelmingly, dental providers believe that tobacco use and poor diet contribute to oral disease, and report using electronic devices at chairside to obtain web-based health information. Conclusion Dental hygienists are well positioned to help facilitate greater integration of oral and general health care. Challenges include lack of evidence-based knowledge, coordination between dental hygienists and dentists, and systems-level support, with opportunities for improvement based upon a theory-driven framework. PMID:27340183

[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.

1 CFR 5.5 - Supplement to the Code of Federal Regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 1 General Provisions 1 2010-01-01 2010-01-01 false Supplement to the Code of Federal Regulations. 5.5 Section 5.5 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER THE FEDERAL REGISTER GENERAL § 5.5 Supplement to the Code of Federal Regulations. The Federal Register serves as a...

1 CFR 5.5 - Supplement to the Code of Federal Regulations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 1 General Provisions 1 2011-01-01 2011-01-01 false Supplement to the Code of Federal Regulations. 5.5 Section 5.5 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER THE FEDERAL REGISTER GENERAL § 5.5 Supplement to the Code of Federal Regulations. The Federal Register serves as a...

1 CFR 5.5 - Supplement to the Code of Federal Regulations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 1 General Provisions 1 2014-01-01 2012-01-01 true Supplement to the Code of Federal Regulations. 5.5 Section 5.5 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER THE FEDERAL REGISTER GENERAL § 5.5 Supplement to the Code of Federal Regulations. The Federal Register serves as a...

1 CFR 5.5 - Supplement to the Code of Federal Regulations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 1 General Provisions 1 2013-01-01 2012-01-01 true Supplement to the Code of Federal Regulations. 5.5 Section 5.5 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER THE FEDERAL REGISTER GENERAL § 5.5 Supplement to the Code of Federal Regulations. The Federal Register serves as a...

1 CFR 5.5 - Supplement to the Code of Federal Regulations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 1 General Provisions 1 2012-01-01 2012-01-01 false Supplement to the Code of Federal Regulations. 5.5 Section 5.5 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER THE FEDERAL REGISTER GENERAL § 5.5 Supplement to the Code of Federal Regulations. The Federal Register serves as a...

Diagnostic Concordance between DSM-5 and ICD-10 Cannabis Use Disorders.

PubMed

Proctor, Steven L; Williams, Daniel C; Kopak, Albert M; Voluse, Andrew C; Connolly, Kevin M; Hoffmann, Norman G

2016-07-01

With the recent federal mandate that all U.S. health care settings transition to ICD-10 billing codes, empirical evidence is necessary to determine if the DSM-5 designations map to their respective ICD-10 diagnostic categories/billing codes. The present study examined the concordance between DSM-5 and ICD-10 cannabis use disorder diagnoses. Data were derived from routine clinical assessments of 6871 male and 801 female inmates recently admitted to a state prison system from 2000 to 2003. DSM-5 and ICD-10 diagnostic determinations were made from algorithms corresponding to the respective diagnostic formulations. Past 12-month prevalence rates of cannabis use disorders were comparable across classification systems. The vast majority of inmates with no DSM-5 diagnosis continued to have no diagnosis per the ICD-10, and a similar proportion with a DSM-5 severe diagnosis received an ICD-10 dependence diagnosis. Most of the variation in diagnostic classifications was accounted for by those with a DSM-5 moderate diagnosis in that approximately half of these cases received an ICD-10 dependence diagnosis while the remaining cases received a harmful use diagnosis. Although there appears to be a generally high level of agreement between diagnostic classification systems for those with no diagnosis or those evincing symptoms of a more severe condition, concordance between DSM-5 moderate and ICD-10 dependence diagnoses was poor. Additional research is warranted to determine the appropriateness and implications of the current DSM-5 coding guidelines regarding the assignment of an ICD-10 dependence code for those with a DSM-5 moderate diagnosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

FY17 Status Report on the Initial Development of a Constitutive Model for Grade 91 Steel

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

Messner, M. C.; Phan, V. -T.; Sham, T. -L.

Grade 91 is a candidate structural material for high temperature advanced reactor applications. Existing ASME Section III, Subsection HB, Subpart B simplified design rules based on elastic analysis are setup as conservative screening tools with the intent to supplement these screening rules with full inelastic analysis when required. The Code provides general guidelines for suitable inelastic models but does not provide constitutive model implementations. This report describes the development of an inelastic constitutive model for Gr. 91 steel aimed at fulfilling the ASME Code requirements and being included into a new Section III Code appendix, HBB-Z. A large database ofmore » over 300 experiments on Gr. 91 was collected and converted to a standard XML form. Five families of Gr. 91 material models were identified in the literature. Of these five, two are potentially suitable for use in the ASME code. These two models were implemented and evaluated against the experimental database. Both models have deficiencies so the report develops a framework for developing and calibrating an improved model. This required creating a new modeling method for representing changes in material rate sensitivity across the full ASME allowable temperature range for Gr. 91 structural components: room temperature to 650° C. On top of this framework for rate sensitivity the report describes calibrating a model for work hardening and softening in the material using genetic algorithm optimization. Future work will focus on improving this trial model by including tension/compression asymmetry observed in experiments and necessary to capture material ratcheting under zero mean stress and by improving the optimization and analysis framework.« less

Innovative zoning to support equine influenza eradication from New South Wales, Australia.

PubMed

Scott-Orr, H

2011-07-01

Following detection of equine influenza (EI) in New South Wales, a complete standstill was imposed the next morning on the movement of all horses and donkeys within the state. Premises' biosecurity guidelines became progressively more stringent with time in an effort to stop local spread. The standstill was highly effective as a primary response to stop EI becoming widespread across Australia, but did not prevent spread to properties contiguous to infected premises in areas of high horse density and small property size, nor transmission by fomites nor possible local airborne transmission. Within 2 weeks of the start of the outbreak, a zoning system of Purple (Special Restricted), Red (Restricted), Amber (Control), and Green (Protected) Zones was implemented, and progressively modified as disease distribution changed. The colour coding system proved to be an easy way to communicate zone changes, the approximate level of disease risk and the stringency of movement restrictions to the general public and should be adopted more generally in AUSVETPLAN. © 2011 The Author. Australian Veterinary Journal © 2011 Australian Veterinary Association.

[The practice guideline 'Pregnancy and puerperium' (first revision) from the Dutch College of General Practitioners; a response from the perspective of gynaecology].

PubMed

Heringa, M P

2004-01-10

The major benefit of the revised version of the Dutch College of General Practitioners' practice guideline about pregnancy and puerperium is the formal starting point of professional equality of midwives and general practitioners as care providers in antenatal and postpartum care. This thorough evidence-based practice guideline is behind the most recent developments in this field. Scientific evidence on vertical HIV transmission favours screening all pregnant women and not just the selective procedure proposed in this guideline. The restrictive attitude towards routine ultrasound screening during pregnancy hardly seems in line with scientific evidence and the public demand. On the other hand the guideline is very progressive as far as the care of women with thyroid disorders is concerned even though evidence on this subject is meagre. Most importantly the transition of antenatal care from the current almost conveyor belt-like procedure to an efficient but individually-adapted care process was not addressed.

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…

Item-Writing Guidelines for Physics

ERIC Educational Resources Information Center

Regan, Tom

2015-01-01

A teacher learning how to write test questions (test items) will almost certainly encounter item-writing guidelines--lists of item-writing do's and don'ts. Item-writing guidelines usually are presented as applicable across all assessment settings. Table I shows some guidelines that I believe to be generally applicable and two will be briefly…

36 CFR § 910.67 - Square guidelines.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 36 Parks, Forests, and Public Property 3 2013-07-01 2012-07-01 true Square guidelines. § 910.67 Section § 910.67 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL... DEVELOPMENT AREA Glossary of Terms § 910.67 Square guidelines. Square Guidelines establish the Corporation's...

Data collection handbook to support modeling the impacts of radioactive material in soil

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

Yu, C.; Cheng, J.J.; Jones, L.G.

1993-04-01

A pathway analysis computer code called RESRAD has been developed for implementing US Department of Energy Residual Radioactive Material Guidelines. Hydrogeological, meteorological, geochemical, geometrical (size, area, depth), and material-related (soil, concrete) parameters are used in the RESRAD code. This handbook discusses parameter definitions, typical ranges, variations, measurement methodologies, and input screen locations. Although this handbook was developed primarily to support the application of RESRAD, the discussions and values are valid for other model applications.

Design of Linear Accelerator (LINAC) tanks for proton therapy via Particle Swarm Optimization (PSO) and Genetic Algorithm (GA) approaches

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

Castellano, T.; De Palma, L.; Laneve, D.

2015-07-01

A homemade computer code for designing a Side- Coupled Linear Accelerator (SCL) is written. It integrates a simplified model of SCL tanks with the Particle Swarm Optimization (PSO) algorithm. The computer code main aim is to obtain useful guidelines for the design of Linear Accelerator (LINAC) resonant cavities. The design procedure, assisted via the aforesaid approach seems very promising, allowing future improvements towards the optimization of actual accelerating geometries. (authors)

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers--a qualitative study.

PubMed

Espeland, Ansgar; Baerheim, Anders

2003-03-24

General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed.

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers – a qualitative study

PubMed Central

Espeland, Ansgar; Baerheim, Anders

2003-01-01

Background General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. Methods Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. Results The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. Conclusions Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed. PMID:12659640

Implementation of Venous Thromboembolism Prophylaxis Guidelines in Clinical Practice: A Retrospective Study in Two Croatian Hospitals.

PubMed

Marušić, Srećko; Knežević, Aleksandar; Bačić Vrca, Vesna; Marinović, Ivana; Bačić, Julija; Obreli Neto, Paulo Roque; Amidžić Klarić, Daniela; Diklić, Dijaneta

2017-12-01

The aim of this study was to evaluate the implementation of the 9th edition of the American College of Chest Physicians (ACCP9) guidelines for prevention of venous thromboembolism in nonsurgical patients in clinical practice in one university and one general Croatian hospital. A retrospective study was conducted at Zadar General Hospital from Zadar and Dubrava University Hospital from Zagreb. Medical charts of all patients admitted to Medical Departments in two periods, before and after implementation of the ACCP9 guidelines, were analyzed. The ACCP9 guidelines were made available to all physicians through the hospital electronic information system immediately after the publication. The Hospital Drug Committees promoted implementation of the guidelines during their periodical clinical visits. Overall, 850 patients were included in the study in two periods. There was no statistically significant difference in the number of high-risk patients receiving thromboprophylaxis after the guidelines implementation in either hospital. In both periods, a signifi-cantly higher number of high-risk patients received thromboprophylaxis in Dubrava University Hos-pital in comparison with Zadar General Hospital (31.7% vs. 3.8% and 40.3% vs. 7.3%, respectively; p<0.001). This study revealed insufficient implementation of evidence-based thromboprophylaxis guidelines in clinical practice in two Croatian hospitals.

Training strategies and materials.

DOT National Transportation Integrated Search

2014-06-01

TxDOT project 0-6706 Design and Scope of Impact of Auxiliary Lanes has developed : guidelines for implementation of auxiliary lanes including general guidelines on the use of : auxiliary lanes and design guidelines for auxiliary lanes. To facil...

The new CMSS code for interactions with companies managing relationships to minimize conflicts.

PubMed

Kahn, Norman B; Lichter, Allen S

2011-09-01

Conflicts of interest in medicine have received significant attention in recent years, through the public and professional media, federal and state governments, and through a 2009 report of the Institute of Medicine on Conflict of Interest in Medical Research, Education and Practice. The Council of Medical Specialty Societies (CMSS) Code for Interactions with Companies was adopted by the CMSS in April 2010. The Code guides specialty societies in the profession of medicine in ethical relationships between societies and the pharmaceutical and medical device industries. The Code serves to protect and promote the independence of specialty societies and their leaders in corporate sponsorships, licensing, advertising, society meetings, exhibits, educational programs, journals, clinical practice guidelines, and research. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Interviewing Guidelines.

ERIC Educational Resources Information Center

Lorenzen, Elizabeth A.; And Others

Directed especially at graduating college seniors, this paper contains information about employment interviews and how to prepare for them. Subjects discussed include the following: preparing for interviews (analyzing strengths and weaknesses, gathering information about the company); points to remember (dress codes, follow up thank-you letters);…

An Olive Branch for Boards.

ERIC Educational Resources Information Center

Harrington-Lueker, Donna

1993-01-01

Peacekeeping strategies for school-board meetings include developing a code of conduct that spells out guidelines for behavior and then enforcing it; bringing in a neutral observer to help board members work through what is really worrying them; and concentrating on policy. (MLF)

Guidelines for reducing dynamic loads in two-bladed teetering-hub downwind wind turbines

NASA Astrophysics Data System (ADS)

Wright, A. D.; Bir, G. S.; Butterfield, C. D.

1995-06-01

A major goal of the federal Wind Energy Program is the rapid development and validation of structural models to determine loads and response for a wide variety of different wind turbine configurations operating under extreme conditions. Such codes are crucial to the successful design of future advanced wind turbines. In previous papers the authors described steps they took to develop a model of a two-bladed teetering-hub downwind wind turbine using ADAMS (Automatic Dynamic Analysis of Mechanical Systems), as well as comparison of model predictions to test data. In this paper they show the use of this analytical model to study the influence of various turbine parameters on predicted system loads. They concentrate their study on turbine response in the frequency range of six to ten times the rotor rotational frequency (6P to 10P). Their goal is to identify the most important parameters which influence the response of this type of machine in this frequency range and give turbine designers some general design guidelines for designing two-bladed teetering-hub machines to be less susceptible to vibration. They study the effects of such parameters as blade edgewise and flapwise stiffness, tower top stiffness, blade tip-brake mass, low-speed shaft stiffness, nacelle mass momenta of inertia, and rotor speed. They show which parameters can be varied in order to make the turbine less responsive to such atmospheric inputs as wind shear and tower shadow. They then give designers a set of design guidelines in order to show how these machines can be designed to be less responsive to these inputs.

Use of antipsychotic medications for the management of delirium: an audit of current practice in the acute care setting.

PubMed

Tropea, J; Slee, J; Holmes, A C N; Gorelik, A; Brand, C A

2009-02-01

Despite delirium being common in older hospitalized people, little is known about its management. The aims of this study are (1) to describe the pharmacological management of delirium in an acute care setting as a baseline measure prior to the implementation of newly developed Australian guidelines; and (2) to determine what areas of delirium pharmacological management need to be targeted for future practical guideline implementation and quality improvement activities. A medical record audit was conducted using a structured audit form. All patients aged 65 years and over who were admitted to a general medical or orthopaedic unit of the Royal Melbourne Hospital between 1 March 2006 and 28 February 2007 and coded with delirium were included. Data on the use of antipsychotic medications for the management of delirium in relation to best practice recommendations were assessed. Overall 174 episodes of care were included in the analysis. Antipsychotic medications were used for the management of most patients with severe behavioral and or emotional disturbance associated with delirium. There was variation in the prescribing patterns of antipsychotic agents and the documentation of medication management plans. Less than a quarter of patients prescribed antipsychotic medication were started on a low dose and very few were reviewed on a regular basis. A wide range of practice is seen in the use of antipsychotic agents to manage older patients with severe symptoms associated with delirium. The findings highlight the need to implement evidence-based guideline recommendations with a focus on improving the consistency in the pharmacological management and documentation processes.

ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

PubMed

Chan, Wiley V; Pearson, Thomas A; Bennett, Glen C; Cushman, William C; Gaziano, Thomas A; Gorman, Paul N; Handler, Joel; Krumholz, Harlan M; Kushner, Robert F; MacKenzie, Thomas D; Sacco, Ralph L; Smith, Sidney C; Stevens, Victor J; Wells, Barbara L

2017-02-28

In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity. Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines. This systematic review was conducted on 4 critical questions, each focusing on the adoption and effectiveness of 4 intervention strategies: (1) reminders, (2) educational outreach visits, (3) audit and feedback, and (4) provider incentives. A scoping review of the Rx for Change database of systematic reviews was used to identify promising guideline implementation interventions aimed at providers. Inclusion and exclusion criteria were developed a priori for each question, and the published literature was initially searched up to 2012, and then updated with a supplemental search to 2015. Two independent reviewers screened the returned citations to identify relevant reviews and rated the quality of each included review. Audit and feedback and educational outreach visits were generally effective in improving both process of care (15 of 21 reviews and 12 of 13 reviews, respectively) and clinical outcomes (7 of 12 reviews and 3 of 5 reviews, respectively). Provider incentives showed mixed effectiveness for improving both process of care (3 of 4 reviews) and clinical outcomes (3 reviews equally distributed between generally effective, mixed, and generally ineffective). Reminders showed mixed effectiveness for improving process of care outcomes (27 reviews with 11 mixed and 3 generally ineffective results) and were generally ineffective for clinical outcomes (18 reviews with 6 mixed and 9 generally ineffective results). Educational outreach visits (2 of 2 reviews), reminders (3 of 4 reviews), and provider incentives (1 of 1 review) were generally effective for cost reduction. Educational outreach visits (1 of 1 review) and provider incentives (1 of 1 review) were also generally effective for cost-effectiveness outcomes. Barriers to clinician adoption or adherence to guidelines included time constraints (8 reviews/overviews); limited staffing resources (2 overviews); timing (5 reviews/overviews); clinician skepticism (5 reviews/overviews); clinician knowledge of guidelines (4 reviews/overviews); and higher age of the clinician (1 overview). Facilitating factors included guideline characteristics such as format, resources, and end-user involvement (6 reviews/overviews); involving stakeholders (5 reviews/overviews); leadership support (5 reviews/overviews); scope of implementation (5 reviews/overviews); organizational culture such as multidisciplinary teams and low-baseline adherence (9 reviews/overviews); and electronic guidelines systems (3 reviews). The strategies of audit and feedback and educational outreach visits were generally effective in improving both process of care and clinical outcomes. Reminders and provider incentives showed mixed effectiveness, or were generally ineffective. No general conclusion could be reached about cost effectiveness, because of limitations in the evidence. Important gaps exist in the evidence on effectiveness of implementation interventions, especially regarding clinical outcomes, cost effectiveness and contextual issues affecting successful implementation. Copyright © 2017 American College of Cardiology Foundation and American Heart Association, Inc. Published by Elsevier Inc. All rights reserved.

ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

PubMed

Chan, Wiley V; Pearson, Thomas A; Bennett, Glen C; Cushman, William C; Gaziano, Thomas A; Gorman, Paul N; Handler, Joel; Krumholz, Harlan M; Kushner, Robert F; MacKenzie, Thomas D; Sacco, Ralph L; Smith, Sidney C; Stevens, Victor J; Wells, Barbara L; Castillo, Graciela; Heil, Susan K R; Stephens, Jennifer; Vann, Julie C Jacobson

2017-02-28

In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity. Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines. This systematic review was conducted on 4 critical questions, each focusing on the adoption and effectiveness of 4 intervention strategies: (1) reminders, (2) educational outreach visits, (3) audit and feedback, and (4) provider incentives. A scoping review of the Rx for Change database of systematic reviews was used to identify promising guideline implementation interventions aimed at providers. Inclusion and exclusion criteria were developed a priori for each question, and the published literature was initially searched up to 2012, and then updated with a supplemental search to 2015. Two independent reviewers screened the returned citations to identify relevant reviews and rated the quality of each included review. Audit and feedback and educational outreach visits were generally effective in improving both process of care (15 of 21 reviews and 12 of 13 reviews, respectively) and clinical outcomes (7 of 12 reviews and 3 of 5 reviews, respectively). Provider incentives showed mixed effectiveness for improving both process of care (3 of 4 reviews) and clinical outcomes (3 reviews equally distributed between generally effective, mixed, and generally ineffective). Reminders showed mixed effectiveness for improving process of care outcomes (27 reviews with 11 mixed and 3 generally ineffective results) and were generally ineffective for clinical outcomes (18 reviews with 6 mixed and 9 generally ineffective results). Educational outreach visits (2 of 2 reviews), reminders (3 of 4 reviews), and provider incentives (1 of 1 review) were generally effective for cost reduction. Educational outreach visits (1 of 1 review) and provider incentives (1 of 1 review) were also generally effective for cost-effectiveness outcomes. Barriers to clinician adoption or adherence to guidelines included time constraints (8 reviews/overviews); limited staffing resources (2 overviews); timing (5 reviews/overviews); clinician skepticism (5 reviews/overviews); clinician knowledge of guidelines (4 reviews/overviews); and higher age of the clinician (1 overview). Facilitating factors included guideline characteristics such as format, resources, and end-user involvement (6 reviews/overviews); involving stakeholders (5 reviews/overviews); leadership support (5 reviews/overviews); scope of implementation (5 reviews/overviews); organizational culture such as multidisciplinary teams and low-baseline adherence (9 reviews/overviews); and electronic guidelines systems (3 reviews). The strategies of audit and feedback and educational outreach visits were generally effective in improving both process of care and clinical outcomes. Reminders and provider incentives showed mixed effectiveness, or were generally ineffective. No general conclusion could be reached about cost effectiveness, because of limitations in the evidence. Important gaps exist in the evidence on effectiveness of implementation interventions, especially regarding clinical outcomes, cost effectiveness and contextual issues affecting successful implementation. © 2017 by the American College of Cardiology Foundation and the American Heart Association, Inc.

10 CFR 960.1 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Applicability. 960.1 Section 960.1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY General Provisions § 960.1 Applicability. These guidelines were developed in accordance with the...

[How to assess clinical practice guidelines with AGREE II: The example of neonatal jaundice].

PubMed

Renesme, L; Bedu, A; Tourneux, P; Truffert, P

2016-03-01

Neonatal jaundice is a very frequent condition that occurs in approximately 50-70% of term or near-term (>35 GA) babies in the 1st week of life. In some cases, a high bilirubin blood level can lead to kernicterus. There is no consensus for the management of neonatal jaundice and few countries have published national clinical practice guidelines for the management of neonatal jaundice. The aim of this study was to assess the quality of these guidelines. We conducted a systematic review of the literature for national clinical practice guidelines for the management of neonatal jaundice in term or near-term babies. Four independent reviewers assessed the quality of each guideline using the AGREE II evaluation. For each of the clinical practice guidelines, the management modalities were analyzed (screening, treatment, follow-up, etc.). Seven national clinical practice guidelines were found (South Africa, USA AAP, UK NICE, Canada, Norway, Switzerland, and Israel). The AGREE II score showed widespread variation regarding the quality of these national guidelines. There was no major difference between the guidelines concerning the clinical management of these babies. The NICE guideline is the most valuable guideline regarding the AGREE II score. NICE showed that, despite a strong and rigorous methodology, there is no evidenced-based recommended code of practice (RCP). Comparing RCPs, we found no major differences. The NICE guideline showed the best quality. The AGREE II instrument should be used as a framework when developing clinical practice guidelines to improve the quality of the future guideline. In France, a national guideline is needed for a more standardized management of neonatal jaundice. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Pain management strategies and lessons from the military: A narrative review

PubMed Central

Vallerand, April Hazard; Cosler, Patricia; Henningfield, Jack E; Galassini, Pam

2015-01-01

BACKGROUND: Wounded soldiers often experience substantial pain, which must be addressed before returning to active duty or civilian life. The United States (US) military has instituted several guidelines and initiatives aimed at improving pain management by providing rapid access to medical care, and developing interdisciplinary multimodal pain management strategies based on outcomes observed both in combat and hospital settings. OBJECTIVE: To provide a narrative review regarding US military pain management guidelines and initiatives, which may guide improvements in pain management, particularly chronic pain management and prevention, for the general population. METHODS: A literature review of US military pain management guidelines and initiatives was conducted, with a particular focus on the potential of these guidelines to address shortcomings in chronic pain management in the general population. DISCUSSION: The application of US military pain management guidelines has been shown to improve pain monitoring, education and relief. In addition, the US military has instituted the development of programs and guidelines to ensure proper use and discourage aberrant behaviours with regard to opioid use, because opioids are regarded as a critical part of acute and chronic pain management schemes. Inadequate pain management, particularly inadequate chronic pain management, remains a major problem for the general population in the US. Application of military strategies for pain management to the general US population may lead to more effective pain management and improved long-term patient outcomes. PMID:26448972

Pediatricians' knowledge of current sports concussion legislation and guidelines and comfort with sports concussion management: a cross-sectional study.

PubMed

Carl, Rebecca L; Kinsella, Sarah B

2014-06-01

Sports-related concussions disproportionately affect young athletes. The primary objective of our study was to determine Illinois pediatricians' level of familiarity with state concussion legislation and with published consensus guidelines for sports concussion diagnosis and treatment. We also sought to determine pediatricians' knowledge regarding concussion management and comfort treating sports concussion patients. This was a cross-sectional survey of pediatrician members of the Illinois Chapter of the American Academy of Pediatrics. Few general pediatricians (26.6%, n = 42) were "very familiar" or "somewhat familiar" with the recently passed Illinois state concussion legislation. Only 14.6% (n = 23) of general pediatrician respondents use concussion consensus guidelines in their practice. Pediatricians were generally very knowledgeable about concussions; only 5 out of 19 knowledge-based items were answered incorrectly by more than 25% of the study participants. General pediatricians are knowledgeable about concussions but most are not well aware of state concussion legislation and concussion consensus guidelines. © The Author(s) 2014.

CoCoNuT: General relativistic hydrodynamics code with dynamical space-time evolution

NASA Astrophysics Data System (ADS)

Dimmelmeier, Harald; Novak, Jérôme; Cerdá-Durán, Pablo

2012-02-01

CoCoNuT is a general relativistic hydrodynamics code with dynamical space-time evolution. The main aim of this numerical code is the study of several astrophysical scenarios in which general relativity can play an important role, namely the collapse of rapidly rotating stellar cores and the evolution of isolated neutron stars. The code has two flavors: CoCoA, the axisymmetric (2D) magnetized version, and CoCoNuT, the 3D non-magnetized version.

Coding of procedures documented by general practitioners in Swedish primary care-an explorative study using two procedure coding systems

PubMed Central

2012-01-01

Background Procedures documented by general practitioners in primary care have not been studied in relation to procedure coding systems. We aimed to describe procedures documented by Swedish general practitioners in electronic patient records and to compare them to the Swedish Classification of Health Interventions (KVÅ) and SNOMED CT. Methods Procedures in 200 record entries were identified, coded, assessed in relation to two procedure coding systems and analysed. Results 417 procedures found in the 200 electronic patient record entries were coded with 36 different Classification of Health Interventions categories and 148 different SNOMED CT concepts. 22.8% of the procedures could not be coded with any Classification of Health Interventions category and 4.3% could not be coded with any SNOMED CT concept. 206 procedure-concept/category pairs were assessed as a complete match in SNOMED CT compared to 10 in the Classification of Health Interventions. Conclusions Procedures documented by general practitioners were present in nearly all electronic patient record entries. Almost all procedures could be coded using SNOMED CT. Classification of Health Interventions covered the procedures to a lesser extent and with a much lower degree of concordance. SNOMED CT is a more flexible terminology system that can be used for different purposes for procedure coding in primary care. PMID:22230095

Syndrome source coding and its universal generalization

NASA Technical Reports Server (NTRS)

Ancheta, T. C., Jr.

1975-01-01

A method of using error-correcting codes to obtain data compression, called syndrome-source-coding, is described in which the source sequence is treated as an error pattern whose syndrome forms the compressed data. It is shown that syndrome-source-coding can achieve arbitrarily small distortion with the number of compressed digits per source digit arbitrarily close to the entropy of a binary memoryless source. A universal generalization of syndrome-source-coding is formulated which provides robustly-effective, distortionless, coding of source ensembles.

[The management of osteoarthritis by general practitioners in Germany: comparison of self-reported behaviour with international guidelines].

PubMed

Rosemann, T; Joos, S; Szecsenyi, J

2008-01-01

In most countries, guidelines for the treatment of osteoarthritis (OA) are available. However, in Germany, no guideline for the primary care sector is available. The care provider of most patients is the general practitioner (GP). The aim of the study was to investigate the approaches in diagnosing and treating OA of German GPs and to assess adherence to international guidelines. Cross-sectional study using a structured questionnaire with a random sample of 144 GPs. Regarding diagnosis, the importance of X-rays was overestimated. Regarding treatment approaches, exercising and weight reduction were regarded as primary treatment targets. Pharmacological treatment approaches were somewhat guideline oriented, but conservative approaches such as physical therapy were overestimated as invasive treatments such as intra-articular injections were underestimated in its benefit. Establishing a guideline specifically for primary care and increasing guideline adherence could help to prevent the present overuse of X-rays and the high amount of referrals to orthopaedics, save costs and reduce inadequate treatments.

Appropriateness of indication and diagnostic yield of colonoscopy: first report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy.

PubMed

Siddique, Iqbal; Mohan, Krishna; Hasan, Fuad; Memon, Anjum; Patty, Istvan; Al-Nakib, Basil

2005-11-28

To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE). A total of 736 consecutive patients (415 males, 321 females; mean age 43.6+/-16.6 years) undergoing colonoscopy during October 2001-March 2002 were prospectively enrolled in the study. The 2000 ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication. The large majority (64%) of patients had colonoscopy for an indication that was considered "generally indicated", it was "generally not indicated" for 20%, and it was "not listed" for 16% in the guidelines. The diagnostic yield of colonoscopy was highest for the "generally indicated" (38%) followed by "not listed" (13%) and "generally not indicated" (5%) categories. In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was "generally indicated" (odds ratio=12.3) and referrals by gastroenterologist (odds ratio =1.9). There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician's specialty. Certain indications "not listed" in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines.

Aerodynamic simulation on massively parallel systems

NASA Technical Reports Server (NTRS)

Haeuser, Jochem; Simon, Horst D.

1992-01-01

This paper briefly addresses the computational requirements for the analysis of complete configurations of aircraft and spacecraft currently under design to be used for advanced transportation in commercial applications as well as in space flight. The discussion clearly shows that massively parallel systems are the only alternative which is both cost effective and on the other hand can provide the necessary TeraFlops, needed to satisfy the narrow design margins of modern vehicles. It is assumed that the solution of the governing physical equations, i.e., the Navier-Stokes equations which may be complemented by chemistry and turbulence models, is done on multiblock grids. This technique is situated between the fully structured approach of classical boundary fitted grids and the fully unstructured tetrahedra grids. A fully structured grid best represents the flow physics, while the unstructured grid gives best geometrical flexibility. The multiblock grid employed is structured within a block, but completely unstructured on the block level. While a completely unstructured grid is not straightforward to parallelize, the above mentioned multiblock grid is inherently parallel, in particular for multiple instruction multiple datastream (MIMD) machines. In this paper guidelines are provided for setting up or modifying an existing sequential code so that a direct parallelization on a massively parallel system is possible. Results are presented for three parallel systems, namely the Intel hypercube, the Ncube hypercube, and the FPS 500 system. Some preliminary results for an 8K CM2 machine will also be mentioned. The code run is the two dimensional grid generation module of Grid, which is a general two dimensional and three dimensional grid generation code for complex geometries. A system of nonlinear Poisson equations is solved. This code is also a good testcase for complex fluid dynamics codes, since the same datastructures are used. All systems provided good speedups, but message passing MIMD systems seem to be best suited for large miltiblock applications.

Facebook Apps for Smoking Cessation: A Review of Content and Adherence to Evidence-Based Guidelines

PubMed Central

2014-01-01

Background Facebook is the most popular social network site, with over 1 billion users globally. There are millions of apps available within Facebook, many of which address health and health behavior change. Facebook may represent a promising channel to reach smokers with cessation interventions via apps. To date, there have been no published reports about Facebook apps for smoking cessation. Objective The purpose of this study was to review the features and functionality of Facebook apps for smoking cessation and to determine the extent to which they adhere to evidence-based guidelines for tobacco dependence treatment. Methods In August 2013, we searched Facebook and three top Internet search engines using smoking cessation keywords to identify relevant Facebook apps. Resultant apps were screened for eligibility (smoking cessation-related, English language, and functioning). Eligible apps were reviewed by 2 independent coders using a standardized coding scheme. Coding included content features (interactive, informational, and social) and adherence to an established 20-item index (possible score 0-40) derived from the US Public Health Service’s Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Results We screened 22 apps for eligibility; of these, 12 underwent full coding. Only 9 apps were available on Facebook. Facebook apps fell into three broad categories: public pledge to quit (n=3), quit-date–based calculator/tracker (n=4), or a multicomponent quit smoking program (n=2). All apps incorporated interactive, informational, and social features except for two quit-date–based calculator/trackers apps (lacked informational component). All apps allowed app-related posting within Facebook (ie, on self/other Facebook profile), and four had a within-app “community” feature to enable app users to communicate with each other. Adherence index summary scores among Facebook apps were low overall (mean 15.1, SD 7.8, range 7-30), with multicomponent apps scoring the highest. Conclusions There are few smoking cessation apps available within Facebook. Among those available, adherence to cessation treatment guidelines was low. Smoking cessation interventions provided via the Facebook platform are a unique and as yet untapped treatment strategy that can harness existing social support and social networks for quitting. Research is needed to examine whether apps that adhere to clinical practice guidelines for tobacco dependence treatment are more effective in promoting cessation than those that do not. PMID:25205129

Facebook apps for smoking cessation: a review of content and adherence to evidence-based guidelines.

PubMed

Jacobs, Megan A; Cobb, Caroline O; Abroms, Lorien; Graham, Amanda L

2014-09-09

Facebook is the most popular social network site, with over 1 billion users globally. There are millions of apps available within Facebook, many of which address health and health behavior change. Facebook may represent a promising channel to reach smokers with cessation interventions via apps. To date, there have been no published reports about Facebook apps for smoking cessation. The purpose of this study was to review the features and functionality of Facebook apps for smoking cessation and to determine the extent to which they adhere to evidence-based guidelines for tobacco dependence treatment. In August 2013, we searched Facebook and three top Internet search engines using smoking cessation keywords to identify relevant Facebook apps. Resultant apps were screened for eligibility (smoking cessation-related, English language, and functioning). Eligible apps were reviewed by 2 independent coders using a standardized coding scheme. Coding included content features (interactive, informational, and social) and adherence to an established 20-item index (possible score 0-40) derived from the US Public Health Service's Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We screened 22 apps for eligibility; of these, 12 underwent full coding. Only 9 apps were available on Facebook. Facebook apps fell into three broad categories: public pledge to quit (n=3), quit-date-based calculator/tracker (n=4), or a multicomponent quit smoking program (n=2). All apps incorporated interactive, informational, and social features except for two quit-date-based calculator/trackers apps (lacked informational component). All apps allowed app-related posting within Facebook (ie, on self/other Facebook profile), and four had a within-app "community" feature to enable app users to communicate with each other. Adherence index summary scores among Facebook apps were low overall (mean 15.1, SD 7.8, range 7-30), with multicomponent apps scoring the highest. There are few smoking cessation apps available within Facebook. Among those available, adherence to cessation treatment guidelines was low. Smoking cessation interventions provided via the Facebook platform are a unique and as yet untapped treatment strategy that can harness existing social support and social networks for quitting. Research is needed to examine whether apps that adhere to clinical practice guidelines for tobacco dependence treatment are more effective in promoting cessation than those that do not.

Documentation of the GLAS fourth order general circulation model. Volume 2: Scalar code

NASA Technical Reports Server (NTRS)

Kalnay, E.; Balgovind, R.; Chao, W.; Edelmann, D.; Pfaendtner, J.; Takacs, L.; Takano, K.

1983-01-01

Volume 2, of a 3 volume technical memoranda contains a detailed documentation of the GLAS fourth order general circulation model. Volume 2 contains the CYBER 205 scalar and vector codes of the model, list of variables, and cross references. A variable name dictionary for the scalar code, and code listings are outlined.

Combustion Safety for Appliances Using Indoor Air (Fact Sheet)

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

Not Available

2014-05-01

This measure guideline covers how to assess and carry out the combustion safety procedures for appliances and heating equipment that uses indoor air for combustion in low-rise residential buildings. Only appliances installed in the living space, or in an area freely communicating with the living space, vented alone or in tandem with another appliance are considered here. A separate measure guideline addresses combustion appliances located either within the living space in enclosed closets or side rooms or outside the living space in an adjacent area like an attic or garage that use outdoor air for combustion. This document is formore » inspectors, auditors, and technicians working in homes where energy upgrades are being conducted whether or not air infiltration control is included in the package of measures being applied. In the indoor combustion air case, guidelines summarized here are based on language provided in several of the codes to establish minimum requirements for the space using simplified prescriptive measures. In addition, building performance testing procedures are provided by testing agencies. The codes in combination with the test procedures offer comprehensive combustion safety coverage to address safety concerns, allowing inexperienced residential energy retrofit inspectors to effectively address combustion safety issues and allow energy retrofits to proceed.« less

Guidelines for the Use of Color in ATC Displays

DOT National Transportation Integrated Search

1999-06-01

Color is probably the most effective, compelling, and attractive method available for coding visual information on a display. However, caution must be used in the application of color to displays for air traffic control (ATC), because it is easy to d...

Student Conduct and Discipline.

ERIC Educational Resources Information Center

Oregon State Dept. of Education, Salem.

To aid Oregon's school districts in developing policies and procedures for student conduct and discipline, this document suggests guidelines for district preparation and distribution of student conduct codes, including formal and informal student assembly, dress and grooming, use of motor vehicles, search and seizure, attendance, freedom of…

Structural evaluation of the 2736Z Building for seismic loads

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

Giller, R.A.

The 2736Z building structure is evaluated for high-hazard loads. The 2736Z building is analyzed herein for normal and seismic loads and is found to successfully meet the guidelines of UCRL-15910 along with the related codes requirements.

76 FR 30229 - Shipping Coordinating Committee; Notice of Committee Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-24

.... --Strategy and planning. --Organizational reforms. --Resource management. --Technical Co-operation Fund--biennial allocation to support the ITCP Programme for 2012-2013. --Results-based budget. --Voluntary IMO... FSS Code for communication equipment for fire-fighting teams. --Development of guidelines for use of...

Dental radiographic guidelines: a review.

PubMed

Kim, Irene H; Mupparapu, Muralidhar

2009-05-01

The 2004 American Dental Association (ADA)/US Food and Drug Administration (FDA) radiographic selection criteria and guidelines were reviewed and compared with the prior radiographic selection criteria and guidelines. The authors reviewed the publications from the US FDA, US Department of Health and Human Services, and National Council on Radiation Protection and Measurements. The positions outlined by the Canadian Dental Association and the European Commission were also reviewed and compared to US guidelines. The FDA guidelines were first published in 1987, and several changes have been made to them over the years. Recent literature reveals that the general compliance of these guidelines is very low, especially within dental schools in the United States and Canada. Little is known about the compliance outside of the dental school environment; however, it is expected to be low for various reasons. In 2007, the International Commission on Radiological Protection (ICRP) revised its estimates of tissue radiosensitivity, which resulted in effective doses of dental radiographs 32% to 422% higher than the 1990 ICRP guidelines. Flow charts summarizing the latest guidelines were developed to facilitate general compliance among practitioners. Based on the literature reviewed and the recent ICRP findings, it would be prudent for dental health care professionals to follow dental radiographic guidelines.

Smartphone Application of Primary Care Guidelines used in Education of Medical Students

PubMed Central

Waldmann, Uta-Maria; Weckbecker, Klaus

2013-01-01

Background and Objective: The guidelines of the German College of General Practitioners and Family Physicians (DEGAM) on frequent and important reasons for encounter in Primary Care play a central role in the teaching of Family Medicine. They were edited by the authors into an app for mobile phones, making them available at all times to General Practitioners and medical students. This study examines the issue: how useful do students consider this application within their learning process in Family Medicine? Method: The short versions of the 15 DEGAM guidelines were processed as a web app (for all smartphone software systems) including offline utilisation, and offered to students in the Family Medicine course, during clinical attachments in General Practice, on elective compulsory courses or for their final year rotation in General Practice. The evaluation was made with a structured survey using the feedback function of the Moodle learning management system [http://www.elearning-allgemeinmedizin.de] with Likert scales and free-text comments. Results: Feedback for evaluation came from 14 (25%) of the student testers from the Family Medicine course (9), the clinical attachment in General Practice (1), the final year rotation in General Practice (1) and elective compulsory courses (4). Students rated the app as an additional benefit to the printed/pdf-form. They use it frequently and successfully during waiting periods and before, during, or after lectures. In addition to general interest and a desire to become acquainted with the guidelines and to learn, the app is consulted with regard to general (theoretical) questions, rather than in connection with contact with patients. Interest in and knowledge of the guidelines is stimulated by the app, and on the whole the application can be said to be well suited to the needs of this user group. Discussion: The students evaluated the guidelines app positively: as a modern way of familiarising them with the guidelines and expanding their knowledge, particularly through its use in waiting periods and the attractive medium smartphone. However, the latter prevents a mandatory curricular use in compulsory courses, since not all students use smartphones. It is a meaningful addition to existing teaching materials and supports evidence-based teaching in Family Medicine and is suitable for use not only in university course teaching but also during clinical training. PMID:23467657

Smartphone application of primary care guidelines used in education of medical students.

PubMed

Waldmann, Uta-Maria; Weckbecker, Klaus

2013-01-01

The guidelines of the German College of General Practitioners and Family Physicians (DEGAM) on frequent and important reasons for encounter in Primary Care play a central role in the teaching of Family Medicine. They were edited by the authors into an app for mobile phones, making them available at all times to General Practitioners and medical students. This study examines the issue: how useful do students consider this application within their learning process in Family Medicine? The short versions of the 15 DEGAM guidelines were processed as a web app (for all smartphone software systems) including offline utilisation, and offered to students in the Family Medicine course, during clinical attachments in General Practice, on elective compulsory courses or for their final year rotation in General Practice. The evaluation was made with a structured survey using the feedback function of the Moodle learning management system [http://www.elearning-allgemeinmedizin.de] with Likert scales and free-text comments. Feedback for evaluation came from 14 (25%) of the student testers from the Family Medicine course (9), the clinical attachment in General Practice (1), the final year rotation in General Practice (1) and elective compulsory courses (4). Students rated the app as an additional benefit to the printed/pdf-form. They use it frequently and successfully during waiting periods and before, during, or after lectures. In addition to general interest and a desire to become acquainted with the guidelines and to learn, the app is consulted with regard to general (theoretical) questions, rather than in connection with contact with patients. Interest in and knowledge of the guidelines is stimulated by the app, and on the whole the application can be said to be well suited to the needs of this user group. The students evaluated the guidelines app positively: as a modern way of familiarising them with the guidelines and expanding their knowledge, particularly through its use in waiting periods and the attractive medium smartphone. However, the latter prevents a mandatory curricular use in compulsory courses, since not all students use smartphones. It is a meaningful addition to existing teaching materials and supports evidence-based teaching in Family Medicine and is suitable for use not only in university course teaching but also during clinical training.

Nursing research in the United States: the protection of human subjects.

PubMed

Oddi, L F; Cassidy, V R

1990-01-01

In the United States the protection of the rights of human subjects in experimentation has evolved at three levels: professional, public, and private. At the professional level, codes, guidelines and the Patient's Bill of Rights address the issues of protecting the dignity, privacy and autonomy of individuals who serve as research subjects. At the public level, regulations promulgated by the Food and Drug Administration and the Department of Health and Human Services have become the standard for protecting human subjects. At the private level, United States common law regulates the conduct of individual researchers by requiring them to act in a manner consistent with generally accepted standards of care. As professionals, nurses must be actively involved in the formation of public policy regarding the conduct of research and strive to formulate a research agenda that will ensure that the ethics of research in nursing is above question.

Attitudes of patients with bipolar disorder toward the Life Chart Methodology: a phenomenological study.

PubMed

van Bendegem, Mischa A; van den Heuvel, Silvio C G H; Kramer, Laura J; Goossens, Peter J J

2014-01-01

The Dutch guideline for bipolar disorder (BD) recommends the use of the Life Chart Methodology (LCM) to help patients to monitor fluctuating mood patterns. But in practice patients show ambivalent attitudes toward this instrument. To describe attitudes and motivations of patients with BD for (non-)using the LCM. A phenomenological study with unstructured in-depth interviews of 14 patients with BD. Patient narratives were audio-taped, transcribed verbatim, analyzed, and coded inductively. The results show that despite variability in perceptions and willingness to work with the LCM, the general attitude toward this instrument was a recognized value for using the LCM. However, the emotional impact of daily mood charting was experienced as a substantial burden, particularly during the early stages of diagnosis. The impact of the diagnosis of BD needs to be taken in account when introducing the instrument for the first time to a patient. © The Author(s) 2014.

A review of reaction rates and thermodynamic and transport properties for an 11-species air model for chemical and thermal nonequilibrium calculations to 30000 K

NASA Technical Reports Server (NTRS)

Gupta, Roop N.; Yos, Jerrold M.; Thompson, Richard A.; Lee, Kam-Pui

1990-01-01

Reaction rate coefficients and thermodynamic and transport properties are reviewed and supplemented for the 11-species air model which can be used for analyzing flows in chemical and thermal nonequilibrium up to temperatures of 3000 K. Such flows will likely occur around currently planned and future hypersonic vehicles. Guidelines for determining the state of the surrounding environment are provided. Curve fits are given for the various species properties for their efficient computation in flowfield codes. Approximate and more exact formulas are provided for computing the properties of partially ionized air mixtures in a high energy environment. Limitations of the approximate mixing laws are discussed for a mixture of ionized species. An electron number-density correction for the transport properties of the charged species is obtained. This correction has been generally ignored in the literature.

Review on Rapid Seismic Vulnerability Assessment for Bulk of Buildings

NASA Astrophysics Data System (ADS)

Nanda, R. P.; Majhi, D. R.

2013-09-01

This paper provides a brief overview of rapid visual screening (RVS) procedures available in different countries with a comparison among all the methods. Seismic evaluation guidelines from, USA, Canada, Japan, New Zealand, India, Europe, Italy, UNDP, with other methods are reviewed from the perspective of their applicability to developing countries. The review shows clearly that some of the RVS procedures are unsuited for potential use in developing countries. It is expected that this comparative assessment of various evaluation schemes will help to identify the most essential components of such a procedure for use in India and other developing countries, which is not only robust, reliable but also easy to use with available resources. It appears that Federal Emergency Management Agency (FEMA) 154 and New Zealand Draft Code approaches can be suitably combined to develop a transparent, reasonably rigorous and generalized procedure for seismic evaluation of buildings in developing countries.

Syndrome-source-coding and its universal generalization. [error correcting codes for data compression

NASA Technical Reports Server (NTRS)

Ancheta, T. C., Jr.

1976-01-01

A method of using error-correcting codes to obtain data compression, called syndrome-source-coding, is described in which the source sequence is treated as an error pattern whose syndrome forms the compressed data. It is shown that syndrome-source-coding can achieve arbitrarily small distortion with the number of compressed digits per source digit arbitrarily close to the entropy of a binary memoryless source. A 'universal' generalization of syndrome-source-coding is formulated which provides robustly effective distortionless coding of source ensembles. Two examples are given, comparing the performance of noiseless universal syndrome-source-coding to (1) run-length coding and (2) Lynch-Davisson-Schalkwijk-Cover universal coding for an ensemble of binary memoryless sources.

46 CFR 403.100 - Applicability of system of accounts and reports.

Code of Federal Regulations, 2010 CFR

2010-10-01

... accordance with the guidelines of the Generally Accepted Accounting Principles (GAAP) issued by the Financial Accounting Standards Board. These guidelines are available by writing to the Director, Great Lakes Pilotage... PILOTAGE UNIFORM ACCOUNTING SYSTEM General § 403.100 Applicability of system of accounts and reports. Each...

Sensemaking, Stakeholder Discord, and Long-Term Risk Communication at a U.S. Superfund Site

PubMed Central

Hoover, Anna Goodman

2018-01-01

Introduction Risk communication can help reduce exposures to environmental contaminants, mitigate negative health outcomes, and inform community-based decisions about hazardous waste sites. While communication best practices have long guided such efforts, little research has examined unintended consequences arising from such guidelines. As rhetoric informs stakeholder sensemaking, the language used in and reinforced by these guidelines can challenge relationships and exacerbate stakeholder tensions. Objectives This study evaluates risk communication at a U.S. Superfund site to identify unintended consequences arising from current risk communication practices. Methods This qualitative case study crystallizes data spanning 6 years from three sources: 1) local newspaper coverage of site-related topics; 2) focus-group transcripts from a multi-year project designed to support future visioning of site use; and 3) published blog entries authored by a local environmental activist. Constant comparative analysis provides the study’s analytic foundation, with qualitative data analysis software QSR NVivo 8 supporting a three-step process: 1) provisional coding to identify broad topic categories within datasets, 2) coding occurrences of sensemaking constructs and emergent intra-dataset patterns, and 3) grouping related codes across datasets to examine the relationships among them. Results Existing risk communication practices at this Superfund site contribute to a dichotomous conceptualization of multiple and diverse stakeholders as members of one of only two categories: the government or the public. This conceptualization minimizes perceptions of capacity, encourages public commitment to stances aligned with a preferred group, and contributes to negative expectations that can become self-fulfilling prophecies. Conclusion Findings indicate a need to re-examine and adapt risk communication guidelines to encourage more pluralistic understanding of the stakeholder landscape. PMID:28282297

Guidelines on treatment of perinatal depression with antidepressants: An international review

PubMed Central

Kamperman, Astrid M; Boyce, Philip; Bergink, Veerle

2018-01-01

Objective: Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice. Methods: An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients. Results: Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines. Conclusion: During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged. PMID:29506399

Guidelines on treatment of perinatal depression with antidepressants: An international review.

PubMed

Molenaar, Nina M; Kamperman, Astrid M; Boyce, Philip; Bergink, Veerle

2018-04-01

Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice. An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients. Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines. During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged.

A new independent authority is needed to issue National Health Care guidelines.

PubMed

Keyhani, Salomeh; Kim, Azalea; Mann, Micah; Korenstein, Deborah

2011-02-01

Health experts emphasize that getting doctors to follow clinical guidelines can save both lives and money. Less attention has been paid to how the guidelines are developed and the variability in the recommendations they include. We examined the quality and content of screening guidelines as a proxy for guidelines in general and found that the source of the guidelines affects their quality. Guidelines with inconsistent recommendations are unlikely to serve patients or physicians well. The creation of an independent organization that would work with multiple stakeholders to develop guidelines holds the potential to improve their quality.

A review of clinical practice guidelines for lung cancer

PubMed Central

Ball, David; Silvestri, Gerard A.

2013-01-01

Clinical practice guidelines are important evidence-based resources to guide complex clinical decision making. However, it is challenging for health professionals to keep abreast available guidelines and to know how and where to access relevant guidelines. This review examines currently available guidelines for lung cancer published in the English language. Important key features are listed for each identified guideline. The methodology, approaches to dissemination and implementation, and associated resources are summarised. General challenges in the area of guideline development are highlighted. The potential to collaborate more widely across lung cancer guideline developers by sharing literature searches and assessments is discussed. PMID:24163752

Do guidelines on first impression make sense? Implementation of a chest pain guideline in primary care: a systematic evaluation of acceptance and feasibility.

PubMed

Kramer, Lena; Rabanizada, Nagela; Haasenritter, Jörg; Bösner, Stefan; Baum, Erika; Donner-Banzhoff, Norbert

2011-11-21

Most guidelines concentrate on investigations, treatment, and monitoring instead of patient history and clinical examination. We developed a guideline that dealt with the different aetiologies of chest pain by emphasizing the patient's history and physical signs. The objective of this study was to evaluate the guideline's acceptance and feasibility in the context of a practice test. The evaluation study was nested in a diagnostic cross-sectional study with 56 General Practitioners (GPs) and 862 consecutively recruited patients with chest pain. The evaluation of the guideline was conducted in a mixed method design on a sub-sample of 17 GPs and 282 patients. Physicians' evaluation of the guideline was assessed via standardized questionnaires and case record forms. Additionally, practice nursing staff and selected patients were asked for their evaluation of specific guideline modules. Quantitative data was analyzed descriptively for frequencies, means, and standard deviations. In addition, two focus groups with a total of 10 GPs were held to gain further insights in the guideline implementation process. The data analysis and interpretation followed the standards of the qualitative content analysis. The overall evaluation of the GPs participating in the evaluation study regarding the recommendations made in the chest pain guideline was positive. A total of 14 GPs were convinced that there was a need for this kind of guideline and perceived the guideline recommendations as useful. While the long version was partially criticized for a perceived lack of clarity, the short version of the chest pain guideline and the heart score were especially appreciated by the GPs. However, change of clinical behaviour as consequence of the guideline was inconsistent. While on a concrete patient related level, GPs indicated to have behaved as the guideline recommended, the feedback on a more general level was heterogeneous. Several suggestions to improve guideline implementation were made by participating physicians. Due to the small number of practice nursing staff evaluating the flowchart and patients remembering the patient leaflet, no valid results regarding the flowchart and patient leaflet modules could be reported. Overall, the participating GPs perceived the guideline recommendations as useful to increase awareness and to reflect on diagnostic issues. Although behaviour change in consequence of the guideline was not reported on a general level, guidelines on history taking and the clinical examination may serve an important conservative and practical function in a technology driven environment. Further research to increase the implementation success of the guideline should be undertaken.

Guidelines for Medication Administration in Schools.

ERIC Educational Resources Information Center

Maryland State Dept. of Health and Mental Hygiene, Baltimore.

These guidelines present standards for administering medication in Maryland schools, both prescribed and over-the-counter medications. In general, medication during school hours is discouraged unless necessary. The guidelines recommend that, whenever possible, children administer their own medication under appropriate supervision. Specifically,…

Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions.

PubMed

Katz, David A; Paez, Monica W; Reisinger, Heather S; Gillette, Meghan T; Weg, Mark W Vander; Titler, Marita G; Nugent, Andrew S; Baker, Laurence J; Holman, John E; Ono, Sarah S

2014-01-24

The US Public Health Service smoking cessation practice guideline specifically recommends that physicians and nurses strongly advise their patients who use tobacco to quit, but the best approach for attaining this goal in the emergency department (ED) remains unknown. The aim of this study was to characterize emergency physicians' (EPs) and nurses' (ENs) perceptions of cessation counseling and to identify barriers and facilitators to implementation of the 5 A's framework (Ask-Advise-Assess-Assist-Arrange) in the ED. We conducted semi-structured, face-to-face interviews of 11 EPs and 19 ENs following a pre-post implementation trial of smoking cessation guidelines in two study EDs. We used purposeful sampling to target EPs and ENs with different attitudes toward cessation counseling, based on their responses to a written survey (Decisional Balance Questionnaire). Conventional content analysis was used to inductively characterize the issues raised by study participants and to construct a coding structure, which was then applied to study transcripts. The main findings of this study converged upon three overarching domains: 1) reactions to the intervention; 2) perceptions of patients' receptivity to cessation counseling; and 3) perspectives on ED cessation counseling and preventive care. ED staff expressed ambivalence toward the implementation of smoking cessation guidelines. Both ENs and EPs agreed that the delivery of smoking cessation counseling is important, but that it is not always practical in the ED on account of time constraints, the competing demands of acute care, and resistance from patients. Participants also called attention to the need for improved role clarity and teamwork when implementing the 5 A's in the ED. There are numerous challenges to the implementation of smoking cessation guidelines in the ED. ENs are generally willing to take the lead in offering brief cessation counseling, but their efforts need to be reinforced by EPs. ED systems need to address workflow, teamwork, and practice policies that facilitate prescription of smoking cessation medication, referral for cessation counseling, and follow-up in primary care. The results of this qualitative evaluation can be used to guide the design of future ED intervention studies. ClinicalTrials.gov registration number NCT00756704.

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.

High Order Modulation Protograph Codes

NASA Technical Reports Server (NTRS)

Nguyen, Thuy V. (Inventor); Nosratinia, Aria (Inventor); Divsalar, Dariush (Inventor)

2014-01-01

Digital communication coding methods for designing protograph-based bit-interleaved code modulation that is general and applies to any modulation. The general coding framework can support not only multiple rates but also adaptive modulation. The method is a two stage lifting approach. In the first stage, an original protograph is lifted to a slightly larger intermediate protograph. The intermediate protograph is then lifted via a circulant matrix to the expected codeword length to form a protograph-based low-density parity-check code.

American Society for Colposcopy and Cervical Pathology

MedlinePlus

... Colposcopy Standards Recommendations Patient Resources Journal Membership Member Benefits Join/Renew Member Resources Careers About History Bylaws ... MD, MS, Thomas C. Wright, Jr, MD ASCCP Mobile App Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer ... * Email: * Enter code: * Message: Thank you Your ...

Teacher-Directed and Student-Mediated Textbook Comprehension Strategies.

ERIC Educational Resources Information Center

Reynolds, Catharine J.; Salend, Spencer J.

1990-01-01

The article describes teacher-directed and student-mediated comprehension strategies to improve the text comprehension skills of mainstreamed students with mild disabilities. Techniques include advance organizers, study guides, color coding, oral reading, critical thinking maps, and self-questioning techniques. Guidelines are offered for assessing…

Providers' perceptions of spinal cord injury pressure ulcer guidelines.

PubMed

Thomason, Susan S; Evitt, Celinda P; Harrow, Jeffrey J; Love, Linda; Moore, D Helen; Mullins, Maria A; Powell-Cope, Gail; Nelson, Audrey L

2007-01-01

Pressure ulcers are a serious complication for people with spinal cord injury (SCI). The Consortium for Spinal Cord Medicine (CSCM) published clinical practice guidelines (CPGs) that provided guidance for pressure ulcer prevention and treatment after SCI. The aim of this study was to assess providers' perceptions for each of the 32 CPG recommendations regarding their agreement with CPGs, degree of CPG implementation, and CPG implementation barriers and facilitators. This descriptive mixed-methods study included both qualitative (focus groups) and quantitative (survey) data collection approaches. The sample (n = 60) included 24 physicians and 36 nurses who attended the 2004 annual national conferences of the American Paraplegia Society or American Association of Spinal Cord Injury Nurses. This sample drew from two sources: a purposive sample from a list of preregistered participants and a convenience sample of conference attendee volunteers. We analyzed quantitative data using descriptive statistics and qualitative data using a coding scheme to capture barriers and facilitators. The focus groups agreed unanimously on the substance of 6 of the 32 recommendations. Nurse and physician focus groups disagreed on the degree of CGP implementation at their sites, with nurses as a group perceiving less progress in implementation of the guideline recommendations. The focus groups identified only one recommendation, complications of surgery, as being fully implemented at their sites. Categories of barriers and facilitators for implementation of CPGs that emerged from the qualitative analysis included (a) characteristics of CPGs: need for research/evidence, (b) characteristics of CPGs: complexity of design and wording, (c) organizational factors, (d) lack of knowledge, and (e) lack of resources. Although generally SCI physicians and nurses agreed with the CPG recommendations as written, they did not feel these recommendations were fully implemented in their respective clinical settings. The focus groups identified multiple barriers to the implementation of the CPGs and suggested several facilitators/solutions to improve implementation of these guidelines in SCI. Participants identified organizational factors and the lack of knowledge as the most substantial systems/issues that created barriers to CPG implementation.

DIC Challenge: Developing Images and Guidelines for Evaluating Accuracy and Resolution of 2D Analyses

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

Reu, Phillip L.; Toussaint, E.; Jones, Elizabeth M. C.

With the rapid spread in use of Digital Image Correlation (DIC) globally, it is important there be some standard methods of verifying and validating DIC codes. To this end, the DIC Challenge board was formed and is maintained under the auspices of the Society for Experimental Mechanics (SEM) and the international DIC society (iDICs). The goal of the DIC Board and the 2D–DIC Challenge is to supply a set of well-vetted sample images and a set of analysis guidelines for standardized reporting of 2D–DIC results from these sample images, as well as for comparing the inherent accuracy of different approachesmore » and for providing users with a means of assessing their proper implementation. This document will outline the goals of the challenge, describe the image sets that are available, and give a comparison between 12 commercial and academic 2D–DIC codes using two of the challenge image sets.« less

DIC Challenge: Developing Images and Guidelines for Evaluating Accuracy and Resolution of 2D Analyses

DOE PAGES

Reu, Phillip L.; Toussaint, E.; Jones, Elizabeth M. C.; ...

2017-12-11

With the rapid spread in use of Digital Image Correlation (DIC) globally, it is important there be some standard methods of verifying and validating DIC codes. To this end, the DIC Challenge board was formed and is maintained under the auspices of the Society for Experimental Mechanics (SEM) and the international DIC society (iDICs). The goal of the DIC Board and the 2D–DIC Challenge is to supply a set of well-vetted sample images and a set of analysis guidelines for standardized reporting of 2D–DIC results from these sample images, as well as for comparing the inherent accuracy of different approachesmore » and for providing users with a means of assessing their proper implementation. This document will outline the goals of the challenge, describe the image sets that are available, and give a comparison between 12 commercial and academic 2D–DIC codes using two of the challenge image sets.« less

A Qualitative Study of Paramedic Duty to Treat During Disaster Response.

PubMed

Smith, Erin; Burkle, Frederick; Gebbie, Kristine; Ford, David; Bensimon, Cécile

2018-04-10

Disasters place unprecedented demands on emergency medical services and can test paramedics personal commitment as health care professionals. Despite this challenge, guidelines and codes of ethics are largely silent on the issue, providing little to no guidance on what is expected of paramedics or how they ought to approach their duty to treat in the face of risk. The objective of this research is to explore how paramedics view their duty to treat during disasters. The authors employed qualitative methods to gather Australian paramedic perspectives. Our findings suggest that paramedic decisions around duty to treat will largely depend on individual perception of risk and competing obligations. A code of ethics for paramedics would be useful, but ultimately each paramedic will interpret these suggested guidelines based on individual values and the situational context. Coming to an understanding of the legal issues involved and the ethical-social expectations in advance of a disaster may assist paramedics to respond willingly and appropriately. (Disaster Med Public Health Preparedness. 2018;page 1 of 6).

IPEM guidelines on dosimeter systems for use as transfer instruments between the UK primary dosimetry standards laboratory (NPL) and radiotherapy centres1

NASA Astrophysics Data System (ADS)

Morgan, A. M.; Aird, E. G. A.; Aukett, R. J.; Duane, S.; Jenkins, N. H.; Mayles, W. P. M.; Moretti, C.; Thwaites, D. I.

2000-09-01

United Kingdom dosimetry codes of practice have traditionally specified one electrometer for use as a secondary standard, namely the Nuclear Enterprises (NE) 2560 NPL secondary standard therapy level exposure meter. The NE2560 will become obsolete in the foreseeable future. This report provides guidelines to assist physicists following the United Kingdom dosimetry codes of practice in the selection of an electrometer to replace the NE2560 when necessary. Using an internationally accepted standard (BS EN 60731:1997) as a basis, estimated error analyses demonstrate that the uncertainty (one standard deviation) in a charge measurement associated with the NE2560 alone is approximately 0.3% under specified conditions. Following a review of manufacturers' literature, it is considered that modern electrometers should be capable of equalling this performance. Additional constructural and operational requirements not specified in the international standard but considered essential in a modern electrometer to be used as a secondary standard are presented.

Anaesthesia Gas Supply: Gas Cylinders

PubMed Central

Srivastava, Uma

2013-01-01

Invention of oxygen cylinder was one of the most important developments in the field of medical practice. Oxygen and other gases were compressed and stored at high pressure in seamless containers constructed from hand-forged steel in1880. Materials technology has continued to evolve and now medical gas cylinders are generally made of steel alloys or aluminum. The filling pressure as well as capacity has increased considerably while at the same time the weight of cylinders has reduced. Today oxygen cylinder of equivalent size holds a third more oxygen but weighs about 20 kg less. The cylinders are of varying sizes and are color coded. They are tested at regular intervals by the manufacturer using hydraulic, impact, and tensile tests. The top end of the cylinder is fitted with a valve with a variety of number and markings stamped on it. Common valve types include: Pin index valve, bull nose, hand wheel and integral valve. The type of valve varies with cylinder size. Small cylinders have a pin index valve while large have a bull nose type. Safety features in the cylinder are: Color coding, pin index, pressure relief device, Bodok seal, and label attached etc., Safety rules and guidelines must be followed during storage, installation and use of cylinders to ensure safety of patients, hospital personnel and the environment. PMID:24249883

Anaesthesia gas supply: gas cylinders.

PubMed

Srivastava, Uma

2013-09-01

Invention of oxygen cylinder was one of the most important developments in the field of medical practice. Oxygen and other gases were compressed and stored at high pressure in seamless containers constructed from hand-forged steel in1880. Materials technology has continued to evolve and now medical gas cylinders are generally made of steel alloys or aluminum. The filling pressure as well as capacity has increased considerably while at the same time the weight of cylinders has reduced. Today oxygen cylinder of equivalent size holds a third more oxygen but weighs about 20 kg less. The cylinders are of varying sizes and are color coded. They are tested at regular intervals by the manufacturer using hydraulic, impact, and tensile tests. The top end of the cylinder is fitted with a valve with a variety of number and markings stamped on it. Common valve types include: Pin index valve, bull nose, hand wheel and integral valve. The type of valve varies with cylinder size. Small cylinders have a pin index valve while large have a bull nose type. Safety features in the cylinder are: Color coding, pin index, pressure relief device, Bodok seal, and label attached etc., Safety rules and guidelines must be followed during storage, installation and use of cylinders to ensure safety of patients, hospital personnel and the environment.

Accounting for the professional work of pathologists performing autopsies.

PubMed

Sinard, John H

2013-02-01

With an increasing trend toward fee-code-based methods of measuring the clinical professional productivity of pathologists, those pathologists whose clinical activities include the performance of autopsies have been disadvantaged by the lack of generally accepted workload equivalents for autopsy performance and supervision. To develop recommended benchmarks to account for this important and often overlooked professional activity. Based on the professional experience of members of the Autopsy Committee of the College of American Pathologists, a survey of autopsy pathologists, and the limited additional material available in the literature, we developed recommended workload equivalents for the professional work associated with performing an autopsy, which we elected to express as multiples of established Current Procedural Terminology codes. As represented in Table 3 , we recommend that the professional work associated with a full adult autopsy be equivalent to 5.5 × 88309-26. Additional professional credit of 1.5 × 88309-26 should be added for evaluation of the brain and for a detailed clinical-pathologic discussion. The corresponding value for a fetal/neonatal autopsy is 4.0 × 88309-26. Although we recognize that autopsy practices vary significantly from institution to institution, it is hoped that our proposed guidelines will be a valuable starting point that individual practices can then adapt, taking into account the specifics of their practice environment.

The Italian Code of Medical Deontology. Historical, ethical and legal issues.

PubMed

Patuzzo, Sara; De Stefano, Francesco; Ciliberti, Rosagemma

2018-06-15

Medical deontology is increasingly important, owing to the interests and rights which the medical profession involves. This paper focuses on the relationships of the Italian Code of Medical Deontology (CMD) with both the ethical and legal dimensions, in order to clarify the role of medical ethics within the medical profession, society and the overall system of the sources of law. The authors analyze the CMD from an ethical perspective and through the new doctrinal guidelines and current trends in the Italian law courts. From an ethical point of view,  moral philosophical analysis scarcely seems to  address professional medical ethics. Nonetheless, the CMD needs to undergo careful ethical analysis. From a legal perspective, the Italian CMD contains provisions which do not have  an official legal nature. However, they are directly binding for medical practitioners, and therefore could be understood as a supplement to the general rules of the legal system. At an ethical level, rigorous debate on the CMD is indispensable, in order to update its specific principles and to make it a real moral normative document. At a legislative level, there is a possible contradiction between a legal system that does not take into account the CMD, but which then attributes significant importance to the violation of its rules.

Toward uniform implementation of parametric map Digital Imaging and Communication in Medicine standard in multisite quantitative diffusion imaging studies.

PubMed

Malyarenko, Dariya; Fedorov, Andriy; Bell, Laura; Prah, Melissa; Hectors, Stefanie; Arlinghaus, Lori; Muzi, Mark; Solaiyappan, Meiyappan; Jacobs, Michael; Fung, Maggie; Shukla-Dave, Amita; McManus, Kevin; Boss, Michael; Taouli, Bachir; Yankeelov, Thomas E; Quarles, Christopher Chad; Schmainda, Kathleen; Chenevert, Thomas L; Newitt, David C

2018-01-01

This paper reports on results of a multisite collaborative project launched by the MRI subgroup of Quantitative Imaging Network to assess current capability and provide future guidelines for generating a standard parametric diffusion map Digital Imaging and Communication in Medicine (DICOM) in clinical trials that utilize quantitative diffusion-weighted imaging (DWI). Participating sites used a multivendor DWI DICOM dataset of a single phantom to generate parametric maps (PMs) of the apparent diffusion coefficient (ADC) based on two models. The results were evaluated for numerical consistency among models and true phantom ADC values, as well as for consistency of metadata with attributes required by the DICOM standards. This analysis identified missing metadata descriptive of the sources for detected numerical discrepancies among ADC models. Instead of the DICOM PM object, all sites stored ADC maps as DICOM MR objects, generally lacking designated attributes and coded terms for quantitative DWI modeling. Source-image reference, model parameters, ADC units and scale, deemed important for numerical consistency, were either missing or stored using nonstandard conventions. Guided by the identified limitations, the DICOM PM standard has been amended to include coded terms for the relevant diffusion models. Open-source software has been developed to support conversion of site-specific formats into the standard representation.

Space shuttle propulsion systems on-board checkout and monitoring system development study (extension). Volume 2: Guidelines for for incorporation of the onboard checkout and monitoring function on the space shuttle

NASA Technical Reports Server (NTRS)

1972-01-01

Guidelines are presented for incorporation of the onboard checkout and monitoring function (OCMF) into the designs of the space shuttle propulsion systems. The guidelines consist of and identify supporting documentation; requirements for formulation, implementation, and integration of OCMF; associated compliance verification techniques and requirements; and OCMF terminology and nomenclature. The guidelines are directly applicable to the incorporation of OCMF into the design of space shuttle propulsion systems and the equipment with which the propulsion systems interface. The techniques and general approach, however, are also generally applicable to OCMF incorporation into the design of other space shuttle systems.

Appropriateness of indication and diagnostic yield of colonoscopy: First report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy

PubMed Central

Siddique, Iqbal; Mohan, Krishna; Hasan, Fuad; Memon, Anjum; Patty, Istvan; Al-Nakib, Basil

2005-01-01

AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE). METHODS: A total of 736 consecutive patients (415 males, 321 females; mean age 43.6±16.6 years) undergoing colonoscopy during October 2001-March 2002 were prospectively enrolled in the study. The 2000 ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication. RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered “generally indicated”, it was “generally not indicated” for 20%, and it was “not listed” for 16% in the guidelines. The diagnostic yield of colonoscopy was highest for the “generally indicated” (38%) followed by “not listed” (13%) and “generally not indicated” (5%) categories. In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was “generally indicated” (odds ratio=12.3) and referrals by gastroenterologist (odds ratio =1.9). CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician’s specialty. Certain indications “not listed” in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines. PMID:16437607

Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery.

PubMed

2017-01-01

Evidence-based interventions may reduce mortality in surgical patients. This study documented the prevalence of sepsis, adherence to guidelines in its management, and timing of source control in general surgical patients presenting as an emergency. Patients aged 16 years or more presenting with emergency general surgery problems were identified over a 7-day period and then screened for sepsis compliance (using the Sepsis Six standards, devised for severe sepsis) and the timing of source control (whether radiological or surgical). Exploratory analyses examined associations between the mode (emergency department or general practitioner) and time of admission, adherence to the sepsis guidelines, and outcomes (complications or death within 30 days). Of a total of 5067 patients from 97 hospitals across the UK, 911 (18·0 per cent) fulfilled the criteria for sepsis, 165 (3·3 per cent) for severe sepsis and 24 (0·5 per cent) for septic shock. Timely delivery of all Sepsis Six guidelines for patients with severe sepsis was achieved in four patients. For patients with severe sepsis, 17·6-94·5 per cent of individual guidelines within the Sepsis Six were delivered. Oxygen was the criterion most likely to be missed, followed by blood cultures in all sepsis severity categories. Surgery for source control occurred a median of 19·8 (i.q.r. 10·0-35·4) h after diagnosis. Omission of Sepsis Six parameters did not appear to be associated with an increase in morbidity or mortality. Although sepsis was common in general surgical patients presenting as an emergency, adherence to severe sepsis guidelines was incomplete in the majority. Despite this, no evidence of harm was apparent. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

GLSENS: A Generalized Extension of LSENS Including Global Reactions and Added Sensitivity Analysis for the Perfectly Stirred Reactor

NASA Technical Reports Server (NTRS)

Bittker, David A.

1996-01-01

A generalized version of the NASA Lewis general kinetics code, LSENS, is described. The new code allows the use of global reactions as well as molecular processes in a chemical mechanism. The code also incorporates the capability of performing sensitivity analysis calculations for a perfectly stirred reactor rapidly and conveniently at the same time that the main kinetics calculations are being done. The GLSENS code has been extensively tested and has been found to be accurate and efficient. Nine example problems are presented and complete user instructions are given for the new capabilities. This report is to be used in conjunction with the documentation for the original LSENS code.

48 CFR 1501.105-1 - Publication and code arrangement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Publication and code arrangement. 1501.105-1 Section 1501.105-1 Federal Acquisition Regulations System ENVIRONMENTAL PROTECTION AGENCY GENERAL GENERAL Purpose, Authority, Issuance 1501.105-1 Publication and code arrangement. The...

Multiple component codes based generalized LDPC codes for high-speed optical transport.

PubMed

Djordjevic, Ivan B; Wang, Ting

2014-07-14

A class of generalized low-density parity-check (GLDPC) codes suitable for optical communications is proposed, which consists of multiple local codes. It is shown that Hamming, BCH, and Reed-Muller codes can be used as local codes, and that the maximum a posteriori probability (MAP) decoding of these local codes by Ashikhmin-Lytsin algorithm is feasible in terms of complexity and performance. We demonstrate that record coding gains can be obtained from properly designed GLDPC codes, derived from multiple component codes. We then show that several recently proposed classes of LDPC codes such as convolutional and spatially-coupled codes can be described using the concept of GLDPC coding, which indicates that the GLDPC coding can be used as a unified platform for advanced FEC enabling ultra-high speed optical transport. The proposed class of GLDPC codes is also suitable for code-rate adaption, to adjust the error correction strength depending on the optical channel conditions.

Guideline 3: Psychosocial Treatment.

ERIC Educational Resources Information Center

American Journal on Mental Retardation, 2000

2000-01-01

The third in seven sets of guidelines based on the consensus of experts in the treatment of psychiatric and behavioral problems in mental retardation (MR) focuses on psychosocial treatment. Guidelines cover general principles, choosing among psychosocial treatments, severity of MR and psychiatric/behavior symptoms, diagnosable disorders, target…

A framework for weight of evidence in ecological assessment

EPA Science Inventory

The U.S. Environmental Protection Agency’s Risk Assessment Forum has developed a framework and guidelines for inference by weight of evidence. Like the Agency’s Guidelines for Ecological Risk Assessment, these guidelines are sufficiently general to be adapted to a wi...

Exploiting Temporal Constraints of Clinical Guidelines by Applying OpenEHR Archetypes.

PubMed

Cintho, Lilian Mie Mukai; Garcia, Diego; da Silva Santos, Bruno Henrique; Sacchi, Lucia; Quaglini, Silvana; Moro, Claudia Maria Cabral

2017-01-01

Studies describing Computer-Interpretable Clinical Guidelines (CIG) with temporal constrains (TC) generally have not addressed issues related to their integration into Electronic Health Record (EHR) systems. This study aimed to represent TCs contained in clinical guidelines by applying archetypes and Guideline Definition Language (GDL) to incorporate decision support into EHRs. An example of each TC class in the clinical guideline for management of Atrial Fibrillation was represented using archetypes and GDL.

Canadian physicians' attitudes about and preferences regarding clinical practice guidelines.

PubMed

Hayward, R S; Guyatt, G H; Moore, K A; McKibbon, K A; Carter, A O

1997-06-15

To assess Canadian physicians' confidence in, attitudes about and preferences regarding clinical practice guidelines. Cross-sectional, self-administered mailed survey. Stratified random sample of 3000 Canadian physicians; 1878 (62.6%) responded. Canada. Physicians' use of various information sources; familiarity with and confidence in guidelines; attitudes about guidelines and their effect on medical care; rating of importance of guidelines and other sources of information in clinical decision-making; rating of importance of various considerations in deciding whether to adopt a set of guidelines; and rating of usefulness of different formats for presenting guidelines. In all, 52% of the respondents reported using guidelines at least monthly, substantially less frequently than traditional information sources. Most of the respondents expressed confidence in guidelines issued by various physician organizations, but 51% to 77% were not confident in guidelines issued by federal or provincial health ministries or by health insurance plans. The respondents were generally positive about guidelines (e.g., over 50% strongly agreed that they are a convenient source of advice and good educational tools); however, 22% to 26% had concerns about loss of autonomy, the rigidity of guidelines and decreased satisfaction with medical practice. Endorsement by respected colleagues or major organizations was identified as very important by 78% and 62% of the respondents respectively in deciding whether to adopt a set of guidelines in their practice. User friendliness of the guidelines format was thought to be very important by 62%; short pamphlets, manuals summarizing a number of guidelines, journal articles and pocket cards summarizing guidelines were the preferred formats (identified as most useful by 50% to 62% of the respondents). Canadian physicians, although generally positive about guidelines and confident in those developed by clinicians, have not yet integrated the use of guidelines into their practices to a large extent. Our results suggest that respected organizations and opinion leaders should be involved in the development of guidelines and that the acceptability of any proposed format and medium for guidelines presentation should be pretested.

14 CFR 1203b.104 - Exercise of arrest authority-general guidelines.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Exercise of arrest authority-general guidelines. 1203b.104 Section 1203b.104 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SECURITY PROGRAMS; ARREST AUTHORITY AND USE OF FORCE BY NASA SECURITY FORCE PERSONNEL § 1203b.104 Exercise...

14 CFR 1203b.104 - Exercise of arrest authority-general guidelines.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Exercise of arrest authority-general guidelines. 1203b.104 Section 1203b.104 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SECURITY PROGRAMS; ARREST AUTHORITY AND USE OF FORCE BY NASA SECURITY FORCE PERSONNEL § 1203b.104 Exercise...

14 CFR 1203b.104 - Exercise of arrest authority-general guidelines.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Exercise of arrest authority-general guidelines. 1203b.104 Section 1203b.104 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SECURITY PROGRAMS; ARREST AUTHORITY AND USE OF FORCE BY NASA SECURITY FORCE PERSONNEL § 1203b.104 Exercise...

14 CFR 1203b.104 - Exercise of arrest authority-general guidelines.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Exercise of arrest authority-general guidelines. 1203b.104 Section 1203b.104 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SECURITY PROGRAMS; ARREST AUTHORITY AND USE OF FORCE BY NASA SECURITY FORCE PERSONNEL § 1203b.104 Exercise...

Validation of a three-dimensional viscous analysis of axisymmetric supersonic inlet flow fields

NASA Technical Reports Server (NTRS)

Benson, T. J.; Anderson, B. H.

1983-01-01

A three-dimensional viscous marching analysis for supersonic inlets was developed. To verify this analysis several benchmark axisymmetric test configurations were studied and are compared to experimental data. Detailed two-dimensional results for shock-boundary layer interactions are presented for flows with and without boundary layer bleed. Three dimensional calculations of a cone at angle of attack and a full inlet at attack are also discussed and evaluated. Results of the calculations demonstrate the code's ability to predict complex flow fields and establish guidelines for future calculations using similar codes.

A Summary of Important Documents in the Field of Research Ethics

PubMed Central

Fischer, Bernard A

2006-01-01

Today's researchers are obligated to conduct their studies ethically. However, it often seems a daunting task to become familiar with the important ethical codes required to do so. The purpose of this article is to examine the content of those ethical documents most relevant to the biomedical researcher. Documents examined include the Nuremberg Code, the Declaration of Helsinki, Henry Beecher's landmark paper, the Belmont Report, the U.S. Common Rule, the Guideline for Good Clinical Practice, and the National Bioethics Advisory Commission's report on research protections for the mentally ill. PMID:16192409

Improving the adaptability of WHO evidence-informed guidelines for nutrition actions: results of a mixed methods evaluation.

PubMed

Dedios, Maria Cecilia; Esperato, Alexo; De-Regil, Luz Maria; Peña-Rosas, Juan Pablo; Norris, Susan L

2017-03-21

Over the past decade, the World Health Organization (WHO) has implemented a standardized, evidence-informed guideline development process to assure technically sound and policy-relevant guidelines. This study is an independent evaluation of the adaptability of the guidelines produced by the Evidence and Programme Guidance unit, at the Department of Nutrition for Health and Development (NHD). The study systematizes the lessons learned by the NHD group at WHO. We used a mixed methods approach to determine the adaptability of the nutrition guidelines. Adaptability was defined as having two components; methodological quality and implementability of guidelines. Additionally, we gathered recommendations to improve future guideline development in nutrition actions for health and development. Data sources for this evaluation were official documentation and feedback (both qualitative and quantitative) from key stakeholders involved in the development of nutrition guidelines. The qualitative data was collected through a desk review and two waves of semi-structured interviews (n = 12) and was analyzed through axial coding. Guideline adaptability was assessed quantitatively using two standardized instruments completed by key stakeholders. The Appraisal Guideline for Research and Evaluation questionnaire, version II was used to assess guideline quality (n = 6), while implementability was assessed with the electronic version of the GuideLine Implementability Appraisal (n = 7). The nutrition evidence-informed guideline development process has several strengths, among them are the appropriate management of conflicts of interest of guideline developers and the systematic use of high-quality evidence to inform the recommendations. These features contribute to increase the methodological quality of the guidelines. The key areas for improvement are the limited implementability of the recommendations, the lack of explicit and precise implementation advice in the guidelines and challenges related to collaborative work within interdisciplinary groups. Overall, our study found that the nutrition evidence-informed guidelines are of good methodological quality but that the implementability requires improvement. The recommendations to improve guideline adaptability address the guideline content, the dynamics shaping interdisciplinary work, and actions for implementation feasibility. As WHO relies heavily on a standardized procedure to develop guidelines, the lessons learned may be applicable to guideline development across the organization and to other groups developing guidelines.

Management of spontaneous pneumothorax compared to British Thoracic Society (BTS) 2003 guidelines: a district general hospital audit.

PubMed

Medford, Andrew Rl; Pepperell, Justin Ct

2007-10-01

In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax (SP). These were refined in 2003. To determine adherence to the 2003 BTS SP guidelines in a district general hospital. An initial retrospective audit of 52 episodes of acute SP was performed. Subsequent intervention involved a junior doctor educational update on both the 2003 BTS guidelines and the initial audit results, and the setting up of an online guideline hyperlink. After the educational intervention a further prospective re-audit of 28 SP episodes was performed. Management of SP deviated considerably from the 2003 BTS guidelines in the initial audit - deviation rate 26.9%. After the intervention, a number of clinical management deviations persisted (32.1% deviation rate); these included failure to insert a chest drain despite unsuccessful aspiration, and attempting aspiration of symptomatic secondary SPs. Specific tools to improve standards might include a pneumothorax proforma to improve record keeping and a pneumothorax care pathway to reduce management deviations compared to BTS guidelines. Successful change also requires identification of the total target audience for any educational intervention.

Knowledge-based verification of clinical guidelines by detection of anomalies.

PubMed

Duftschmid, G; Miksch, S

2001-04-01

As shown in numerous studies, a significant part of published clinical guidelines is tainted with different types of semantical errors that interfere with their practical application. The adaptation of generic guidelines, necessitated by circumstances such as resource limitations within the applying organization or unexpected events arising in the course of patient care, further promotes the introduction of defects. Still, most current approaches for the automation of clinical guidelines are lacking mechanisms, which check the overall correctness of their output. In the domain of software engineering in general and in the domain of knowledge-based systems (KBS) in particular, a common strategy to examine a system for potential defects consists in its verification. The focus of this work is to present an approach, which helps to ensure the semantical correctness of clinical guidelines in a three-step process. We use a particular guideline specification language called Asbru to demonstrate our verification mechanism. A scenario-based evaluation of our method is provided based on a guideline for the artificial ventilation of newborn infants. The described approach is kept sufficiently general in order to allow its application to several other guideline representation formats.

Constructions for finite-state codes

NASA Technical Reports Server (NTRS)

Pollara, F.; Mceliece, R. J.; Abdel-Ghaffar, K.

1987-01-01

A class of codes called finite-state (FS) codes is defined and investigated. These codes, which generalize both block and convolutional codes, are defined by their encoders, which are finite-state machines with parallel inputs and outputs. A family of upper bounds on the free distance of a given FS code is derived from known upper bounds on the minimum distance of block codes. A general construction for FS codes is then given, based on the idea of partitioning a given linear block into cosets of one of its subcodes, and it is shown that in many cases the FS codes constructed in this way have a d sub free which is as large as possible. These codes are found without the need for lengthy computer searches, and have potential applications for future deep-space coding systems. The issue of catastropic error propagation (CEP) for FS codes is also investigated.

Dealing with foreign cultural paradigms: A systematic review on intercultural challenges of international medical graduates

PubMed Central

Farhan, Nabeel; Motschall, Edith; Vach, Werner; Boeker, Martin

2017-01-01

Objectives An increasing number of International Medical Graduates (IMG), who are defined to be physicians working in a country other than their country of origin and training, immigrate to Western countries. In order to ensure safe and high-quality patient care, they have to take medical and language tests. This systematic review aims to (1) collect all empiric research on intercultural communication of IMGs in medical settings, (2) identify and categorize all text passages mentioning intercultural issues in the included studies, and (3) describe the most commonly reported intercultural areas of communication of IMGs. Methods This review was based on the PRISMA-Guidelines for systematic reviews. We conducted a broad and systematic electronic literature search for empiric research in the following databases: MEDLINE, BIOSIS Citation Index, BIOSIS Previews, KCI-Korean Journal Database and SciELO Citation Index. The search results were synthesized and analyzed with the aid of coding systems. These coding systems were based on textual analysis and derived from the themes and topics of the results and discussion sections from the included studies. A quality assessment was performed, comparing the studies with their corresponding checklist (COREQ or STROBE). Textual results of the studies were extracted and categorized. Results Among 10,630 search results, 47 studies were identified for analysis. 31 studies were qualitative, 12 quantitative and 4 studies used mixed methods. The quality assessment revealed a low level of quality of the studies in general. The following intercultural problems were identified: IMGs were not familiar with shared decision-making and lower hierarchies in the health care system in general. They had difficulties with patient-centered care, the subtleties of the foreign language and with the organizational structures of the new health care system. In addition, they described the medical education in their home countries as science-oriented, without focusing on psychosocial aspects. Conclusion There is a need for a better training of IMGs on culture-related and not culture-related topics in the new workplace country. The topics that emerged in this review constitute a basis for developing these courses. Further empiric research is needed to describe the findings of this review more precisely and should be in accordance with the existing reporting guidelines. PMID:28715467

Dealing with foreign cultural paradigms: A systematic review on intercultural challenges of international medical graduates.

PubMed

Michalski, Kerstin; Farhan, Nabeel; Motschall, Edith; Vach, Werner; Boeker, Martin

2017-01-01

An increasing number of International Medical Graduates (IMG), who are defined to be physicians working in a country other than their country of origin and training, immigrate to Western countries. In order to ensure safe and high-quality patient care, they have to take medical and language tests. This systematic review aims to (1) collect all empiric research on intercultural communication of IMGs in medical settings, (2) identify and categorize all text passages mentioning intercultural issues in the included studies, and (3) describe the most commonly reported intercultural areas of communication of IMGs. This review was based on the PRISMA-Guidelines for systematic reviews. We conducted a broad and systematic electronic literature search for empiric research in the following databases: MEDLINE, BIOSIS Citation Index, BIOSIS Previews, KCI-Korean Journal Database and SciELO Citation Index. The search results were synthesized and analyzed with the aid of coding systems. These coding systems were based on textual analysis and derived from the themes and topics of the results and discussion sections from the included studies. A quality assessment was performed, comparing the studies with their corresponding checklist (COREQ or STROBE). Textual results of the studies were extracted and categorized. Among 10,630 search results, 47 studies were identified for analysis. 31 studies were qualitative, 12 quantitative and 4 studies used mixed methods. The quality assessment revealed a low level of quality of the studies in general. The following intercultural problems were identified: IMGs were not familiar with shared decision-making and lower hierarchies in the health care system in general. They had difficulties with patient-centered care, the subtleties of the foreign language and with the organizational structures of the new health care system. In addition, they described the medical education in their home countries as science-oriented, without focusing on psychosocial aspects. There is a need for a better training of IMGs on culture-related and not culture-related topics in the new workplace country. The topics that emerged in this review constitute a basis for developing these courses. Further empiric research is needed to describe the findings of this review more precisely and should be in accordance with the existing reporting guidelines.

General Guidelines on Criteria for Adoption or Rejection of Evaluated Libraries and Data by the Nuclear Data Team

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

Neudecker, Denise; Conlin, Jeremy Lloyd; Gray, Mark Girard

This memo contains general guidelines on what documentation and tools need to be in place as well as format and data testing requirements such that evaluated nuclear data sets or entire libraries can be adopted by the nuclear data team. Additional requirements beyond this memo might apply for specific nuclear data observables. These guidelines were established based on discussions between J.L. Conlin, M.G. Gray, A.P. McCartney, D. Neudecker, D.K. Parsons and M.C. White.

What influences the implementation of the New Zealand stroke guidelines for physiotherapists and occupational therapists?

PubMed

Mudge, Suzie; Hart, Anna; Murugan, Sankaran; Kersten, Paula

2017-03-01

Purpose To explore perceived barriers and facilitators to the use of the New Zealand (NZ) stroke guidelines by occupational therapists and physiotherapists. Methods A qualitative descriptive methodology was used. Eligible physiotherapists and occupational therapists (NZ registered, working in one of two hospitals, treating at least 10 patients with stroke in the previous year) were invited to participate in semi-structured interviews to elicit their perceptions of the utility and feasibility of the NZ stroke guidelines and identify barriers and facilitators to their implementation. All interviews were audio-recorded and transcribed. Conventional content analysis with constant comparative methods was used for coding and analysis. Results The main themes influencing guideline implementation were resources and characteristics of the guidelines, the organization, the patient and family and the therapist. Insufficient resources were a major barrier that crossed many of the themes. Participants suggested a range of strategies relating to the organization to improve therapists' alignment to the guidelines. Conclusion Alignment to the guidelines in NZ is influenced both positively and negatively by a range of interacting factors, consistent with other studies. Alignment might be improved by the introduction of some relatively simple strategies, such as ring-fencing time for access to resources and training in the use of the guidelines. Many of the barriers and related interventions are likely to be more complex. Implications for rehabilitation Alignment with stroke guidelines has been shown to improve patient outcomes. Therapist alignment with the implementation of the New Zealand stroke guidelines is influenced by guideline characteristics, organizational characteristics, resources, patient and family characteristics and therapist characteristics. Frequently encountered barriers related to limited resources, particularly time. Ring-fencing regular time for access to resources and training in the use of guidelines are examples of simple strategies that may reduce barriers.

41 CFR 60-3.13 - Affirmative action.

Code of Federal Regulations, 2012 CFR

2012-07-01

... action programs. These guidelines are also intended to encourage the adoption and implementation of... 3-UNIFORM GUIDELINES ON EMPLOYEE SELECTION PROCEDURES (1978) General Principles § 60-3.13... validated pursuant to these guidelines does not relieve users of any obligations they may have to undertake...

41 CFR 60-3.13 - Affirmative action.

Code of Federal Regulations, 2014 CFR

2014-07-01

... action programs. These guidelines are also intended to encourage the adoption and implementation of... 3-UNIFORM GUIDELINES ON EMPLOYEE SELECTION PROCEDURES (1978) General Principles § 60-3.13... validated pursuant to these guidelines does not relieve users of any obligations they may have to undertake...

Whitebark pine planting guidelines

Treesearch

Ward McCaughey; Glenda L. Scott; Kay L. Izlar

2009-01-01

This article incorporates new information into previous whitebark pine guidelines for planting prescriptions. Earlier 2006 guidelines were developed based on review of general literature, research studies, field observations, and standard US Forest Service survival surveys of high-elevation whitebark pine plantations. A recent study of biotic and abiotic factors...

An EPA FRAMEWORK ?FOR WEIGHT OF EVIDENCE ?IN ENVIRONMENTal ASSESSMENT

EPA Science Inventory

The U.S. Environmental Protection Agency’s Risk Assessment Forum has developed a framework and guidelines for inference by weight of evidence. Like the Agency’s Guidelines for Ecological Risk Assessment, these guidelines are sufficiently general to be adapted to a wi...

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.

School Emergency Planning Guide. [Revised.

ERIC Educational Resources Information Center

Pennsylvania State Emergency Management Agency, Harrisburg.

Guidelines to help school districts in Pennsylvania recognize potential hazards and develop a plan of community action are presented in this guidebook. The 1988 Emergency Management Services Code requires that every publicly funded state school have a disaster response plan that is exercised annually. Further, all publicly funded educational…

Sequenced Instructional Programs in Physical Education for the Handicapped.

ERIC Educational Resources Information Center

Carr, Dorothy B.; And Others

The curriculum guidelines for a comprehensive physical education program consist of developmentally sequenced skills and instructional activities appropriate for handicapped children from early preschool age (18 months) through high school. Suggested activities and materials are arranged in color-coded sections on motor and movement skills,…

The Politics of Performance.

ERIC Educational Resources Information Center

Mattimore, Michael J.

1988-01-01

Identifies problems that may arise when school music groups perform at events held on behalf of a particular cause or partisan event. Examines performance guidelines such as THE MUSIC CODE OF ETHICS, published by the Music Educators National Conference, which discourages performances at events that are not appropriate educational experiences. (GEA)

(Re)disclosing physician financial interests: rebuilding trust or making unreasonable burdens on physicians?

PubMed

Sperling, Daniel

2017-06-01

Recent professional guidelines published by the General Medical Council instruct physicians in the UK to be honest and open in any financial agreements they have with their patients and third parties. These guidelines are in addition to a European policy addressing disclosure of physician financial interests in the industry. Similarly, In the US, a national open payments program as well as Federal regulations under the Affordable Care Act re-address the issue of disclosure of physician financial interests in America. These new professional and legal changes make us rethink the fiduciary duties of providers working under new organizational and financial schemes, specifically their clinical fidelity and their moral and professional obligations to act in the best interests of patients. The article describes the legal changes providing the background for such proposals and offers a prima facie ethical analysis of these evolving issues. It is argued that although disclosure of conflicting interest may increase trust it may not necessarily be beneficial to patients nor accord with their expectations and needs. Due to the extra burden associated with disclosure as well as its implications on the medical profession and the therapeutic relationship, it should be held that transparency of physician financial interest should not result in mandatory disclosure of such interest by physicians. It could lead, as some initiatives in Europe and the US already demonstrate, to voluntary or mandatory disclosure schemes carried out by the industry itself. Such schemes should be in addition to medical education and the address of the more general phenomenon of physician conflict of interest in ethical codes and ethical training of the parties involved.

Tranexamic Acid Use in US Children’s Hospitals

PubMed Central

Nishijima, Daniel K.; Monuteaux, Michael C.; Faraoni, David; Goobie, Susan M.; Lee, Lois; Galante, Joseph; Holmes, James F.; Kuppermann, Nathan

2016-01-01

Background The prevalence of tranexamic acid (TXA) use for trauma and other conditions in children is unknown. Objective The objective of this study was to describe the use of TXA in US children’s hospitals for children in general, and specifically for trauma. Methods We conducted a secondary analysis of a large, administrative database of 36 US children’s hospitals. We included children younger than 18 years who received TXA (based on pharmacy charge codes) from 2009 to 2013. Patients were grouped into the following diagnostic categories: trauma, congenital heart surgery, scoliosis surgery, craniosynostosis/craniofacial surgery, and other, based on ICD-9 principle procedure and diagnostic codes. TXA administration and dosage, in-hospital clinical variables, and diagnostic and procedure codes were documented. Results A total of 35,478 pediatric encounters with a TXA charge were included in the study cohort. The proportions of children who received TXA were similar across the years 2009–2013. Only 110 encounters (0.31%) were for traumatic conditions. Congenital heart surgery accounted for more than one-half of the encounters (22,863, 64%).. Overall the median estimated weight-based dose of TXA was 22.4 mg/kg (IQR 7.3 to 84.9 mg/kg). Conclusions We identified a wide frequency of use and range of doses of TXA for several diagnostic conditions in children. The use of TXA among injured children, however, appears to be rare despite its common use and efficacy among injured adults. Further work is needed to recommend appropriate indications for TXA, and provide dosage guidelines among children with a variety of conditions, including trauma. PMID:27017532

A Statistical Analysis of a Traffic-Light Food Rating System to Promote Healthy Nutrition and Body Weight.

PubMed

Larrivee, Sandra; Greenway, Frank L; Johnson, William D

2015-06-30

Restaurant eating while optimizing nutrition and maintaining a healthy weight is challenging. Even when nutritional information is available, consumers often consider only calories. A quick and easy method to rate both caloric density and nutrition is an unmet need. A food rating system created to address that need is assessed in this study. The food rating system categorizes food items into 3 color-coded categories: most healthy (green), medium healthy (yellow), or least healthy (red) based on calorie density and general nutritional quality from national guidelines. Nutritional information was downloaded from 20 popular fast-food chains. Nutritional assessments and the 3 color coded categories were compared using the Wilcoxon and Median tests to demonstrate the significance of nutrition differences. Green foods were significantly lower than yellow foods, which in turn were significantly lower than red foods, for calories and calories from fat, in addition to content of total fat, saturated fat and carbohydrates per 100 g serving weight (all P < .02). The green foods had significantly lower cholesterol than the yellow (P = .0006) and red (P < .0001) foods. Yellow foods had less sugar than red foods (P < .0001). Yellow foods were significantly higher in dietary fiber than red foods (P = .001). The food rating color-coded system identifies food items with superior nutrition, and lower caloric density. The smartphone app, incorporating the system, has the potential to improve nutrition; reduce the risk of developing diabetes, hypertension, heart disease, and stroke; and improve public health. © 2015 Diabetes Technology Society.

A Statistical Analysis of a Traffic-Light Food Rating System to Promote Healthy Nutrition and Body Weight

PubMed Central

Larrivee, Sandra; Greenway, Frank L.; Johnson, William D.

2015-01-01

Background: Restaurant eating while optimizing nutrition and maintaining a healthy weight is challenging. Even when nutritional information is available, consumers often consider only calories. A quick and easy method to rate both caloric density and nutrition is an unmet need. A food rating system created to address that need is assessed in this study. Methods: The food rating system categorizes food items into 3 color-coded categories: most healthy (green), medium healthy (yellow), or least healthy (red) based on calorie density and general nutritional quality from national guidelines. Nutritional information was downloaded from 20 popular fast-food chains. Nutritional assessments and the 3 color coded categories were compared using the Wilcoxon and Median tests to demonstrate the significance of nutrition differences. Results: Green foods were significantly lower than yellow foods, which in turn were significantly lower than red foods, for calories and calories from fat, in addition to content of total fat, saturated fat and carbohydrates per 100 g serving weight (all P < .02). The green foods had significantly lower cholesterol than the yellow (P = .0006) and red (P < .0001) foods. Yellow foods had less sugar than red foods (P < .0001). Yellow foods were significantly higher in dietary fiber than red foods (P = .001). Conclusion: The food rating color-coded system identifies food items with superior nutrition, and lower caloric density. The smartphone app, incorporating the system, has the potential to improve nutrition; reduce the risk of developing diabetes, hypertension, heart disease, and stroke; and improve public health. PMID:26134833

The confusion in complying with good manufacturing practice requirements in Malaysia

NASA Astrophysics Data System (ADS)

Jali, Mohd Bakri; Ghani, Maaruf Abdul; Nor, Norazmir Md

2016-11-01

Food manufacturing operations need to fulfil regulatory requirements related to hygiene and good manufacturing practices (GMP) to successfully market their products as safe and quality products. GMP based on its ten elements used as guidelines to ensure control over biological, chemical and physical hazards. This study aims to investigate the confusion for design and facilities elements among food industries. Both qualitative and quantitative techniques are used as systematic tools. Design and facilities elements lay a firm foundation for good manufacturing practice to ensure food hygiene and should be used in conjunction with each specific code of hygiene practice and guidelines.

Lightning Protection Guidelines for Aerospace Vehicles

NASA Technical Reports Server (NTRS)

Goodloe, C. C.

1999-01-01

This technical memorandum provides lightning protection engineering guidelines and technical procedures used by the George C. Marshall Space Flight Center (MSFC) Electromagnetics and Aerospace Environments Branch for aerospace vehicles. The overviews illustrate the technical support available to project managers, chief engineers, and design engineers to ensure that aerospace vehicles managed by MSFC are adequately protected from direct and indirect effects of lightning. Generic descriptions of the lightning environment and vehicle protection technical processes are presented. More specific aerospace vehicle requirements for lightning protection design, performance, and interface characteristics are available upon request to the MSFC Electromagnetics and Aerospace Environments Branch, mail code EL23.

Guidelines for developing vectorizable computer programs

NASA Technical Reports Server (NTRS)

Miner, E. W.

1982-01-01

Some fundamental principles for developing computer programs which are compatible with array-oriented computers are presented. The emphasis is on basic techniques for structuring computer codes which are applicable in FORTRAN and do not require a special programming language or exact a significant penalty on a scalar computer. Researchers who are using numerical techniques to solve problems in engineering can apply these basic principles and thus develop transportable computer programs (in FORTRAN) which contain much vectorizable code. The vector architecture of the ASC is discussed so that the requirements of array processing can be better appreciated. The "vectorization" of a finite-difference viscous shock-layer code is used as an example to illustrate the benefits and some of the difficulties involved. Increases in computing speed with vectorization are illustrated with results from the viscous shock-layer code and from a finite-element shock tube code. The applicability of these principles was substantiated through running programs on other computers with array-associated computing characteristics, such as the Hewlett-Packard (H-P) 1000-F.

The Fast Scattering Code (FSC): Validation Studies and Program Guidelines

NASA Technical Reports Server (NTRS)

Tinetti, Ana F.; Dunn, Mark H.

2011-01-01

The Fast Scattering Code (FSC) is a frequency domain noise prediction program developed at the NASA Langley Research Center (LaRC) to simulate the acoustic field produced by the interaction of known, time harmonic incident sound with bodies of arbitrary shape and surface impedance immersed in a potential flow. The code uses the equivalent source method (ESM) to solve an exterior 3-D Helmholtz boundary value problem (BVP) by expanding the scattered acoustic pressure field into a series of point sources distributed on a fictitious surface placed inside the actual scatterer. This work provides additional code validation studies and illustrates the range of code parameters that produce accurate results with minimal computational costs. Systematic noise prediction studies are presented in which monopole generated incident sound is scattered by simple geometric shapes - spheres (acoustically hard and soft surfaces), oblate spheroids, flat disk, and flat plates with various edge topologies. Comparisons between FSC simulations and analytical results and experimental data are presented.

The obligations of Member Countries of the OIE (World Organisation for Animal Health) in the Organisation of Veterinary Services.

PubMed

Vallat, B; Wilson, D W

2003-08-01

The authors discuss the mission, organisation and resources of Veterinary Services in the new international trading environment and examine how the standards for Veterinary Services, contained in the OIE (World Organisation for Animal Health) International Animal Health Code (the Code), help provide the necessary support for Veterinary Services to meet their rights and obligations under the provisions of the Sanitary and Phytosanitary (SPS) Agreement of the World Trade Organization (WTO). The authors describe the challenges of gaining access to international trading markets through surveillance and control of OIE listed diseases. Finally, the approach in the Code to the principles underpinning the quality of Veterinary Services and to guidelines for evaluating Veterinary Services, is discussed.

[Statement of the Association of Pneumological Clinics and the German Respiratory Society on the coding of invasive and non-invasive ventilation in intensity care].

PubMed

2013-07-01

Mechanical ventilation in patients with respiratory failure represents one of the most important aspects of intensity care. It can be performed invasively and non-invasively depending on the clinical situation and the underlying disease. The expenditure and consumption of resources is the basis of the compensation for each patient case in the German diagnosis related group system. For ventilated patients it is calculated based on the hours of ventilation, according to the standard coding guideline. In this statement, the German Respiratory Society and the Association of Pneumological Clinics aim to clarify some aspects of the coding of invasive and non-invasive ventilation. © Georg Thieme Verlag KG Stuttgart · New York.

Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context.

PubMed

London, Leslie; Tangwa, Godfrey; Matchaba-Hove, Reginald; Mkhize, Nhlanhla; Nwabueze, Remi; Nyika, Aceme; Westerholm, Peter

2014-06-23

International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace. A stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region.

Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context

PubMed Central

2014-01-01

Background International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Discussion Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace. Summary A stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region. PMID:24957477

Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

PubMed Central

Adams, Diane L.; Norman, Helen; Burroughs, Valentine J.

2002-01-01

Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from participation in government programs. Part II of this article recommends an approach for assessing potential risk, preventing improper billing, and improving financial management of the medical practice. Images p432-a PMID:12078924

Characteristics of communication guidelines that facilitate or impede guideline use: a focus group study

PubMed Central

Veldhuijzen, Wemke; Ram, Paul M; van der Weijden, Trudy; Niemantsverdriet, Susan; van der Vleuten, Cees PM

2007-01-01

Background The quality of doctor-patient communication has a major impact on the quality of medical care. Communication guidelines define best practices for doctor patient communication and are therefore an important tool for improving communication. However, adherence to communication guidelines remains low, despite doctors participating in intensive communication skill training. Implementation research shows that adherence is higher for guidelines in general that are user centred and feasible, which implies that they are consistent with users' opinions, tap into users' existing skills and fit into existing routines. Developers of communication guidelines seem to have been somewhat negligent with regard to user preferences and guideline feasibility. In order to promote the development of user centred and practicable communication guidelines, we elicited user preferences and identified which guideline characteristics facilitate or impede guideline use. Methods Seven focus group interviews were conducted with experienced GPs, communication trainers (GPs and behavioural scientists) and communication learners (GP trainees and medical students) and three focus group interviews with groups of GP trainees only. All interviews were transcribed and analysed qualitatively. Results The participants identified more impeding guideline characteristics than facilitating ones. The most important impeding characteristic was that guidelines do not easily fit into GPs' day-to-day practice. This is due to rigidity and inefficiency of communication guidelines and erroneous assumptions underpinning guideline development. The most important facilitating characteristic was guideline structure. Guidelines that were structured in distinct phases helped users to remain in control of consultations, which was especially useful in complicated consultations. Conclusion Although communication guidelines are generally considered useful, especially for structuring consultations, their usefulness is impaired by lack of flexibility and applicability to practice routines. User centred and feasible guidelines should combine the advantages of helping doctors to structure consultations with flexibility to tailor communication strategies to specific contexts and situations. PMID:17506878

12 CFR 618.8015 - Policy guidelines.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Policy guidelines. 618.8015 Section 618.8015 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM GENERAL PROVISIONS Related Services § 618.8015 Policy guidelines. (a) The board of directors of each System bank or association providing...

48 CFR 514.270-2 - Guidelines for use.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Guidelines for use. 514.270-2 Section 514.270-2 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Solicitation of Bids 514.270-2 Guidelines for use. (a...

Uniform system of traffic guidance on European inland waterways : guidelines and criteria for vessel traffic service in inland waters

DOT National Transportation Integrated Search

2003-03-11

The International Maritime Organization (IMO) has developed guidelines on the principles and general operational provisions for the operation of a vessel traffic service (VTS).However, these guidelines only address seagoing vessels that have to compl...

Management of medical confidentiality in English professional football clubs: some ethical problems and issues

PubMed Central

Waddington, I; Roderick, M; Bundred, P

2002-01-01

Objective: To examine the ways in which confidential matters are dealt with in the context of the relationship between the club doctor (or physiotherapist) and the player as patient in English professional football clubs. Methods: Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. Results: There is among club doctors and physiotherapists no commonly held code of ethics governing how much and what kind of information about players may properly be passed on to managers; associated with this, there is considerable variation from one club to another in terms of the amount and kind of information passed on to managers. In some clubs, medical staff attempt to operate more or less on the basis of the rules governing confidentiality that apply in general practice, but in other clubs, medical staff are more ready to pass on personal information about players. In some situations, this raises serious ethical questions. Conclusions: Guidelines dealing with confidentiality in practitioner-patient relationships in medical practice have long been available and have recently been restated, specifically in relation to the practice of sports medicine, by the British Olympic Association, the British Medical Association, and the Football Association. This is a welcome first step. However, if the guidelines are to have an impact on practice, detailed consideration needs to be given to ensuring their effective implementation; if this is to be achieved, consideration also needs to be given to identifying those aspects of the culture and organisation of professional football clubs that may hinder the full and effective implementation of those guidelines. PMID:11916894

Management of medical confidentiality in English professional football clubs: some ethical problems and issues.

PubMed

Waddington, I; Roderick, M

2002-04-01

To examine the ways in which confidential matters are dealt with in the context of the relationship between the club doctor (or physiotherapist) and the player as patient in English professional football clubs. Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. There is among club doctors and physiotherapists no commonly held code of ethics governing how much and what kind of information about players may properly be passed on to managers; associated with this, there is considerable variation from one club to another in terms of the amount and kind of information passed on to managers. In some clubs, medical staff attempt to operate more or less on the basis of the rules governing confidentiality that apply in general practice, but in other clubs, medical staff are more ready to pass on personal information about players. In some situations, this raises serious ethical questions. Guidelines dealing with confidentiality in practitioner-patient relationships in medical practice have long been available and have recently been restated, specifically in relation to the practice of sports medicine, by the British Olympic Association, the British Medical Association, and the Football Association. This is a welcome first step. However, if the guidelines are to have an impact on practice, detailed consideration needs to be given to ensuring their effective implementation; if this is to be achieved, consideration also needs to be given to identifying those aspects of the culture and organisation of professional football clubs that may hinder the full and effective implementation of those guidelines.

Attitudes Toward Practice Guidelines Among ICU Personnel: A Cross-Sectional Anonymous Survey

PubMed Central

Quiros, Dave; Lin, Susan; Larson, Elaine L

2007-01-01

Objectives To assess attitudes of ICU staff members toward practice guidelines in general and toward a specific guideline, CDC's Guideline for Hand Hygiene in Healthcare Settings; to correlate these attitudes with staff and hospital characteristics; and to examine the impact of staff attitudes toward the Hand Hygiene Guideline on self reported implementation of the Guideline. Methods A cross-sectional survey of staff in 70 ICUs in 39 U.S. hospitals, members of The National Nosocomial Infection Surveillance (NNIS) System. A survey, “Attitudes Regarding Practice Guidelines”, was administered anonymously to all willing staff during a site visit at each hospital; 1,359 ICU personnel: 1,003 nurses (74%), 228 physicians (17%), and 128 others (10%) responded. Results Significantly more positive attitudes toward practice guidelines were found among staff in pediatric as compared with adult ICUs (p<0.001). Nurses and other staff when compared with physicians had more positive attitudes toward guidelines in general but not toward the specific Hand Hygiene Guideline. Those with more positive attitudes were significantly more likely to report that they had implemented recommendations of the Guideline (p<0.001) and used an alcohol product for hand hygiene (p=0.002). Conclusions The majority of staff members were familiar with the CDC Hand Hygiene Guideline. Staff attitudes toward practice guidelines varied by type of ICU and by profession, and more positive attitudes were associated with significantly better self-reported guideline implementation. Because differences in staff attitudes might hinder or facilitate their acceptance and adoption of evidence-based practice guidelines, these results may have important implications for the education and/or socialization of ICU staff. PMID:17628198

14 CFR § 1203b.104 - Exercise of arrest authority-general guidelines.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Exercise of arrest authority-general guidelines. § 1203b.104 Section § 1203b.104 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SECURITY PROGRAMS; ARREST AUTHORITY AND USE OF FORCE BY NASA SECURITY FORCE PERSONNEL § 1203b.104...

IFLA General Conference, 1985. Division on Libraries Serving the General Public. Section on Public Libraries. Papers.

ERIC Educational Resources Information Center

International Federation of Library Associations, The Hague (Netherlands).

This document includes papers on public libraries which were presented at the 1985 International Federation of Library Associations (IFLA) conference. The first paper, "International Guidelines for Public Libraries," is the report of an IFLA working group and it includes guidelines in six areas: public library services; media of…

29 CFR Appendix B to Subpart I of... - General Testing Conditions and Additional Guidelines for Personal Fall Protection Systems (Non...

Code of Federal Regulations, 2010 CFR

2010-07-01

...) OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR SHIPYARD EMPLOYMENT Personal Protective Equipment (PPE) Pt. 1915... Personal Fall Protection Systems (Non-Mandatory) B Appendix B to Subpart I of Part 1915 Labor Regulations... Guidelines for Personal Fall Protection Systems (Non-Mandatory) 1. Personal fall arrest systems—(a) General...

29 CFR Appendix B to Subpart I of... - General Testing Conditions and Additional Guidelines for Personal Fall Protection Systems (Non...

Code of Federal Regulations, 2011 CFR

2011-07-01

...) OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR SHIPYARD EMPLOYMENT Personal Protective Equipment (PPE) Pt. 1915... Personal Fall Protection Systems (Non-Mandatory) B Appendix B to Subpart I of Part 1915 Labor Regulations... Guidelines for Personal Fall Protection Systems (Non-Mandatory) 1. Personal fall arrest systems—(a) General...

Guidelines for the Preparation of General Guides to National Archives: A RAMP Study.

ERIC Educational Resources Information Center

Hildesheimer, Francoise

Based on a comparative study of guides from the Bahamas, Barbados, France, Italy, the Netherlands, Rhodesia, Spain, the United Kingdom, the United States, West Germany, and Zambia, this handbook provides guidelines for the organization and content of a general guide to archives, particularly national archives. It is noted that the handbook is…

76 FR 54110 - Attorney General's Guidelines on Implementation of the Provisions of the Voting Rights Act...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-31

... General's Guidelines on Implementation of the Provisions of the Voting Rights Act Regarding Language... the Voting Rights Act, which require certain states and political subdivisions to conduct elections in... language requirements in sections 4(f)(4) and 203 of the Voting Rights Act. The rule also amends the...

A Handbook for Public Playground Safety. Volume I: General Guidelines for New and Existing Playgrounds.

ERIC Educational Resources Information Center

Consumer Product Safety Commission, Washington, DC.

This handbook presents some general guidelines that may be used to increase the safety of public playgrounds. Information is provided about hazards associated with the use of public playground equipment, and suggestions are made to reduce the frequency and severity of injuries. A discussion is presented on playground-related injuries and the…

The Relationship Between Guideline-Recommended Initiation of Therapy, Outcomes, and Cost for Patients with Metastatic Non-Small Cell Lung Cancer.

PubMed

Casebeer, Adrianne; Antol, Dana Drzayich; DeClue, Richard W; Hopson, Sari; Li, Yong; Khoury, Raya; Michael, Todd; Sehman, Marina; Parikh, Aparna; Stemkowski, Stephen; Bunce, Mikele

2018-06-01

Guideline-recommended therapy for metastatic non-small cell lung cancer (mNSCLC) encourages evidence-based treatment; however, there is a knowledge gap regarding the influence of guideline-recommended initiation of therapy on outcomes and cost. To investigate if lack of guideline-recommended initiation of first-line systemic therapy was associated with worse patient outcomes and increased costs for patients with mNSCLC. In this retrospective analysis, 1,344 Medicare patients with mNSCLC were identified from Humana data. Performance status (PS) was imputed using procedure, diagnosis, and durable medical equipment codes pre-index. Guideline-recommended initiation of therapy was defined as ≥1 cycle of National Comprehensive Cancer Network-recommended first-line therapy based on age and PS or targeted therapies regardless of age and PS. Demographics and clinical characteristics were compared by guideline-recommended initiation of therapy. A Cox model assessed factors associated with 6-month mortality. End-of-life quality of care indicators included hospital admission and oncology infusions 30 days preceding death and were evaluated using logistic regression models. A generalized linear model assessed the relationship between guideline-recommended initiation of therapy and total health care costs in the 6 months post-index controlling for clinical, demographic, and treatment characteristics. Logistic models for inpatient stays and emergency department visits were also evaluated. Guideline-recommended therapy initiation was observed in 75.5% of patients. Patients not initiating guideline-recommended therapy were older, with a mean (SD) age of 72.5 (6.7) versus 71.2 (6.2) years (P = 0.001), and more frequently identified as having a low-income subsidy (30.0% vs. 16.4%; P < 0.001). Among the 24.6% of patients who died ≤ 6 months post-index, a greater percentage had not initiated guideline-recommended therapy (28.8% vs. 23.2%; P = 0.040). In adjusted models, PS (not initiation of guideline-recommended therapy) was predictive of mortality (patients with poor PS had an 84% higher probability of death [P = 0.014]). Among decedents, 64.2% were hospitalized, and 33.9% had an oncology-related infusion within 30 days of death, with no differences by guideline-recommended initiation of therapy. These end-of-life quality indicators were not associated with guideline-recommended initiation of therapy in adjusted models. Overall, 47.5% of patients who initiated guideline-recommended therapy were hospitalized compared with 55.0% of patients who did not (P = 0.026). Patients initiating guideline-recommended therapy had higher post-index total and oncology-related health care costs and fewer hospitalizations. In models, these differences in costs and hospitalizations were not associated with initiation of guideline-recommended therapy. Most patients initiated guideline-recommended therapy, with no differences in mortality and quality of care at the end of life by guideline-recommended initiation of therapy, though adherence beyond treatment initiation was not assessed. Unadjusted hospitalization rates were lower and costs were higher for patients who initiated guideline-recommended therapy. These differences were no longer observed after risk adjustment, suggesting that they may have been influenced by patient characteristics, disease progression, and subsequent treatment decisions. This study was sponsored by Genentech. Khoury, Michael, Parikh, and Bunce are employed by Genentech. Casebeer, Drzayich Antol, DeClue, Hopson, Li, and Stemkowski are employed by Comprehensive Health Insights, Humana, which was contracted by Genentech to conduct this study. Sehman is employed by Humana. Based on this research, 2 posters were presented at the Academy of Managed Care Pharmacy Nexus 2017 on October 16-19, 2017, in Dallas, Texas. Another poster was also presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Annual European Congress on October 29-November 2, 2016, in Vienna, Austria.

Health sciences librarians' awareness and assessment of the Medical Library Association Code of Ethics for Health Sciences Librarianship: the results of a membership survey.

PubMed

Byrd, Gary D; Devine, Patricia J; Corcoran, Kate E

2014-10-01

The Medical Library Association (MLA) Board of Directors and president charged an Ethical Awareness Task Force and recommended a survey to determine MLA members' awareness of and opinions about the current Code of Ethics for Health Sciences Librarianship. THE TASK FORCE AND MLA STAFF CRAFTED A SURVEY TO DETERMINE: (1) awareness of the MLA code and its provisions, (2) use of the MLA code to resolve professional ethical issues, (3) consultation of other ethical codes or guides, (4) views regarding the relative importance of the eleven MLA code statements, (5) challenges experienced in following any MLA code provisions, and (6) ethical problems not clearly addressed by the code. Over 500 members responded (similar to previous MLA surveys), and while most were aware of the code, over 30% could not remember when they had last read or thought about it, and nearly half had also referred to other codes or guidelines. The large majority thought that: (1) all code statements were equally important, (2) none were particularly difficult or challenging to follow, and (3) the code covered every ethical challenge encountered in their professional work. Comments provided by respondents who disagreed with the majority views suggest that the MLA code could usefully include a supplementary guide with practical advice on how to reason through a number of ethically challenging situations that are typically encountered by health sciences librarians.

Health sciences librarians' awareness and assessment of the Medical Library Association Code of Ethics for Health Sciences Librarianship: the results of a membership survey

PubMed Central

Byrd, Gary D.; Devine, Patricia J.; Corcoran, Kate E.

2014-01-01

Objective: The Medical Library Association (MLA) Board of Directors and president charged an Ethical Awareness Task Force and recommended a survey to determine MLA members' awareness of and opinions about the current Code of Ethics for Health Sciences Librarianship. Methods: The task force and MLA staff crafted a survey to determine: (1) awareness of the MLA code and its provisions, (2) use of the MLA code to resolve professional ethical issues, (3) consultation of other ethical codes or guides, (4) views regarding the relative importance of the eleven MLA code statements, (5) challenges experienced in following any MLA code provisions, and (6) ethical problems not clearly addressed by the code. Results: Over 500 members responded (similar to previous MLA surveys), and while most were aware of the code, over 30% could not remember when they had last read or thought about it, and nearly half had also referred to other codes or guidelines. The large majority thought that: (1) all code statements were equally important, (2) none were particularly difficult or challenging to follow, and (3) the code covered every ethical challenge encountered in their professional work. Implications: Comments provided by respondents who disagreed with the majority views suggest that the MLA code could usefully include a supplementary guide with practical advice on how to reason through a number of ethically challenging situations that are typically encountered by health sciences librarians. PMID:25349544

[Survey on the measures of asepsis taken by general practitioners].

PubMed

Chambonet, Jean-Yves; Cluis, Patrice

2004-01-31

CURRENT STATE OF THE QUESTION: Many legislative and administrative texts rule asepsis and prophylaxis in health care centres. The deontological code provides the guidelines for medical corps. To identify the measures set-up to prevent the transmission of infections in general practitioners' consulting rooms and to compare them with the data in the literature. A postal survey using a questionnaire was sent to a representative sample of 119 general practitioners in the Loire-Atlantique area in France. The response rate was of 69%. The majority of physicians declared that had a wash basin in the consulting room, 43% declared that they did not systematically wash their hands between 2 patients in their consulting rooms and 78% during home visits, 23% used an ordinary soap, 49% a hydro-alcoholic solution, and 62% wiped their hands with a cotton towel. Blood interventions were performed with gloves by more than 80% of the participants, complete decontamination procedures of the material were performed by 6%, but more than 80% used single use material. Although 45% believed they had changed their habits, 23% remained wary of any eventual recommendations and 43% made no comments. This survey method collects declarative data and remains limited with regard to information. In-depth analysis of the daily activity of the participants would be useful for an approach of performance criteria, in view of the fact that some consultations do not include any, or even partial, clinical examination. The investments required for the purchase of the material compatible with the specifications applicable to health care centres may appear excessive for their current activity. The generalisation of the use of single use material represents a great progress in the field of prevention. Comparison with similar earlier studies shows the good progress made and the improvement in quality. Nevertheless, studies using a strict methodology are necessary to establish guidelines to be applied in general medical practice. The drawing-up of Referentials requires great rigour and the participation of the practitioners in their development and organisation would lead to substantial benefits.

General linear codes for fault-tolerant matrix operations on processor arrays

NASA Technical Reports Server (NTRS)

Nair, V. S. S.; Abraham, J. A.

1988-01-01

Various checksum codes have been suggested for fault-tolerant matrix computations on processor arrays. Use of these codes is limited due to potential roundoff and overflow errors. Numerical errors may also be misconstrued as errors due to physical faults in the system. In this a set of linear codes is identified which can be used for fault-tolerant matrix operations such as matrix addition, multiplication, transposition, and LU-decomposition, with minimum numerical error. Encoding schemes are given for some of the example codes which fall under the general set of codes. With the help of experiments, a rule of thumb for the selection of a particular code for a given application is derived.

[Barriers to evidence-based medicine encountered among GPs - an issue based on misunderstanding? A qualitative study in the general practice setting].

PubMed

Bölter, Regine; Kühlein, Thomas; Ose, Dominik; Götz, Katja; Freund, Tobias; Szecsenyi, Joachim; Miksch, Antje

2010-01-01

The Chronic Care Model (CCM) is a framework for the structured care of patients with chronic conditions. It requires access of both physicians and patients to scientific evidence in order to facilitate shared treatment decision-making on the basis of the patient's individual needs and the best available external evidence. The aim of this study was to find out whether general practitioners (GP) actually make use of evidence-based information and guidelines and whether and how they communicate this information to their patients. We interviewed 14 general practitioners and conducted a content analysis. The majority of these GPs take a sceptical view towards evidence-based guidelines. Their main point of criticism is that guidelines disregard the individual patient's reality and life style. Instead, GPs emphasize the relevance of their own knowledge of the personal and medical history of and the continual care for their patients. Since GPs themselves often do not accept guidelines, they seldom impart their content to their patients. According to the GPs' experience there are contradictions between guideline-conformant therapy and individual treatment. The integrative character of evidence-based medicine is not recognized. The reason is that evidence-based medicine is equated with guidelines and trial results by the majority of the GPs interviewed. To facilitate guideline implementation in everyday practice GPs need to be provided with adequate access to scientific evidence and an understanding of the intentions of guidelines. If the doctors themselves do not accept guidelines, they will not share them with their patients. It must be made clear that guidelines are not intended as normative demands for a specific therapy for every patient, but are rather meant to assist the physician with his struggle for the best therapy for individual patients. Copyright © 2010. Published by Elsevier GmbH.

Inverse relationship between nonadherence to original GOLD treatment guidelines and exacerbations of COPD

PubMed Central

Foda, Hussein D; Brehm, Anthony; Goldsteen, Karen; Edelman, Norman H

2017-01-01

Background Prescriber disagreement is among the reasons for poor adherence to COPD treatment guidelines; it is yet not clear whether this leads to adverse outcomes. We tested whether undertreatment according to the original Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines led to increased exacerbations. Methods Records of 878 patients with spirometrically confirmed COPD who were followed from 2005 to 2010 at one Veterans Administration (VA) Medical Center were analyzed. Analysis of variance was performed to assess differences in exacerbation rates between severity groups. Logistic regression analysis was performed to assess the relationship between noncompliance with guidelines and exacerbation rates. Findings About 19% were appropriately treated by guidelines; 14% overtreated, 44% under-treated, and in 23% treatment did not follow any guideline. Logistic regression revealed a strong inverse relationship between undertreatment and exacerbation rate when severity of obstruction was held constant. Exacerbations per year by GOLD stage were significantly different from each other: mild 0.15, moderate 0.27, severe 0.38, very severe 0.72, and substantially fewer than previously reported. Interpretation The guidelines were largely not followed. Undertreatment predominated but, contrary to expectations, was associated with fewer exacerbations. Thus, clinicians were likely advancing therapy primarily based upon exacerbation rates as was subsequently recommended in revised GOLD and other more recent guidelines. In retrospect, a substantial lack of prescriber adherence to treatment guidelines may have been a signal that they required re-evaluation. This is likely to be a general principle regarding therapeutic guidelines. The identification of fewer exacerbations in this cohort than has been generally reported probably reflects the comprehensive nature of the VA system, which is more likely to identify relatively asymptomatic (ie, nonexacerbating) COPD patients. Accordingly, these rates may better reflect those in the general population. In addition, the lower rates may reflect the more complete preventive care provided by the VA. PMID:28123293

Inverse relationship between nonadherence to original GOLD treatment guidelines and exacerbations of COPD.

PubMed

Foda, Hussein D; Brehm, Anthony; Goldsteen, Karen; Edelman, Norman H

2017-01-01

Prescriber disagreement is among the reasons for poor adherence to COPD treatment guidelines; it is yet not clear whether this leads to adverse outcomes. We tested whether undertreatment according to the original Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines led to increased exacerbations. Records of 878 patients with spirometrically confirmed COPD who were followed from 2005 to 2010 at one Veterans Administration (VA) Medical Center were analyzed. Analysis of variance was performed to assess differences in exacerbation rates between severity groups. Logistic regression analysis was performed to assess the relationship between noncompliance with guidelines and exacerbation rates. About 19% were appropriately treated by guidelines; 14% overtreated, 44% under-treated, and in 23% treatment did not follow any guideline. Logistic regression revealed a strong inverse relationship between undertreatment and exacerbation rate when severity of obstruction was held constant. Exacerbations per year by GOLD stage were significantly different from each other: mild 0.15, moderate 0.27, severe 0.38, very severe 0.72, and substantially fewer than previously reported. The guidelines were largely not followed. Undertreatment predominated but, contrary to expectations, was associated with fewer exacerbations. Thus, clinicians were likely advancing therapy primarily based upon exacerbation rates as was subsequently recommended in revised GOLD and other more recent guidelines. In retrospect, a substantial lack of prescriber adherence to treatment guidelines may have been a signal that they required re-evaluation. This is likely to be a general principle regarding therapeutic guidelines. The identification of fewer exacerbations in this cohort than has been generally reported probably reflects the comprehensive nature of the VA system, which is more likely to identify relatively asymptomatic (ie, nonexacerbating) COPD patients. Accordingly, these rates may better reflect those in the general population. In addition, the lower rates may reflect the more complete preventive care provided by the VA.

Marriage and Family Counseling: Ethics in Context

ERIC Educational Resources Information Center

Southern, Stephen; Smith, Robert L.; Oliver, Marvarene

2005-01-01

Codes of ethics typically provide rules and guidelines for best practices in marriage and family counseling. An emerging model for ethical decision making emphasizes the ethics of virtues and aspirations. Exploring fundamental models of helping, as well as contemporary issues in community systems, affords context for examining the professional…

Ethics in Psychotherapy and Counseling: A Practical Guide. Second Edition.

ERIC Educational Resources Information Center

Pope, Kenneth S.; Vasquez, Melba J. T.

Although they may be reflected in professional guidelines, formal standards, or law, ethics are not static codes. They are an active process by which the individual therapist or counselor struggles with the sometimes bewildering, always unique constellation of questions, responsibilities, contexts, and competing demands of helping another person.…

Towards a Sustainability Reporting Guideline in Higher Education

ERIC Educational Resources Information Center

Huber, Sandra; Bassen, Alexander

2018-01-01

Purpose: So far, sustainability reporting in higher education is in a very early stage--partly, because of the lack of an established and widely recognized sustainability reporting framework for higher education institutions (HEIs). Therefore, a modification of the sustainability code for the use in the higher education context was recently…

Court-Recommended Guidelines for Managing Unethical Students and Working with University Lawyers.

ERIC Educational Resources Information Center

Cobb, Norman H.

1994-01-01

Management of social work students engaging in unethical behavior is discussed, drawing on litigation decisions and a professional association ethics code. The role of university lawyers is also examined, and recommendations for informing lawyers about the special circumstances of professional education and potential liability of problem students…

Exercise Administrator Administrative Instructions for Age Classes 1, 2 & 3. Year 11, October 1979-May 1980.

ERIC Educational Resources Information Center

Research Triangle Inst., Durham, NC.

This manual for Exercise Administrators of the National Assessment of Educational Progress; Second Literature Third Reading Assessment, consists of administrative instructions for use immediately preceding, during and after assessment sessions in schools. Definitions of racial/ethnic categories, associated codes, and guidelines for solicting…

Academic Interventions for Children with Dyslexia Who Have Phonological Core Deficits.

ERIC Educational Resources Information Center

Frost, Julie A.; Emery, Michael J.

1996-01-01

This article briefly defines phonological core deficits in cases of dyslexia; considers student classification based on federal and state learning disability placement guidelines; and suggests 10 interventions such as teaching metacognitive strategies, providing direct instruction in language analysis and the alphabetic code, and teaching reading…

Ethics in Practice

ERIC Educational Resources Information Center

Medlin, E. Lander

2010-01-01

Ethics is defined as a set of guidelines and/or rules for the conduct of individual behavior in an organization or civil society. This ethical code of conduct is intended to guide policies, practices, and decision-making for employees on behalf of the organization. This article explores the importance of ethics, the basis for making ethical…

Advisory on Relocatable and Renovated Classrooms. IAQ Info Sheet.

ERIC Educational Resources Information Center

California State Dept. of Health Services, Berkeley.

Many California school districts, in complying with the Class Size Reduction Program, will obtain relocatable classrooms directly from manufacturers who are under no specific guidelines or codes relative to indoor air quality (IAQ). This document, designed to aid school facility managers in minimizing potential IAQ problems, summarizes the indoor…

75 FR 11134 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-10

... limits (ACL) and accountability measures (AM). This meeting of the SAC is open to the public. DATES: The... with new ACL and AM requirements. The NS1 guidelines include recommendations for establishing several.... [FR Doc. 2010-5086 Filed 3-9-10; 8:45 am] BILLING CODE 3510-22-S ...

75 FR 971 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-07

...) and accountability measures (AM). This meeting of the SAC is open to the public. DATES: The meeting... with new ACL and AM requirements. The NS1 guidelines include recommendations for establishing several.... [FR Doc. E9-31427 Filed 1-6-10; 8:45 am] BILLING CODE 3510-22-S ...

76 FR 22676 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-22

...) and accountability measures (AM). This meeting of the SAC is open to the public. DATES: The meeting... MSA to provide guidance on how to comply with new ACL and AM requirements. The NS1 guidelines include.... 2011-9803 Filed 4-21-11; 8:45 am] BILLING CODE 3510-22-P ...

76 FR 51985 - ICD-9-CM Coordination and Maintenance Committee Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-19

... and Public Health Data Standards Staff, announces the following meeting. Name: ICD-9-CM Coordination.... 2012 ICD-10-PCS GEM and Reimbursement Map Updates. ICD-10-PCS Official Coding Guidelines. ICD-10 MS... Pickett, Medical Systems Administrator, Classifications and Public Health Data Standards Staff, NCHS, 3311...

World Wide Web Page Design: A Structured Approach.

ERIC Educational Resources Information Center

Gregory, Gwen; Brown, M. Marlo

1997-01-01

Describes how to develop a World Wide Web site based on structured programming concepts. Highlights include flowcharting, first page design, evaluation, page titles, documenting source code, text, graphics, and browsers. Includes a template for HTML writers, tips for using graphics, a sample homepage, guidelines for authoring structured HTML, and…

Appropriate Conduct

ERIC Educational Resources Information Center

Di Lullo, Louis

2004-01-01

Many years ago when the author assumed the role of assistant principal for school climate, discipline, and attendance, he inherited many school policies and guidelines that were outdated, unfair, and without merit in the current school climate. Because the school conduct code had not been revised since the school opened in 1960, many of the…

Student Disciplinary Codes -- What Makes Them Tick.

ERIC Educational Resources Information Center

Johnson, Donald V.

In this speech, the author describes how one school developed discipline guidelines with the cooperation of staff, parents, and students. Due process procedures, types of discipline, and an alternative out-of-school program for adjustment students (those who have experienced chronic or serious disciplinary problems in the school) are described.…

Interconnection Guidelines

EPA Pesticide Factsheets

The Interconnection Guidelines provide general guidance on the steps involved with connecting biogas recovery systems to the utility electrical power grid. Interconnection best practices including time and cost estimates are discussed.

The wound/burn guidelines - 2: Guidelines for the diagnosis and treatment for pressure ulcers.

PubMed

Tachibana, Takao; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Kadono, Takafumi; Fujiwara, Hiroshi; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Isei, Taiki; Ito, Takaaki; Inoue, Yuji; Ohtsuka, Mikio; Ogawa, Fumihide; Kodera, Masanari; Kawakami, Tamihiro; Kawaguchi, Masakazu; Kukino, Ryuichi; Kono, Takeshi; Sakai, Keisuke; Takahara, Masakazu; Tanioka, Miki; Nakanishi, Takeshi; Nakamura, Yasuhiro; Hashimoto, Akira; Hasegawa, Minoru; Hayashi, Masahiro; Fujimoto, Manabu; Maekawa, Takeo; Matsuo, Koma; Madokoro, Naoki; Yamasaki, Osamu; Yoshino, Yuichiro; Le Pavoux, Andres; Ihn, Hironobu

2016-05-01

The Wound/Burn Guidelines Committee consists of members commissioned by the Board of Directors of the Japanese Dermatological Association (JDA). It held several meetings and evaluations in writing since October 2008, and drafted five guidelines for the diagnosis and treatment including commentaries on wounds in general and the Guidelines for the Diagnosis and Treatment for Pressure Ulcers by taking opinions of the Scientific Committee and Board of Directors of JDA into consideration. © 2016 Japanese Dermatological Association.

Guidelines for Professional Training of Junior Medical Staff in the Context of European Experience

ERIC Educational Resources Information Center

Sosnova, Myroslava

2016-01-01

The article deals with outlining guidelines for improving professional training of junior medical staff based on European experience. Consequently, guidelines and recommendations on enhancing the efficiency of medical education in general and junior medical specialists' professional training, in particular, published by European Union of Medical…

10 CFR 960.1 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Applicability. 960.1 Section 960.1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY... jurisdiction for the resolution of differences between the guidelines and 10 CFR part 60. The guidelines have...

10 CFR 960.1 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Applicability. 960.1 Section 960.1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY... jurisdiction for the resolution of differences between the guidelines and 10 CFR part 60. The guidelines have...

10 CFR 960.1 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Applicability. 960.1 Section 960.1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY... jurisdiction for the resolution of differences between the guidelines and 10 CFR part 60. The guidelines have...

10 CFR 960.1 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Applicability. 960.1 Section 960.1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY... jurisdiction for the resolution of differences between the guidelines and 10 CFR part 60. The guidelines have...

10 CFR 960.3-2-2-5 - Formal site nomination.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3-2-2-5 Formal site nomination. After the final..., consideration of the available evidence, evaluations, and the resultant findings for the guidelines of subparts...

10 CFR 960.3-2-2-5 - Formal site nomination.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3-2-2-5 Formal site nomination. After the final..., consideration of the available evidence, evaluations, and the resultant findings for the guidelines of subparts...

10 CFR 960.3-2-2-5 - Formal site nomination.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3-2-2-5 Formal site nomination. After the final..., consideration of the available evidence, evaluations, and the resultant findings for the guidelines of subparts...

10 CFR 960.3-2-2-5 - Formal site nomination.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3-2-2-5 Formal site nomination. After the final..., consideration of the available evidence, evaluations, and the resultant findings for the guidelines of subparts...

Indoor Air Quality Guidelines for Pennsylvania Schools.

ERIC Educational Resources Information Center

Zimmerman, Robert S., Jr.

This report provides information and practical guidance on how to prevent indoor air quality (IAQ) problems in schools, and it describes how to implement a practical plan of action using a minimal amount of resources. It includes general guidelines to prevent or help resolve IAQ problems, guidelines on specific indoor contaminants, recommendations…

40 CFR 420.07 - Effluent limitations guidelines and standards for pH.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Effluent limitations guidelines and standards for pH. 420.07 Section 420.07 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS IRON AND STEEL MANUFACTURING POINT SOURCE CATEGORY General Provisions...

School Capital Policies, Regulations and Guidelines.

ERIC Educational Resources Information Center

Alberta Dept. of Education, Edmonton. Finance and Administration Div.

This document is a compendium of the policies, regulations, and guidelines that govern provincial school capital funding in Alberta. The compendium supplements the general framework of policies, guidelines, and procedures contained in the earlier Management and Finance Plan (MFP). Each section of the compendium contains a set of policies,…

25 CFR 163.81 - Assessment guidelines.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Assessment guidelines. 163.81 Section 163.81 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER GENERAL FORESTRY REGULATIONS Program Assessment § 163.81 Assessment guidelines. Assessments shall be national in scope and shall include: (a) An...

Practice guidelines need to address the 'how' and the 'what' of implementation.

PubMed

McKillop, Ann; Crisp, Jackie; Walsh, Kenneth

2012-01-01

The aim of this study was to explore the realities of everyday nursing practice associated with the implementation of a guideline for the assessment and management of cardiovascular risk. The use of clinical practice guidelines is pivotal to improving health outcomes. However, the implementation of guidelines into practice is complex, unpredictable and, in spite of much investigation, remains resistant to explanation of what works and why. Exploration of the nature of guideline implementation has the potential to illuminate the complexities of guideline implementation by focussing on the nature of practice. Nurses are well placed at the front line of primary health care to contribute to an understanding of how guideline implementation plays out in their everyday practice. Qualitative description was used, involving focus groups and interviews with 32 participants (20 nurses, four doctors, five managers and three funder/planners), to explore the use of a guideline in everyday primary health-care practice. Thematic analysis of data was managed through an inductive process of familiarisation, coding, categorising and generation of themes. Four themes were generated from the data portraying the realities of guideline implementation for primary health-care nurses: self-managing patient, everyday nursing practice, developing new relationships in the health team and impact on health-care delivery. The findings reveal that, even with the best of intentions to implement the guideline, health professionals were frustrated and at a loss as to how to achieve that in practice. Consequently, cardiovascular risk assessment and management was uneven and fragmented. Primary health-care practice environments vary so much that solutions to the difficulties of implementing evidence into practice requires context-specific solution-finding through collaborative teamwork. Furthermore, the attention of guideline developers, health-care policymakers, funders and researchers requires direct focus on the 'how' and the 'what' of evidence implementation.

Simplified basic periodontal examination (BPE) in children and adolescents: a guide for general dental practitioners.

PubMed

Cole, Emma; Ray-Chaudhuri, Arijit; Vaidyanathan, Mina; Johnson, Joanna; Sood, Sanjeev

2014-05-01

Dental plaque-induced periodontal diseases are common in children and adults. Guidelines were previously not available for the periodontal screening of under 18s. However, new guidelines have been introduced by the British Society of Periodontology and the British Society of Paediatric Dentistry which set out recommendations for the periodontal screening and management of under 18s in primary dental care. This article provides a practical guide for general dental practitioners on how to use the BPE in children and adolescents, and highlights the importance of early detection and management of periodontal diseases in this age group. A failure to use the modified BPE in a young patient who is later diagnosed with periodontitis may leave a dentist vulnerable to a medico-legal complaint or claim. New BPE guidelines for children and adolescents have been introduced by the BSPD and BSP; it is important that all dentists are aware of these guidelines and how to implement them in general practice.

On the Application of Time-Reversed Space-Time Block Code to Aeronautical Telemetry

DTIC Science & Technology

2014-06-01

Keying (SOQPSK), bit error rate (BER), Orthogonal Frequency Division Multiplexing ( OFDM ), Generalized time-reversed space-time block codes (GTR-STBC) 16...Alamouti code [4]) is optimum [2]. Although OFDM is generally applied on a per subcarrier basis in frequency selective fading, it is not a viable...Calderbank, “Finite-length MIMO decision feedback equal- ization for space-time block-coded signals over multipath-fading channels,” IEEE Transac- tions on

The effects of NICE guidelines on the management of third molar teeth.

PubMed

McArdle, L W; Renton, T

2012-09-01

Third molar surgery (TMS) is probably one of the most commonly performed surgical procedures undertaken in the NHS. In 2000, the National Institute of Clinical Excellence (NICE) introduced guidelines relating to TMS. These recommended against the prophylactic removal of third molars and listed specific clinical indications for surgery. The impact of these guidelines has not been fully evaluated and this research hopes to focus the effect of these guidelines over the last ten years. Using data obtained from a variety of NHS databases such as HES (Eng & Wales), the NHSBSA and data from NHS Scotland, we looked at the age range of patients requiring third molar removal and the number of patients having third molars removed in both primary and secondary care environments from 1989 to 2009. In addition we looked at the clinical indications for TMS activity in secondary care. The mean age of patients increased from 25 years in 2000 to 32 years in 2010, with the modal (most common) age increasing from 26 to 29 years. After the introduction of clinical guidelines the number of patients requiring third molar removal in secondary care dropped by over 30%, however, since 2003 the number of patients has risen by 97%. There is also a significant increase in caries as an indication for third molar removal. More patients are requiring third molar removal with an increasing number of patients having caries related to their third molars. Patients are, on average, older confirming that the removal of third molars is shifting from a young adult population group to an older adult population group. NICE guidelines did appear to have contributed to a fall in the volume of third molars removed within the NHS post 2000. However, concluding that this reduction demonstrates the success of NICE's guidance would be a premature assumption. The number of patients now requiring third molar removal is comparable to that of the mid 1990s. NICE has influenced the management of patients with third molars but this has not resulted in any reduction in the number of patients requiring third molar removal. Coding and data collection for third molars is not uniform, leading to potential misrepresentation of data. This perhaps raises the issue that an improved universal coding system is required for the NHS and that the NICE guidelines need review.

1 CFR 11.3 - Code of Federal Regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 1 General Provisions 1 2010-01-01 2010-01-01 false Code of Federal Regulations. 11.3 Section 11.3 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER AVAILABILITY OF OFFICE OF THE FEDERAL... complete set of the Code of Federal Regulations is $1,019 per year for the bound, paper edition, or $247...

1 CFR 11.3 - Code of Federal Regulations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 1 General Provisions 1 2011-01-01 2011-01-01 false Code of Federal Regulations. 11.3 Section 11.3 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER AVAILABILITY OF OFFICE OF THE FEDERAL... complete set of the Code of Federal Regulations is $1,019 per year for the bound, paper edition, or $247...

1 CFR 21.14 - Deviations from standard organization of the Code of Federal Regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 1 General Provisions 1 2010-01-01 2010-01-01 false Deviations from standard organization of the... CODIFICATION General Numbering § 21.14 Deviations from standard organization of the Code of Federal Regulations. (a) Any deviation from standard Code of Federal Regulations designations must be approved in advance...

1 CFR 11.3 - Code of Federal Regulations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 1 General Provisions 1 2012-01-01 2012-01-01 false Code of Federal Regulations. 11.3 Section 11.3 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER AVAILABILITY OF OFFICE OF THE FEDERAL... complete set of the Code of Federal Regulations is $1,019 per year for the bound, paper edition, or $247...

48 CFR 501.105-1 - Publication and code arrangement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Publication and code arrangement. 501.105-1 Section 501.105-1 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION GENERAL GENERAL SERVICES ADMINISTRATION ACQUISITION REGULATION SYSTEM Purpose, Authority, Issuance...

Contextual Constraint Treatment for coarse coding deficit in adults with right hemisphere brain damage: Generalization to narrative discourse comprehension

PubMed Central

Blake, Margaret Lehman; Tompkins, Connie A.; Scharp, Victoria L.; Meigh, Kimberly M.; Wambaugh, Julie

2014-01-01

Coarse coding is the activation of broad semantic fields that can include multiple word meanings and a variety of features, including those peripheral to a word’s core meaning. It is a partially domain-general process related to general discourse comprehension and contributes to both literal and non-literal language processing. Adults with damage to the right cerebral hemisphere (RHD) and a coarse coding deficit are particularly slow to activate features of words that are relatively distant or peripheral. This manuscript reports a pre-efficacy study of Contextual Constraint Treatment (CCT), a novel, implicit treatment designed to increase the efficiency of coarse coding with the goal of improving narrative comprehension and other language performance that relies on coarse coding. Participants were four adults with RHD. The study used a single-subject controlled experimental design across subjects and behaviors. The treatment involves pre-stimulation, using a hierarchy of strong- and moderately-biased contexts, to prime the intended distantly-related features of critical stimulus words. Three of the four participants exhibited gains in auditory narrative discourse comprehension, the primary outcome measure. All participants exhibited generalization to untreated items. No strong generalization to processing nonliteral language was evident. The results indicate that CCT yields both improved efficiency of the coarse coding process and generalization to narrative comprehension. PMID:24983133

78 FR 72979 - Bovine Spongiform Encephalopathy; Importation of Bovines and Bovine Products

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-04

...We are amending the regulations that govern the importation of animals and animal products to revise the conditions for the importation of live bovines and products derived from bovines with regard to bovine spongiform encephalopathy (BSE). We are basing importation conditions on the inherent risk of BSE infectivity in specified commodities, as well as on the BSE risk status of the region in which the commodities originate. We are establishing a system for classifying regions as to BSE risk that is consistent with the system employed by the World Organization for Animal Health (OIE), the international standard-setting organization for guidelines related to animal health. The conditions we are adopting for the importation of specified commodities are based on internationally accepted scientific literature, and are, in general, consistent with guidelines set out in the OIE's Terrestrial Animal Health Code. We are also classifying certain specified countries as to BSE risk and are removing BSE restrictions on the importation of cervids and camelids and products derived from such animals. We are making these amendments after conducting a thorough review of relevant scientific literature and a comprehensive evaluation of the issues and concluding that the changes to the regulations will continue to guard against the introduction of BSE into the United States, while allowing the importation of additional animals and animal products into this country.

Quality and accuracy of publicly accessible cancer-related physical activity information on the Internet: a cross-sectional assessment.

PubMed

Buote, R D; Malone, S D; Bélanger, L J; McGowan, E L

2016-09-01

In this study, we assessed the quality of publicly available cancer-related physical activity (PA) information appearing on reputable sites from Canada and other English-speaking countries. A cross-sectional Internet search was conducted on select countries (Canada, USA, Australia, New Zealand, UK) using Google to generate top 50 results per country for the keywords "'physical activity' AND 'cancer'". Top results were assessed for quality of PA information based on a coding frame. Additional searches were performed for Canadian-based sites to produce an exhaustive list. Results found that many sites offered cancer-related PA information (94.5%), but rarely defined PA (25.2%). Top 50 results from each country did not differ on any indicator examined. The exhaustive list of Canadian sites found that many sites gave information about PA for survivorship (78.3%) and prevention (70.0%), but rarely defined (6.7%) or referenced PA guidelines (28.3%). Cancer-related PA information is plentiful on the Internet but the quality needs improvement. Sites should do more than mention PA; they should provide definitions, examples and guidelines. With improvements, these websites would enable healthcare providers to effectively educate their patients about PA, and serve as a valuable resource to the general public who may be seeking cancer-related PA information. © 2016 John Wiley & Sons Ltd.

Legal principles of confidentiality and other public interests: Part 1.

PubMed

Fullbrook, Suzanne

The principles of confidentiality are of paramount importance to nurses and all health professionals. This is explicitly so as the Common Law recognizes confidentiality and supports its importance. However, current practice must take cognizance of the realities of 21st century healthcare delivery - we live in an age of electronic data that is potentially very difficult to keep secret. New rules, protocols and guidelines are being formulated, and regulatory bodies such as the Nursing and Midwifery Council (NMC) reflect such rules in their codes of professional conduct. There is, however, a debate that is suggesting that the rules that relate to confidentiality may need to expand or even bend a little as innovate ways of obtaining, storing, utilizing and communicating data continue to occupy the minds of government and those who formulate legal principles (British Medical Association, 2005). This series of three articles will explore these issues. The first part is a review of case law that explores the fundamental legal principles that underpin confidentiality. The second will concentrate on a review of the guidelines that are to be found in professional regulatory documentation - the NMC and the General Medical Council as they relate to the legal principles. The third and last part will review and reflect on issues that relate expressly to the implementation of electronic patient records, with a review of appropriate statutory legislation and principles of common law.

Low Density Parity Check Codes Based on Finite Geometries: A Rediscovery and More

NASA Technical Reports Server (NTRS)

Kou, Yu; Lin, Shu; Fossorier, Marc

1999-01-01

Low density parity check (LDPC) codes with iterative decoding based on belief propagation achieve astonishing error performance close to Shannon limit. No algebraic or geometric method for constructing these codes has been reported and they are largely generated by computer search. As a result, encoding of long LDPC codes is in general very complex. This paper presents two classes of high rate LDPC codes whose constructions are based on finite Euclidean and projective geometries, respectively. These classes of codes a.re cyclic and have good constraint parameters and minimum distances. Cyclic structure adows the use of linear feedback shift registers for encoding. These finite geometry LDPC codes achieve very good error performance with either soft-decision iterative decoding based on belief propagation or Gallager's hard-decision bit flipping algorithm. These codes can be punctured or extended to obtain other good LDPC codes. A generalization of these codes is also presented.

Coding conventions and principles for a National Land-Change Modeling Framework

USGS Publications Warehouse

Donato, David I.

2017-07-14

This report establishes specific rules for writing computer source code for use with the National Land-Change Modeling Framework (NLCMF). These specific rules consist of conventions and principles for writing code primarily in the C and C++ programming languages. Collectively, these coding conventions and coding principles create an NLCMF programming style. In addition to detailed naming conventions, this report provides general coding conventions and principles intended to facilitate the development of high-performance software implemented with code that is extensible, flexible, and interoperable. Conventions for developing modular code are explained in general terms and also enabled and demonstrated through the appended templates for C++ base source-code and header files. The NLCMF limited-extern approach to module structure, code inclusion, and cross-module access to data is both explained in the text and then illustrated through the module templates. Advice on the use of global variables is provided.

Development and evaluation of online evidence based guideline bank system.

PubMed

Park, Myonghwa

2006-01-01

The purpose of this study was to develop and evaluate the online evidence-based nursing practice guideline bank system to support the best evidence-based decision in the clinical and community practice settings. The main homepage consisted of seven modules for introduction of site, EBN, guideline bank, guideline development, guideline review, related sites, and community. The major contents in the guidelines were purpose, developer, intended audience, method of development, target population, testing, knowledge components, and evaluation. Electronic versions of the guidelines were displayed by XML, PDF, and PDA versions. The system usability were evaluated by general users, guideline developers, and guideline reviewers on the web and the results showed high scores of satisfaction. This online evidence-based guideline bank system could support nurses' best and cost-effective clinical decision using the sharable standardized guidelines with education module of evidence based nursing.

Measuring urban water conservation policies: Toward a comprehensive index

USGS Publications Warehouse

Hess, David; Wold, Christopher; Worland, Scott C.; Hornberger, George M.

2017-01-01

This article (1) discusses existing efforts to measure water conservation policies (WCPs) in the United States (U.S.); (2) suggests general methodological guidelines for creating robust water conservation indices (WCIs); (3) presents a comprehensive template for coding WCPs; (4) introduces a summary index, the Vanderbilt Water Conservation Index (VWCI), which is derived from 79 WCP observations for 197 cities for the year 2015; and (5) compares the VWCI to WCP data extracted from the 2010 American Water Works Association (AWWA) Water and Wastewater Rates survey. Existing approaches to measuring urban WCPs in U.S. cities are limited because they consider only a portion of WCPs or they are restricted geographically. The VWCI consists of a more comprehensive set of 79 observations classified as residential, commercial/industrial, billing structure, drought plan, or general. Our comparison of the VWCI and AWWA survey responses indicate reasonable agreement (ρ = 0.76) between the two WCIs for 98 cities where the data overlap. The correlation suggests the AWWA survey responses can provide fairly robust longitudinal WCP information, but we argue the measurement of WCPs is still in its infancy, and our approach suggests strategies for improving existing methods.

Treatment of gonorrhoea in Auckland, New Zealand: marked variation in prescriber adherence to treatment guidelines.

PubMed

Forster, Rose; Ng, Diana; Upton, Arlo; Franklin, Rick; Thomas, Mark

2017-06-01

The relentless emergence and spread of strains of Neisseria gonorrhoeae that are resistant to many antimicrobial agents has led to frequent changes in treatment guidelines, with a consequent risk that prescribers may not be aware of current guidelines. To determine the proportion of patients with gonorrhoea who were treated with a regimen consistent with the New Zealand Sexual Health Society (NZSHS) guidelines. We audited the treatment given to adult patients with laboratory-proven gonorrhoea in Auckland, New Zealand, during the first 6 months of 2015. Treatment compliant with the current NZSHS guidelines was administered in only 65% (458/706) episodes overall. Guideline-compliant treatment was much more likely to be prescribed for patients who presented to a sexual health clinic (89%) than for patients who presented to either a general practice or other community clinic (52%) or to a hospital (56%) (P < 0.0001). Overall, 52 of 706 (7%) episodes were not treated with any antimicrobial regimen by the service that diagnosed the patients' gonorrhoea, 13 of 62 (21%) episodes in patients who presented to a hospital, 34 of 403 (8%) episodes in patients who presented to a general practice or other community clinic and 5 of 241 (2%) episodes in patients who presented to a sexual health clinic (P < 0.0001). Low levels of compliance with treatment guidelines increase the risk that antibiotic-resistant strains of N. gonorrhoeae will spread within the Auckland region. Improved compliance with treatment guidelines, particularly in patients who present either to general practice or to hospitals, is necessary to maintain the efficacy of current treatment regimens. © 2017 Royal Australasian College of Physicians.

A study of the management of erectile dysfunction in general practice.

PubMed

Griffiths, L; Bush, N; Mottram, D; Armstrong, D

2005-06-01

The Department of Health issued guidelines for the NHS treatment of erectile dysfunction (ED) with phosphodiesterase type 5 inhibitors (PDE 5 inhibitors) in 1999. There has been an increasing trend in the prescribing of PDE 5 inhibitors within Bebington and West Wirral Primary Care Trust (PCT) over the 3-year period from February 2001 to January 2004. The objective of the study was to investigate implementation of Government guidelines on prescribing of PDE 5 inhibitors for ED and the cost of prescribing outside these guidelines. Practice data were collected for all patients prescribed a PDE 5 inhibitor in 16 surgeries within Bebington and West Wirral Primary Care Trust, from November 2002 to December 2003. The data were evaluated with respect to adherence to UK Government guidelines. Analysis was made on the cost to the PCT with respect to treatment provided outside the guidelines. Prescribing for 78% of patients was within Government guidelines. With respect to frequency of prescribing, 89% of patients in the PCT received less than or equal to the recommended frequency of one tablet per week. The percentage range for practices was 67-100%. The cost to the PCT for PDE 5 inhibitor treatment provided outside the guidelines was 19,060 pounds sterling over the period of study. Prescribers generally follow Government guidelines, however, stricter adherence to guidelines could result in more efficient use of National Health Service resources.

29 CFR Appendix B to Subpart I of... - General Testing Conditions and Additional Guidelines for Personal Fall Protection Systems (Non...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Personal Fall Protection Systems (Non-Mandatory) B Appendix B to Subpart I of Part 1915 Labor Regulations... Guidelines for Personal Fall Protection Systems (Non-Mandatory) 1. Personal fall arrest systems—(a) General... create the free fall distance should be the one supplied with the system, or in its absence, the least...

29 CFR Appendix B to Subpart I of... - General Testing Conditions and Additional Guidelines for Personal Fall Protection Systems (Non...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Personal Fall Protection Systems (Non-Mandatory) B Appendix B to Subpart I of Part 1915 Labor Regulations... Guidelines for Personal Fall Protection Systems (Non-Mandatory) 1. Personal fall arrest systems—(a) General... create the free fall distance should be the one supplied with the system, or in its absence, the least...

29 CFR Appendix B to Subpart I of... - General Testing Conditions and Additional Guidelines for Personal Fall Protection Systems (Non...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Personal Fall Protection Systems (Non-Mandatory) B Appendix B to Subpart I of Part 1915 Labor Regulations... Guidelines for Personal Fall Protection Systems (Non-Mandatory) 1. Personal fall arrest systems—(a) General... create the free fall distance should be the one supplied with the system, or in its absence, the least...